The Federation of State Medical Boards’ move to leave out telecommunications in its guidelines for the use of telemedicine has divided the national telemedicine community. But it also calls attention to the enormous challenge of instituting nationwide policies to states that may have widely differing healthcare needs and policies for addressing them.
To be clear, the federation’s policy statement doesn’t represent a legal document but is intended to help state medical boards to roll out professional policies and standards for members.
The biggest points of contention included focusing on video conferencing and requiring telemedicine physicians to be licensed in each state where their service is used. The video stipulation is designed to reinforce the idea that physicians and patients need to at least see each other to make the interaction more meaningful.
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In a phone interview, Jonathan Linkous, the president of the American Telemedicine Association, pointed out that the federation was doing a great service to at least acknowledge telemedicine as part of the practice of medicine.
He added that although it’s helpful to have guidelines, the focus on video conferencing was an outdated way to think of telemedicine. “It’s helpful to define the universe, but if you use that definition to limit [telemedicine] that’s where problems arise. ” He pointed out that three states — California, South Dakota and Oregon –have included coverage for telephone-based consults under their Medicaid plans. He also pointed out that some telemedicine companies that use video conferencing also rely substantially on telephone consults for business.
Historically, telemedicine was very much restricted to serving the patient population of the state. But in the past 10 years or so companies have moved to expand the geographic regions they cover as states, especially those with rural populations, use the service to increase access to specialists.
Federal law permits military doctors to use telemedicine to go across state boundaries to consult and treat veterans for conditions ranging from traumatic brain injuries to PTSD.
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Linkous views state opposition to allowing out-of-state physicians to practice telemedicine as unfairly shielding the state’s doctors from outside competition. This week, Florida’s senate rejected a telemedicine provision in a healthcare bill that would allow doctors from out of state. It’s a particularly interesting issue there since Florida is home to so many snowbirds who come from other states to escape a harsh winter and might want to be treated by their own physicians.
Linkous pointed out that roughly 35 states are reviewing some form of telemedicine legislation.
Patient advocates have also expressed dismay with the federation’s guidelines. A letter representing eight patient advocacy groups said:
“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.”
[Photo credit: telemedicine photo from BigStock Photos]