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October 30, 2019

Telemedicine and Your Practice: What Do You Need to Know?

By Thomas J. Bryant, ARM
President, Physicians Insurance

Virtual medicine is booming in popularity. It’s estimated that demand for interactive audio and video health technology, otherwise known as “telemedicine” will increase by 18 percent annually nationwide. These new technologies will likely become an important part of most medical practices in the coming decade.

The payer community is also expanding into new types of telehealth. Earlier this year, Massachusetts lawmakers approved telehealth benefits for mental health patients enrolled in MassHealth, Medicaid, and CHIP, opening new avenues of care for more than 2 million covered state residents.

I’d like to briefly discuss four important areas of consideration for physicians and practice managers considering an expansion into telemedicine service:

1. Malpractice Coverage

Telemedicine is becoming more mainstream each year but is still considered a new arrival in the medical insurance risk arena. It’s likely your insurer is evaluating the need for expanded and/or extended coverage policy forms, but it is vital to discuss this with your broker and ask if any additional coverage might be available. Just as traditional malpractice insurance can vary significantly among carriers, so can telemedicine policies and riders. A full evaluation of your needs and options with a trusted broker-advisor is in order.

2. Licensure

Massachusetts — like most states — requires a physician practicing telemedicine to hold a valid license in the state where the patient resides. These regulations are consistent with the telemedicine guidelines published by the Federation of State Medical Boards (FSMB), which stipulate that the medical care occurs where the patient is located at the time of the telemedicine encounter. Some states have begun to offer reciprocity to qualifying physicians, check https://imlcc.org to see which states have interstate licensure agreements.

3. Crossing State Lines

Telemedicine delivery regulations are fairly straightforward if there is a clear and existing patient-physician relationship and the patient lives in the state where the doctor holds his or her license. However, in several New England health care markets, patients regularly cross state lines to visit physicians and seek care. Practices must be extra attentive to any rules and regulations in states where care is being delivered remotely to patients, including issues of licensing, venues, privacy, data security, and other non-tort risks along with the clinical challenges of whether a duty of care is owed.

4. HIPAA

It’s important for telehealth providers to follow the standards in HIPAA and HITECH that pertain to covered entities (CEs) and business associates (BAs) standards to protect ePHI. Risk exposure in telemedicine can include erroneous transmission of data, security breaches from human error, and cyberattack/malware — creating a new set of concerns over privacy and security of patients’ protected health information.

In conclusion, it’s important that practices planning to launch telemedicine services discuss the nature and extent of their plans with their brokers in detail. This conversation will ensure brokers and insurers are responding thoughtfully to the specific circumstances of the practices they serve.

Thanks for reading. If you’d like to know more, I recommend some further reading on the topic:

The American Telemedicine Association and other professional associations have published a number of telehealth practice guidelines.

https://thesource.americantelemed.org/home

www.coverys.com/Knowledge-Center/Telemedicine-Reducing-the-Risks

www.medpro.com/documents/10502/3667697/Risk+Tips_Addressing+Risks+Associated+With+Telehealth.pdf

www.medpro.com/telehealth-privacy-security-risks

www.medicaleconomics.com/news/how-avoid-legal-risks-telemedicine

Additional Resources regarding COVID-19:

Physicians Insurance March 20, 2020 notice to clients

Massachusetts Medical Society webpage on COVID-19 including Telehealth and Virtual Care

MA Telehealth Order (March 15, 2020)

Physicians Insurance President Thomas J. Bryant, ARM, is a licensed Property, Casualty, Life, Accident, and Health broker in all six New England states and has been an adjunct clinical assistant professor in the School of Health Sciences at Bryant University since 2016. Most recently Tom developed a video presentation on malpractice basics for Harvard Medical School 4th-year students, and has participated in NEJM Resident 360 virtual panels on topics related to financial matters important to early-career physicians.

Is it time to examine your current policy? What you don’t know can hurt you. For more information on how Physicians Insurance can support your practice and help you mitigate risk, visit www.piam.com or call 800.522.7426.