The nation's largest physicians' association has officially put its foot forward with telemedicine, after establishing guiding principles to ensure appropriate coverage and reimbursement for telemedicine services.

 

It's the latest in a continuing barrage of votes, letters, position papers and announcements from professional organizations, trade groups and other telemedicine advocates to push the needle ahead on this technology and give providers the support they need to use telemedicine, telehealth and mHealth tools.

 

During its annual meeting, the American Medical Association approved a list of guiding principles "for ensuring the appropriate coverage of and payment for telemedicine services."

 

[See also: Health IT doc to head the AMA.]

 

The organization pointed out that many organizations, beginning with the American Telemedicine Association, have adopted guidelines and positions statements on the use of telemedicine and telehealth – though there is no consensus on a definition for either term. 

 

"With a growing number of services being provided via telemedicine technologies, there is a need for a set of safeguards and standards in AMA policy to support the appropriate coverage of and payment for telemedicine services," the AMA document states. "In this report, the (AMA's) Council (on Medical Service) recommends a set of principles to ensure the appropriate coverage of and payment for telemedicine services. These principles aim to support future innovation in the use of telemedicine, while ensuring patient safety, quality of care and the privacy of patient information, as well as protecting the patient-physician relationship and promoting improved care coordination and communication with medical homes."

 

The AMA's eight-page list of principles, presented at the annual meeting by Council of Medical service Chairman Charles F. Wilson, MD, is designed to guide providers as they move to adopt telemedicine.

 

"As telemedicine continues to evolve, with a growing number of services being provided via telemedicine technologies, the Council firmly believes that there is a need for a set of safeguards and standards in AMA policy to support the appropriate coverage of and payment for telemedicine services," the document states. "Such standards and safeguards need to support future innovation in the use of telemedicine, while ensuring patient safety, quality of care and the privacy of patient information, as well as protecting the patient-physician relationship and promoting improved care coordination and communication with medical homes."

 

In its document, the AMA is dividing telemedicine as it currently stands into three categories: Real-time interaction through an online portal, remote monitoring through devices, and store-and-forward practices.

 

Before any of these approaches are used, the organization said, the physician and patient must have a "face-to-face" visit – which could be done in person or via video – to establish the parameters of a telehealth relationship. In addition, the AMA said, the physician must advise the patient of "cost-sharing responsibilities and limitations in drugs that can be prescribed via telemedicine."

 

New AMA president Robert Wah, MD explained that telemedicine can "strengthen the patient-physician relationship" to ultimatley improve outcomes. 

 

"Whether a patient is seeing his or her physician in person or via telemedicine," Wah said in a prepared statement, "the same standards of care for the patient must be maintained." 

 

In the document, the AMA points out that coverage for telemedicine varies widely. It lauds the efforts of private insurers, including WellPoint, Aetna and Highmark, to provide coverage for telemedicine, and notes that Medicare pays about $6 million a year for such services. In addition, it said, 46 states and the District of Columbia now offer some form of Medicaid payment for telemedicine services – though only nine cover store-and-forward and 14 cover remote patient monitoring in some form. And 19 states and DC have mandated that private payers cover telemedicine services, though those definitions change with each state.

 

"State coverage of and payment for telemedicine services are related to state laws addressing what services providers can and cannot deliver remotely and what requirements need to be met in order to do so," the document stated. "The Council notes that there is little consistency among states in how telemedicine is defined and regulated."

 

Those inconsistencies, the AMA believes, are hindering the adoption of telemedicine across the country.