We continue to convene our Candello Community to talk about the impact of COVID-19 on our business processes, risk exposures, and patient safety. While we typically have calls for our different groups (i.e., Claims, Underwriting, Analytics, etc.) we invited our entire Candello Community to discuss the explosive growth of telehealth due to the pandemic. Telehealth growth has implications for patient safety/risk management, underwriting, and claims management. We were joined by industry experts who shared insights from each of their perspectives.
- David Feldman, MD, Healthcare Risk Advisors Senior Vice-President & Chief Medical Officer, Healthcare Risk Advisors & Chief Medical Officer, The Doctors Company
- Paul Greve, JD, Markel Specialty
- Chad Brouillard, Esq., Partner, Foster & Eldredge, LLP
Across the industry, use of telemedicine services has grown exponentially. Our guest panelists talked about this growth and the potential risks and liabilities that might come with it. Below are some of the key take-aways from the call
David Feldman: “Some of the greatest growth in digital tools being used by physicians over the past three years—prior to the pandemic—has been around tele-visits and remote monitoring, according to a survey conducted earlier this year by the AMA. Physicians were also asked what the most important issues were with regards to using digital tools like telehealth and the response was whether there was malpractice insurance coverage. The amount of telehealth that is going to be around after the pandemic is still going to be greater than before, so we need to be prepared for that.”
Dr. Feldman offered some telehealth tips such as having a good “Web-side” manner or having a pre-visit to help manage workflow. His complete list of telehealth tips are available in this article, Top 7 Tips for Telehealth During COVID-19.
Paul Greve: “Telehealth goes far beyond patient-physician video encounters. It can also encompass data storage and review, patient assessment through scanners, communication and education with apps and portals, telemedicine real-time care delivery, and monitoring. What really pushed along the current growth in telehealth was the federal government waiver of HIPAA penalties per OCR/DHHS for use of “everyday communications technologies.” This allowed patients to use their smartphones, FaceTime, Zoom, among others. In addition, CMS significantly broadened payment for “office, hospital, and other visits.” While these regulatory expansions were done on a temporary basis, I don’t see how they can walk back on it due to the lower cost, increased patient access, and ease of use for patients. With the increased use of telehealth there may be increased risk, but this can be managed with planning and careful thought. For example, do you provide a consent and disclosure of telemedicine limitations?"
Chad Broulliard: "Telemedicine isn’t new, but the volume is. In my experience I’ve seen radiology and psychiatry cases but beyond that they have been minimal. Three core medical liability considerations with telehealth are licensure issues, documentation, and liability. Most states when they put out an emergency declaration about telehealth were very clear that the standard of care has to be the same as a face-to-face encounter, but to be fair to physicians, it is not the same. The relation between new technology and the standard of care is a complicated topic but the nature of this technology is interesting. One of the things that will impact whether a new standard of care is developed will be how jurors view telemedicine. Historically they have seen telemedicine as inferior because they hadn’t experienced it but now that could change as they will ultimately recognize the benefits. We will have to wait and see how this plays out in the courts."
Melissa Kemp, VP Underwriting of CRICO offered some insights from an underwriting perspective. She commented that coverage really depends on the carrier’s policy, for example, does the policy allow physicians to provide telemedicine across state lines?
Some of our Candello Members from around the country weighed in to share how they have evaluated the potential exposures from telehealth and determine what insureds need (for coverage). Candello Members generally agreed that it is going to be hard to walk back the progress we have seen with telehealth. It is likely that this will be the new normal and we, as insurers, need to be prepared to support our insureds with the proper coverage and education to safely deliver care via telehealth.
Candello Members can access the slides and a recording of the call here in the member-only online Candello Community.
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