From AMA telemedicine report at : http://mb.cision.com/Public/373/9600400/99c2f1db96d7fec3.pdf with title:
REPORT 7 OF THE COUNCIL ON MEDICAL SERVICE (A-14) Coverage of and Payment for Telemedicine (Reference Committee A)
Quote: "Since the release of the IOM report, the definition of telemedicine, as well as telehealth, has continued to evolve, and there is no consensus on the definition of either of the two terms. Today, there are three broad categories of telemedicine technologies: store-and-forward, remote monitoring, and (real-time) interactive services. Store-and-forward telemedicine involves the transmittal of medical data (such as medical images and bio signals) to a physician or medical specialist for assessment. It does not require the presence of both parties at the same time and has thus become popular with specialties such as dermatology, 34 radiology and pathology, which can be conducive to asynchronous telemedicine. " ..."
CMS Rep. 7-A-14 -- page 2 of 8
Remote monitoring, or self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is typically used to manage chronic diseases or specific conditions (e.g., heart disease, diabetes mellitus, or asthma), as devices that can be used by patients at home to capture such health indicators as blood pressure, glucose 5 levels, ECG and weight. 6 7 Interactive telemedicine services provide real-time, face-to-face interaction between patient and provider (e.g., online “portal” communications). Telemedicine, where the patient and provider are connected through real-time audio and video technology (generally a requirement for payment) has
been used as an alternative to the traditional method of care delivery, and in certain circumstances can be used to deliver such care as the diagnosis, consultation, treatment, education, care management and self-management of patients."...
"Arkansas ANGELS :
The Antenatal & Neonatal Guidelines, Education & Learning System (ANGELS) of the University of Arkansas for Medical Services (UAMS) provides patients with around-the-clock and telemedical support to address high-risk obstetrical care needs. With approximately thirty telemedicine sites, ANGELS delivers subspecialty care services to high-risk mothers and their infants. Notably, UAMS houses many of state’s only board-certified maternal-fetal medicine specialists and genetic counselors. ANGELS uses a variety of telemedicine technologies to deliver care, including specialized ultrasound equipment that digitally transfers a sonogram image to UAMS, as well as special devices to perform colposcopies via telemedicine to allow for remote cervical examination and biopsy. In 2012, there were 5,221 telemedicine visits as part of ANGELS, as well as 2,062"...
"CMS Rep. 7-A-14 -- page 5 of 8
telemedicine obstetric ultrasound visits and 130 fetal echocardiogram visits. Also in 2012, 1,629 2 colposcopy exams were provided, which identified 303 women with high-grade lesions requiring treatment and five diagnosed with cancer."...
"AMA policy states that physicians should uniformly be compensated for their professional services at a fair fee for established patients with whom the physician has had previous face-to-face professional contact, whether the current consultation service is rendered by telephone, fax, electronic mail or other forms of communication (Policy H-390.859). Policy H-390.859 also calls for CMS and other payers to separately recognize and adequately pay for non-face-to-face electronic visits. "...
Clinical standards
Policies H-480.974, H-480.968 and H-480.969 encourage national specialties to develop appropriate and comprehensive practice parameters, standards and guidelines to address the clinical and technological aspects of telemedicine. Policy H-480.968 urges national private accreditation organizations to require that medical care organizations that establish ongoing arrangements for medical care delivery from remote sites require practitioners at those sites to meet no less stringent credentialing standards and participate in quality review procedures that are at least equivalent to those at the site of care delivery."...
"CMS Rep. 7-A-14 -- page 6 of 8
1 Licensure
Policy H-480.969 states that medical boards of states and territories should require a full and unrestricted license in that state for the practice of telemedicine, and outlines principles for any telemedicine license category. Policy D-480.999 opposes a single national federalized system of medical licensure. Policy H-160.937 outlines principles for the supervision of non-physician providers and technicians when telemedicine is used. "...
" Prior to delivering services via telemedicine, the Council believes a valid patient-physician relationship must be established, through at minimum a face-to-face examination, if a face-to-face encounter would otherwise be required in the provision of the same service not delivered via telemedicine. The face-to-face encounter could occur in person or virtually through real-time audio and video technology. Also, before a telemedicine service is provided, the physician or other health professional must notify the patient of cost-sharing responsibilities and limitations in drugs that can be prescribed via telemedicine. When a service is delivered using telemedicine, mechanisms to ensure continuity of care, follow-up care and referrals for emergency services must 36 be in place. "...
"The Council believes that key tenets in the delivery of in-person services hold true for the delivery of telemedicine services. Notably, physicians and other health practitioners delivering telemedicine services must abide by state licensure laws and requirements as well as state medical practice laws including, for example, laws concerning consent involving minors, prescribing, reproductive rights, end-of-life, and scope. In addition, prior to the delivery of any telemedicine service, physicians need to verify that their medical liability insurance policy covers telemedicine services, including telemedicine services provided across state lines if applicable. It is essential that patients have access to the licensure and board certification qualifications of the health care practitioners who are providing the care in advance of their visit. "...
To ensure quality of care, patient safety, and coordination of care in the provision of telemedicine services, the Council believes it is essential for national medical specialty societies to continue to develop appropriate and comprehensive practice parameters, standards and guidelines to address the clinical and technological aspects of telemedicine, as called for in Policies H-480.974, H-480.968 and H-480.969. In addition, the Council notes that it is essential that specialty societies 10 leverage, to the extent practicable, the work of national telemedicine organizations, including the ATA, in the area of technical standards and take the lead in the development of clinical practice guidelines for telemedicine.
