Lawmakers appear to be a year away from establishing a comprehensive telemedicine policy that would boost health care access in regions of the state with physician shortages, particularly rural areas.
But that plan is not quick enough for some who have introduced legislation that would make Maryland the 12th state to require medical insurers to pay doctors who see patients from afar via telecommunications the same way traditional, face-to-face care is reimbursed.
Questions surrounding the delivery of telemedicine, its costs and appropriate coverage levels have most legislators awaiting the findings of a state task force established in June by the Maryland Health Quality and Cost Council.
After initially examining how telemedicine could improve acute stroke care, the Maryland Telemedicine Task Force is set to research its applications in other specialties, including neurology, cardiology and psychiatry. Recommendations are due by year's end.
"In other parts of the country, telemedicine has become a community standard of care," Dr. Barney Stern, a neurology professor at the University of Maryland Medical School and co-chair of the task force, said during a Feb. 23 Senate Finance Committee hearing.
A 2008 study sponsored by the Maryland Hospital Association and Maryland State Medical Society found critical shortages of primary care doctors and most medical specialists in southern and western Maryland and on the Eastern Shore.
Student loan forgiveness and repayment programs have been developed to help attract recent medical graduates to rural regions, but many believe any solution needs to incorporate telemedicine, which uses technology to link patients with doctors  similar to teleconferencing in the corporate world. Psychiatric patients can confer with their therapist through video monitors, while critical-care specialists can monitor patients and their vital signs with cameras and data feeds.
"It's one of those tools in the toolbox that we're going to need in order to address the shortage," said state Sen. Thomas M. Middleton (D-Dist. 28) of Waldorf, who chaired a 2008 task force that examined physician shortages in rural areas. "As far as putting rates in place right now, even the advocates agree that it's probably a little bit premature, that you need to do the study in advance."
A survey of in-state telemedicine programs last year revealed that almost all are being funded by grants and that insurance reimbursement is the key obstacle blocking statewide expansion of the technology, said Michelle Clark, executive director of the Maryland Rural Health Association.
"Without telemedicine you're never going to connect patients to the specialists they need in rural Maryland," she said.
At Calvert Memorial Hospital in Prince Frederick, which recently completed its first year in a six-hospital telemedicine program, intensive care unit mortality was down 60 percent in 2010, while the average length of stay declined 37 percent and the rate of transfers to a tertiary care center fell 11 percent, hospital CEO Jim Xinis told the Finance Committee.
Del. Michael D. Smigiel Sr. (R-Dist. 36) of Elkton sponsored bills that would require insurers to cover telemedicine and to create a task force to study its use in medically underserved areas, but both received unfavorable reports from the House Health and Government Operations Committee.
Smigiel said he "got no bad vibes" from the committee and was assured the General Assembly would reconsider reimbursement next session after the task force completes its work, but he still believes telemedicine "is ready for prime time."
"I don't have patience and, unfortunately, in government everybody wants to have a committee and have a talk and have a summer study, and I'd rather move forward," he added.
State Sen. E.J. Pipkin (R-Dist. 36) of Stevensville cross-filed Smigiel's bills, but they will likely be re-examined during the 2012 session.
CareFirst BlueCross BlueShield lobbyist Deborah Rivkin testified at the Feb. 23 hearing in support of Pipkin's bills and another sponsored by state Sen. Catherine E. Pugh (D-Dist. 40) of Baltimore city requiring reimbursement. Rivkin said the insurer, the largest in Maryland, favors a telemedicine policy similar to Virginia's, which began last April and covers "interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment" but excludes telephone conversations, e-mails and faxes.
"We support taking a look at the issue now and not moving too fast, but putting a timeline in place and determining what works best for Maryland," said Kimberly Robinson, executive director of the League of Life and Health Insurers of Maryland.