Many state medical boards looking to update telemedicine policy

Andis Robeznieks , Senior News Writer

Throughout the COVID-19 pandemic, telehealth has provided patients with enhanced access to their physicians and a policy adopted by the Federation of State Medical Boards (FSMB) that seeks to bolster continuity of care is being considered by individual state medical boards.

Protecting telehealth

Comprehensive telehealth reform is critical to the future of health care. The AMA is fighting for legislation to permanently remove restrictions on telehealth coverage and payment.

The FSMB policy (PDF) facilitates continuity of care via telehealth for patients who are temporarily in a different state. Kentucky and Mississippi have already adopted the policy as their own while nearly half of state boards will be considering an update to their telemedicine policies, according to an FSMB member survey.

The policy includes recommendations from an AMA Council on Medical Service report that was presented at the 2021 AMA Annual Meeting.

“This report addresses a common frustration among physicians—that, outside of the temporary licensure flexibilities put in place during the public health emergency, they are prohibited by most states from using telehealth to provide longitudinal care to existing patients who may live across a state border, attend college in another state, or travel for work or seasonally,” the AMA council report (PDF) says.

In addition to those patients described above, others who make frequent use of telehealth are patients with cancer or who have had an organ transplant and received treatment at an out-of-state center of excellence, said Lisa Robin, the FSMB’s chief advocacy officer.

Almost 423,000 (5%) of the nearly 8.4 million Medicare patients who used telemedicine in the first six months of 2021 had one or more out-of-state telemedicine visits, according to a study published in JAMA Health Forum.

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The FSMB policy was developed by a work group that included AMA President Jack Resneck Jr., MD, and others.

“We had a policy done in 2014 that was really widely accepted among our members, but COVID changed everything,” Robin said. “We recognized that we needed to revisit that 2014 policy based on what we learned because you had this huge increase in utilization of telemedicine during the pandemic.”

While some use the terms “telehealth” and “telemedicine” interchangeably, the FSMB considers “telehealth” to be an umbrella term that also includes wellness or fitness applications, while “telemedicine” refers to a medical service delivered remotely.

Supporting telehealth is a core element of the AMA Recovery Plan for America’s Physicians.

Telehealth is critical to the future of health care, which is why the AMA continues to lead the charge to aggressively expand telehealth policy, research and resources to ensure physician practice sustainability and fair payment.

Patients’ location matters

The prevailing standard for licensure found in the medical practice acts of each state affirms that the practice of medicine occurs where the patient is located, according to an AMA issue brief on licensure and telehealth (PDF). This standard enables states to ensure that health professionals adhere to that state’s laws and regulations and the public is protected from the unprofessional and improper practice of medicine. 

The FSMB policy, adopted in April, states that “a patient that is temporarily located outside the jurisdiction of a physician with which the patient has an established relationship may receive care via telemedicine technologies provided it is possible for the physician to gather sufficient clinical information during the evaluation to provide care that meets the accepted standard of care.”

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“If the patient is presenting with new medical conditions, the physician may consider directing the patient to obtain local care,” the policy adds.

“It went to our House of Delegates and was adopted unanimously,” Robin said. “The state boards use our policy as a guidance document for their own policy work. Some will take pieces of it or add to it depending on their particular circumstances and patient population.”

While some temporary telemedicine regulations enacted during the pandemic are starting to expire, 21 states (PDF) have permanent rules governing telemedicine use, according to the FSMB.