The Bay State is a bit behind with the laws and regulations regarding telemedicine services. Unlike some of its neighbors, Massachusetts is yet to jump on the bandwagon and introduce proper regulation when it comes to the appropriate ways to practice telehealth, but also reimburse providers who practice it.

In the light of the increasingly concerning COVID-19 pandemic, it seems that Massachusetts officials have been blind to all the benefits of this particular practice. Even in normal circumstances, America is struggling to provide and care for all the patients that require help. The need for new solutions in its healthcare system is painfully apparent.

Two main areas that should be covered are the following:

1. Reimbursement policy
2. Appropriate laws to regulate the practice

The Massachusetts Medical Society is making an effort to improve the situation by taking part in the launch of the Telehealth Initiative. The joint venture, which includes many organizations from all over the country, should assist physicians with implementing telehealth services into their practice.

We hope this is the beginning of a new chapter for the Bay State. We expect the lawmakers to rise to the task as soon as possible.

What is telemedicine?

Telemedicine uses electronic communication channels or other forms of information technology to connect doctors and patients from different sites. It means that a caregiver can provide assistance and conduct examination, diagnosis, and issue prescriptions through video conference calls, text messages, emails, or chat.

There is no doubt that the practice brings fundamental changes in the way we view medical services, especially the doctor-patient relationship, but it proved to be an excellent way to improve the quality and availability of healthcare.

Some of the immediate benefits are:

• Allowing access to primary and specialty care for more patients
• Improving the population health
• Upgrading the client experience
• Reducing the per-capita expenditures

Although specific telemedicine tools have been around for decades, this practice started to gain momentum recently. The most important aspect of telemedicine is the possibility of reducing expenses. 

The main reason practicing telemedicine is not the financial gain, but the opportunity to treat more people, or provide better, more appropriate care for patients in need. The overall strategy of developing telehealth should concentrate on improving the medical system’s capacities and delivering better results.

How does telemedicine work?

With the use of modern technology, telemedicine enables practitioners to reduce downtime and allocate the resources to their main goal—taking care of the patients. Physicians, nurses, and other personnel can avoid spending time on non-medical tasks and focus solely on patients and their needs.

Telemedicine employs various tools and apps to:

• Speed up and simplify administration 
• Decrease waiting time
• Prevent mistakes related to documentation and reporting
• Eliminate the need for double entry

Telemedicine helps patients who live in remote areas get access to their physicians. It improves their experience by reducing travel time. It also enables patients to reach their doctor even when they are traveling.

Doctors are in a position to monitor their patients at any time, which allows them to react swiftly. Handy tools like electronic health records (EHRs), which became a standard in modern healthcare, provide ease of access to all relevant information, even in the case of new clients. A telehealth platform that integrates with your EHRs can increase the efficiency of your practice significantly. The table below sums up the most important uses of telemedicine.

Telemedicine vs. telehealth

The two terms seem to refer to the same thing, but many practitioners tend to differentiate between them. The definitions vary from one organization to another, and even different states regulate their use in their own ways.

Most experts say that telehealth refers to remote healthcare in the broader sense and includes non-clinical practices, such as education and disease prevention. There is no legal definition of these two terms in Massachusetts, but the American Telemedicine Association recommends using the words in the same way we would use health and medicine.

Common issues with telemedicine services

Despite its numerous positive aspects, telemedicine raises a couple of concerns that should be taken into consideration:

1.  Data privacy
2. Care continuity
3. Scope of practice
4. Licenses and credentials

Data security and privacy

Using electronic communication channels for providing medical services simplifies the doctor-patient interaction while keeping digital medical records allows ease of access for both parties. However, privacy issues and data protection may be reasons for concern.

The use of a digital platform in telemedicine means that a third party must be involved in the process. For the process to be safe and effective, data protection must be secured through encryption and passwords.

