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Telemedicine: Effective risk management strategies

Vital Signs: Season 3, Episode 3

April 11, 2025

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This session is a key installment in our podcast series, which is specifically designed to support healthcare providers as they navigate the rapidly changing world of telemedicine. Our knowledgeable podcast host and guest will explore a range of topics, including the latest best practices for implementing telemedicine programs, effective risk management strategies and innovative solutions to common challenges. Whether you're new to telemedicine or looking to enhance your existing program, this episode offers valuable insights and practical advice to help you succeed in this evolving field.

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Vital Signs: Risk and Insurance for Healthcare: Season 3, Episode 3 (Telemedicine)
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      Telemedicine: Effective risk management strategies

      Transcript for this episode

      JUDY KLEIN: It's really important to understand state laws and licensure requirements. Why is that? Because the patient might not be in the same state as the physician that's offering or conducting the virtual visit. So what that means is that licensure requirements for multiple states might be relevant.

      SPEAKER: Welcome to the WTW podcast, Vital Signs: Risk and Insurance for Healthcare, where we discussed the risk management and insurance trends and issues facing the U.S. healthcare industry. We'll speak with our industry experts and clients in search of ways to improve your risk and insurance vital signs.

      JOAN PORCARO: Welcome to the WTW Vital Signs podcast program. My name is Joan Porcaro, and I'm the senior vice president of risk services for WTW Healthcare. I'm very excited as today's podcast continues our newest series designed for physicians, providers, and medical practices.

      This podcast series is dedicated to helping those healthcare professionals navigate the complexities of medical practice with confidence and peace of mind. In each episode, we'll delve into practical strategies, expert insights, and real-world case scenarios to empower you with knowledge and tools needed to minimize legal risk and enhance patient safety.

      Today's podcast, we will be focusing on the topic of telemedicine, and there is a variety of different ways to cover on this particular topic. So in light of that, today's session will be a first within a subseries of our physician series. So today, we're joined by Judy Klein.

      For over 30 years, Judy has contributed to risk management publications and speaks frequently on a regional, state, and national level on risk and patient safety-related topics. She has 30 years of experience working as a physician assistant, healthcare risk manager, and working in medical professional liability insurance. She has extensive experience working for both physician and hospital medical malpractice insurance carriers, both in claims and risk management. Welcome, Judy.

      JUDY KLEIN: Thanks for having me, Joan, and thanks for the introduction.

      JOAN PORCARO: All right, well, let's go ahead and get started. So, Judy, define telemedicine.

      JUDY KLEIN: Joan, that's a great starting point, because I think it's important for individuals to understand that the terms virtual medicine, virtual care, telehealth, telemedicine are often used very interchangeably. As far as telehealth goes, it's viewed as a broader term and refers to the use of technology to support health care from a distance for non-clinical services. So good example of that would be for education purposes.

      While telemedicine is viewed as a modality to deliver care or, in other words, the actual practice of or providing the healthcare. The American Telemedicine Association considers telemedicine and telehealth synonymous. Their definition is, quote, "the remote delivery of health care services and clinical information using telecommunications technology, which also includes a wide array of clinical services using the internet, wireless, satellite, and telephone media."

      So for our purposes during the discussion on this topic, I may refer to telemedicine, telehealth, virtual visits, virtual care interchangeably. Also, I wanted to share that the American Telemedicine Association is a great resource for all things telemedicine and telehealth.

      JOAN PORCARO: Thank you, Judy. So, what are some of the legal and regulatory implications to consider with telemedicine?

      JUDY KLEIN: Joan, that's another great question. There are several legal and regulatory implications to consider when we're talking about the topic of telemedicine or telehealth. So, to that end, it's really important to understand state laws and licensure requirements. Why is that? Because the patient might not be in the same state as the physician that's offering or conducting the virtual visit. So what that means is that licensure requirements for multiple states might be relevant.

      In addition to state licensure requirements, practitioners need to also comply with applicable state and federal laws regarding telemedicine. So a really good example of that is if you think back to the pandemic, there were waivers that were established. And most of those were set to expire on December 31st of 2024 but were extended until March 31st of 2025.

      But it's important to understand that starting April 1, you must, again, be in an office or medical facility located in a rural area in the United States for most telehealth services. If you aren't in a rural healthcare setting, you can still get certain telehealth services, including from a Medicare perspective.

