AMA ethics council pushes off telemedicine guidelines

By Brian Dolan

Brian Dolan - MobiHealthNews Editor-in-ChiefThis week the American Medical Association’s ethics council attempted to come to an agreement over a set of guidelines focused on ethical considerations related to the use of online or mobile visits between patients and physicians, but a physician from Texas helped convince the committee to rethink its plans. The guidelines were tabled and sent back to committee for further review. The earliest they could be floated again is November.

The delegate from Texas, Dr. Arlo F. Weltge, argued that the AMA's proposed guidelines would run counter to the guidelines established by his state's medical board in April. The main concern: Should a patient establish a relationship with a doctor by having an in-person visit with a physician before any remote visits are conducted? Texas' board says 'yes', while the AMA guidelines indicate a face-to-face online visit might be enough to establish a relationship, but the organization takes pains to encourage docs to abide by their state's unique regulations, too.

Of course, the Texas state medical board is currently embroiled in a lawsuit over those same guidelines with telemedicine company Teladoc. 

"Telemedicine is emerging as clearly important and these guidelines are essential," Weltge said at the AMA meeting this week, according to a MedPage Today report. "However, there's an issue: the Texas Medical Board is currently being sued for an interpretation... These [AMA] ethical guidelines, as they are currently written, would place Texas physicians in conflict with the ethical standard ... by our Texas Medical Board."

Before the gathering this week, the AMA ethics group made the case that these guidelines were timely and important.

“As the public becomes increasingly fluent in utilizing novel technologies in all aspects of daily life, evolving applications in health care are altering the contours of when, where, and how patients and patients and physicians engage with one another," the AMA wrote. "In any model of care, patients need to be able to trust that physicians will place patient welfare above other interests, provide competent care, provide the information patients need to make well-considered decisions about care, respect patient privacy and confidentiality, and take steps to ensure continuity of care.”

The group was also planning to provide guidelines that suggest physicians “inform patients about limitations of services provided, advise telehealth users how to arrange for any needed follow-up care,” and “be proficient in telehealth technologies.”

Between now and November, which is when the AMA's council has the next opportunity to officially offer up these telemedicine guidelines, it's likely that a lot will change in the video visits space. The industry may have a verdict in the Texas-Teladoc suit. Teladoc will likely be a public company by then. Walgreens' video visits offering through MDLive will have an even larger footprint. And tech-savvy docs across the US will have 11 months experience using the new chronic care management billing code to pay for video visits with some of their Medicare patients.

To the extent that physicians still look to the American Medical Association for leadership on the pressing issues of the day, its ethics council failed them this week by not taking a position. In November those doctors who are both still figuring out telemedicine and paying attention to the AMA will hopefully get the long overdue guidance.

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