House Bill 188 (HB 188) requires the State Medical Board of Ohio (SMBO) to adopt rules governing the requirements for a physician to prescribe or otherwise provide a prescription drug to a person on whom the physician has never conducted a physical examination and who is at a location remote from the physician. This includes an initial telemedicine visit.
Pursuant to the SMBO’s request for comments relative to adoption of rules governing the requirements for a physician to prescribe or otherwise provide a prescription drug to a person for whom the physician has never conducted a physical examination and who is at a location remote from the physician, look the Ohio Academy of Family Physicians, representing more than 4,800 family physicians, family medicine residents, and medical students in Ohio, submitted the following comments:
In order to establish a legitimate physician-patient relationship with a patient who the physician is caring for remotely, technology must be utilized to conduct an examination of the patient that is consistent with the minimal standard of care for in-person care. The initial examination of a patient never seen previously by the physician, in order to be consistent with the minimal standard of care, must include a medical evaluation and the collection of relevant clinical history as is needed to establish a diagnosis, identify any underlying conditions, and identify any contraindications to the treatment that is recommended or provided. In most instances, minimal standards for an appropriate exam would be difficult to meet via today’s audio and video technology.
The physician who has a prior patient-physician relationship with the patient and who has previously examined the patient in-person is vastly better equipped to conduct a virtual visit with a patient. It would be very difficult for a physician who has never before seen the patient, to adhere to this minimum standard from a remote location.
Telemedicine can be an important tool in the physician’s tool box to increase access to care but should not be used in ways that further fragment care and create safety concerns for patients. Patients should be encouraged to first seek care from their personal physician who has an established relationship with them and who has access to their medical record.
We have very specific concerns with physicians who prescribe antibiotics to unestablished patients; concerns about overuse of antibiotics and antibiotic resistance are well documented. You cannot diagnose strep throat remotely. Prescribing antibiotics without a careful examination of the patient’s throat, ears, and nose and listening to the patient’s heart and lungs is inappropriate. Prescribing controlled substances without an in-person examination is also highly inappropriate. These are just two examples.
Insurers, however, seem anxious to pay telehealth physicians who work in a call center writing prescriptions for patients they have never examined but refuse to pay the patient’s primary care physician for providing a far superior phone or video visit – superior by virtue of having an established relationship with the patient and access to that patient’s medical records.
Establishment of a patient-physician relationship with a telemedicine physician must constitute an appropriate examination of the patient as outlined above. Anything less fails to meet the minimal standard of care.
The OAFP worked collaboratively with the SMBO in drafting its 2012 interpretive guideline on telemedicine, has worked with the SMBO since that time on telemedicine administrative rule drafts, and appreciates the opportunity to work with the SMBO in this latest effort to satisfy the directives of HB 188.
Submitted comments were based on discussions of the OAFP Payer and Practice Issues Committee and the OAFP Board of Directors. Comments are due into the SMBO by Wednesday, February 10. The SMBO is required to adopt the initial rules by mid-March 2017.