      Some examples of that are monthly end-stage renal disease visits for home dialysis, services for diagnosing, evaluating, or treating of symptoms of an acute stroke wherever you are, including in a mobile stroke unit, or services for diagnosis, evaluation, or treatment of a mental or behavioral health disorder, including substance use disorder, in your home. So it's really important to consult with your attorney to ensure you're in compliance with state and federal telemedicine laws and licensing requirements because they do vary by state. And as I just mentioned, I mean, they continue to evolve.

      I think another thing that we need to be aware of when we talk about these types of visits are that they do have limitations. So it's so important that if a physician needs to see a patient in person to get a complete picture of that patient's condition in order to make a diagnosis, then they need to see that patient person. And sometimes during that initial visit, you may not know that until you assess the patient. And you may need to tell that patient, in order for me to make a diagnosis, I'm going to need to see you in-person. Because nothing can replace laying hands on a patient. So organizations need to have a process and a plan in place for when and how to escalate a virtual visit to a face-to-face visit.

      Joan, I think it's also important to understand standard of care. Using telemedicine does not change the standard of care. What that means is the standard of care for a telemedicine visit is the same as for seeing a patient in the office or hospital. The provider needs to evaluate or have in place patient selection and suitability criteria for participation, or that patient participating in that telemedicine visit. So as we just mentioned, telemedicine visits do have limitations. It may not be appropriate in every situation.

      Think about language barriers or the patient's ability to actively participate in the visit, or does the patient have adequate technology to be able to participate in a virtual visit? And if that standard of care requires that physician have hands-on to examine that patient or a face-to-face visit, then telemedicine would not be an appropriate platform to conduct that visit.

      It's also important, I think, for clinicians to have access to the patient's past medical records. Because having that patient's past medical history and other data, lab results, imaging studies, for example, those need to be accessible to the provider during the visit.

      And I wouldn't be a good risk manager, Joan, if I didn't mention how important documentation is. Documenting all verbal, audio, visual, and written communication in that patient's medical record. Observing all medical and legal standards of care is critical. And you also need to ensure that documentation for that virtual visit integrates with your organization's electronic health record.

      Along the same lines, you want to ensure that documentation of informed consent also integrates into that electronic health record. Both oral and written informed consent need to take place. Disclosing information about the telemedicine system, potential risks and benefits of telemedicine, the equipment and technology limitations, and both the practitioners' and the patients' responsibilities as part of that virtual visit. Many states do require that practitioners obtain informed consent from patients ahead of that virtual visit before the visit takes place. So this is another area where you want to consult with an attorney as to any state-specific informed consent requirements.

      And then I think, lastly, Joan, we can't forget privacy and security right. Why is that? Because telemedicine uses technology, and it can place a practitioner or an organization in a very vulnerable position for malware attacks and hacks. So keeping private health information protected is paramount.

      Security management needs to incorporate things like firewalls, ensure privacy protections are in place, and ensuring that your organization uses a secured, non-public facing communication platform that can result in privacy breaches. You need to make sure that the appropriate platform is used to prevent breaches.

      Providers and organizations need to adhere to applicable state and federal privacy laws and evaluate their cybersecurity risk. A good way to do that is to consult with experts outside of your organization. There's a lot of professionals. Look to your cyber carriers who often can conduct risk assessments of your organization's preparedness to protect you from a privacy and security perspective.

      JOAN PORCARO: Thank you, Judy. You've provided our audience with a really nice summary of some of the exceptionally key areas that they would want to focus on, whether they currently have a program for telemedicine or they're thinking about establishing one. So, what steps does a physician need to take to establish that physician and patient relationship? Is there anything different here?

      JUDY KLEIN: Well, Joan, that's a great point to bring up. With regard to establishing the physician patient relationship, you do need to ensure that you meet your state requirements for the visit. Again, it's important to consult with your legal counsel to ensure that you're complying with your own state's regulations. As an example, the law regarding establishing a physician-patient relationship, it does vary by state. Some states require that to take place face-to-face, in-person, while other states allow you to do that during a telemedicine or a virtual visit. So I think, with regard to physician-patient relationship, check in to ensure that you're following your state laws.

