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Telemedicine Providers Welcome AMA Guidelines

 |  By jfellows@healthleadersmedia.com  
   July 17, 2014

In its recommendations, the AMA cements what providers have been hearing for years: Telemedicine needs more regulation and reimbursement.

In what is seen as its biggest step forward in acknowledging the value of telemedicine, the American Medical Association issued, in early June, a list of eight policy recommendations for providers who provide telemedicine services to follow.

The AMA's suggestions include establishing a "valid patient-physician relationship" before telemedicine services are provided; requiring physicians to be licensed in the state where the patient who is receiving telemedicine services resides; transparency in services and cost, as well as encouraging more reimbursement, research, and support for telemedicine pilot projects.

The overall message received by the telemedicine provider community was a reflection of what other organizations, including the American Telemedicine Association, have been saying for years about telemedicine: It needs regulation and reimbursement.


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"The policy, as a whole, is a good one," says Ben Green, MD, a medical director at Carena, a primary and urgent care telemedicine provider based in Seattle. "The fact that the AMA has recognized telemedicine is great. It's an excellent step in the right direction. We need better evidence, and clinical practice guidelines for telemedicine."

The ATA also commends the AMA's policy recommendations. ATA CEO Jonathan Linkous says the AMA and ATA have had "positive dialogue" over the years, but calls this step major progress.

"We have a good working relationship with them for the first time in 20 years," he says.

The one sticking point the ATA has with the AMA's recommendations is requiring physicians to have a license to practice in each state where their patients live. The suggested requirement is a barrier, says Linkous, because people become attached to their doctors.


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"Take snowbirds, for example," says Linkous, referring to the seasonal travelers who leave behind the snow for sand in winter. "We're saying patients should have the ability to choose their physicians."

Green, an ATA member, calls the requirement limiting, but not a barrier. Green is one of more than a dozen providers at Carena who deliver telemedicine care in six states: Washington, California, Illinois, Missouri, Kentucky, and Nebraska.

"The policy is a good one," Green says regarding the AMA's stance on state licensure. "We've been able to get our providers licensed in those states, but it takes time. It's not a new issue. We're all hoping for improvements."

There are two proposals circulating that would ease the state-by-state licensing requirement. The one that Linkous holds out hope for is reciprocity, where one state recognizes the license of provider in another state. That's the easiest approach, but likely to encounter stiff resistance from state medical boards.


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Another proposal is from the Federation of State Medical Boards, which creates a simplified pathway to get an out-of-state license to practice. Under the FSMB proposal, willing states would step forward and enter into a compact.

Providers would have to fill out one set of forms for an out-of-state license. They'd still have to pay the individual state medical board fees, but the paperwork would be reduced.

Karen Rheuban, MD, director for the University of Virginia Health System's Center for Telehealth, and past ATA president, says the AMA's strict policy stance is understandable and sound because it protects patients. She says:

The AMA and the Federation of State Medical Boards have taken this position so to ensure the ability of the boards to respond to complaints and enforce actions against providers. The Federation is in the process of developing an expedited licensure process that still will require any physician who provides services in another state to obtain a license in that state, albeit more quickly. Once implemented, we look forward to working with the Federation and our Board of Medicine to determine the success of this new process. There are many patients who can benefit from consulting with providers in another state, and as compared to true licensure portability, this new process still risks being time consuming and costly to providers, albeit very much an improvement.

Telemedicine policies on regulation and reimbursement vary state-by-state. In some states, obtaining a license is relatively easy compared to others. For that reason, Green says Carena works with states "friendly" to telemedicine. Some insurers do pay for some telemedicine services, including Wellpoint, Aetna, and Medicare, and Medicaid.

The adoption of telemedicine as a viable access point to providing care has moved more quickly than legislators and state medical boards, but the AMA's policy recommendations are a shot in the arm to telemedicine, despite the state licensing requirement, says Linkous.

"Even though there are some issues where we disagree, we both agree on appropriate regulation, reimbursement, and some of the other rules," he says. "In all honesty, we have a better relationship with AMA now."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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