Can Nurse Practitioners Use Telehealth?

Advanced practice registered nurses (APRNs), a subset of healthcare that includes nurse practitioners, has been increasingly called upon over the past few decades to extend healthcare beyond the primary care physician safety net. Nurse practitioners bridge a serious gap in services between a declining number of primary care providers and a growing elderly population that far exceeds the number of physicians available to treat them.

Currently, there are 230,000 licensed APRNs, with 87% certified in primary care. These providers could extend care even further when armed with telehealth technology. Telehealth allows care providers to reach remote patients by using modern technology tools.

Here’s how combining telehealth with nurse practitioners or other midlevel providers could improve access to care and overcome some of the pressing geographic barriers to care for vulnerable populations in the United States.

“For nurse practitioners to address health care of the future, advanced knowledge and skills in the use and application of telehealth technologies in practice are becoming essential.”
Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives
Advances in Medical Education and Practice

Nurse practitioners often serve as the primary care providers for disadvantaged and rural populations. Healthcare providers around the country struggle to provide cost-effective but high-quality care, particularly in rural communities. The problem has worsened with the widespread closure of rural hospitals in all 50-states.

More than 70 rural hospitals have closed their doors since 2010. But we’re not done yet; another 673 are vulnerable to closure in the next few years. What happens to a community when a rural hospital closes? Modern Healthcare points out, “Hospitals are often the economic drivers of rural communities.” Each time a rural hospital closes its doors, per capita income in the region drops by 4% while the unemployment rate climbs. These vulnerable communities run the risk of becoming a “healthcare desert,” where the only way to receive specialty care is to drive – sometimes hundreds of miles – to a city for necessary medical treatment.

Studies show that 80% of rural communities are now medically underserved, lacking adequate provider coverage from primary care doctors but also pharmacists, dentists, and other healthcare service providers.

But midlevel providers can extend the safety net further by leveraging telehealth technology. Without it, a lack of access to quality healthcare may require extensive travel for sick patients seeking specialty treatment. Sadly, this problem happens far too often in the most vulnerable populations in the country. However, using telemedicine to reach patients by videoconference has a number of benefits for these vulnerable populations, including quantifiable cost savings for patients and providers. In addition to providing needed healthcare, telehealth can:

• Cut transportation costs for rural patients.
• Reduce worker absences for employers.
• Reduce hospital readmissions or unnecessary trips to the ER.
• Improve access to specialty care.
• Cut office no-shows for healthcare providers.
• Improve patient outcomes.

Ironically, it is rural patients that are most at-risk for complex and chronic diseases. They are more prone to obesity and inactivity, smoke, have higher alcohol use rates, and have more chronic health conditions than urban populations.

“States should look into the practice authority of nurse practitioners and physician assistants. In most cases, that authority should broaden in scope. Allowing more clinicians to deliver primary and chronic care will result in increased healthcare access.”
Patient Engagement HIT

But there remain a number of barriers to providing care via telehealth for nurse practitioners seeking to use these tools. Some of these barriers include:

• Credentialing and Licensure
  Nurse practitioners are typically only licensed in the state in which she or he practices. But telemedicine can allow these clinicians to practice across state lines. The problem is that there is wide variation in telemedicine rules across the states. There is a movement afoot to pass the new APRN Compact, which will allow a nurse practitioner to now hold one multistate license that allows practice across APRN states. However, as of this writing, only three states have adopted these rules.
• Reimbursement
  Like licensure, reimbursement for nurse practitioners varies by state Medicaid and private payer plans. Even the definition of telehealth varies; some states define it as strictly videoconferencing while others pay for store-and-forward or asynchronous virtual visits.
• Patient Privacy
  Nurse practitioners must be careful to ensure their telemedicine vendor protects patient privacy as defined under several laws including HIPAA and HITECH. Typically, business video conferencing services such as Skype or personal tools like FaceTime are not compliant with these rules.

Nurse practitioners seeking to leverage telehealth should take the following steps to limit risk when launching a telemedicine practice, including:

• Researching and understanding the prescribing and licensure requirements for the states you’re practicing in. This includes the state where you’re providing care and the patient’s home state if it is different from your own. Some states or public and private payers may require that you establish a clinician/patient relationship with an in-person visit before conducting a telemedicine exam.
• Ensuring the technology you’re using is fully secure and compliant with proper encryption to protect the transmission of data from cyber attack. If using a mobile app, make sure it is also HIPAA-compliant.
• Creating a telehealth examination room that incorporates video technology into the natural flow of the patient encounter. Work with your telehealth vendor to determine the necessary workflows and best practices for conducting these exams. Make certain these visits are private; having clinical staff walking behind you during the videoconference may not violate HIPAA-rules per se, but it is certainly not a recommended best practice.
• Understanding the ins and outs of your telehealth platform, including what support is available should a problem arise. For nurse practitioners that work as an independent contractor at multiple practices or hospitals, make certain to conduct dry runs of the telehealth platform(s) you may be using.
• Securing patient consent at each encounter is a recommended best practice for any telehealth visit.

Nurse practitioners should anticipate an increase in the use of telehealth tools to provide treatment in the coming years. That’s why it’s important now for these clinical providers to comprehend and master the technology for use during the patient encounter.

Whether a nurse practitioner or doctor, it’s clear that telehealth can extend our healthcare delivery safety net to the most vulnerable populations in our nation. Talk with the OrthoLive team about ways to enhance your care delivery network.