As dermatologists, we have all seen those subject lines in our emails, “Start telemedicine today!” As more vendors enter the market, those emails are now much more frequent. The good news is that it has never been easier to pick a system and start offering telemedicine to patients. But before you open that next email and start down the telemedicine journey, consider how these top 5 factors fit into your practice. It just might save you a little time and energy.
Knowing what you can do before deciding what you want to do is the first and most important step. Unfortunately, understanding what is and is not allowed can often be difficult given that states are only beginning to develop telemedicine specific laws. In some states, like California, the laws explicitly define telehealth as well as asynchronous telemedicine in their statutes.1 In addition, the condition for prescribing is simply an “appropriate prior examination.”2 In other states, like Michigan, telemedicine is only defined as it relates to reimbursement.3 Here the condition for dispensing a prescription is an established provider-patient relationship but nothing in the law states that must be done in person.4
The point here is not to overwhelm or discourage you from thinking about telemedicine. The better you understand the legal framework the more confident you will be in this new endeavor. As a general rule, you should be knowledgeable about the following:
• How is telemedicine defined in your state?
• Are there explicit restrictions regarding patient care via telemedicine?
• What are the requirements to prescribe to patients via telemedicine?
A good place to start is at the Center for Connected Health Policy (http://cchpca.org/), a nonprofit website with links to the latest telemedicine laws in all 50 states and much more. Seek the opinion of a qualified attorney specializing in telemedicine if you have any doubts. Someone knowledgeable in telemedicine can quickly find the applicable statutes and provide direction.
The next limiting factor will be your professional liability or malpractice policy. In my experience, most insurance carriers now cover telemedicine as part of their standard policy. You should reach out to your agent, confirm coverage, and understand any restrictions. In some cases, you may need to fill out a simple questionnaire affirming who you will see via telemedicine (new vs existing patients) and how you will see them (live video vs asynchronous telemedicine).
It is important to note that many carriers have recently clarified their position regarding telemedicine coverage. I have heard of some practices initially being told telemedicine was not covered but when pressed for an explanation found it was, in fact, covered—be persistent, especially if there are colleagues in your state already practicing telemedicine.
At this point you should know:
• Are you able to see new patients or existing patients in your state?
• If you are only able to see existing patients, are you able to see those patients for new conditions or only established conditions?
• If you are covered by your existing malpractice policy or you need additional coverage for telemedicine?
3. Practice Goals
Now that you know the legal and liability constraints, next you need to develop your practice goals. Telemedicine is a new model of care that allows you to grow your practice, retain existing patients, and increase patient satisfaction. You can focus on one of these or aim to achieve all of them using telemedicine. If you want to grow your practice, offering online visits to new patients can increase your visit volume and attract additional patients to the clinic. You can also cut down on unreimbursed care and recover no-show visits by offering online visits. If you have an established practice that is trying to absorb current patient demand, telemedicine follow-ups for routine visits is a great way to free up your clinic schedule to meet that additional demand.
The benefits of telemedicine are not always directly financial. It can also be a great way to enhance continuity of care and increase patient satisfaction. If you see a lot of cosmetic cases, online follow-ups for those patients can be a great way to differentiate your practice. I personally do online follow-ups with most of my surgery cases to reassure patients that their wound is healing without complications. On a few occasions, I have even been able to identify early infections despite patients not calling to report any symptoms to our office.
4. Organization Readiness
Running a practice can be an all consuming experience some days and it is easy to lose steam when trying to add something new to your clinic.
In multiple provider practices, collective interest in offering telemedicine might exist but it is important to have a “telemedicine champion” who is the point person. Everyone might have different ideas when it comes to telemedicine. The champion is someone who should be responsible for communicating with everyone, documenting the legal and liability aspects, and building consensus within the practice. Having a point person is also helpful when dealing with telemedicine vendors. That way you know your practice goals and needs are being consistently communicated to vendors.
I have heard too many times of a practice signing a contract and beginning implementation only to discover that a vendor did not support their needs. Having a single telemedicine champion to direct these efforts can help avoid this situation.
5. Ask Around
Now, before you respond to that latest vendor email or start googling, ask colleagues which telemedicine vendor they are using. Do not be afraid to ask them for candid feedback and pricing information. If you do not know anyone in your area using telemedicine, ask the vendor for a reference. The most reputable companies should have dermatology practices ready to vouch for them.
I have experienced the promise of telemedicine in my own practice and I love being able to offer its convenience to my patients. Telemedicine is here to stay and it will only become more integral to the way we practice medicine. For those who are ready to start offering telemedicine, taking time to answer the questions I laid out can help put you on the road to success with your own practice.
Dr Pena-Robichaux is a board-certified dermatologist practicing in Austin, TX. She is also the chief medical officer and cofounder of MyDerm Portal, a private practice focused telemedicine platform for dermatologists. You can contact her at email@example.com.
1. CA Business & Professions Code Sec. 2290.5. http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=BPC§ionNum=2290.5. Accessed July 24, 2016.
2. CA Business & Professions Code Sec. 2242.1(a). http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=BPC§ionNum=2242.1. Accessed July 24, 2016.
3. The Insurance code of 1956 (Excerpt) Act 218 of 1956. Sec. 500.3476 Telemedicine services; provisions; definition; applicability.
Accessed July 24, 2016.
4. Public Health Code (Excerpt) Act 368 of 1978. Sec 333.17751 Dispensing prescription drug or device; requirements. http://www.legislature.mi.gov/(S(2iz23xbkhnl20drbxqrhn1aq))/mileg.aspx?page=getObject&objectName=mcl-333-17751. Accessed July 24, 2016.