SIU Virtual Congress 2020: Regulatory and Medicolegal Considerations Surrounding the Provision of E-Health, Telemedicine in Various Groups: Re-Imbursement for Services Delivered by Telehealth/Telemedicine

( In an associated instructional course at the Société Internationale d'Urologie (SIU) 2020 Virtual Annual Congress examining digital health and telemedicine, Dr. Chad Ellimootil discussed a number of considerations which may cause physicians reticence to embrace telehealth, namely regulatory, medicolegal, and reimbursement related issues.

Beginning, he defined telehealth as any remote technology used to diagnose, treat, and manage health. This is synonymous with virtual care, telemedicine, and digital health.

He highlighted that telehealth has been around for decades but has barely been used. In fact, Medicare began paying for virtual care in 2001. However, utilization was limited by barriers as a result of the originating site require which specified where a physician must be located in order to participate in telehealth and specified that a patient could not connect from home but rather had to travel to a medical facility.

eligible sites for telehealth

Prior to February 2020, less than 1% of all Medicare beneficiaries and providers had participated in telehealth. However, in recent months, as a result of the COVID-19 pandemic, there has been rapid adoption of telehealth approaches as a result of changes in reimbursement which relaxed many of these restrictive rules. In March 2020, rules were relaxed allowing patients to connect from home, physicians to practice across state lines and to be reimbursed the same as in-person visits. Also, privacy rules were relaxed allowing the use of common technology.

privacy rules of technology

Using data from EPIC medical health records, there was a precipitous drop in ambulatory office visits in March 2020, with a concomitant (but much smaller) risk in telehealth visits. Over the following months, these trends continued, though in-person care has now started to return to pre-COVID levels. However, telehealth visits are much more common than pre-COVID times.

ambulatory vists before COVID

Moving forward, Dr. Ellimootil anticipated a number of regulatory and medicolegal considerations. Medicare leadership has suggested that reversion to previous patterns will not allow. However, the aforementioned originating site requirements will need to be permanently removed as these are currently temporary. This is likely to be widely supported by bipartisan political groups and commercial payers will likely end up following Medicare’s lead.

An unrelated change in billings based on medical decision making or time will also facilitate reimbursement for telehealth interactions. However, loosening of privacy requirements is, in Dr. Ellimootil’s perspective, unlikely to remain and we can expect a return to prior HIPPA compliance regulations. Similarly, relaxed requirements for practitioner licensure in the state where the patient is located are likely to be reversed following the conclusion of the public health emergency though this will change at the state level.

Finally, Dr. Ellmootil considered the question of malpractice insurance – while telehealth is generally considered low-risk, it is important to ensure that each physician’s malpractice insurance covers telehealth. Dr. Ellmootil highlighted a number of important general considerations which would guard against malpractice liability.

considerations for malpractice insurance

Presented by: Chad Ellimootil, MD, MS, Assistant Professor, Department of Urology, University of Michigan Medicine, Ann Arbor, Michigan

Written by: Christopher J.D. Wallis, MD, PhD, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, Tennessee, Twitter: @WallisCJD at the 2020 Société Internationale d'Urologie Virtual Congress (#SIU2020), October 10th - October 11th, 2020