Continuity of care

In some instances, telemedicine services will not suffice, and traditional practice has to take over. The continuity of care refers to emergency protocols that have to exist if the condition of the patient suddenly declines, and there is a need for hospitalization.

The patient should be entitled to follow-up care after the initial diagnosis. Health providers should be available for check-ups and further instructions. If a medical professional only practices telemedicine, they must refer their patients to other institutions for more serious conditions.

Scope of practice

With all its benefits, telemedicine also has its limits. Certain conditions are not eligible for treatment through telehealth. It is essential to understand that these services will not be able to replace traditional practice entirely.

Telemedicine practitioners must inform their patients about the limitations and have a backup plan ready for such cases. 

Licenses and credentials

Credentialing medical professionals for telemedicine practice is yet to be regulated by law. Every state has its way of licensing, so the situation is a bit confusing. The question remains if the service should be regulated according to the residence of the patient or the health provider.

With malpractice liability and many other issues common in medical practice, it is vital to come up with proper legislation on the federal level. That is the only way to protect the rights of both parties, as well as their safety.

What about Massachusetts telemedicine?

In the Bay State, many healthcare providers are eager to incorporate telemedicine into their existing practice or start focusing entirely on it. The demand is high, and the possibilities seem to be endless, so remote diagnosis and care are becoming increasingly popular among patients and medical professionals.

Massachusetts’ Board of Registration in Medicine (BRM) and other relevant entities are not helpful in this matter. There are no comprehensive guides for telemedicine or telehealth, and the formal regulations and instructions are vague.

Following the rules that apply to in-person medical practice is the safest way to proceed, and the highest standards must apply in both cases. Practitioners seeking to establish a respectable telemedicine service should focus on the following:

• Establishing a doctor-patient relationship
• Protecting patients’ privacy and information
• Enabling adequate evaluation and treatment
• Prescribing medication responsibly

Doctor-patient relationship in telemedicine 

This sacred and obliging bond has been undergoing some changes lately. The traditional practice rules still have to apply to ensure that the client is receiving the best possible care. The Board of Registration in Medicine requires a face-to-face meeting for the relationship to be established. It is unclear if this necessitates an in-person meeting or if a video call will be a valid starting point.

What is certain is that a phone call, email, or text do not fit the requirements of BRM for initiating the doctor-patient relationship. It is important to start the relationship by obtaining enough information about the patient, so telemedicine providers should:

1. Identify the patient and their location
2. Provide information about the practitioner

In Massachusetts, it is not mandatory to get informed consent from the patient, but it is advisable to obtain it just in case.

Protection of privacy

When it comes to the protection of privacy, the federal regulations apply, so making sure that all information is protected and confidential is of utmost importance. HIPAA (Health Insurance Portability and Accountability Act) compliance, medical retention rules, and strict privacy policy are to be observed.

All channels of communication have to be secure and private, so the technology that you use must have encryption and password protection. Disclosing any details to third parties must be in compliance with federal rules and regulations.

Treatment and evaluation

Taking into consideration the patient’s previous medical history, the health provider should evaluate the patient during the initial telemedicine session and advise if telemedicine is the best course of action. If there are any doubts regarding the efficiency of the service, the doctor must switch to traditional in-person practice. In such cases, if the physician only practices telemedicine, they should refer the patient to another appropriate institution.

Continual care is essential, so every health provider should have an emergency protocol for patients whose condition takes a turn for the worse. These protocols must be presented to the patient, preferably in the written form.

Prescriptions

When prescribing medication, the physician should follow strict procedures that comply with federal and state laws. There should be no preferred pharmacies, and the doctor should never recommend a particular establishment, according to Massachusetts regulation. Integrating with e-prescribing systems is an excellent way to ensure the patient’s safety and avoid errors.

The challenges of practicing telemedicine in Massachusetts

With almost no help from the authorities, establishing a telehealth practice in the Bay State can be quite a tricky endeavor. The lack of regulation only adds to the confusion. Proper legislation allows practitioners to protect themselves from liability and any misinterpretation of the rules.

