Telemedicine: Less Travel, More Rules

While telemedicine drastically reduces travel requirements for both patients and clinicians, it can increase the rules and regulations that clinicians need to navigate.

Our Underwriting Department assessed all the wrinkles and ironed out guidance for the risk managers and clinicians at our member institutions. Many of these issues need to be addressed at an organizational level, but here are the highlights for individual clinicians:

• CRICO medical professional liability covers care provided via telemedicine [1];
• Telemedicine rules and regulations vary by state. While “telemedicine” often includes real-time videoconferencing, in some states the term also encompasses exchanges by telephone, fax, and email.
• The wrinkles:
  • Licensing
    You must meet the licensing requirements of all jurisdictions involved: where you are and where your patient is.
  • Additional Requirements
    Some states place additional standards on telemedicine, e.g., informed consent, medical records, prescribing, etc. For providers with Medicare patients, other requirements must be met to qualify for reimbursement.
  • Provider-Patient Relationship
    Most states allow a provider-patient relationship to be established via telemedicine; however, specific requirements vary by state. The AMA has additional information.
  • Scope of Practice
    The scope of practice for advanced practice clinicians [2] varies by state. Your scope of practice in your patient’s location may differ from that in your home state.
  • Patient Privacy
    Telemedicine sessions (and recordings of them) require the same level of confidentiality as any other patient information. However, telemedicine encounters have a unique privacy risk that both the clinician and the patient must adequately address.

Confused? There’s help at hand.

• Reach out to your Risk Management Department and/or Office of General Counsel for specific guidance.
• Consult the American Telemedicine Association (ATA) practice guidelines for telemedicine best practices across a range of services.
• Consult the American Medical Association (AMA) guidelines for ethical issues in telemedicine.

1. Coverage does not apply in any circumstance for activities performed in countries or territories excluded by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury.

2. For CRICO coverage to apply, advanced practice clinicians can provide telemedicine only if directed by their employer.