The use of telemedicine is soaring, driven by ease of access. Losses are low due to the limited number of conditions most
telemedicine providers are authorized to treat.
RISK FOCUS: PROFESSIONAL LIABILITY
The Promise of Telemedicine
Ease of access and
limitations on usage
make this game-changing health care
a popular choice
for patients and a
palatable risk for
By Dan Reynolds
Talk to a hospital risk manager in the Midwest and they will say this: “We don’t have enough beds and providers to deliver adequate mental health services to wide swaths of the population.” Now add in the access issues faced by rural residents to health care services in general. Or the fact that many providers do not take Medicaid
patients. Or consider the risk of transporting a combative, fearful autistic child to
the doctor’s office; or the fear of attack that a health care provider confronts when
treating a potentially violent prison inmate.
Telemedicine — the ability for a medical provider to consult with a patient in a
video conference — seems to present the cure for these societal ailments.
Its use is taking off like a rocket. The global telemedicine market is expected to
be a $35 billion industry by 2020. Just two years ago, according to industry studies,
there were approximately 20 million telemedicine consultations. That number is
expected to increase to about 160 million — an increase of 700 percent — by 2020.
“We’ve been pretty heavily involved in the telemedicine arena for five years
now and have seen exponential growth,” said Danny Talley, a Denver-based
director of voluntary benefits with HUB.
Talley said ease of access and the fact that many minor afflictions, from colds to
skin rashes, can be addressed in a teleconference are some of the keys to that growth.
The approach also lends itself well to mental health treatment, where
talking through an issue with a licensed therapist in a video conference closely
approximates a face-to-face visit.
At the very least, said Talley, a video conference with a caregiver can help to
assess someone’s mental health and determine whether a face-to-face meeting, or
some other intervention, might be necessary.
“With psychiatric care, the bulk of it has to do with talking to the patient,
asking them questions,” said Njoki Wamiti, a vice president with IronHealth, the
health care division of specialty underwriter Ironshore.
“In my opinion, I don’t think it makes that much of a difference. Whether it’s
via a video or one-on-one, you are still having the same conversation,” she said.
“A full 50 percent of our clinical encounters have been in the realm of mental
health services. This in part relates to the challenges of a serious shortage of
mental health providers in the rural areas of our state,” said Dr. Karen Rheuban,
a co-founder of the University of Virginia Center for Telehealth. Last year, the
center was renamed the Karen S. Rheuban Center for Telehealth in honor of
Rheuban’s work to expand health care opportunities through telemedicine.
“In most circumstances, a high quality video conference comports with the
standard of care in mental health,” she added.
But as we assess potential liability in this field, let us not confuse a telephone
conversation with a video conference conversation. When it comes to establishing
a verifiable doctor/patient relationship, they are two very different things.
Rheuban said the Commonwealth of Virginia and the Drug Enforcement
Administration have weighed in on the prescribing of Schedule II through
Schedule V psychotropic drugs in the absence of a prior in-person visit.
“We are concerned about the risk of establishing a doctor-patient relationship
with a telephone encounter alone that
results in the prescribing of controlled
substances,” she said.
The UVA program offers telehealth
services across the health care
continuum, from prenatal to palliative
care, to acute care, consultations,
follow-up visits and remote patient
monitoring. It offers live video-based
visits and store forward technologies.
As an example, ophtalmologists
with the UVA program have trained
community providers to obtain retinal
“Licensure is the big risk for
telemedicine providers, as
they attempt to match a patient
with a physician licensed in
the state in which the patient is
—Larry Hansard, regional managing director,
Arthur J. Gallagher
• Telemedicine shows great
promise in treating mental health
• Underwriters are warming up
to telemedicine as a medical
professional liability risk.
• State licensure issues are one of
the biggest risks in telemedicine.