Telemedicine & telehealth accelerates with American Medical Association’s New Telemedicine Principles

The American Medical Association (AMA) approved guiding principles to ensure appropriate coverage of and payment for telemedicine services. During its 2014 Annual Meeting, the AMA voted to approve these telemedicine principles to encourage use of telemedicine “to deliver care to patients could greatly improve access and quality of care, while maintaining patient safety,” according to the press release.

The principles aim to help foster innovation in the use of telemedicine, protect the patient-physician relationship and promote improved care coordination and communication with medical homes.

The guiding principles stem from a policy reportPDF FIle developed by the AMA’s Council on Medical Service addressing coverage and payment for telemedicine, which provided robust background on the delivery of telemedicine. It also outlined current coverage and telemedicine payment rules, a summary of specialty society practice guidelines and position statements on telemedicine, and case studies.

The American Medical Association’s President remarked on the telemedicine principles as follows:

Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained. Telemedicine can strengthen the patient-physician relationship and improve access for patients to receive health care services remotely as medically appropriate including care for chronic conditions, which are proven ways to improve health outcomes and reduce health care costs.

AMA Wire adds that the AMA policy also:

  • Encourages additional research to develop a stronger evidence base for telemedicine
  • Supports additional pilot programs in the Medicare program to enable coverage of telemedicine services, including but not limited to store-and-forward telemedicine
  • Urges physicians to verify that their medical liability insurance policy covers telemedicine services, including telemedicine services provided across state lines if applicable, prior to the delivery of any telemedicine service
To ensure quality of care, patient safety and coordination of care in the provision of telemedicine services, the policy reiterates the importance of national medical specialty societies continuing to be involved in the development of appropriate and comprehensive practice parameters, standards and guidelines to address the clinical and technological aspects of telemedicine…. Delegates also called for a study of the issues associated with the state-based licensure and the portability of state licensure for telemedicine services.
Licensing issues continue to thwart or threaten national expansion of telemedicine programs–in particular the legal requirement in most states that the physician delivering telemedicine, telehealth, or telepsychiatry, be licensed both in the home state where the physician is located, as well as in the remote state where the patient is located.
Previously, AMA already had a number of policies regarding telemedicine, including:
  • H-160.937 The Promotion of Quality Telemedicine
  • H-480.974The Evolving Impact of Telemedicine
  • H-480.969 The Promotion of Quality Telemedicine
  • H-480.961 Teleconsultations and Medicare Reimbursement
  • H-480.968 Telemedicine

The new principles, among other things, state the following:

  • Definition of Telemedicine: There is no consensus on the definition of telemedicine or telehealth. Rather, there are three broad categories of telemedicine technologies: store-and-forward, remote monitoring, and real-time interactive services.
  • Standard of care: The standards of care and practice guidelines are evolving.
  • Professional Liability Insurance: Before physicians provide any telemedicine service, they should verify that their medical liability insurance policy covers telemedicine.
  • Insurance coverage and reimbursement for telemedicine: Medicare/Medicaid and many private health insurers provide coverage and payment for telemedicine under specified circumstances.
  • AMA policy “states that physicians should uniformly be compensated for their professional services at a fair fee for established patients with whom the physician has had previous face-to-face contact, whether the current consultation service is rendered” in person or via telemedicine.
  • Prior face-to-face: Prior to delivering services via telemedicine, a valid patient-physician relationship must be established, “through at minimum a face-to-face examination,” which “could occur in person or virtually through real-time audio and video technology.”
  • Informed consent must be followed.
The report also states that telemedicine services should be covered and reimbursed if they abide by certain principles, including those above; and others (for example, the patient’s medical history must be collected; services must be evidence-based; the telemedicine visit should be properly documented, privacy and security concerns must be addressed; etc.).
  • Telemedicine raises many legal issues. Contact our telemedicine and telehealth team if you have questions about your telemedicine project or practice.
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