No one can predict how the future of healthcare will unfold, especially given the current political climate. Last October, with my husband who is a family physician, I attended the American Telemedicine Association Fall Forum. I listened to speakers discuss many aspects of how this growing segment of the medical community is branching out to a new area of patient care. Many providers such as physicians, nurses, psychologists and even physical therapists already use telemedicine. I asked myself, where are the RDNs?
Telemedicine began in the 1960s with NASA. The astronauts’ spacesuits were wired so that basic functions like heart rate and oxygen levels could be monitored while the astronauts were in space. Eventually, this technology was used to connect remote locations to medical centers, particularly in times of disasters, like earthquakes. As technology improved and the internet became more sophisticated, medical fields like radiology could send x-rays over computer lines to diagnose disease. Today, primary care physicians, as well as other specialists, use telemedicine to discuss and diagnose a multitude of medical problems from simple to complex. Gadgets are being invented that allow patients to monitor and document all kinds of bodily functions. The practitioner on the other end of the line can then evaluate the result, make a diagnosis and prescribe treatment.
Registered dietitian nutritionists have been using telenutrition to reach patients and clients in rural areas for several years, but growth has been slower than our physician colleagues for several reasons:
- Unlike physicians, who have begun to enter into multi-state compacts for the purpose of telemedicine licensing, RDN licensing standards vary widely from state to state. To be able to see patients in a multi-state telenutrition system, RDNs would have to negotiate a convoluted and inconsistent state-by-state series of requirements with all the inherent costs for training and licenses, including possible residency requirements. Professional liability insurance also will be necessary for all the states in which RDNs intend to practice.
- For Medicare and Medicaid, RDNs still need a relationship with a physician to bill for services, and in many cases require the telemedicine encounter be initiated with the patient at the physician’s office, rather than at the patient’s home, which is more commonplace with telemedicine.
- Like traditional RDN services, commercial insurance companies must figure out how to pay for this service. Currently a telemedicine patient pays for 15-minute intervals of care at an average cost of $25 to $59 dollars, depending on location. Diet and nutrition-related problems are difficult to be heard, discussed and solved in 15 minutes to be effective.
Many RDN pioneers own successful nutrition practices. Here are a few options for entering the telenutrition field as an RDN today:
- Use a web-based telenutrition platform. With some of these services, RDNs pay a monthly subscription fee and with others there is no initial buy-in, but a percentage will be taken out of what is earned. Benefits include integrated billing, notes, intake forms and HIPAA-compliance.
- Work with a hospital or corporate wellness department. These entities hire RDNs to handle nutrition referrals in their distance health programs.
- Get listed on “customer acquisition” sites where RDNs can pay to have their names added to a vendor database. Liability insurance is required for some platforms, and there are a variety of these types of sites that work in slightly different ways, so RDNs should be sure to check into specific requirements.
Telenutrition is in its infancy for our profession, but our social media savvy children are not afraid of this new technology, and there are companies owned by physicians already in the telemedicine market who are looking for experienced RDNs. To learn more about the subject, research on your own, check out the excellent session on telemedicine from FNCE 2016 and read the information available on eatrightPRO using keywords telehealth or telenutrition.