This October 22, 2014 posting addresses the proposed telemedicine rule’s requirement that physicians using telemedicine must personally assess the education, training, experience and abilities of each non-physician health care provider who requires physician supervision.

Non-physician health care providers requiring physician supervision – qualifications and scope – electronic availability of the physician

Proposed rule 653-13.11(9)

Summary. If a physician who uses telemedicine relies upon or delegates medical services to a non-physician health care provider who requires physician supervision, the physician must ensure that each non-physician health care provider is qualified and competent to safely perform each medical service being provided by personally assessing each non-physician health care provider’s education, training, experience, and ability. The physician must further ensure that services being provided by each such non-physician health care provider are within their respective scopes of practice, including their education, training, experience, ability, licensure and certification. The physician must be available electronically to consult with the non-physician health care provider, particularly in cases of injury or emergency.

Considerations. This rule imposes significant responsibilities upon individual physicians that now do not exist at this level of detail when the physician provides the same medical care services in-person, for instance, in a hospital or other facility setting. Is it realistic and necessary to require an individual physician using telemedicine to personally assess the qualifications of each such non-physician provider the physician relies upon or delegates medical services to? Physicians should be able to reasonably rely upon the credentialing functions and employment decisions of those facilities in which they practice and which offer telemedicine services the physician uses unless circumstances would dictate otherwise.

AMA policy H-480.946, “Coverage of and Payment for Telemedicine,” adopted by the June 2014 House of Delegates, does not include a provision such as this one as a safeguard for telemedicine delivery of care. The Federation of State Medical Boards (FSMB), in its “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine (adopted in April 2014), says that physicians who provide medical care, electronically or otherwise, should properly supervise non-physician clinicians. The FSMB report does not suggest or require personal assessment of each non-physician clinician’s credentials by the telemedicine physician.

The intent of this proposed provision is a good one: any non-physician health care provider engaged in telemedicine must be qualified, competent, and licensed or certified to do so. It is inarguable that a physician must delegate medical services only to medical personnel competent and qualified to provide those medical services. The question here is the extent to and circumstances under which a physician using telemedicine should be required by IBM rule to personally assess those such criteria for each non-physician health care provider requiring physician supervision. This provision seems to suggest that the physician must personally credential the individual non-physician provider.

Failure to comply with the micro-details of this proposed standard can result in licensee discipline by the IBM and potentially serve as evidence of a misstep in a professional liability case alleging negligent delegation or supervision. Redrafting of this particular provision could bring appropriate focus and establish fair and reasonable expectations of physicians who rely upon other medical practitioners in providing medical services via telemedicine. In its current form, this proposed standard appears neither reasonable nor workable.

The October 23, 2014 posting will addresses the proposed rule’s requirement for disclosures and functionality of telemedicine services and other provisions of the proposed rule that may be less the responsibility of physicians who use telemedicine and more the responsibility of entities that purchase, offer and maintain telemedicine equipment and services used by the physician.

See our page dedicated to Telemedicine for all related articles, including our most current post.