RECOMMENDATIONS
The Council on Medical Service recommends that the following be adopted and the remainder of the report be filed:
1. That American Medical Association (AMA) policy be that telemedicine services should be covered and paid for if they abide by the following principles:
a) A valid patient-physician relationship must be established before the provision of telemedicine services, through:
-a face to face examination if a face to face encounter would be otherwise required in the provision of the same service not delivered by telemedicine.
-a consultation with another physician who has an on-going patient-physician relationship with the patient. The physician who has established a valid physician-patient relationship must agree to supervise the care; or
-Meeting standards of establishing a patient-physician relationship included as part of evidence-based clinical practice guidelines on telemedicine developed by major medical specialty societies, such as those of radiology and pathology.
Exceptions to the foregoing include on-call, cross coverage situations; emergency medical treatment; and other exceptions that become recognized as meeting or improving the standard of care. If a medical home does not exist, telemedicine providers should facilitate the identification of medical homes and treating physicians where in-person services can be delivered in coordination with the telemedicine services.
b) Physicians and other health practitioners delivering telemedicine services must abide by state licensure laws and state medical practice laws and requirements in the state in which the patient receives services.
c) Physicians and other health practitioners delivering telemedicine services must be licensed in the state where the patient receives services, or be providing these services as otherwise authorized by that state’s medical board.
d) Patients seeking care delivered via telemedicine must have a choice of provider, as required for all medical services.
e) The delivery of telemedicine services must be consistent with state scope of practice laws.
f) Patients receiving telemedicine services must have access to the licensure and board certification qualifications of the health care practitioners who are providing the care in advance of their visit.
g)The standards and scope of telemedicine services should be consistent with related in- person services.
h)The delivery of telemedicine services must follow evidence-based practice guidelines, to the degree they are available, to ensure patient safety, quality of care and positive health outcomes.
i)The telemedicine service must be delivered in a transparent manner, to include but not be limited to, the identification of the patient and physician in advance of the delivery of the service, as well as patient cost-sharing responsibilities and any limitations in drugs that can be prescribed via telemedicine.
j)The patient’s medical history must be collected as part of the provision of any telemedicine service. The provision of telemedicine services must be properly documented and should include providing a visit summary to the patient.
k)The provision of telemedicine services must include care coordination with the patient’s medical home and/or existing treating physicians, which includes at a minimum identifying the patient’s existing medical home and treating physician(s) and providing to the latter a copy of the medical record.
m) Physicians, health professionals and entities that deliver telemedicine services must establish protocols for referrals for emergency services.
CMS Rep. 7-A-14 -- page 8 of 8
2. That AMA policy be that delivery of telemedicine services must abide by laws addressing the privacy and security of patients’ medical information. (New HOD Policy)
3. That our AMA encourage additional research to develop a stronger evidence base for telemedicine. (New HOD Policy)
4. That our AMA support additional pilot programs in the Medicare program to enable coverage of telemedicine services, including, but not limited to store-and-forward telemedicine. (New HOD Policy)
5. That our AMA support demonstration projects under the auspices of the Center for Medicare and Medicaid Innovation to address how telemedicine can be integrated into new payment and delivery models. (New HOD Policy)
6. That our AMA encourage physicians to verify that their medical liability insurance policy covers telemedicine services, including telemedicine services provided across state lines if applicable, prior to the delivery of any telemedicine service. (New HOD Policy)
7. That our AMA encourage national medical specialty societies to leverage and potentially collaborate in the work of national telemedicine organizations, such as the American Telemedicine Association, in the area of telemedicine technical standards, to the extent practicable, and to take the lead in the development of telemedicine clinical practice guidelines. (New HOD Policy)
8. That our AMA reaffirm Policies H-480.974, H-480.968 and H-480.969, which encourage national medical specialty societies to develop appropriate and comprehensive practice parameters, standards and guidelines to address the clinical and technological aspects of telemedicine. (Reaffirm HOD Policy). "
This was not copyrighted by AMA, so therefore I am also not copyrighting it. It was sent to my inbox [another account that it known to be mine for long time] ; but I am adding in who I am, where I am, and the date and time for purposes of documenting this.
Also, I put the standards of care of admission for any real ambulatory surgery or major surgery in a hospital setting on another blog of mine at:
http://gloriapoole.livejournal.com. Compare that to how abortuaries routinely treat their patients like cattle going to slaughter on a conveyer belt; with no information, no true informed consent, and no standards of care for surgery, either as pre-op or post-op.
Also, I put the standards of care of admission for any real ambulatory surgery or major surgery in a hospital setting on another blog of mine at:
http://gloriapoole.livejournal.com. Compare that to how abortuaries routinely treat their patients like cattle going to slaughter on a conveyer belt; with no information, no true informed consent, and no standards of care for surgery, either as pre-op or post-op.
Gloria Poole, RN licensed in Missouri; artist in all mediums, at my own private apt in Missouril 12 June 2014 at 6:47pm. I am also known as merely Gloria on art I create and as gloriapoole on web and other variations of my real, legal, born with name of Gloria Poole including gloria-poole; gloria.poole; gloria0817 ; artist-gloriapoole ; gpoole817; @gloriapoole;gloriapoole.RN.
