American College of Physicians Outlines Recommendations for Telemedicine Use in Primary Care

The American College of Physicians has made several policy recommendations for the use of telemedicine in primary care, noting that the potential benefits of the practice must be weighed against its associated risks and challenges, FierceHealthIT reports.

The recommendations were published in a position paper in the Annals of Internal Medicine.

Position Paper Details

According to FierceHealthIT, the paper is a follow-up to one written in 2008, when the ACP addressed the use and effects of various technologies, such as:

• Electronic health records;
• Patient portals; and
• Telemedicine (Hall, FierceHealthIT, 9/8).

In the new position paper, ACP said it supports the expanded role of telemedicine in health care for its potential benefits (Feller, UPI, 9/8).

However, the organization noted that policymakers and other stakeholders must bolster oversight and develop implementation guidelines and policies that mitigate the risks of telemedicine (Gruessner, mHealth Intelligence, 9/8).

Recommendations

Specifically, ACP recommended that:

• Physicians ensure their use of telemedicine is compliant with federal and state security and privacy laws;
• Physicians protect themselves against liabilities and ensure their liability coverage has provisions for telemedicine;
• Telemedicine services be held to the same practice standards as those for in-person visits; and
• Telemedicine services support all patients, taking into account literacy levels, affordability and availability of technology and Internet access, as well as ease of use.

ACP also said that:

• Physicians should use their professional judgment to determine when the use of telemedicine is appropriate for a patient; and
• Valid patient-provider relationships must be established, noting that physicians with no prior direct contact with a patient before a telemedicine visit should take steps to establish the relationship or consult with another physician who has a relationship with the patient.

Meanwhile, ACP said it supports:

• Establishing a streamlined process for obtaining multiple medical licenses to allow providers to offer telemedicine services across state lines;
• Committing federal funding to support the infrastructure necessary for telemedicine services;
• Allocating federal funding to establish an evidence base for the safety, efficacy and cost of telemedicine;
• Lifting geographic restrictions that limit Medicare reimbursements for telemedicine services that originate outside of Metropolitan Statistical Areas or for patients who live or receive services in a Health Professional Shortage Area;
• Providing reimbursement for "appropriately structured" telemedicine communication, noting that such services are a comparable alternative to face-to-face encounters;
• Using telemedicine as a way to enhance patient-provider collaboration, improve outcomes and increase access to care; and
• Allowing hospitals to "privilege by proxy" under a CMS rule that lets facilities rely on information from the originating site of telemedicine services when providing medical credentialing and privileging for those who provide the services (ACP release, 9/8).