      JOAN PORCARO: Thank you, Judy. As we close today's session, I wanted to go back for a moment and spend some time on informed consent. A lot of times, I'll get calls from different professionals out there wondering, is there any special considerations for informed consent? Do we need to have a separate telemedicine consent form? What are your thoughts on that?

      JUDY KLEIN: I'm so glad that you brought this up, Joan, because it is important for organizations to have specific informed consent for telemedicine, and patients need to be advised that it is required for care delivery to be provided for telemedicine and for any medical tests or treatments that might be offered in that regard. So, to that end, physicians need to explain the benefits, the risks, alternatives, and document the patient's understanding and agreement.

      Consider your state requirements, too. Most organizations have looked at this and consider having that patient sign the appropriate forms during an in-office visit ahead of the telemedicine visit. Some may email the documents or send them via U.S. mail. But the important point is to make sure that is done ahead of the actual first virtual visit with that patient.

      According to the American Telemedicine Association-- again, another great resource with regard to informed consent-- the following needs to be addressed as part of telemedicine informed consent. First, that the potential benefits, constraints, and risks of telemedicine medicine are reviewed, that the types of cases that are appropriate or inappropriate for remote visit are discussed, that the potential for an equipment or technology failure that can result in an inaccurate diagnosis is reviewed with the patient. And it's also important to review, as part of the informed consent, any follow-up care, who to contact for help in the event that, for example, the technology breaks down during the visit or there's an unforeseen outcome. How does that patient know to continue the visit? Who do they call? Who do they contact to make sure their care continues?

      They also need to have information provided to them about their rights, including the right to stop or refuse treatment during a telemedicine visit at any time. Their responsibilities need to be reviewed with them during that telemedicine visit. And then, finally, the American Telemedicine Association recommends addressing the process for filing a complaint or grievance to resolve any ethical concerns or other issues that might arise as a result of the telemedicine visit. So that's a really good question and topic to take a look at, Joan.

      JOAN PORCARO: Well, thank you, Judy. I really appreciate your very thorough review of some of the key points for providing telemedicine services.

      JUDY KLEIN: Thank you to you, Joan. It's been my pleasure. I've enjoyed it very much. And I look forward to our next visit.

      JOAN PORCARO: And in closing, I want to thank our audience. And for those who've tuned into our discussion, I hope you will be joining us for future conversations in the coming weeks. Our next episode on telemedicine will be focused a little bit more on how the physician, provider, and care team can prepare for the telemedicine visit.

      Again, if you've enjoyed this episode, don't forget to subscribe wherever you get your podcasts. Thank you for listening to our podcast, WTW Vital Signs.

      SPEAKER: Thank you for joining us for this WTW podcast featuring the latest thinking on the intersection of people, capital, and risk. WTW hopes you found the general information provided in this podcast informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors.

      In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, WTW offers insurance products through licensed entities, including Willis Towers Watson Northeast Incorporated in the United States, and Willis Canada Incorporated in Canada.

      Podcast host


      Joan Porcaro
      Senior Vice President, Risk Services - Healthcare, WTW

      Joan has over 30 years of extensive experience as a health system risk management professional. Prior to her work in risk management, she served as an operational leader in acute care, emergency, home health, hospice, and physician practice settings. Joan’s current responsibilities include providing clinical risk management consulting as well as support and resources to healthcare clients to assist them in better managing and reducing their risks.


      Podcast guest


      Judy Klein
      Senior Risk Solutions Consultant, MedPro Group

      Judy has over 30 years of experience working as a physician’s assistant, healthcare risk manager and working in medical professional liability insurance. She has extensive experience working for both physician and hospital medical malpractice insurance carriers, both in claims and risk management including developing the risk management program and managing the risk management department for a malpractice carrier. Judy holds a B.S. degree in medical science from Alderson-Broaddus College, is a PA, CPHRM, and is a Fellow of ASHRM. She is past President of the Indiana Society for Healthcare Risk Management (ISHRM), past President of the Ohio Society of Healthcare Risk Managers (OSHRM) and is a board member for the Ohio Patient Safety Institute (OPSI) and a committee member for MSHRM (Michigan Society of Healthcare Risk Management, ASHRM, and the Hospital Insurance Forum (HIF).


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