Telehealth Credentialing and Privileging: The Story

Until now, the story has not been told about how the Centers for Medicare & Medicaid Service (CMS) telehealth credentialing and privileging rule came to be.

Thanks to the Oregon Health Network, we can tell the story about the behind the scenes “twists and turns” that resulted in CMS changing their credentialing and privileging process.

[If you don't have the time to read this entire article, please leave your comments below on how the credentialing and privileging rule is working for you or your institution.  If there are issues, we need to know!]

As folks in the telehealth community know well, CMS was prepared to enforce their longstanding position that each telehealth provider be fully credentialed and privileged at each originating site hospital.

That would have been disastrous, as I soon would find out.

I joined The Robert J. Waters Center for Telehealth and e-Health Law (CTeL) in the summer of 2008.  I was brand new to telehealth.

Our founder, Bob Waters, told me to report to the conference room at 8:00 am on my first morning.  But, he didn’t tell me what I was to find.

My first day on the job was a CTeL Board meeting.  Talk about jumping right into the pool!  I still get jokes from our CTeL Board of Directors that they were surprised I came back a second day!

I remember the words “credentialing and privileging” being repeated and how concerned the board was.  I didn’t have a clue what that meant.

A few weeks later, at Bob’s instruction, I spoke with a high ranking official from the Joint Commission.  When I reported back to Bob the dire prediction from this official, he ordered an immediate, emergency CTeL Board meeting.

We laid in place a plan of action, starting with a survey of the telemedicine community to assess the impact of full credentialing and privileging at telehealth originating sites.  We hoped presenting CMS with some data would change their position.  It didn’t.

Then, through CTeL’s sister organization, the Telehealth Leadership Initiative, work began on Capitol Hill to seek a legislative fix in the healthcare reform bill moving through Congress.

Given the much larger, politically charged issues at play in healthcare reform, a telehealth credentialing and privileging fix didn’t get much traction.

When healthcare reform moved without telehealth credentialing and privileging language, we needed to look to a different fix.

The Oregon Health Network article below tells the rest of the story.  How “the right people, policies, and resources can come together at just the right time and place to affect real, positive change.”

I want to give special credit to CTeL Board member, Dr. Karen Rheuban of the University of Virginia Health System.   A telehealth specialist, not a politician, she absorbed immediately what needed to be done “politically” to convince Administration officials change was critical.  Without Dr. Rheuban’s leadership, this change wouldn’t have happened.

Special appreciation needs to be provided to Marilyn Tavenner, CMS Administrator, and former Rep. Richard Boucher (D-VA).   Rep. Boucher was a catalyst of bringing key people together (one CMS official commented, “I didn’t know who Congressman Boucher was two weeks ago, but I know who he is now!”).

And had Ms. Tavenner not “heard the message” and told the CMS folks to “fix the problem,” it’s not too hard to guess we would be in a vastly different position today.

Finally, in the telehealth community, we often are frustrated at the CMS bureaucracy.   As one with over 28 years of experience working in Congress and the executive branch, I can tell you with certainty that had the CMS “foot soldiers” not been supportive of making a change, we would not be where we are today.   They proved the naysayers wrong.  They listened and they acted.   A real example that government can do the right thing.

Please leave your comments below on how the credentialing and privileging rule is working for you or your institution.  If there are issues, we need to know!

Click here for the Oregon Health Network interview on the history of the CMS telehealth credentialing and privileging rule.

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