The Joint Commission has decided not to go ahead with new accreditation standards related to “direct-to-patient” telehealth, according to Modern Healthcare. The private sector, nonprofit agency, which accredits 77% of healthcare organizations in the United States, told the publication that feedback from a technical advisory panel, a standards review panel, and an online field survey “showed that existing requirements were sufficient.”
The Joint Commission earlier proposed requiring hospitals and their ambulatory care providers to confirm the location of a patient to ensure that he or she was assigned a telehealth provider licensed in the state where the patient resided. In addition, telehealth providers were supposed to discuss the patient’s proposed care, including the type of communication modality to be used, as part of the informed consent process.
Besides these “revised standards of performance,” the Joint Commission proposed a new standard that included three elements:
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The hospital informs the patient about the telehealth care that the hospital provides directly or by contractual arrangement
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The patient receives information about charges for which they will be responsible prior to provision of care
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Information provided to the patient prior to the provision of care includes the provider’s name and credentials and the hospital’s contact information
In a September 12 blog post posted on Health Care Law Today, Nathaniel Lacktman, a partner and healthcare lawyer at Foley & Lardner, wrote a critique of the Joint Commission’s proposed rule changes. While the requirement that telehealth providers be appropriately licensed under state laws is “reasonable and consistent with state laws across the U.S.,” he said, many states do not require providers to obtain informed consent for telehealth services. In fact, Oklahoma and some other states “have eliminated their prior informed consent requirement, realizing it can be cumbersome and largely unnecessary,” he wrote. So the Joint Commission standard would be more restrictive than many state laws.
The new performance standard, Lacktman said, would compel providers to take steps not required under many state laws or Medicare’s conditions of participation. Because of the inconsistent insurance coverage of telehealth, he noted, it is not clear whether hospitals can easily predict a patient’s financial responsibility. And requiring hospitals to inform patients of how much they owe in advance might conflict with the federal Emergency Medical Treatment and Active Labor Act requirements, under which a hospital must treat or stabilize a patient without regard to his or her ability to pay.
It is unclear whether the Joint Commission pulled its telehealth proposal because of negative industry reaction. The accreditation body has not made an official statement about the situation. But Lacktman told Modern Healthcare he suspected that the Joint Commission had received strong pushback from stakeholders, especially telehealth providers.
States have become increasingly supportive of telehealth. In 32 states, insurance companies are now required to cover virtual visits, which typically cost $40 to $50 each. Texas recently passed a law reversing the state medical board’s requirement that doctors have a face-to-face encounter with a patient before they can diagnose and treat them remotely, using telehealth technology.
Meanwhile, a growing number of healthcare systems are offering telehealth services, according to Medical Economics. In most cases, they contract with telehealth companies such as American Well, MDLive, Doctor on Demand, and Teladoc, which supply the technology and the contracted providers. A few healthcare systems are experimenting with using their own physicians to provide virtual visits.
The Joint Commission’s pullback on telehealth mirrors the body’s recent about-face on order texting. Last December, after having issued a policy that lifted an order-texting ban, the accreditor reinstated its prohibition on this practice.
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