Marcia Frellick

June 12, 2014

CHICAGO — Appropriately used telemedicine can greatly improve access to care without compromising patient safety, according to the American Medical Association (AMA).

Delegates approved the guiding principles listed in a report on telemedicine presented here at the AMA 2014 Annual Meeting.

In the policy, the House of Delegates voiced support for additional Medicare pilot programs to enable coverage of telemedicine services, including store-and-forward telemedicine, which involves transmitting medical data (such as medical images and biosignals) to a physician or medical specialist for assessment. Both parties don't have to be present at the same time.

The AMA will work with the Centers for Medicare and Medicaid Services and other payers to develop and test payment models, and will evaluate the effect of various telemedicine technologies on cost, quality, and the patient–physician relationship.

The policy encourages physicians, before they deliver any telemedicine services, to verify that their medical liability insurance covers such services, including those provided across state lines.

"We believe that a patient–physician relationship must be established to ensure proper diagnoses and appropriate follow-up care," said AMA president Robert Wah, MD, in a statement. "This new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care, and manage chronic conditions."

Physicians Denounce Plan to Let "Unmatched" Students Practice

Physicians strongly opposed granting "unmatched" graduates a special licensing pathway that would allow them to practice in primary care in a medically underserved area under a collaborative practice agreement with a physician.

A bill pending in Missouri's state legislature would establish "assistant physician" licensure. Under this initiative, students who graduate with an MD or DO but who are not matched to a residency program — about 500 graduates a year — could practice.

Physicians overwhelmingly agreed that allowing such a designation would undermine the practice of medicine and weaken the public trust.

"Letting unlicensed physicians get a license to practice just because we need more physicians in the workforce is not the way to go," said David Rosman, MD, a radiologist at Massachusetts General Hospital in Boston.

Others spoke about the danger of a 2-tiered system of licensure, which could confuse the public and counter the efforts being made to curtail the expansion of the scope of practice of nonphysicians.

Granting an assistant physician license sends the message that primary care doesn't require residency training, which is wrong, said Kesavan Kutty, MD, professor of medicine at the Medical College of Wisconsin in Milwaukee.

Although physicians recognize the plight of students who aren't chosen for residency programs, by letting them practice under this proposal, "we are replacing a hardship with a danger," said Alan Klitzke, MD, FACNM, a radiologist from the Roswell Park Cancer Institute in Buffalo, New York.

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