adminAdditional Resources:
Video update on PAMED’s legislative efforts regarding telemedicine (2015)
A Member’s Perspective on Telehealth (2015)
AMA Telemedicine Policy (2014)
With a growing number of services being provided via telemedicine technologies, there is a need for a set of safeguards and standards to support the appropriate coverage of and payment for telemedicine services.
Geography, weather, availability of specialists, transportation, and other factors can create barriers to accessing appropriate health care, including behavioral health care. One way to provide, ensure, or enhance access to care given these barriers is through the appropriate use of technology to allow health care consumers access to qualified health care providers.
On May 19, 2015, the Pennsylvania Medical Society (PAMED) Board of Trustees approved draft legislation from PAMED’s Telehealth Task Force, which is aimed at addressing barriers to telemedicine in Pennsylvania and bringing clarity to the expanded use of telemedicine in the commonwealth.
Provisions in the draft legislation include:
- Participation Eligibility — A variety of health care providers would be eligible to participate in telemedicine/telehealth in addition to physicians. The draft legislation offers as examples the Medicare list of eligible providers. Providers would be required to practice within their scope subject to state licensure laws and regulations.
- Licensure—Physicians and other eligible providers who provide telemedicine/telehealth care to patients in Pennsylvania would be required to be licensed in Pennsylvania with limited specific exceptions. An important principle is that the practice of medicine occurs in the state where the patient is located.
- Professional Liability Coverage—Professional liability coverage requirements would apply to
- providers of telemedicine/telehealth.
- Evaluation and Treatment of the Patient—A proper provider-patient relationship would need to be established if such action would otherwise be standard acceptable medical practice in the provision of the same service not delivered via telemedicine/telehealth. A list of minimum requirements is outlined to include a virtual face-to-face examination, and, if necessary, incorporates peripherals and diagnostic tests with limited specific exceptions.
- Informed Consent and Privacy Practices—Providers would need to comply with informed consent rules as they relate to telemedicine/telehealth as well as follow all privacy practices, such as the Health Insurance Portability and Accountability Act (HIPAA).
- Medical Records—Providers would be required to maintain a complete medical record of the patient’s care in accordance with the standards applicable to traditional face-to-face encounters for documentation, maintenance, and transmission of records.
- Fraud and Abuse—Providers would be required to follow all applicable state and federal statutes and regulation for fraud and abuse.
- Coverage of Telemedicine Services—Health insurers would be required to provide coverage for the cost of health care services provided through telemedicine/telehealth on the same basis that the insurer would for the provision of the same service provided through in-person consultation or contact.
- Medicaid Program—Telemedicine/telehealth coverage would be required to be provided by Medicaid, HealthChoices Physical Health Managed Care Organizations, and HealthChoices Behavioral Health Managed Care Organizations.
PAMED Advocacy staff will work with other affirmative stakeholders to have the bill introduced and enacted.
PAMED Past President Marilyn Heine, MD, chairs the task force that drafted the legislation to bring to the PAMED Board for its approval. Task force members include representatives from a number of specialists and primary care physicians nominated by their state specialty society. The task force also sought feedback on the draft legislation from counties, specialties, and the Hospital and Healthsystem of Pennsylvania.
Addressing barriers to telemedicine, improving access to care while ensuring patient safety, is one of PAMED’s many advocacy priorities for 2015.
Many have asked what is the difference between telemedicine and telehealth.
The draft legislation says that:
“Telehealth is defined as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
Telehealth refers to a broader scope of remote health care services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth includes remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.”