Patient Advocacy, Provider Groups Take Issue With Telehealth Policy

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In a recent letter to Federation of State Medical Boards Chair Donald Polk, eight patient advocacy and provider groups raised concerns about FSMB's new model telehealth policy, Kaiser Health News reports (Gillespie, Kaiser Health News, 5/2).

Details of Model Telehealth Policy

During its annual meeting last month, FSMB approved an 11-page "Model Policy on the Appropriate Use of Telemedicine Technologies in the Practice of Medicine."

The non-binding guide for its 70 member boards aims to serve as a consistent, nationwide approach to the use of telehealth technologies.

The model policy calls on providers to:

  • Use video technology rather than audio or email technologies for their first telehealth encounter with a patient; and
  • Create credible "patient-physician" relationships that ensure patients are appropriately evaluated and treated and follow established guidelines for data privacy and security, informed consent and safe prescribing.

In addition, the policy calls for the same standards of care for in-person health care visits to also apply to telehealth.

State boards have the option of adopting the new policy, altering the policy before adoption or choosing to keep their current telehealth policies (iHealthBeat, 4/29).

Details of Letter

In the letter, the groups wrote, "We believe the policy ... did not account for many of the safe, secure ways patients are accessing health care today, including 'audio-only' telephone. Our goal is patient access to safe, secure telemedicine and this may be thwarted if the existing policy is allowed to stand" (Kaiser Health News, 5/2).

The letter was signed by:

  • The ERISA Industry Committee;
  • Family Voices;
  • National Alliance for Caregiving;
  • National Association of ACOs;
  • National Council for Behavioral Health;
  • National Multiple Sclerosis Society;
  • Parkinson's Action Network; and
  • United Spinal Association (FSMB letter, 5/1).

Amy Comstock Rick, CEO of the Parkinson's Action Network, said, "If you limit [telehealth] to video conference, there may be an equity issue. Not everyone has that equipment or is comfortable using it -- we're just trying to break down the barriers so people who want to use it can use it." She asked, "Are we going to go backwards if the model policy is prohibiting non-telephone interactions?" (Kaiser Health News, 5/2).

The groups asked Polk to "appoint another working group to review FSMB's model telemedicine policy," adding, "This time, we hope the FSMB will invite patient and employer groups like ours, who are the users of telemedicine, to express our views on its regulation" (FSMB letter, 5/1).

Roger Downey
The FSMB guidelines do not rule out the telephone for the first telehealth encounter but only for the first encounter to establish the doctor-patient relationship. If someone is already an existing patient, the use of the telephone for the first telehealth encounter or future encounters is appropriate. If someone is unknown to the physician, however, the telephone is not appropriate to establish the relationship because the doctor cannot see the patient. That's the distinction that the media and the healthcare groups have had difficulty understanding. What makes the doctor-patient relationship so important is that a physician can then prescribe prescription medication when appropriate. Prescribing without the relationship in place is generally considered unprofessional conduct by the physician's licensing agency.

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