AMA telemedicine policy emphasizes in-state licensure, in-person visits

Patient safety and care quality is a primary focus of a telemedicine policy adopted by the American Medical Association this week. It errs on the side of caution in its recommendations, calling for in-person consults in some cases, for example.

The policy calls for a "valid patient-physician relationship" by way of an in-person consultation for services that otherwise would require face-to-face examinations before continuing treatment via telemedicine. Additionally, the policy recommends that doctors delivering telemedicine be licensed in the state where a patient is receiving treatment.

Telemedicine services also should include care coordination with a patient's medical home, according to the policy, which further recommends that patients receiving such care have access to both licensure and board certification qualifications of providers in advance f their appointment.

Protocols also must be developed for the delivery of emergency services, which the policy cites as an exception to the face-to-face provision.

A similar model policy adopted in April by the Federation of State Medical Boards also requires that physicians be licensed in the same state where their patients receive treatment, and calls on identification of doctors and their credentials prior to treatment.

But it was not well received by the American Telemedicine Association. 

ATA, in a letter to FSMB, said that the latter requirement "would prohibit a state medical board from entering into a reciprocal relationship with neighboring states … regarding state licensure whereby a license to practice medicine in one state is recognized by the other state." Such a policy, ATA added, also conflicts with federal policy for doctors treating patients in the military.

Joseph Kvedar, founder and director of the Boston-based Partners' Center for Connected Health, praised FSMB's model policy last month, saying in a blog post that it "allows for regulatory certainty while encouraging future innovation by creating clear definitions and guidelines on how and when telehealth can be most effectively incorporated into quality patient care."

The AMA's policy also pushes for "additional evidence" of telemedicine's reliability via continued support for pilot programs.

"Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained," AMA President Robert Wah said in a statement. "Telemedicine can strengthen the patient-physician relationship and improve access for patients to receive healthcare services remotely as medically appropriate, including care for chronic conditions, which are proven ways to improve health outcomes and reduce healthcare costs."

To learn more:
- read AMA's policy (.pdf)
- here's AMA's announcement

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