Telemedicine: A Checklist for Health Care Providers
A recent New York Times article spotlighted the use of telepsychiatry, or the use of web-based video conferencing technology such as Skype or iChat, to connect patients with psychiatrists. The article described a patient receiving an appointment “reminder” on her iPhone, then fixing herself a mojito and lounging poolside while her therapist counseled her via webcam.
The use of such technologies to provide health care remotely (commonly referred to as telemedicine) may sound idyllic, but can also raise numerous compliance issues for health care providers. For example, is the use of such technologies within the scope of practice? Do state laws place a restriction on the use of telemedicine? Is the standard of care for services provided via telemedicine the same as services provided in real life?
The following are a few issues that providers should consider before using telemedicine as a means to treat patients.
What do state statutes or licensing boards say about the use of telemedicine? First and foremost, a provider should check with his/her state licensing board or consult applicable state statutes to determine if telemedicine is contemplated within the scope of practice. For example, in Michigan the statute defining practice of medicine does not include telemedicine, as some other states such as Indiana. In addition to statutory guidance, state licensing boards may have issued informal or formal guidance to providers regarding the use of telemedicine. If the state licensing board is silent on the issue, a provider should consult with any professional societies he/she may belong to (American Medical Association, American Psychological Association, etc.) for information.
After the jump - additional considerations for providers.
Is an initial face-to-face patient encounter required? For example, the Federation of State Medical Boards (FSMB) recommends that an in-person patient encounter must be conducted prior to providing any treatment, and that online treatment and consultations will be held to same standard of care as in a face-to-face setting. Accordingly, based on the FSMB guidelines, a physician may not issue an electronic prescription for a telemedicine patient without an initial face-to-face meeting.
Interstate practice of medicine issues. Most states take the approach that the practice of medicine occurs in the state where the patient is located. Therefore, providers using telemedicine to treat out of state patients should check with that state’s respective licensing board to determine the steps they should take in order to be legally able to do so. For example, some states have special purposes licenses or waivers to allow out-of-state physicians to treat in-state patients using telemedicine
Reimbursement. Importantly, some insurers (like Medicare) only cover the costs of services provided via telemedicine if the patient is located in a certain defined “originating site” (which does not include the patient’s home); the service is provided by a particular provider; and the originating site is located in a rural health professional shortage area, or a county not classified as a metropolitan statistical area. Additionally, only certain procedures are eligible for reimbursement. Providers should consult with any insurers they intend to submit charges to for telemedicine services to make sure such services are covered.
Providers with additional questions about telemedicine should contact Mercedes Varasteh Dordeski at (248) 952-0400 or mdordeski@fhwnlaw.com
