In late April 2014, the Federation of State Medical Boards (FSMB), a non-profit organization representing state medical licensing boards, approved a model telemedicine policy for possible adoption by state medical boards. The Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine sets forth guidelines for physicians using telemedicine technologies in delivering patient care. Among other requirements, the guidelines would require that a physician be “licensed by, or under the jurisdiction of” the medical board of the state in which the patient is located. The physician must also obtain a “documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient” before providing treatment or prescribing medication. Additionally, physicians must obtain evidence of informed patient consent for the use of telemedicine, including identification of the patient, the physician, and the physician’s credentials, details on security measures taken with the use of telemedicine, etc. Finally, the guidelines state that physicians should meet or exceed federal and state privacy and security requirements.
The FSMB policy spurred debate by defining telemedicine as generally “not an audio-only telephone conversation, e-mail/instant messaging conversation, or fax.” Rather, the policy states that telemedicine “typically involves the application of secure video conferencing or store and forward technology . . . .” Prior to adoption of the model guidelines, the American Telemedicine Association asked the FSMB to delete the reference to telephone and email consultations. It argued that physicians had historically provided telephone consultations outside of business hours or for follow-up care, that a growing number of health systems had approved email communications with patients, and that at least three states had included coverage for telephone-based consults under Medicaid. (As we discussed in a March 12, 2014 post, Medicare Part B pays for telemedicine services furnished to rural beneficiaries through an “interactive telecommunications system” that provides for real-time audio and video communication.)
Because the guidelines are offered only as a model, it remains to be seen whether state boards will adopt them as drafted.