21st Century Care

Affirming states’ control of telemedicine, House approves revamped AOA policy

New policy outlines physicians’ responsibilities, opposes national efforts to pre-empt state control.

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It is becoming increasingly common for a patient in a rural area of one state to “see” a physician in another state via audiovisual software and an Internet connection. Telemedicine experts say this scenario raises new concerns about physician licensure, liability and reimbursement.

Such advances in technology combined with the widespread use of telecommunications in patient care have created the need a new online medicine policy, according to the AOA Bureau of State Government Affairs, which sponsored the resolution. Yesterday the AOA House of Delegates approved the new policy, which has been renamed the “AOA Policy on Telemedicine.”

The policy supports telemedicine and online technologies in patient care while reaffirming the AOA’s position that individual states should set their own telemedicine policies and laws. “The AOA believes that state-based licensure and the ability of states to govern activities within their borders is paramount and would oppose any national licensure or efforts to pre-empt state statutes,” the amended policy reads.

“I agree that states should continue to oversee telemedicine,” said Robert L. Hunter, DO, a family physician in Dayton, Ohio, and a trustee of the American Osteopathic Association of Medical Informatics. In an interview with The DO, he said the AOA charged the informatics group with revising the online medicine policy.

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Dr. Hunter said his state medical board is looking at the issue of telemedicine that crosses state lines. Current Ohio law does not disallow this, he said.

“We also need to look at HIPAA and protecting patient privacy when using newer applications, such as texting, and devices like the iPad,” said Dr. Hunter. “A doctor could text the wrong person.”

The AOA’s new telemedicine policy encourages protocols that ensure security and compliance with state and federal laws regarding patient privacy.

Quality, scope of care

Provisions in the policy directed at physicians and other clinicians include the following:

  • Telemedicine should not diminish the quality of care to the patient or its patient-centeredness or comprehensive nature. The standard of care should be equivalent to that provided when in close physical proximity to the patient.
  • The scope of care delivered through telemedicine should not exceed education, training and applicable state and federal law.
  • Physicians must make clear to their telemedicine patients their location, the state or states where they are licensed to practice and any limitations of the technology they are using to deliver care.

In addition, the policy affirms the AOA’s belief that physicians are still practicing medicine when providing medical services via simultaneous two-way communication but without physical interaction. The policy “advocates that public and private payers adopt payment systems” that include telemedicine.

Physician-patient relationship

The reality, however, is that some states require a face-to-face visit before a physician can establish a telemedicine relationship. There is no uniform definition of what constitutes the physician-patient relationship in telemedicine, according to a Michigan delegate, Michael D. Weiss, DO, an obstetrician and gynecologist in Rochester Hills. Some insurers, he said, will not reimburse a physician who does not physically examine a patient.

“Our world today is electronic. Let’s enter the 21st century. A telemedicine interaction on Skype or a similar Internet service does constitute a physician-patient relationship,” said Dr. Weiss, who wrote a House resolution on telemedicine on behalf of the Michigan Osteopathic Association.

The resolution, which the House elected to refer back to the Michigan association, sought to have the AOA help state societies develop policies and guidelines for the appropriate use of the Internet and other telemedicine practices.

The review committee’s concern about the resolution is that, as worded, it appears to ask the AOA to dictate to the states how to do telemedicine, said Jack M. Ramey, DO, the chairman of the Ad Hoc House Committee. “It’s up to the states to clarify that relationship,” he told The DO.

When told of this comment, Dr. Weiss said he understands the committee’s concern but still believes in the need for a national standards on telemedicine and online physician-patient relationships. His primary goal, he said, is to increase access to health care.

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  1. Pingback: Osteopathic Physicians Move Toward New Telemedicine Policy | GlobalMed Blog

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