During its Annual Meeting on June 11, 2014, the American Medical Association (AMA) voted to approve a list of guiding principles for coverage of and payment for telemedicine services, designed to “foster innovation in the use of telemedicine, protect the patient-physician relationship and promote improved care coordination and communication with medical homes.” The policy is titled “Coverage and Payment of Telemedicine Services.”
In addition to coverage and payment, the AMA policy addresses licensure and cross-border practices, recommendations supporting additional research, standards of care, and pilot programs and demonstration projects regarding telemedicine. The policy proposes that the AMA work with the Centers for Medicare & Medicaid Services and others to develop a reimbursement system for telemedicine care, similar to payment for traditional consultations.
Among the AMA recommendations set forth in the policy are the following:
• Physicians and other health practitioners delivering telemedicine services must be licensed in the state where the patient receives services, or be providing these services as otherwise authorized by that state’s medical board.
• States should follow principles for the supervision of non-physician providers and technicians when telemedicine is used.
• 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 professional contact, whether the current consultation service is rendered by telephone, fax, email or other forms of communication.
Telemedicine Standard of Care
• A valid patient-physician relationship must be established before the provision of telemedicine services.
• The standards and scope of telemedicine services should be consistent with related in-person services. However, the standards of care and practice guidelines relevant to telemedicine are evolving and vary based on specialty and service provided.
• National specialties should develop appropriate and comprehensive practice parameters, standards and guidelines to address the clinical and technological aspects of telemedicine.
• The patient’s medical history must be collected as part of the provision of any telemedicine service.
• Telemedicine services must be properly documented and should include providing a visit summary to the patient.
• Telemedicine services must include care coordination with the patient’s medical home and/or existing treating physicians, which includes at a minimum identifying the patient’s existing medical home and treating physician(s) and providing to the latter a copy of the medical record.
• Physicians, health professionals and entities that deliver telemedicine services must establish protocols for referrals for emergency services.
• The telemedicine service must be delivered in a transparent manner, to include but not be limited to, the identification of the patient and physician in advance of the delivery of the service, as well as patient cost-sharing responsibilities and any limitations in drugs that can be prescribed via telemedicine.
Privacy and Security
• Telemedicine services must abide by laws addressing the privacy and security of patients’ medical information.
• Physicians should 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.
“We believe that a patient-physician relationship must be established to ensure proper diagnoses and appropriate follow up care,” said AMA President Robert M. Wah, M.D. “This new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care and manage chronic conditions.”