Questions that were not answered live:

“Does someone have a consent form that I can share with my system regarding telemedicine risks (eg, audio/visual limitations)? How about written education for healthcare providers on documentation and avoiding risks?”

The Coverys “Permission for a Telemedicine Consult” sample form can be found here.
Forms provided by the American Telemedicine Association can be found here.
In addition, the Coverys COVID-19 Resource Center provides resources and tools needed by healthcare professionals on the front lines of this pandemic, which can be found here.

“What are the recommendations for treating adolescents when a parent is not available to provide consent for the adolescent to receive prescription medicine?”

Decisions on how best to manage adolescent care and involvement with parents can sometimes be tricky. However, telemedicine encounters do not waive the need for parental consent when it is required. The logistics of accomplishing this, however, may require some additional steps to be sure you communicate with the parent when appropriate and have an opportunity to review the necessary information for adequate informed consent. The clinician should carefully document the substance of the communications and obtain whatever signatures are appropriate through mail, via email, or in person (having the parent come into the office before the prescription is authorized and filled). Emergent and urgent situations should be clinically managed according to the circumstances.

“Where can we find the new billing codes?”

The American Medical Association website has information about billing codes for COVID-19:
www.ama-assn.org/practice-management/cpt/covid-19-coding-and-guidance.

“You mentioned a robust package including informed consent. Can you share this package?”

The Coverys “Permission for a Telemedicine Consult” sample form can be found here.
Forms provided by the American Telemedicine Association can be found here.
In addition, the Coverys COVID-19 Resource Center provides resources and tools needed by healthcare professionals on the front lines of this pandemic, which can be found here.

“Are the billing codes for video telemedicine versus audio-only telemedicine the same?”

Billing is not our area of expertise, so you may want to check with your state medical society, Medicare/Medicaid, and relevant health insurance carriers. Here is a document on billing that you may find helpful: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf.

“Can you please share the BMJ article?”

The remote consultations infographic is found here: www.bmj.com/content/368/bmj.m1182/infographic.

“Physicians are making difficult decisions about what is truly urgent/emergent in the face of this pandemic. How do you think ‘standard of care’ during this pandemic will be defined after the fact?”

It is too early to tell how lawsuits will spring forth from this crisis. The situation is constantly evolving, and there is no way of predicting how this will all shake out in the context of standard of care. Some states are expanding Good Samaritan statutes to address crisis-related events. Although physicians and other clinicians may have little control over the situation, solid communication and documentation skills continue to be a time-tested strategy to inoculate oneself against lawsuits.

“I have a question about examining children when a parent is next to the child. Is the patient allowed to pull up their shirt so we can see the respiratory effort or whether there is any accessory muscle usage, retraction, rash, etc.?”

I’m not sure what the question is here from a legal standpoint. If it is clinically appropriate and the sought-after information can be properly obtained in this manner, then it should be treated just as if the parent and child were in the office. If the information cannot be obtained this way, then how important it is and whether the patient should be seen in an office setting is a clinical decision that must be considered. There should be careful consideration of the confidentiality of the encounter and of privacy for the child during the virtual visit, as with all telemedicine encounters.

“I am a cardiologist in Miami Beach who is new to telemedicine. Will I need to have seen a patient in person before I can prescribe a medication to treat heart disease, or can it be done during an initial telemedicine encounter?”

State laws and regulations may differ regarding prescription practices. Prescribing medications may be challenging without first physically examining a patient. State medical licensure may also be an issue. We would encourage you to check with your malpractice insurance carrier and local statutes and laws on this issue as well as proper clinical practice.

“From a business standpoint, are there any legal impediments to me conducting telemedicine with patients outside of the country?”

We cannot give business advice. Check with your malpractice insurance carrier; most will want to know more about how you plan on practicing telemedicine, including how much of your practice will be virtual medicine, the location of your patients, etc. Your policy may specify that your coverage applies only to malpractice cases brought against you in a state(s) and/or country where the insurance company operates (eg, your malpractice carrier may not defend you if a lawsuit is brought against you in Brazil because they do not sell insurance there). Also, laws, regulations, and limitations on practicing medicine outside of your locality are likely subject to US, state, and international laws. Furthermore, the laws and regulations governing your licensure as well as in the patient’s foreign jurisdiction are likely to have a position on this issue. Before starting any such practice, we encourage you to seek professional guidance on your particular circumstances, what licenses you may need to obtain, and what laws and regulations govern the practice of medicine in the foreign jurisdiction.

Helpful Resources:

Centers for Disease Control and Prevention: COVID-19, Pregnancy, and Breastfeeding – www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Fpregnant-women-faq.html

American Medical Association: Quick Guide to Telemedicine in Practice
www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice?fbclid=IwAR3LqElKjGkYcQRbQUo0F3GiRaxU0m5Ht0O2i1YMtbcdcClo1iI9jxcXe2c

American Psychiatric Association: Telepsychiatry Toolkit
www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit?fbclid=IwAR3l_oaidUX5KpOrRzotSHErq9XVkQCKr9m-qhdZz8Aa8ijozzAzKJjL9Ds

Centers for Medicare & Medicaid Services: Telehealth Services Resource Kit
www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf

Related Video: https://www.youtube.com/watch?v=xvhb3mvMWts&feature=youtu.be

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