Telemedicine is proving a critical tool for addressing the COVID-19 outbreak. The CDC, several state public health agencies, and numerous industry groups are promoting telemedicine as a response mechanism.
Considerations for Implementing Telemedicine:
- Utilize all the risk mitigating and patient safety tools you would normally use:
- thorough communication,
- coordination of care, and
- documentation of your clinical thinking and decision-making process.
- Laws and regulations have been relaxed and expanded over the past few years to facilitate greater telemedicine adoption.
- Barriers to the use of telemedicine have been reduced in response to the pandemic.
- Professional liability coverage may be affected. MPIE encourages our insureds to utilize telemedicine delivered care whenever practicable at no additional cost. This coverage is available immediately through the duration of the current CDC social distancing recommendations upon notification and request to MPIE Underwriting at underwriting@mpie.org.
Risk Management Tips for Providers Delivering Telemedicine Services:
- Appropriateness – Ensure that the patient’s condition can be adequately assessed and examined via the telehealth platform.
- Technology – Ensure the patient has the necessary technology to make telehealth possible and effective for examining the patient.
- Authenticate – Ensure you are examining and prescribing for the correct patient.
Have the patient hold up their driver’s license and compare information to authenticate identity
Check insurance eligibility: confirm the patient’s name, address, date of birth, and social security number.
- Documentation – Ensure the encounter is thoroughly documented, including all communication, orders or tests/results, follow -up recommendations, and coordination of care.
- Confidentiality – Document that the patient agrees and understands that there are limits of confidentiality when communicating via telehealth.
- Technical Issue – Document if any technical issues were encountered and interfered with the contact, including poor internet connectivity, camera malfunction, patient inability to use the technology adequately for the exam.
Risk Management Tips for Risk Managers of Hospital Employed Providers:
- Credentialing – Evaluate credentialing by proxy options to streamline and expedite the credentialing needs of remote providers
- Licensure – Provider licensure should cover the states where patients will be assessed and treated and consider potential exceptions to licensure and licensure compacts.
- Standard of Care – Telemedicine does not inherently change the standard of care. However, the provider using telemedicine should consider whether the method of communication makes it more challenging to provide appropriate medical care.
- Scope of Practice – Comply with state delegation and supervision laws of non-physician providers that will be delivering telemedicine services.
- Documentation – Ensure all provider-patient interaction using telemedicine technology is appropriately captured in the patient’s health record
- Controlled Substances – Comply with federal and state laws regarding prescribing controlled substances.
- Financial – Review reimbursement mechanisms to ensure payment.
Expanded CMS Reimbursement
Regarding reimbursement, Medicare has temporarily expanded its coverage of telehealth services. These services extend the current telehealth covered services, to give patients access from more places (including their homes), to a broader range of communication tools (including smartphones), to interact with a variety of providers (such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social worker). During this time, patients will be able to receive a specific set of services through telehealth, including evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. This change helps ensure patients can visit their health care providers from their home, without having to go to a doctor’s office or hospital, which reduces the risk of exposure to COVID-19.
Resources
The American Hospital Association (AHA) COVID-19 telehealth resources provide real-time updates to the telehealth rules and other helpful information. The link to these useful resources is: https://www.aha.org/issue-landing-page/2020-03-24-coronavirus-covid-19-telehealth-and-virtual-care
The Center for Connected Health Policy’s (CCHP) National Telehealth Policy and Resource Center (NTRC-P). Lists 50-state laws, reimbursement regulations, policies, resources, and multiple links (as well as telephone contacts) for detailed resources and information. Located: https://www.cchpca.org/
Centers for Medicare and Medicaid Services
- https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
- https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak
Medicare Temporary Expansion of Telehealth Services (Midway down page)
ASHRM Whitepaper examining telehealth risks utilizing the eight enterprise risk management (ERM) domains
ASHRM: Telemedicine Risk Management Considerations
For frequently asked questions on coverage during COVID-19, please see: MPIE COVID-19 FAQs on Coverage and Resources.