Controversial New Medical Board Telehealth Policy Dismays Teladoc

The Federation of State Medical Boards (FSMB) recently caused a stir with its new telemedicine policy guidelines.  Modern Healthcare reports that the update of its over-a-decade-old model telehealth policy on the use of telemedicine technologies gives preference to the use of video over voice-only (phone) technologies. This has caused a small upset among some telehealth providers and patient advocate groups.  Among these are Teladoc, one of the oldest and largest providers of virtual doctor consultations today.  Unlike competitors MDLIVE and American Well which grabbed the doctor video visit bull by the horns, Teladoc has lagged on its video strategy, focusing instead on doctor phone consultations.  Now it looks like video telemedicine platforms like MDLIVE and American Well are looking to overtake Teladoc’s market share with video consults.

Telehealth Policy A Step Up

On the up side, the revised policy is definitely a step in the right direction for making it easier to practice telemedicine. It now endorses the initiation of a patient relationship “whether or not there has been an encounter in person between the physician (or other appropriately supervised healthcare practitioner) and patient.” It also allows for the establishment of a physician-patient relationship through the use of telemedicine technologies “provided the standard of care is met.”

While telehealth proponents should be happy about this, what’s controversial is the policy’s understanding of telemedicine which clearly favors video.  It states that in first-time encounters, “Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.”

Some of the concerns Teladoc and other telehealth proponents favoring a broader view of telemedicine cite are access of care for the disabled, economically disadvantaged, and chronically ill if video in first-time encounters is required .

FSMB’s chief privacy officer Lisa Robin explains that the emphasis on video is due to a concern that the “standard of care” may not be met in a voice-only encounter, especially in a first-time visit.  Considering that 30 states still require a face-to-face visit for a physician to write a patient a prescription, even giving video conferencing the thumbs up is a good thing for telemedicine.

While the FSMB telemedicine policy guidance is not binding, it is usually adopted by the regulating state medical boards with few changes.

The FSMB policy has also been criticized for not supporting cross-state licensing.  However, Robin notes that the FSMB is currently involved in helping state boards work together to come up with telemedicine-friendly, multi-state physician licensing compact, but this would require legislative action by each state to take effect.

More on the Telemedicine Video Policy:

  • Nice summary of FSBM telehealth policy issues from iHealthbeat
  • Another article from Modern Healthcare