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PATTY MITCHELL, RN | Legal Health Care
Telemedicine: The New Frontier in Healthcare?
Welive in a digital age and what we have al- ways seen and done in healthcare is changing. Telemedi- cine is an evolving eld here to stay. As technology grows, physicians, nurses, as well as attorneys and the legal system must grow with it and face the challenges associated with this relatively new eld of practice. A 2015 research2guidance report stated 80% of physicians use smartphones or medical apps in their practices. An article in the Washington Post reported 15 million Americans annu- ally are already receiving remote care. Kaiser Permanente one of the nation’s largest healthcare systems reported it provides more virtual visits annually than it does in person. Are you ready to meet the changing face of health-
care?
e AMA de nition of telemedi-
cine is “the practice of medicine us- ing electronic communications and information technology between a li- censed health care professional in one location and a patient in another lo- cation.” Modern day telemedicine was rst reported in the 1950s with trans- mission of radiology images over the phone for interpretation by a special- ist. Telehealth programs originated out of a necessity to meet the needs of underserved populations and have grown to include follow-up visits, re- mote management of chronic disease, remote post hospital care, preventive care support, school-based telehealth, and assisted living support. Advan- tages cited for use of telemedicine include improved patient access, cost savings, and more engaged patients with improved outcomes.
Forbes magazine reported that global telemedicine will be a $66 bil- lion industry by the end of 2021.
With change, always comes chal- lenges. Telemedicine regulations and laws vary from state to state and pa- tient location decides the applicable
patient care law. is can cause pro- viders to go awry either accidentally or intentionally. Common issues found within telemedicine cases in- volve:
Licensure of Providers: Physicians are usually required to be licensed in the state in which they treat a patient. Some large telemedicine companies employ physicians all over the coun- try and connect patients with a doc- tor already in that state. e Interstate Medical Licensure Compact has 24 state participants and allows for treat- ment of patients within those states by doctors with compact licensure. Some states require a telemedicine license to practice that discipline within the state.
Medical Malpractice Coverage:
Providers need to con rm that their malpractice insurance covers tele- medicine, and what limitations there are. Telemedicine visits have been associated with reduced liability, re- ported due to performance of low risk services, such as routine follow up visits and improved documentation requirements by providers. Standard of care for the provider is o en the same for telemedicine visits, as for in person services.
Physician Patient Relationship: Many states prohibit telemedicine services prior to establishment of such a relationship with a face-to-face visit. Exception to this can be consul- tation by a physician in another state, for a patient under direct care of a physician in the patient’s home state.
Reimbursement: May vary widely depending on state and providers. Medicare covers live services via au- diovisual communication, for pa- tients at a quali ed site (e.g. physician practice or hospital, in a rural setting), with an authorized provider of tele- medicine services (e.g. physician or physician’s assistant), and the service must be approved by CMS. In January 2018, Remote Patient Monitoring was
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approved by Medicare for reimburse- ment (e.g. ECG, blood pressure or glucose monitoring), when reviewed by a quali ed practitioner, and re- quiring at least 30 minutes.
Online Prescribing: Follows state guidelines with notable exceptions. Passage of the Haight Act in 2008 pro- hibits prescribing of controlled sub- stances without an in-person exam. is can be altered by the setting in which the consultation occurred, for example in a hospital or clinic with an onsite prescriber ordering the medi- cations.
Informed Consent: Some states re- quire documentation of informed consent for telemedicine services, and this is supported by the American Telemedicine Association.
Fraud and Abuse: False claims, anti- kick-back statutes and self-referral laws. A recent example of high dollar fraud involved medical supply com- panies hiring physicians to prescribe devices such as back braces and dia- betic supplies not needed by the pa- tients. A second case involved a group of pharmaceutical companies which used a Telehealth company to provide insurance information and unneces- sary prescriptions for pain creams and medications to the tune of $931 million.
Privacy and Con dentiality: Tele- medicine has higher risk of HIPAA breach. ere can be pitfalls related to encryption and use of non-compliant video protocols such as FaceTime and Skype.
Telemedicine is the wave of the fu- ture, with state and federal laws fall- ing behind usage and technology. Fa- miliarity with the
telehealth system and the possible is- sues are essential to e ectively evaluate telemedicine cases.
Patty Mitchell, RN, BSN, CLNC is the president of Central Florida Legal Nurse Consultants. Her nursing career has spanned over 24 years, in the hospital acute care setting. She is a graduate of the Medical Legal Consulting Insti- tute and maintains her certi cation. Patty is the president elect of the Greater Orlando Chapter of the American Association of Legal Nurse Consultants. She has provided consulting services since 2014, to both plaintiff and defense attorneys on a wide variety of cases. She is a member of the National Association of Certi ed Legal Nurse Consultants, and Sigma Theta Tau, nursing honor society.
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