FSMB Ratification Of Telemedicine Model Policy Sparks Opposition

By Christine Kern, contributing writer

Telehealth guideline requiring video draws mixed reviews.

In a recent press release, the CEO of American Well lauded the Federation of State Medical Boards (FSMB) and its State Medical Boards Appropriate Regulation of Telemedicine (SMART) Workgroup for developing an innovative model state policy for the safe and secure utilization of telemedicine in the delivery of healthcare as a “bold step towards a reality where all patients can access quality care irrespective of time, place, and location.”

This policy, "Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine" – developed through a robust and collaborative process – will provide states with clear definitions and principles they can look to for guidance when developing new policies that govern telehealth. Individual state medical boards have discretion as to if they adopt the guidelines contained therein.

However, the new guidelines were not met with enthusiasm by everyone. Despite protests from some quarters, the policy was approved with no changes, according to Dr. Henry DePhillips, chief medical officer of Teladoc, which protested the policy's seeming restrictions on telephone-based physician-patient first encounters. Patient advocacy groups and Kaiser Permanente also opposed the guidelines.

“Not everybody has a video device or has access to the bandwidth” to make it useful, DePhillips said. And, based on the company's experience, even those consumers who are in an urban setting, “over 95 percent of the time, will chose the telephone, even if they have the device and the bandwidth." So, consumer choice “was obviously excluded” in drafting the policy, he said.

According to the American Well press release, telehealth – real-time video encounters between patients and providers – is becoming a widely accepted practice across the United States. A study by Deloitte predicts that this year alone, there could be up to 75 million e-visits in North America alone. As of April, 20 states and the District of Columbia have passed mandates for coverage of commercially provided telehealth services, and 46 states offer some type of Medicaid reimbursement for telehealth services provided. In addition, many states have launched pilots or formed workgroups to explore the potential which exists to address gaps in care through telehealth.

Yet there currently exists an inconsistent and dated patchwork of state laws and regulations that have suppressed the deployment of telehealth in both the private and public sectors, a situation the new guidelines were designed to correct.

The policy insists that a physician-patient relationship needs to be established for physicians to engage in telemedicine. Then, in a nod to new technologies, it says such a relationship can be created “whether or not there has been an encounter in person between the physician (or other appropriately supervised healthcare practitioner) and patient,” adding that a relationship “may be established using telemedicine technologies provided the standard of care is met.”

But in defining telemedicine, the policy says that to establish the essential patient-physician relationship on a first visit, “Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.”

Dr. Humayun J. Chaudhry, the foundation's president and CEO, said in a release that the new guidelines allow flexibility that would include telephone and email interactions, which seems to contradict policy language that generally limits telephone communications.

Amy Comstock Rick is CEO of the Parkinson's Action Network, a Washington patient advocacy group, which protested the handling of telephone conferencing and the fact there were no patients or patient-advocacy groups that participated in the study leading up to the drafting of the policy.

She stated, “You can't adopt a written policy that says one thing and you say, no, no, we meant something else,” Comstock Rick said. “We would call on FSMB to reopen this issue with patients as part of the conversation.”