BRM does not provide actual guidelines regarding who can practice telemedicine in Massachusetts. According to federal law, it’s necessary to have a state-issued license. You should also have the appropriate permits for all the states in which your patients reside. Massachusetts is yet to join the Interstate Medical Licensure Compact, which will make cross-state telemedicine licensing a lot easier.

Recent development

We hope that the recent initiative from the State Governor Charles Baker will improve telemedicine in the Bay State. The proposed bill aims to expand the coverage of telehealth services by private payers and to provide necessary regulations. 

Mental health services, drug prescription costs, as well as practice standards for mid-level physicians, are all addressed in Baker’s proposal, which focuses on pushing telehealth forward. The governor believes that precise regulations and clear reimbursement policies can make remote care appealing to more people. 

Massachusetts currently sits at the bottom of the list regarding telehealth. Baker thinks that in-person care is not advanced enough for state officials to not consider remote services as a way to improve the availability of healthcare.

Reimbursement

Reimbursement for telemedicine by private payers is still not regulated in the Bay State. None of the insurance companies are obliged to offer coverage, and the parity law is not in place. Every practitioner must rely on direct payment methods. With the demand for telehealth services going up, we hope that there would soon be a parity law that would mandate that insurance coverage of telemedicine services matches that of in-person care.

When it comes to Medicaid, things are a little better. Although this state-federal partnership covers only select managed care organizations and not fee-for-service, it represents a starting point. All eyes are on the officials in the hope that the formal policy regarding reimbursement for telemedicine services through Medicaid will be regulated soon.

How to set up a telemedicine practice in Massachusetts 

All medical professionals who are thinking about providing telemedicine services or implementing them into their existing practice will face numerous challenges. Since telemedicine seems to be the future of healthcare, the transition may even become necessary.

The reward of successful implementation can have a positive impact on your practice, but it is crucial to plan each step and anticipate the potential risks. You should conduct the following:

• Needs assessment
• Service analysis
• Potential partners research

Assessing the needs for telemedicine 

It is important to understand that not every environment or community requires telehealth services, though it is safe to say that Massachusetts does. The timing of the transition is crucial, and so is your capacity to support it. Picking the right moment requires a thorough analysis of the market. 

You should identify potential patients and try to find out what their needs are. You should also check if they are already using telemedicine and to what extent. It will help you determine the amount of time and money you will have to spend on marketing and promotion. 

Analyzing the services

Telemedicine incorporates a variety of services, and you should only go for those that could benefit your patients and your business. There is a danger of overreaching, which can be damaging to your practice.

You should consider your existing capacities in terms of staff, logistics, and expertise. It can help you decide if telehealth is the right way to go. Your patients must come first, so ask yourself if you can improve their experience and the quality of care you provide by introducing telemedicine.

Choosing the right platform

The technology behind telemedicine is as important as the goodwill and knowledge that the practitioner has. Your business partner must be reliable and accountable in providing proper communication channels, security, and support. It is the only way for your operation to be successful, so choose the platform wisely.

Curogram is an excellent example of what to look for when researching potential vendors. The table contains our scope of service.

The online solution that you will be using for telemedicine is equally as important as your expertise and knowledge. Your app or platform must be user-friendly and simple enough for all types of patients. One of the most attractive aspects of telehealth is the ease of access. 

Another thing to think about is electronic health records. They are the basis of any successful practice because they revolutionized the way medical records are kept. EHRs should contain all doctor-patient communication, but also all test results, instructions, prescriptions, scans, etc. Your platform should be able to integrate with your EHR. Curogram integrates with any EHR, and the integration process is done in less than 48 hours. 

In the end, you should realize that there is no universal solution for telemedicine practice. We are hoping that the Massachusetts officials will catch up with the legislation, which should make the process of setting up a telemedicine practice easier.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.