American College of Rheumatology Releases Position Statements for Telemedicine Use

The American College of Rheumatology (ACR) has issued a set of position statements for the use of telemedicine in the management of patients with rheumatic diseases. The full report is published on the ACR website.¹

Until now, the implementation of telemedicine in rheumatology practices has been challenging for rheumatologists and rheumatology professionals because of issues related to federal and state regulations, reimbursement, and the practicality of providing care.² However, many of these barriers have been lifted during the coronavirus disease 2019 (COVID-19) pandemic, making telemedicine beneficial in terms of access and continuity of care for patients with rheumatic diseases. The ACR committee added that these potential benefits be carefully evaluated before implementation during and after the current crisis.

ACR Telemedicine Position Statements

1. The ACR supports the use of telemedicine to increase access and improve care of patients with rheumatic diseases; however, telemedicine must not replace essential in-person visits at appropriate intervals.
2. To maintain the economic viability of rheumatology practices and to provide care, the ACR endorses parity of reimbursement by payers for all visits after the declared COVID-19 public health emergency (PHE) has ended, if telemedicine services include a patient-provider relationship based on the American Medical Association Code of Medical Ethics; a range of rheumatology providers for patients; a standard of care that is consistent across telemedicine and in-person visits, taking into consideration the limitations of the technology and ways to overcome them; and documentation of the provision of telemedicine services.
3. Telemedicine platforms should include a mechanism to obtain informed consent for the provision of virtual services, including information about features of telemedicine, credentials of the providers, and limitations of the technologies involved. In situations where written consent is not feasible, documentation of verbal consent may be sufficient. The ACR emphasizes the importance of patient education in accessing an electronic virtual platform, ideally before the consult.
4. While providing telehealth services, appropriate protocols should be used to protect the security and integrity of patient information.
5. The ACR opposes geographic restrictions, including rural designation requirements, for delivering telemedicine practices, and strongly recommends that these restrictions be relaxed permanently so that patients can access virtual services even at the end of the declared PHE.
6. Proposals, including transitioning the definition of site of care and/or the uniform adoption of the Interstate Medical Licensure Compact, to enable the streamlining of telemedicine services across state lines may be considered.
7. The ACR does not support payer policies that impose the use of certain telemedicine platforms over others, for the construction of restrictive networks, or to divert patients toward specific rheumatology providers.
8. Although there is some evidence regarding the efficacy and cost-effectiveness of telemedicine, there may be some uncertainties with regard to best practices; thus, the ACR encourages outcome-based research of telemedicine use in rheumatology practices.

“Looking forward, the ACR supports the role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic disease,” the committee concluded.

References

1. American College of Rheumatology. American College of Rheumatology position statement. Accessed July 8, 2020. https://www.rheumatology.org/Portals/0/Files/Telemedicine-Position-Statement.pdf
2. American College of Physicians. 2020 ACP member survey about telehealth implementation. Updated March, 2020. Accessed July 12, 2020. https://www.acponline.org/system/files/documents/practice-resources/health-information-technology/telehealth/acp-telehealth-survey-results-2020-march.pdf