There is a huge discrepancy between how telemedicine is practiced in a particular state and what that state’s telemedicine policies are. What physicians need to understand is that the Medical Practice Act applies to the physicians, which the medical boards enforce.
The medical boards aren’t concerned with the companies which hire the doctors, even if they aren’t following the rules. A telemedicine company isn’t governed by the state medical board, the doctor is. If you don’t follow your state medical board rules, you’re exposing yourself to risk.
Some state medical boards are reasonable and lenient. They might point out your errors and help you correct them. Some state medical boards are more punitive, downright vindictive.
The enforcement of the rules by state medical boards is all over the map. For example, a state medical board will mandate that all telemedicine visits be done by video visits only. But they will turn a blind eye even though most telemedicine is completed through phone calls in their state.
This is all fine and dandy until you land under the microscope of that state medical board – suddenly what you were doing for the past 2 years is no longer acceptable and you’ll be reprimanded for it.
To their credit, it’s not easy being a state medical board. They don’t have a ton of resources and doctors aren’t the easiest people to deal with. Telemedicine is a rapidly evolving field and it’s hard to stay abreast of all the regulations.
Before Starting Telemedicine
Here is a simple move which could help you a lot down the road. Before doing telemedicine in a particular state, email that state medical board and ask them what their regulation are regarding telemedicine. If they are a cooperative state medical board, they will get back to you timely and with lots of information.
Tell them which particular telemedicine company you’re doing work for. Let them know how that telemedicine company expects you to connect with their patients. Is it legit? Does that state medical board have any problems with it?
You can use their reply in your defence in the future. That’s why you need to do it either over email or through certified mail.
I’ve tried this and didn’t get anywhere. 2 of the 3 state medical boards I contacted didn’t get back to me. They weren’t willing to comment on whether what I was doing was legit. Maybe they were busy, maybe they didn’t want to have anything in writing.
If this happens to you then you can hire a lawyer ($200) and have them send a certified letter from their office to the state medical board. They can include wording such as “If there is no timely reply to this letter within a set period of time then we will assume that the medical board has no issues with this matter and my client will engage in patient care through the means outlined with this telemedicine company.”
Telemedicine Rules by State
There are a lot of websites which list each state’s telemedicine rules. Few are up-to-date which is why I recommend that you ping your own state medical board before getting started.
Telemedicine companies don’t have to fear reprisal. The worst thing that’ll happen to a telemedicine company is that they’ll get a letter saying that they have to change their workflow. Which is really how it should be done. If only doctors were given equal leeway.
The physician could have their license suspended, restricted, and would spend thousands of dollars out-of-pocket to defend themselves against their own state medical board.
Resources
I’ll list some resources for you guys which go over the various state rules regarding telemedicine. It’s what I used to write this post and they should point you in the right direction.
1. Evisit
Here is a state-by-state telemedicine policy by evisit.com.
Evisit’s website is thorough but offers little in terms of what we, as clinicians, need to worry about in regards to rules and regulations of a valid patient visit. This site is better suited for a company which likes to start a telemedicine platform.
2. Connected Health Policy
Connected Health Policy is also geared towards companies wanting to branch out into telemedicine. You can do a state-by-state search here.
They have a PDF which links you to each state’s legal code regarding their telemedicine regulations. These state legislature bills might be more useful for the clinician.
3. FSMB
The Federation of State Medical Boards in their PDF document, outlines the policies by each state regarding telemedicine.
I’ll let you decide how useful these resources are. Of note, these are policies written for physicians who are the ones getting licensed b the state medical boards. Unfortunately, the terminology isn’t easy to understand for the average non-lawyer physician.
4. State Medical Board
Some states are on top of it. Their website will have all sorts of useful information. And if that info isn’t available then you can always email the medical board people and they will help you out.
Here is a list of state medical boards. Though I suspect that you know your medical board’s website.
5. Your Telemedicine Company
If you’ve taken my advice to start your own telemedicine practice using VSee, you can email the VSee team to get information on your state’s telemedicine rules and regulations.
If you are an independent contractor for a telemedicine company then you can email your contact there to ask them what information they have regarding your state’s telemedicine rules. Each company has their lawyers review the current legal climate and comes up with an internal workflow document that passes the sniff test.