Editor's Note: This story has been updated to include additional follow-up comments from the Joint Commission.
Months after releasing draft telehealth standards, the Joint Commission has decided not to move forward with proposed changes that would have added new burdens to hospitals and ambulatory care clinics with telehealth programs.
In May, the Joint Commission announced a field review of several new standards along with a 36-day comment period. But the organization has since decided to table the standards.
“At this time, we have closed the field review and decided not to move forward with the proposed telehealth standards,” Joint Commission spokesperson Katie Looze Bronk said in an email to FierceHealthcare. “We will continue to accept comments and evaluate options.”
The decision comes as a relief for telehealth advocates who had raised concerns about several of the proposed standards that would have been more restrictive than the Centers for Medicare & Medicaid Services' Conditions of Participation as well as most state regulations. The Joint Commission's proposal would have required hospitals providing direct-to-telehealth services to obtain informed consent from the patient about the type of care provided and the modality used. The Joint Commission already has broad standards that require hospitals to have a policy on informed consent, but the new standards would have added new requirements specifically for telehealth programs.
“It’s really problematic for hospitals that spent a lot of time and resources and thoughtfulness in building out patient-centered innovative telehealth programs only to have a relatively esoteric Joint Commission standard come into effect and turn that all upside down,” Nathaniel Lacktman, a partner at Foley & Lardner LLP who chairs the firm’s telemedicine industry team, told FierceHealthcare.
According to the American Telemedicine Association, 20 states and the District of Columbia require physicians to obtain additional informed consent prior to a telehealth encounter.
The Joint Commission’s proposal flew under the radar for several months. Lacktman, who posted a copy of the draft standards on his blog Health Care Law Today in September, said the accreditor is so large and influential for hospitals that “it might as well be federal law” and if finalized, the standards would have “injected additional steps and burden” with little impact on quality or access to care.
He added that he was pleased to see the accreditor back off the proposed standards and continue evaluating feedback from stakeholders.
“I think that shows they are willing to listen to providers and hospitals in the telemedicine industry,” he said. “What that does mean is hospitals and telemedicine providers need to take time to submit comments or their feedback.”
Following the publication of this story, Joint Commission spokesperson Katie Looze Bronk sent a follow-up email indicating that a review of existing requirements determined that quality and safety concerns for direct-to-patient telehealth were already addressed in seven standards chapters.
"In addition, input from a technical advisory panel, standards review panel, and online field review survey indicated that The Joint Commission’s existing accreditation requirements adequately apply to [direct-to-patient] telehealth services and that no additional requirements are necessary," she said.
Moving forward, Bronk said the Joint Commission plans to:
- Enhance survey methodology to incorporate a robust process of assessing DTP telehealth services using existing requirements
- Develop guidance for surveyors on how to conduct a thorough review of the quality and safety issues associated with DTP telehealth services
- Continue to evaluate additional options to ensure that critical quality and safety issues related to the provision of DTP telehealth services are addressed
Bronk added that new surveyor guidance will include "DTP telehealth-specific sample questions, patient tracer suggestions and additional information on applicable standards."