Physicians take on telemedicine to bolster care delivery

Recognizing the ability of telemedicine to improve access to care, increase care coordination and quality, and reduce growth in health care spending, the nation’s physicians have set out to shape essential elements of telemedicine to ensure patients receive the best possible care.

At the 2014 AMA Annual Meeting last month, physicians approved a set of principles for telemedicine set forth in a new report (AMA login required) by the AMA Council on Medical Service. Here are some of the top issues the AMA is addressing so the potential benefits of telemedicine can be harnessed for physicians and their patients:

The new telemedicine principles call for additional research and the development of evidence-based clinical practice guidelines that should be followed when delivering telemedicine services. The AMA is working with medical specialty societies and is urging the Center for Medicare and Medicaid Innovation and the Patient Centered Outcomes Research Institute to significantly increase funding in this area.

To ensure proper diagnoses and follow-up care, the principles specify that a valid patient-physician relationship should exist before using telemedicine or the physician should meet the standard of care and other safeguards outlined in the AMA policy for establishing this relationship using appropriate telecommunication technologies. (Even when physicians have an existing valid relationship, use of telemedicine should comply with the patient safeguards outlined in the policy.) Chief among the safeguards outlined in AMA policy is the need to ensure that these technologies are covered to enhance care coordination and information-sharing between those who provide virtual care and in-person care.

The AMA is working with the Federation of State Medical Boards and other stakeholders to advance an interstate compact that would streamline the licensing process, removing administrative and financial barriers to licensure in more than one state and facilitating the responsible practice of telemedicine across state lines. The principles call for physicians to be licensed where the patient receives the services and to follow that state’s medical practice laws.

Telemedicine technology also must facilitate easy information sharing and comply with Health Insurance Portability and Accountability Act (HIPAA) privacy and security requirements. The AMA is working with telemedicine stakeholders to identify solutions and establish technical standards.

Medicaid programs in 46 states and the District of Columbia offer some form of payment for telemedicine services, but the definition and regulation of telemedicine varies considerably. Similarly, coverage by private insurers is quite different from one payer to another. The new telemedicine principles call for additional pilots that can demonstrate which kinds of payment and delivery models work best with this care. The AMA also is providing clear recommendations to policymakers and others about the conditions that should be met for telemedicine services to be covered and paid.

Educational resources can help physicians safely navigate this emerging field of care delivery, including such weighty concerns as HIPAA compliance and medical liability coverage. The AMA principles advise physicians to make sure their liability insurance covers telemedicine services—especially for patients in other states—before engaging in such activity.

The AMA also is advocating for adoption of these principles with state and federal lawmakers through testimony to congressional committees and other vital activities.