The Board recently reviewed a case involving the practice of telemedicine by a licensee. It turned out that the telemedicine provider was engaged in unethical business practices that resulted in patients being price-gouged, which resulted in a complaint to the Board. The licensee had no idea that patients were being overcharged.
This situation prompted the Board to revive a Forum article from 2012, written by Associate Medical Director Scott Kirby, MD, urging licensees to do their homework before contracting with anyone to provide medical care:
NCMB continues to receive requests for information and advice from practitioners who have been contacted by recruiters or who have seen advertisements for various telemedicine positions and providers. The Board recognizes that telemedicine is a useful tool with rapidly evolving technology that, if employed appropriately, may provide important benefits to patients. However, physicians should protect themselves by thoroughly evaluating a telemedicine provider and proposed means of delivering care before agreeing to treat patients. It is important for licensees to recognize that, while NCMB may not have direct jurisdiction or authority over telemedicine companies or platforms, it does have, and will employ, regulation and oversight of licensees providing these services. Additional important guidance on this topic is available from the Board’s Position Statement on “
Telemedicine”.
Here are several considerations:
How are you being contacted?
Your point of contact may not be the actual owner of the telemedicine service. A recruiting company, email contact, or advertisement may provide vague or incorrect answers to your questions. Affirmatively determine who actually owns the telemedicine service. The owner of the telemedicine practice may be an out-of-state non-physician, which could raise concerns about illegal or unethical business arrangements.
Have an attorney experienced in North Carolina health care law review all contracts and documents.
Confirm that the means you will be using to provide patient care remotely is acceptable and in accord with North Carolina law and Medical Board policies.
If you will be providing telemedicine patient care in more than one state be aware of the multiple state license domino effect.
Many practitioners who practice telemedicine hold medical licenses in multiple states. If an individual is disciplined by a medical board in one state, it often rapidly triggers a cascade of medical board investigations in all states where a physician is licensed. It is possible to be disciplined by other state medical boards for conduct in a different state, even if you have not provided any patient care—via telemedicine or face-to-face—in those other states.
Physicians practicing via telemedicine will be held to the same standard of care as licensees employing more traditional in person medical care.
You will be held to the standard of care applicable to the type of care you are providing. There is no watered down or special standard of care for telemedicine practice. If you are providing primary or family medicine care you will be held to the standard of care expected of a family medicine physician seeing the patient in person. Licensees should only provide telemedicine care in areas of practice in which they are current and competent. Telemedicine, in some respects, requires even greater knowledge and recent experience than direct in person care. Retired physicians or those who have recent experience only in administrative positions should not undertake telemedicine care without assuring their knowledge base in the areas which they will be providing telemedicine care is current and up-to-date. Failure to conform to the appropriate standard of care may subject the physician to discipline by the Board.
Physicians using telemedicine to provide care to patients located in North Carolina must provide an appropriate examination prior to diagnosing or treating the patient.
Obviously, the examination will not be exactly the same as an exam conducted in person. However, the examination must be substantially equivalent to one that would be conducted in person and allow the practitioner to gather all needed information to reach a diagnosis and prescribe properly. This is particularly true for telemedicine providers of direct to consumer (DTC) medication prescribing.
Physicians using telemedicine should have some means of verifying that the person seeking treatment is in fact who they claim to be.
In some cases the Board is aware of telemedicine practitioners who have prescribed in the name of one person knowing the medication is actually intended for someone else. For example, it is not appropriate to prescribe antibiotics to a wife who does a telemedicine consultation on behalf of her husband.
Licensees using telemedicine must ensure the availability of appropriate follow-up care and maintain a complete medical record.
Records must be available to the patient and to other treating health care providers. If there is a pharmacist question about your prescription you, or a backup physician, should be readily available. Telemedicine providers should also make themselves aware of how the medical records are maintained and how they are transmitted when a request is made.
Understand and be aware of what is going on behind the scenes.
The Board recently investigated a physician who was unaware his prescriptions were being altered and then routed to a compounding pharmacy associated with the telemedicine service, and that patients were being charged exorbitant fees upon filling the prescriptions.
Prescribing controlled substances by means of telemedicine is a high risk activity.
Be thoroughly aware of current Federal regulations regarding control substance prescribing and seek guidance from the DEA before undertaking telemedicine prescribing of controlled substances. Licensees prescribing controlled substances by means of telemedicine are expected to participate in, and properly use, the North Carolina PDMP (Controlled Substances Reporting System). Prescribing of opioids for the treatment of chronic pain exclusively by means of telemedicine is inadvisable and should be avoided.
