IBM Holds Hearing on Proposed Telemedicine Practice Standards

Date of Publication (January 17, 2015)

On Thursday, the Iowa Board of Medicine (IBM) held a public hearing to continue the public vetting process for the proposed telemedicine practice standard rules we told you about last month. IMS continues to closely monitor development of these rules to ensure that appropriate, uniform standards for telemedical practice are enacted, while still offering sufficient flexibility to allow for future innovation in this rapidly evolving field of medicine. In endorsing the IBM’s proposed Interstate Medical Licensure Compact Legislation, which would create a voluntary, expedited process by which physicians might obtain multiple state licenses, the IMS Board of Directors acknowledged that such a measure has the potential to result in an increase in out-of-state physicians obtaining Iowa licenses for the purposes of expanding their telemedical practices into this state. The Board expressed reservations over Iowa joining the Compact absent uniform standards to ensure safe, appropriate telemedical care for Iowa patients and stressed the importance of having such measures in place prior to the Compact becoming operational.

At Thursday’s hearing, IMS submitted written comments and offered oral testimony in support of enacting the telemedicine rules. IMS proposed the following measures to further strengthen these rules:

  • Create an additional pathway for establishing valid physician-patient relationship. The current rules delimitate three options by which a valid relationship may be established for the purposes of telemedical practice, including establishing a relationship via telemedicine in accordance with evidence-based practice guidelines from a national medical specialty organization. Currently, only four national specialty organizations have such standards in place. IMS recommended that the IBM create an option for physicians in specialties that have not yet established telemedical practice guidelines to be able to establish a valid physician-patient relationship via telemedicine by diagnosis through the use of acceptable medical practices.
  • Clarify the expectations for physicians who delegate to non-physicians utilizing telemedicine. IMS reminded the board that the proposed rules, as written, would impose greater responsibility on physicians with respect to assessing the qualifications of non-physicians than currently exist for in-person practice. IMS proposed amending the section to recognize that physicians should be able to rely on the credentialing and employment processes of the facilities in which they practice, and not be required to personally assess the credentials of every non-physician with which they work via telemedicine. IMS also recommended that the IBM carve out emergent care and situations where a physician is simply consulting with a non-physician via telemedicine, to ensure that the rules do not place impractical and potentially dangerous additional administrative burdens on physicians.
  • Clarify the requirements for disclosing care fees to the patient. Practices do not current provide patients with the fee schedule for care they receive in-person, as the typical practice operates under a number of fee schedules depending on payer and contracting arrangements; coordinating this sort of information for every patient would represent a significant administrative burden on Iowa practices. IMS recommended that the Board clarify its draft rules to only require disclosure of fees when they differ from the fees associated with an in-person visit so that, if a patient faces no additional costs for receiving care via telemedicine, the practice is not required to undertake additional administrative burden.
  • Strengthen the restrictions on prescribing based solely on an internet request or questionnaire, and add flexibility for prescribing based upon a telephonic evaluation. The IBM has fielded a number of complaints and inquiries in recent years regarding prescriptions resulting from an internet survey or questionnaire. IMS agrees with the board that these brief online documents alone are not sufficient for completing the appropriate evaluation necessary to safely issue a prescription. IMS recommended the board strengthen its proposed ban on prescribing controlled substances based on these forms, to include a ban on all prescribing under these circumstances. IMS also reminded the board that it is common practice for physicians to evaluate an established patient telephonically from time to time and issue a prescription. IMS recommended that the IBM amend its proposed rules to allow this practice to continue.

Following the public hearing, IBM staff indicated that they would work through the oral and written comments submitted and determine what additional changes should be made to the rules. They anticipate the full Board of Medicine will take further action on the proposed rules at its February meeting.

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