PAs Are Ready to Lead in Telehealth

COVID-19 has prompted a significant shift in care delivery, from in-person visits to telehealth. Last March, at the start of the pandemic, medical practices across the country scrambled to figure out how to continue patient care safely and effectively amid a lockdown. According to a recently published study from the American Academy of Physician Assistants, physician assistant (PA) use of telehealth increased last year from an average of 1% of surveyed PAs in February to 67% of surveyed PAs in June.

We know that telehealth will continue to be used frequently given high patient satisfaction and favorable outcomes related to its use.In the early days of the pandemic, the shift to telehealth was unorganized, with practices using everything from Zoom to FaceTime to Google Hangouts for virtual visits. As time went on, practices were forced to consider more formal, integrated approaches to telehealth.

Legal Issues for PAs in Telehealth

To be successful, PAs must educate themselves about telehealth laws and best practices as well as PA-specific laws and regulations. This can be a daunting task, particularly for PAs who are licensed in multiple states. Keeping track of these laws and regulations can be the biggest barrier for those who want to practice via telehealth, but it is essential to be in legal compliance.

PAs must follow state PA scope of practice and supervision/collaboration laws. This includes any laws requiring a PA to be in the same location as the supervising physician for any amount of time. In many states, on-site supervision can be waived through a case-by-case board review, but this is another cumbersome step in providing care for patients.

The provider and the supervising/collaborating physician also must be licensed in the state where the patient is located. Some states have waived this requirement during the pandemic, and there is a movement to make these waivers permanent, but it still varies from one state to the next.

In addition, telehealth-specific state and federal regulations vary widely. Some states only allow certain provider types to practice via telehealth, some allow the provider to establish care with a patient via asynchronous methods, and others require synchronous or even in-person visits to establish a patient-provider relationship. Some states do not allow patients with certain diagnoses to be treated via telehealth, and others require the PA to be physically in the state to provide care.

With the addition of waivers related to the pandemic, keeping track of all of these other regulations can be mind-boggling. Telehealth laws were changing rapidly even before COVID-19, but now they seem to be changing at lightning speed. PA practice laws can be found on websites from the state board, state PA associations, and the American Academy of Physician Assistants. For telehealth laws, it can be trickier, but there are several excellent resources available.

The Center for Connected Health Policy provides information on telehealth regulations in each state, including Medicaid and private payer information, and professional regulations in a user-friendly manner. They also send out great updates via email.
The Alliance for Connected Care advocates for providers and companies in telehealth with a heavy emphasis on legislative work/lobbying. This is a great resource for up-to-date, rapid changes; legislation being looked at currently; and resources supporting the use of telehealth.
The National Consortium of Telehealth Resource Centers is a collaborative group of 12 regional and two national resource centers funded by the US Department of Health and Human Services. They are available as a resource for anyone who wants to start a telehealth practice or learn more about telehealth. They offer startup guides, recommendations on equipment, and are always helpful with questions you may have about any aspect of telehealth.

Beyond the Legalities

Whether you are just starting in telehealth or you are investigating how to continue your telehealth visits post-pandemic, it's important to consider several factors about your practice and patient population to know what steps may be involved to establish a formal telehealth practice.

First, consider your patient population. Are they older adults? Young patients? Tech-savvy? Different populations will require varying levels of support to access care. Do they have consistent access to adequate internet service? Patients with poor or faulty internet and cell service are more likely to miss appointments because of these barriers.

What is the typical visit acuity you expect to see via telehealth? Higher acuity visits may require investment in peripheral devices (diagnostic tools such as digital stethoscopes or pulse oximeters). In some circumstances, medical assistants or nurses can go to the patient's home to help maneuver the peripheral devices.

Second, consider yourself and any other providers involved. Are you tech-happy or tech-averse? Choosing a platform that is too complicated can limit providers' uptake and require an investment in training. Do you plan to have dedicated telehealth days and times, or will virtual visits be interspersed with in-person visits? Some PAs find that interspersing telehealth visits with in-person visits leads to a more hectic day and lower provider satisfaction, whereas others enjoy this setup.

Third, make sure your malpractice insurance covers telehealth visits. Some companies list telehealth as a "high risk" category, so it's important to verify and shop around if needed.

Based on these considerations, you can choose the modalities you will use, such as live video and store-and-forward applications. Once you've made these decisions, it is much easier to shop for telehealth platforms, especially given the variety of choices that have come on the market this year.

PAs have an important role in this movement. If you're not using at least some telehealth, I encourage you to consider it and even drive the effort if your practice has been hesitant to start. The future of medicine has arrived more suddenly than we ever thought possible. PAs are ready to lead.

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