New issued by the Federation of State Medical Boards could have a chilling effect on the growth of telemedicine 鈥� especially in rural areas and among low-income patients, say some patient advocates, health care providers and health care companies. But the federation says the updated guidance will safeguard patients鈥� privacy and ensure high-quality care in the current fast-changing health care delivery environment.
As part of a wide-reaching April 26 policy statement, changed the definition of telemedicine to care that 鈥渢ypically involves the application of secure videoconferencing鈥� to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between provider and a patient.鈥� It is not, according to the federation, 鈥渁n audio-only, telephone conversation, e-mail/instant messaging conversation or fax.鈥�
The statement, which is not a legal document but is intended to help state medical boards鈥� develop professional policies and standards for their members, triggered a backlash from some stakeholders. 聽
Eight patient advocacy and provider groups 鈥淲e believe the policy 鈥� did not account for many of the safe, secure ways patients are accessing health care today, including 鈥榓udio-only鈥� telephone. Our goal is patient access to safe, secure telemedicine and this may be thwarted if the existing policy is allowed to stand,鈥� the groups write.
But Humayun Chudhry, FSMB鈥檚 CEO, said the 鈥減olicy is not designed to limit the use of the telephone.鈥� Instead, it鈥檚 designed to ensure that a patient鈥檚 care does not proceed 鈥渇or months or years on end鈥� based entirely on 鈥渁udio only鈥� conversations, adding neither FSMB or state medical boards have a say in how private insurers or Medicaid reimburse for these consultations.
鈥淭he concern is that 鈥� patient safety not be forgotten. Just because you鈥檙e using [technology] you should not be able to cut corners. It鈥檚 a cautionary note for physicians and for patients,鈥� Chaudhry said.
Opponents warn, though, that it could have unintended consequences.聽
Some consumers do not have a computer or Internet access at home and would have to drive to the nearest telemedicine facility. For a chronically ill or elderly patient 鈥� the very patients telemedicine is geared to help 鈥� that could become a deterrent to seeking care.
Dale Gibbs, director of telehealth services at Catholic Health Initiatives Nebraska, a nonprofit health system; and director of outreach services at Good Samaritan Hospital, a regional referral center that serves rural patients within a 200-mile radius in Nebraska, said that most Good Samaritan鈥檚 patients come from rural locations where there is a shortage of specialty providers. After they undergo complex surgeries and recover, the hospital uses both video and telephone visits for follow-up care. For those who may not be 鈥渨ired鈥� or technologically savvy, the telephone remains a critical tool.
鈥淲e need to be able to talk to patients, and we won鈥檛 get video into a remote farm house,鈥� he said. 鈥淭elemedicine is far more than just video. It involves back and forth between the patient and provider.鈥�
Most private insurers and state Medicaid plans reimburse for telehealth visits, but Medicare still lags behind with tight restrictions on who and what conditions qualify for payment under the program鈥檚 telehealth rules. Some stakeholders worry the FSMB policy model also could influence payers. 聽
The modes of communication 鈥� for instance, telephone talk or instant-message conversation 鈥� not included in the model policy, 鈥渃an be mechanisms to improve care and I am concerned the policy statement could be interpreted [to say] that such care is inappropriate,鈥� said Ateev Mehrotra, a professor of health care policy at Harvard Medical School.
Meanwhile, getting ready for the future is also a reason to broaden rather than narrow what interactions should be categorized as telemedicine, according to Amy Comstock Rick, CEO of the Parkinson鈥檚 Action Network.
Though her organization does not have numbers on how many Parkinson鈥檚 patients rely on telehealth instead of in-person visits at a facility, she guesses the number will be huge in the future.
鈥淚f you limit to video conference, there may be an equity issue. Not everyone has that equipment or is comfortable using it 鈥� we鈥檙e just trying to break down the barriers so people who want to use it can use it,鈥� she said. 鈥淎re we going to go backwards if the model policy is a prohibiting non-telephone interactions?鈥�
FSMB鈥檚 policy statement also recommends that physicians:
- be licensed in the state where the patient is located.
- verify the identity and location of the patient they are treating, disclose their credentials and get a consent form from the patient for the care they are delivering.
- not write prescriptions for patients based only on an online questionnaire.