PSG Rumblings Newsletter Summer 2020

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Legal Corner

Telemedicine & Legal Issues Beyond COVID-19

Richard E. Moses, DO, JD

ACOs are established networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently, i.e., when they save money. Telemedicine has played a strong role in cost saving under this model with the best example being patients with Inflammatory Bowel Disease. Most private insurers have been reluctant to reimburse, however, for telemedicine delivery. States also had individual restrictions although these have been loosened over time. @therealgidoc

A ccording to the American

Telemedicine Association, telemedicine has existed for approximately 40 years. Telehealth refers to a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. A few telehealth examples include remote patient monitoring of vital signs, ECG, blood pressure, oxygen level, transmission of medical imaging, and educational services. Telemedicine is a form of telehealth. This refers to remote doctor-patient consultations using technology. Telemedicine makes it possible to treat patients whenever and wherever the patient is via electronic media such as a computer or smartphone. The Affordable Care Act (ACA) promoted telemedicine in order to enhance healthcare delivery in rural areas. In an attempt to reduce healthcare costs, the ACA encouraged physicians, hospitals, and other healthcare providers to establish Accountable Care Organizations (ACOs) in the Medicare program.

Telemedicine has grown exponentially over the past 5-10 years in some specialties of medicine and geographic areas of the United States. The COVID-19 pandemic imperiled our country and the world. As the pandemic spread in the US from SARS-CoV-2, the Centers for Disease Control and Prevention (CDC), public health agencies, and health insurers recognized telemedicine could be utilized to help prevent a surge, by allowing patients continued access to care, with minimal exposure. COVID-19 has rapidly and drastically elevated telemedicine as a care delivery platform due to the need to take care of patients despite the universal lock down of our country. Telemedicine platforms were ideally situated to help patients during the pandemic. The Coronavirus Aid, Relief, and Economic Security (CARES) Act significantly loosened the federal restrictions on telemedicine temporarily. This included the Office of Civil Rights temporarily pulling back some of the HIPAA restrictions during the COVID-19 pandemic. The Coronavirus Preparedness and Response Supplemental

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Appropriations Act of 2020 (CPRSAA) is an emergency aid package that, among other things, expanded access to telemedicine for Medicare beneficiaries during the coronavirus public health emergency. CPRSAA permitted the U.S. Department of Health & Human Services (HHS) Secretary to take action broadening the circumstances under which Medicare will reimburse healthcare services provided via telemedicine. Many states and many insurers also liberalized their policies on telemedicine due to the COVID-19 pandemic. There are a number of medicallegal issues regarding telemedicine delivery. Although the COVID-19 pandemic “bent the rules,� once the pandemic measures have been lifted, we will likely return to the former laws and issues controlling telemedicine.

State Laws and Licensure

The telemedicine visit is defined by the originating site (location) of the patient. If the patient is in Pennsylvania, that is the state where the televisit took place. This means that the healthcare practitioner must have a valid medical license in Pennsylvania. Physicians practicing telemedicine across state lines will need a valid medical license in the state in which the patient is located.


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