Jan. 16, 2025
Risk Management Considerations With Today's Telemedicine
By Jessica Sofie
Telemedicine is one of the fastest growing means
of delivering patient care, and its technologies and policies are evolving rapidly. Physicians Insurance, WSMA's exclusively endorsed professional liability carrier, last provided risk-management telemedicine guidance to WSMA Reports readers in 2020. We thought the time was ripe to bring our guidance up to date—and to answer some of your frequently asked questions. As this area of health care is evolving rapidly, we advise you to continue to stay current on federal and state regulatory changes.
What organizational policies should be in place before providing telemedicine services to patients?
The standard of care for telemedicine is the same standard as for in-person visits, so the same policies for patient care will apply. In addition, your policies and procedures should address common topics impacted by telemedicine. These could include the following:
- Provisions for obtaining informed consent for telemedicine services.
- Which patient visits are eligible for telemedicine.
- How the physician will verify and authenticate the patient's identity and location at each virtual encounter.
- How the physician will determine patient readiness in a private environment.
- How preventive maintenance for equipment will be handled.
- Which quality data will be monitored and how improvement will be implemented.
- How to handle a patient medical emergency that develops during a telemedicine visit.
- Any documentation differences.
- Changes to billing procedures.
- Backup plans or downtime procedures for telemedicine interruption.
Are there license or geographic restrictions to providing patient care via telemedicine?
Each state regulates the scope of practice and requirements for licensure regarding the provision of telemedicine in their jurisdiction. Most require licensure in the state where the patient is located. For instance, if a Washington state-licensed physician is seeing a patient in Oregon, that professional is obligated to be licensed in Oregon, as well, and adhere to its scope of practice. There are exceptions where a rare appointment may be provided, such as if a patient is temporarily traveling out of state and has a follow-up question post procedure or needs a medication refill. Check with your professional regulating bodies, state regulations, and federal agencies for up-to-date practice acts and licensure laws including those that pertain to telemedicine.
Should I notify my professional liability carrier about new or expanded telemedicine services?
You are required to notify your professional liability carrier of changes in services to ensure you have adequate insurance coverage.
What are the credentialing considerations for providing telemedicine services?
All physicians and practitioners should be credentialed through their organization to include telemedicine privileges, if indicated. In addition, organizations should also check with their accreditation agencies for any telemedicine credentialing requirements. If telemedicine services are provided from a distant-site hospital, an agreement should state that the distant-site hospital is responsible for credentialing requirements.
Is written informed consent necessary when holding telemedicine visits?
Since state requirements vary, it is important to know the regulatory requirements for your state(s) of practice as well as for the patient's state of residency. While it is standard practice to obtain written patient consent for medical care, informed consent for telemedicine should include patient education about telemedicine and how it differs from an in-person visit.
A single consent form may be used for multiple visits as long as the same physician is treating the patient. When that changes, the patient should sign a new form. Even when the same physician continues to treat the same patient, it is recommended that a new form be signed annually.
Patient communication should include information on the unique characteristics of telemedicine services, such as:
- Technologies used, capabilities and limitations of each.
- Potential technical problems that may occur and what to do if an issue arises.
- Agreement that telemedicine is appropriate for care.
- Available alternatives to telemedicine.
- Credentials of the physicians or practitioners involved.
Be sure to set realistic expectations with the patient regarding the scope of service, who will be present during the appointment, billing, prescribing policies, and follow-up communications.
How can I obtain written informed consent for telemedicine?
Prior to the telemedicine visit—and if indicated, the informed-consent document translated into commonly used languages—forms may be exchanged through the patient portal, electronically (either secure email or facsimile), or by standard USPS mail. Ensure receipt of the signed form. The completed documentation should be included in the patient's medical record. If a patient is unable to return electronic confirmation of signed informed consent, then document the following: consent has been reviewed with the patient, the patient is unable to respond electronically, and verbal consent has been obtained. If possible, a second staff member should listen in and attest as a witness.
Is international telemedicine allowed?
Many state medical boards have dictated that medical licenses are for the practice of health care within their specifc state or within U.S. borders. Since telemedicine rules apply where the patient is located, if a patient is a permanent resident of a foreign country, a physician would typically need to be licensed in that country for international care. An additional factor involves privacy rules and HIPAA compliance for telemedicine platforms.
Physicians traveling internationally who wish to deliver telemedicine services while abroad to U.S. residents may do so, provided the physician is licensed in the state where the patient receiving care is located and the platform used for telemedicine is HIPAA compliant (see the question after next).
If an established patient has left the state to attend college, can I continue treatment by using telemedicine visits?
Our recommendation is to check your licensing state's rules, as most states require the physician to be licensed where the patient is physically located.
Can I provide telemedicine services from my home or other location that is not my office?
The physician's obligation for patient privacy extends to any setting where care is provided. With proper privacy safeguards and consideration given to a professional presentation, it is possible to use the home setting. Keep in mind that public-facing communication resources, such as Facebook, Instagram, and others, are not appropriate for electronic health visits because the software or platform used for telemedicine must be HIPAA compliant.
Am I required to provide interpretation services on a telemedicine visit?
During a telemedicine visit, patients in need of interpretation services should have access to a certified health care interpreter. Physicians or their staff should be competent concerning how to bring the certified interpreter into the conference, and they should document this service. Check with Physicians Insurance or your professional liability carrier for more guidance on the use of certified health care interpreters.
Am I allowed to prescribe medications via telemedicine visits?
When deemed appropriate for the patient, a telemedicine physician may prescribe, as long as it is done within the scope of their licensure. Special caution must be used hen prescribing controlled substances. Currently, the DEA mandates how to prescribe for controlled substances via telemedicine. Please review their website and reach out to your pharmacy and medical board to verify state rules.
If you are a Physicians Insurance-insured member and have questions that are not covered here, visit phyins.com/resources or reach out to our risk management or underwriting departments. We also encourage you to seek input from your general counsel or attorney to maintain regulatory and legal compliance.
Jessica Sofe, CPHRM, is a senior risk consultant with Physicians Insurance.
This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.