As an emerging technology, telemedicine presents many challenges to patients and providers. While many of these challenges are technical or financial, there are also some thorny legal issues which have kept some medical professionals from fully embracing this new health care platform. Whether it is cross-state licensing, malpractice insurance, prescribing medications or reimbursement, there are legal restrictions you should be aware of before you fully integrate telemedicine into your practice.
A foundational issue for many telemedicine regulatory bodies is defining telemedicine itself. It is critical that the scope of telemedicine is clearly defined so that insurers and payers are reimbursing physicians for appropriate services. While many industry groups and some state boards may use a broad definition of telemedicine, others, including the Center for Medicare and Medicaid Services (CMS) do not include telephone conversations, emails or faxes within the scope of telemedicine. Under these restrictive regimes, telemedicine is primarily video conferencing.
In an effort to lower barriers to practicing medicine across jurisdictions, the Federation of State Medical Boards drafted the Interstate Medical License Compact in 2014. The IMLC introduced an expedited multi-state licensure process that allows medical providers to practice traditional medicine and telemedicine across state lines. There are currently 18 states and 23 medical and osteopathic boards participating in the IMLC. In early 2017, seven states began accepting IMLC licensure applications.
Due to concerns that physicians may prescribe medications for patients they may not know well, some states have imposed some restrictions on e-prescribing certain compounds, especially Schedule II drugs. Many of these jurisdictions require that physicians must meet face-to-face prior to writing a prescription. There may be allowances if the patient is receiving care in hospital or clinic, or if there is a licensed health professional on hand, so it is prudent to understand both legal regimes in the states where the provider and patient are.
Many providers recognize the benefits of telemedicine for patients in remote locations, but many insurers are still in the process of formulating reimbursement protocols. This includes Medicare which has some strict requirements for reimbursement of telehealth services. Although this rule is under review, Medicare currently stipulates that a provider must originate care from a hospital or doctor’s office. Furthermore, the patient interaction must be via real-time audio-video technology, and the patient must be in a medical professional shortage area.
Among private insurers, there is popular support for telemedicine which is considered a more efficient care channel. This is also the reason why 30 states have implemented telehealth parity laws which mandate reimbursement, and ten more states are currently considering similar laws.
Although the uninformed opinion is that telemedicine would raise a physician’s liability and, consequently, increase malpractice insurance rates, the reality runs counter to that. The majority of telehealth services involve low-risk, routine interactions like checkups and prescriptions. Historically, these rarely translate into major liability issues, so most insurers are comfortable with physicians engaging in telemedicine. There is, of course, some lag in wholesale adoption by the insurance industry, but expect only minor price adjustments to your malpractice policy in the years to come.
Article written by:
Dr. Robert Moghim, CEO Moghim Medical Consulting Inc.