Co-Authored with Mike Sacopulos of Medical Risk Institute
As we write this post, our nation is in the throes of a horrific pandemic. Tens of millions of our fellow citizens are unemployed. Hundreds of thousands have contracted COVID-19. Sadly, more than 40,000 have died as a result of COVID-19. The world of aesthetic medicine has been largely placed into suspended animation. “Shelter in place,” “flatten the curve,” and “social distancing” have come into our vocabulary.
But with any radical change in circumstances comes opportunities. For aesthetic practices, it appears that telemedicine may be a light in the darkness. Both the federal government and state boards of medicine have moved quickly to remove obstacles to telemedicine. If ever there were a time to explore the possibility of telemedicine, this is it. However, there are several questions that need to be asked before developing infrastructure for telemedicine. The entry level question is: Are you practicing medicine or just interacting with potential patients via the internet? There are next to no regulations or requirements for those who are interested in one-on-one marketing and educating of potential patients. Depending upon the scope of the interaction, telemedicine rules and regulations may not apply at all. A simple exploratory interaction with discussion of generalized results obtained for other patients may well not constitute the practice of medicine in your state. If you steer clear of specific advice to an individual and set clear boundaries, you may not be practicing telemedicine.
Assuming that your online interaction with an individual crosses the line into the practice of medicine, there are still other questions to be asked. At the moment, many regulations and requirements for telemedicine have been suspended by state boards of medicine and by federal agencies such as the Office of Civil Rights and CMS (Centers for Medicare & Medicaid Services). If you are only interested in practicing telemedicine temporarily, you would not need to develop the infrastructure required for a longer-term commitment. Knowing your time horizon directs how much infrastructure is needed for telemedicine. For example, in the pre-COVID-19 world, interaction with patients had to be done on a secure or encrypted platform. In the current COVID-19 world, those requirements are specifically not being enforced by the Office of Civil Rights. This means that you can use platforms such as Facetime, Zoom, Google Hangouts, or Skype to conduct telemedicine visits. When the pandemic eases and requirements are reinstated, these platforms will likely not be acceptable. If telemedicine is only a stop-gap solution during the pandemic, then platform choices are more a matter of convenience than strict industry requirements. Those who are thinking longer term and more strategically will want to select a communication platform that is HIPAA compliant. Thankfully, the government has identified a number of different options for this.
Let’s now assume that you wish to make a longer-term commitment to telemedicine. You are going to use it to some extent both during these days of the pandemic and those happier times to follow. This means you should develop a compliant telemedicine program. This may not be as difficult as it seems. We recommend that you look at the Federation of State Medical Boards’ guide for telemedicine, which dates back to 2014. This document provides a roadmap for compliance, and it is freely available on the internet.
One of the first issues you will encounter is licensing. When practicing telemedicine, you must be licensed in the state where the patient is located. This means that you may need to have multiple licenses, depending upon your potential patient population. Specific documents will also need to be created. Informed consent documents must include things that relate to telemedicine, but are not necessary for in-person visits. For example, the patient needs to acknowledge that the physician has ultimate say as to the appropriate scope of the appointment when it is done remotely. Another area that needs to be focused upon is the notices placed on your practice’s website for telemedicine. These disclosures should address things like response time to emails. Your website should also be ADA compliant. This is not as difficult as it may sound. That said, your website needs to be tended to if you are moving into the telemedicine space. A little preparation will go a long way to making your telemedicine practice both smooth and compliant.
One other major area that needs to be addressed before seeing patients in a telemedicine setting is insurance. This is not specifically addressed by the Federation of State Medical Boards, but is extraordinarily important. When seeing patients across state lines, you will need to have professional liability in all states where you have patients. This means contacting your broker and explaining your new telemedicine program to make sure you are properly insured. Also, you may now be handling significantly larger amount of electronic information. This means that you should revisit your cyber insurance policy. If you do not have a cyber insurance policy already, this is a significant liability. Get with the program to acquire proper cyber coverage. This is a significant threat to all practices, especially those that are handling remote patient visits. Again, this is a conversation to have with your insurance broker. It is a rookie mistake to embark on telemedicine without speaking to your insurance broker.
By its very nature, telemedicine requires proper IT and website infrastructure. Make sure to select your IT and web vendors appropriately. They can make or break a telemedicine practice. These days of no elective cases and social distancing may prove just the time and change of perspective to move toward the telemedicine practice. We wish you great success in starting your telemedicine practice.
Mike Sacopulos of Medical Risk Institute (http://www.medriskinstitute.com), a recognized authority in medical legal issues, has co-authored this blog with MetaMed Marketing.
Brent Cavender is a co-founder of MetaMed Marketing. He heads up business development and marketing for MetaMed where he is the organization's chief practice educator and primary point of contact.