WHEREAS,              MSV Policy 10.9.16 states- The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

  1. 1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship.
  2. 2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients; and 

WHEREAS,               Telemedicine has evolved significantly through the course of the COVID-19 pandemic and became a lifeline for patients seeking care in ways that could minimize infectious exposure; and 

WHEREAS,              Telemedicine visits have been embraced as a welcome alternative to in-person care by patients and physicians, with research supporting the desire for continuing virtual access; and

WHEREAS,              Physicians embraced and utilized telemedicine to care for their patients as well as generate revenues for their practices during a time when visits dropped dramatically, and elective procedures were suspended; and

WHEREAS,               A significant proportion of patients want to continue to receive care through telemedicine and many physicians have started to implement practice redesign to integrate telemedicine into their routines and care paradigms, and

WHEREAS,               The public health emergency (PHE) caused by the COVID-19 pandemic led to executive and legislative mandates that reduce regulatory and payer burdens and expanded the scope of care permitted; and

WHEREEAS,            The state of Virginia has a baseline  of regulations supporting the use and payment for telemedicine and embraced the federal deregulation of constraints and protections to increase access to care for patients in a variety of ways that include adding preventive care codes as well as the originating and distant site care locations; and

WHEREEAS,            Many of these enhancements are likely to expire as the pandemic recedes, to the detriment of patients and physician practices, and will need both consumer and physician advocacy to become permanent; and

WHEREEAS,            It will be important for our MSV to have the appropriate policy and informed advocacy to support and preserve the progress made in telemedicine; andi

RESOLVED,             that the Medical Society of Virginia amend Policy 10.9.16 to be the following:

The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

  1. 1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship.
  2. 2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients.
  3. 3. All private and public health plans, including self-insured, fully insured, and Medicaid recognize and pay for telemedicine using equivalent service elements for all E&M, preventive, emergency, and chronic care CPT codes
  4. 4. All payers/plans pay for the comparable telemedicine codes at par for face-to-face visits providing they include the same standardized elements.
  5. 5. That the “originating site” for patients and “distant” site for the physician can be at their office, home or any other location providing there is an established patient-physician relationship in place or one that is established through an initial encounter.
  6. 6. All forms of health information technology used to facilitate, support, and record patient care be interoperable and that all EMR platforms integrate telemedicine into the patient record.
  7. 7. Regulatory or legislative barriers that disrupt the continuity of care between a patient and a physician should only exist if they serve the patient.

 

i https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

https://www.healthleadersmedia.com/clinical-care/patients-eager-embrace-telemedicine-new-survey-finds

https://evisit.com/state-telemedicine-policy/virginia/

4 replies
  1. jlesko
    jlesko says:

    Request for Clarification

    Josh Lesko, speaking on behalf of myself.  Regarding the added 7th statement, is there any disruption to the continuity of care that would benefit the patient?  I would err on the side of not including that option, absent a good example.

  2. RLibby
    RLibby says:

    item 7

    the original reslove was: That the MSV support the concept that a telemedicine visit with an established patient who is out of state for any reason such as college, travel, or work, is, with their consent, considered to be receiving care in the state that their treating physician is licensed and/or located. During the COVID-19 PHE, doctors are allowed to treat patients in other states, but their malpractice policy may not cover them and/or the state where the patient is located may require licensure there,  If your physician has been treating you and you need continuing care through a telemedicine visit, we should support legislative or regulatory changes that allow it.  The wording in item 7 attempts to give a broad basis for the benefit of continuity of care.

  3. TMOFFATT
    TMOFFATT says:

    Resolved, bullet 4: I figure

    Resolved, bullet 4: I figure most 
    standardized elements include at least one instance of actually touching the patient (problem centered exam). “on a par” dermeans the value of physical exam/ supportive touching (like squeezing a hand. Not the right message. Stick with “appropriate reimbursement.”

  4. RLibby
    RLibby says:

    why we need to support this resolution

    I can appreciate how some of us have not easily adjusted to the changes imposed upon us during this pandemic.  Telemedicine is a relatively new way to care for patients and is not just a phone call with video.  It requires an adjustment in how you connect with your patients and can enhance your ability to provide high quality care.  It does require thinking through how that can evolve in your practice and integrating it into your care paradigms and processes.  It is a part of practice, not a replacement for hands on medicine.   After suffering through the shutdown of our practices and the financial and professional hardship, we feel redeemed and gratified to get back to the office and see our patients the way we were trained and by which we built our practices.  Some of us may find it difficult to conduct an office visit virtually on an A/V platform, but seeing them in the office with a gown, gloves, mask, and face shield is not a satisfactory alternative.  A telemedicine visit should permit you to have a more focused and complete visit, with fewer distractions and a more comfortable setting for your patient. 

    There have been numerous surveys and ongoing research since the start of the pandemic that have significantly shown that patients want access to their doctor through telemedicine.  That does not mean only through telemedicine, but as a dimension of care that can be appropriately used to improve access, convenience, monitoring of chronic conditions, and early detection of evolving problems that can reduce ER use and hospitalizations.  There is remote technology for auscultation, ENT exams, EKG’s, patient guided ultrasound, that can enhance our virtual exams, and with remote monitoring we can capture the data needed to improve individual and population health.

    Telemedicine is a part of practice and it needs to be supported through equal payment for equal service.  The changes in regulations and insurance coverage that have helped us get through the COVID-19 public health emergency need to be continued.  Our MSV should have policy to support this evolution in patient care and physician practice.

    This resolution is not about creating legislation, it is about being ready to support it if it comes before the GA.  We need to update our policy around telehealth to support physicians and their efforts to navigate and innovate in an ever-changing healthcare environment.

    https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html

    https://www.medicaleconomics.com/view/survey-most-patients-satisfied-with-virtual-care

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