ACP: Face-To-Face Contact Necessary Before Implementing Telemedicine

By Christine Kern, contributing writer

Policy recommendations include direct contact before engaging in telehealth services.

As pressure to reduce costs, increase efficiency, and improve patient outcomes mounts, more and more healthcare organizations are realizing the benefits of telemedicine in shaping the overall healthcare experience. As Health IT Outcomes’, Ken Congdon wrote, “The stage is set for a telehealth revolution.”

But not all healthcare providers are on board with such universal acceptance of telehealth. In a recent position paper, the American College of Physicians (ACP) wrote the benefits offered by telemedicine “must be measured against the risks and challenges associated with its use.” The paper elaborates on a 2008 report, E-Health and Its Impact on Medical Practice, in which it examined the impact of various aspects of eHealth on the practice of medicine including electronic health records, patient portals, and telemedicine.

In this most recent paper, Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper, the ACP writes that, while it supports the expansion of telemedicine as a way to increase access to care and to reduce healthcare costs, it cautions physicians must use proper judgement regarding when remote care is — or is not — appropriate. It also recommends telemedicine be implemented only once a patient and physician have established an ongoing relationships, and then “only as an intermittent alternative to a patient’s primary care physician when necessary to meet the patient’s immediate acute care needs.”

The ACP further recommends developing evidence-based guidelines on telemedicine’s appropriate use to improve patient outcomes and establishing a streamlined process for obtaining licensure in multiple states, while letting states retain individual licensing and regulatory authority. Additionally, the ACP states Medicare’s geographic restrictions on reimbursement and providing reimbursement for telemedicine communications should be removed, thereby reducing the burden on healthcare providers.

Currently, the battle over whether or not an established relationship must be in place before implementing telehealth services is still being waged. Teladoc and the Texas Medical Board are battling in court over the board’s requirement for an initial in-person visit. However, Colorado has expanded the use of telemedicine and does not require an initial in-person visit, and patients are not required to be in a specific facility to conduct a telehealth visit.