• Telehealth and Telemedicine

    The AAFP supports expanded use of telehealth and telemedicine as an appropriate and efficient means of improving health, when conducted within the context of appropriate standards of care. The appropriateness of a telemedicine service should be dictated by the standard of care and not by arbitrary policies. Available technology capabilities as well as an existing physician-patient relationship impact whether the standard of care can be achieved for a specific patient encounter type.

    Telehealth technologies can enhance patient-physician collaborations, increase access to care, improve health outcomes by enabling timely care interventions, and decrease costs when utilized as a component of, and coordinated with, longitudinal care. Responsible care coordination is necessary to ensure patient safety and continuity of care for the immediate condition being treated, and it is necessary for effective longitudinal care (for clarification, forwarding documentation by electronic means, including fax, is not acceptable for coordination of care with the primary care physician or medical home). As such, the treating physician within a telemedicine care encounter should bear the responsibility for follow-up with both the patient and the primary care physician or medical home regarding the telemedicine encounter.

    The AAFP recommends streamlined licensure processes for obtaining several medical licenses that would facilitate the ability of physicians to provide telemedicine services in multiple states. The AAFP encourages states to engage in reciprocity compacts for physician licensing, especially to permit the use of telemedicine. Within a state licensure framework, the AAFP strongly believes that patients with an established relationship, who are traveling, should be allowed to be treated by their primary care physician, so long as the physician is licensed in the state in which the patient receives their usual care.

    The AAFP recommends medical schools and family medicine residencies provide education to medical students and resident physicians on the unique aspects of telemedicine. Such education and training opportunities should progress through the spectrum of observed, simulated, and actual patient encounters, and practice-implementation of guidelines and resources.

    Payment models should support the patient’s freedom of choice in the form of service preferred (i.e., copays should not force patients to a specific modality). Value-based payment models must also support telehealth services by addressing the service's role in patient attribution, ensuring risk scoring (i.e., HCC scoring) is enabled during such visits, and that quality measures support care delivered via telehealth visits. Additionally, payment models should support the physician’s ability to direct the patient toward the appropriate service modality (i.e., provide adequate reimbursement) in accordance with the current standard of care. The AAFP believes current reimbursement policies warrant increased standardization among payers, especially in regard to eligible originating and distant sites, and use of asynchronous store-and-forward technology. The current unneeded variability in policies among payers leads to administrative complexity and burden for physicians and patients. Some telemedicine visits require the same level of work by the physician and incur the same level of liability as in-person visits; therefore, those telemedicine services should be reimbursed at parity with the corresponding in-person visit. 

    As telemedicine services are expanded and utilized to achieve the desired aims, it is imperative that outcomes are closely monitored to ensure disparities in care are not widened among vulnerable populations, attributed to increased use of telemedicine. Policies should acknowledge the geographical and socioeconomic disparities that exist and could be exacerbated by the improper adoption of telehealth if not explicitly addressed. Access to broadband is a social determinant of health.  All patients and practices should have broadband access to support delivery of telehealth services in accordance with AAFP's policy on Health Care for All.

    The AAFP defines telehealth and telemedicine as:

    Telemedicine is the practice of medicine using technology to deliver care at a distance, over a telecommunications infrastructure, between a patient at an originating (spoke) site and a physician, or other practitioner licensed to practice medicine, at a distant (hub) site.

    Telehealth refers to a broad collection of electronic and telecommunications technologies and services that support at-a-distance healthcare delivery and services. Telehealth technologies and tactics support virtual medical, health and education services.

    Telehealth is different from telemedicine in that it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services such as provider training, continuing medical education or public health education, administrative meetings, and electronic information sharing to facilitate and support assessment, diagnosis, consultation, treatment, education, and care management.

    (1994) (January 2022 COD)