David L. Feldman, MD, MBA, CPE, FAAPL, FACS, Chief Medical Officer for The Doctors Company and for the TDC Group of companies, shared an update to our previous conversation we had with him in May 2020.
At the start of the pandemic, health care systems, hospitals, and doctors’ offices saw an exponential increase in the use of telehealth services. This was in response to COVID-19 and only possible due to changes in federal and billing regulations.
The expanded use of telehealth is of interest to the medical professional liability (MPL) insurers as it has direct implications on our businesses, including underwriting as well as patient safety risks that could lead to potential malpractice claims. The impact on claims is yet to be seen as civil courts are still closed across most of the country.
In May 2020, we convened our clients on a Candello Community call, Telehealth in the Age of COVID-19 & Beyond. Attendees included underwriters, claims managers, and patient safety/risk managers. The panelists included three experts who spoke about telehealth, one of whom was David Feldman, who recently spoke with us for an update.
TELEHEALTH IN THE AGE OF COVID-19 & BEYOND: AN UPDATE
After sharing some data about the increased use of telehealth and the demographics using it, Dr. Feldman discussed key factors impacting telehealth including:
- State licensing
- Privacy-HIPAA and cyber security
While these factors have remained somewhat stable since we spoke with him in May, there have been some changes, such as on December 1, 2020, CMS made permanent a number of the temporary expansions to the telehealth services covered by Medicare.
TECHNOLOGY AND TELEHEALTH
One impact that remains unknown is the innovations in telehealth technology. As more data becomes available from technology that monitors health, including a growing number of wearables, doctors need a way to aggregate and interpret the data. While excited about this potential, Dr. Feldman cautioned about potentially overwhelming physicians with this volume of data noting, “A doctor may have a patient panel with multiple patients managing chronic conditions. A huge volume of information could be available to them through the new technologies. But there is no way that any doctor will be able to look at all that information and interpret it. They are going to need help from machines or artificial intelligence.”
He also noted that in addition to helping doctors interpret the data, having a way to help them see and find these data is crucial. There is the potential that a piece of information could be lost within the volumes of data if there isn’t a program or application that processes and stores these data and makes them available for retrieval and review.
MEDICAL MALPRACTICE RISKS OF TELEHEALTH
It is unknown, at this point, what impact telehealth may have on medical malpractice claims. The clinician workflow is different when using telehealth so at The Doctors Company, they have tried to emphasize to their members that telehealth isn’t about taking your office and making it remote. Clinicians need to know what works in virtual health and when to refer the patient to be seen in person.
Pre-pandemic, most virtual health involved behavior health and radiology, as we discussed on our call in May. The Doctors Company looked at its medical malpractice data—coded using the CRICO taxonomy—and found very few cases that involved telehealth, pre-pandemic. Of those cases, the majority were diagnosis-related tele-radiology claims. Recognizing the growing role of virtual health visits in the era of telemedicine, CRICO has enhanced its taxonomy to better capture the unique vulnerabilities of direct patient care via telemedicine.
As Dr. Feldman said, “It remains to be seen what the legal landscape will look like when all is said and done with this explosion of telehealth.”
Watch the Q&A with Dr. Feldman to hear his thoughts on updates to his tips for using telehealth, where telehealth may go in the future, and potential liability risks.
- COVID-19 Telehealth Resource Center, The Doctors Company
- Your Patient Is Logging On Now: The Risks and Benefits of Telehealth in the Future of Healthcare, The Doctors Company
- Telehealth: The Right Care, at the Right Time, via the Right Medium, NEJM Catalyst