Late last year, the American Medical Association (AMA) held a virtual special meeting of its House of Delegates where a majority of the physicians present agreed that expanding access to telemedicine during the COVID-19 pandemic benefitted both patients and medical practices.
Despite that agreement, delegates present at the meeting had a hard time creating policy recommendations to preserve the new telehealth flexibilities offered by the pandemic without avoiding unintended consequences. Some of the unintended consequences included payers diverting patients to non-physicians for care (such as nurse practitioners and physician assistants) and the age-old issue of caring for patients across state lines. Delegates were also concerned about the limitations older patients may have in accessing the full array of medical services.
Therefore, the policy resolution adopted by the delegation directs the AMA to continue to advocate “for the widespread adoption of telehealth services in the practice of medicine for physicians and physician-led teams post SARS-COV-2.” Included in the policy resolution are several steps the AMA should follow to reach the goal, including:
- Urging the federal government, Centers for Medicare and Medicaid Services (CMS), states, and insurers to “adopt clear and uniform laws, rules, regulations, and policies relating to telehealth services that provide equitable coverage that allows patients to access telehealth services wherever they are located”
- Providing “the use of accessible devices and technologies, with appropriate privacy and security protections, for connecting physicians and patients”
- Advocating for “equitable access to telehealth services” for vulnerable and low-income patients
- Pushing for greater funding and planning related to telehealth infrastructure, for both practices and patients, including for broadband
- Supporting telehealth as a means “to reduce health disparities and promote access to health care.”
Several other ideas were referred to the Board for further study, with no policies adopted:
- Promoting continuity of care by preventing payors from using cost-sharing or other policies to prevent or disincentivize patients from receiving care via telehealth from their own physician or the physician of the patient’s choice
- Providing equitable payment for telehealth services that are comparable to in-person services
- Ensuring qualifications of physicians that are licensed in the state where the patient is located to provide telemedicine services in a secure environment.
Comments from Physicians
“As a family doctor, without telehealth, we would have gone bankrupt and closed the office,” said Chris Bush, MD, an alternate delegate from Michigan, speaking on his own behalf. “Now with another surge upon us, this item is of utmost urgency, and I speak against referral.”
Michael Miller, MD, a delegate from Wisconsin, speaking for himself, agreed with Bush. “If there’s going to be a change of presidential administration or a Supreme Court ruling, why wouldn’t we want to have really good policy in place?” Miller asked. Any necessary modifications to policy could be made later, he added.
Sandra Swantek, MD, a delegate for the American Association of Geriatric Psychiatrists, opposed requiring that physicians be licensed in states where telehealth patients reside, noting that “Physicians may treat patients temporarily out of state due to school vacation or temporary migration during the winter.” Swantek herself treats snowbirds from Chicago who spend their winters in Florida.