COMMENTARY

Telemedicine for Family Medicine Practice

AAFP Policy Position, Resources, and Advocacy

Steven E. Waldren, MD, MS

Disclosures

February 02, 2018

Editorial Collaboration

Medscape &

The AAFP Physician Health First portal provides numerous online resources to support physician well-being.

Hello. I am Steve Waldren, a family physician and informaticist with the American Academy of Family Physicians (AAFP). I direct our Alliance for eHealth Information, which is responsible for all of the health information technology (IT) activities and advocacy here at the Academy.

I want to talk to you a little bit about some new technology that has been around for decades but was not really ready for primetime for the ambulatory family physician: telemedicine or, maybe even more broadly, telehealth. If you want to learn more about those exact definitions as they relate to the AAFP, we have a new policy on telehealth and telemedicine. Briefly, the difference for us is that telemedicine refers to a clinician or physician providing services to the patient remotely. Telehealth doesn’t require the [presence of a] clinician or physician, so nursing staff and others can provide some telehealth services. The policy goes into a little bit more detail, of course.

In our policy, you can see our advocacy positions on making sure that physicians get paid appropriately for these activities, and that patients are not artificially steered to either in-person or telemedicine because of policies by insurance companies or others. [We advocate that] it should be the clinician or physician and the patient making those decisions.

Additionally, we have some real concerns about continuity of care. While telemedicine provides nice access and can help improve the quality of care and health of patients, there is the potential for interfering with continuity or longitudinal care of the patient as standalone telemedicine services are being brought up. We are trying to make sure that we thread the needle to make sure that patients have appropriate access, and that physicians have the right technology. At the same time, we do not [want] any detriment to longitudinal care for our primary care patients.

We have tried to provide a lot of resources and advocacy. On the advocacy front, we have done a lot of work inside the federal government—in Congress and within the Office of the National Coordinator for Health Information Technology, which is responsible for all of the health IT activities of the federal government. You can find some links on our advocacy page to letters we have submitted to those [groups].

Additionally, we had some concerns [voiced] at the the AAFP's Congress of Delegates in 2016. We wanted to make sure that local family physicians are engaged in telemedicine resources. We wrote letters to the leaders of the five biggest health plans about our problems with telemedicine being performed outside the scope of the family physician practice, and [we stated] that family physicians need to be part of the care for those patients even if it is via telemedicine. As they write contracts with telemedicine providers, continuity has to be included and they have to [add] enforcement in those contracts. We will continue to advocate for this at meetings we have with them on an annual basis.

We also put together a page on the AAFP website underneath our practice management and health IT sections that has a litany of resources around telehealth and telemedicine. Each state has different policy and privacy frameworks, so we link out to some resources from the American Medical Association and the American Telemedicine Association on state policies. We also have links to products, services, and resources about putting telemedicine into your practice.

The AAFP and members have started a member interest group for telehealth that you can join if you are a member of the AAFP. Over 80 family physicians are part of that group right now. They have been doing some demos looking at products and having some really good discussions about taking care of patients from a telemedicine perspective.

Finally, we have been engaging with the national resource centers for telemedicine. If you are participating in the meaningful use program, you have likely worked with a regional extension center in your state. [Telemedicine resource] centers are very similar to those organizations and are there to help practices and family docs add telemedicine to their office. They are federally funded, so many of the services are free to physicians, especially in rural areas. I ask you to seek those out. We link to a directory of these centers on our website.

The last thing I want to say is that the AAFP is looking at how to support family docs in taking care of patients from a telemedicine perspective. We are actively looking at products and services in this space. We want to make sure that there are good products for family medicine at affordable prices to help us take care of our patients. We need to make sure that we are getting paid to do this type of work, and as we move to value-based payment, we need these additional ways to take care of our patients outside the four walls of our practice. We can make sure that patients are getting good access to good, quality care at low cost.

We will reap the rewards both professionally (by having a great population of healthy patients) and financially, as we look at prospective payments, getting a share of cost reductions, and quality improvement programs like pay-for-performance.

Check out our resources on telemedicine. Think about how you can add telemedicine as a resource for your patients from your practice. If you need anything, come to the AAFP website, where we have those resources, or you can call me, Steven Waldren, at the AAFP.

Follow Steve Waldren on Twitter.

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