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Challenges with the process

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The cost affiliated with credentialing and privileging is burdensome, particularly when Medicare and Medicaid payments are being reduced and the cost of providing health care is rising. Since a telehealth provider can administer healthcare services to patients anywhere in the country, the issue becomes one of who is responsible for credentialing and privileging, and why a provider would want to pay for credentialing at every site at which he or she may provide services.  

One telehealth provider in the Mid-Atlantic area estimates that the two-year cost of privileging its telehealth network is $4.8 million. In rural South Dakota, the estimated two-year costs of credentialing physicians who provide remote intensive-care monitoring from the tertiary-care-facility hub site to 22 rural facilities amounts to approximately $85,536 for just 16 physicians.  

In the past two years, this health system has added other telehealth services such as e-emergency and e-stroke to address growing rural health care needs. Each practitioner providing care from the hub site must be credentialed at each rural site for $160 for the initial credentialing and $83 for re-credentialing after two years at each site. The cost, time, and duplication of the credentialing process is adding to the rising costs of healthcare and causing undue problems in administering telehealth services for rural facilities and their patients.  

For specialist providers, the barrier is even greater. High-demand providers such as dermatologists and endocrinologists have little need to provide telehealth to supplement their practices. Those who explore the telehealth option often find there are few prospective patients at any one rural hospital, and they must provide services at several facilities. At this point, they face the daunting task of filling out thick credentialing packets for each site and then tracking and renewing their credentials on a different timeline for each site. For these specialists, there is very little incentive to practice telehealth at small sites with only a handful of prospective patients. Because of these barriers, most providers will not expand their practices into telehealth.