Telemedicine - Who, What, When, Where and How!

LOUISIANA ACADEMY OF MEDICAL
PSYCHOLOGISTS
Continuing Education Conference
Telemedicine – Who, what, when, where and how!
Conrad Meyer JD MHA FACHE

Health Care Sections
Chehardy Sherman Law Firm
cm@chehardy.com
(504) 830-4141

10/6/2014 Chehardy Sherman 1
Telehealth Services
 History
 Pre January 1999 – CMS had limited coverage for
services delivered via telecommunications
 Did not require face to face meeting
 BBA – provided coverage
 October 2001 – Benefits Improvement Protection Act
(BIPA)
 Expands telehealth services
 Adds – consults, office visits, office psych
services, and “any additional service
specified by the Secretary”
 Required interactive telecommunication
system

Telehealth Services
 History
 BIPA – Also provided annual updates to
Telehealth services
 Established a process for providers to request CMS add
services to the list of telehealth services (CMS is very
conservative)
 Defined eligible telehealth individual – one who
receives telehealth services at an “originating site”
 Originating sites included:
 Practitioner Office; Critical Access Hospital (CAH); rural
health clinic (RHC); FQHC

Telehealth Services
 History
 MIPPA – Medicare Improvements for
Patients and Providers Act (2008)
 Expanded list of telehealth
“originating sites”
 Now includes: Hospital Based
Renal Dialysis Centers; SNFs;
and Community Mental Health
Centers (CMHCs).
 The added sites must be located
in a rural health professional
shortage area (HPSA); not in a
Metropolitan Statistical Area
(MSA)

Telehealth Services
 Billing
 To be reimbursed as Telehealth Services the
following must happen:
 Telehealth services must be furnished to eligible
beneficiary at originating site
 Originating site must be listed as approved by CMS
 One of services listed as approved telehealth services by
CMS
 Performed by practitioner at distant site provided
practitioner can perform services pursuant to state law
via telecommunications system
Telehealth Services
 Billing
 To be reimbursed as Telehealth Services the
following must happen:
 Practitioner shall be paid amount equal to amount practitioner would have
been paid if the service were performed live
 Proper modifiers must be used
 Facility fee is paid to originating site
 Be careful to code properly for telehealth services – follow requirements –
must be INTERACTIVE communication to be telehealth – NOT simply
reading electrocardiogram by physician received by phone.

Telehealth Services
 Barriers to Telehealth
 Reimbursement
 Licensure
 Credentialing
 Liability

Telehealth Services
 Reimbursement
 Show me the money? – Medicare/Medicaid? Private
Payors?
 Medicare
 Requires – Real time two way communication via Audio/Video between
patient at distant site and practitioner
 Beneficiaries must meet eligibility – be at originating site in a HPSA
 Must be medically necessary
 Distant site physician paid the same amount (by fee schedule) if services were
performed in his/her local area
 Distant site physician must be acting within scope of practice
 Beneficiary pays copay/deductible
 Originating site gets facility fee (varies based on facility type)

Telehealth Services
 Reimbursement
 Show me the money? – Medicare/Medicaid? Private Payors?
 State Medicaid/Private Payors
 Usually look to Medicare for guidance
 No consistency – some full reimbursement others outright deny
claims
 Private Payors – vary by contractor
 Telehealth venture’s should be wary of fee schedules and Medicaid
reimbursement policies for telemedicine for each state it ventures to do
business
Telehealth Services
 Licensure
 Multistate reach of services presents problems for
providers
 States individually license
 Some states have special purpose telemedicine license
 Physicians should have compliance program that
identifies the state’s licensure issues in states the
telehealth company desires to do business
 Exception of common consultations may not apply if
care involves telemedicine link

Telehealth Services
 Licensure
 Federation of State Medical Boards (FSMB)
 Developed Model Act to regulate practice of medicine
across state lines
 Created special purpose license
 Louisiana has special purpose telemedicine license –
LSBME

Telehealth Services
 Credentialing
 Who’s job is it?
 CMS differs with TJC on credentialing distant site
physicians
 TJC uses a reciprocity approach -
 CMS does not – requires both distant and originating hospital to
follow full credentialing process; some flexibility for CAHs where
CMS allows CAHs to enter into rural health networks for
credentialing as opposed to going through process
 DNV Healthcare, Inc (DNV) – new credentialing
standards
 Approved by CMS in September 2008 as alternative to TJC
accreditation

Telehealth Services
 Credentialing
 TJC
 LSBME
 Facility?
 Distant Site?
 Originating Site?

Telehealth Services
 Credentialing
 TJC – CMS won battle
 Effective 7/15/2010 – TJC revised standards to bring in line with

CMS
 New standards for TJC provide for 2 different processes:
 Hospitals that use TJC accreditation for “deemed” status (most
do for COPS) then telemedicine providers must be fully
credentialed and privileged at originating site – See MS .06.01.03
and MS .06.01.13
 Hospital that do NOT use TJC accreditation for “deemed”
status can use TJC reciprocity approach.

Telehealth Services
 Liability
 Creating physician/patient relationship via telehealth
 What standard of care is to be applied? – Unknown
 Texas holds online physician to same standard of care as physician conducting
office consultation
 Hawaii holds online physician to lesser standard
 Will liability coverage extend to online services? – Unknown
 Website disclaimers – are they enforceable/effective? – Unknown
 Most sites have disclaimers to limit liability – will they shield physicians from
liability?
 Will coverage extend to physician sites that simply offer information with no
rendering of care? – Likely not

Telehealth Services
 Telepharmacies
 New frontier – E-pharmacies – electronic
prescriptions
 Some states require specific regulations for e-
prescribing
 Most simply require telemedicine to be performed with
appropriate standards of care
 Rogue pharmacies are aggressive prosecuted and also tie
activities to medical licensing sanctions – See SR 81

Telehealth Services
 Telepharmacies
 DEA – issued guidance (2008)
 Regulations that affect physicians for e-prescribing
 Require detailed procedures and system requirements
for:
 Health care providers who e-prescribe controlled substances
 Service providers who create software and systems for e-
prescribing
 Pharmacies that dispense controlled substances via e-
presciption
 New regs present potential civil and criminal liability

Telehealth Services
 Telepharmacies
 DEA – Rogues pharmacies
on rise
 Enforcement on rise
 Ryan Haight Act – enacted
in 2008 – bans sale or
distribution of prescription
drugs over internet without a
“valid prescription”
 Defined “valid prescription”
to require a practitioner to
examine patient in person –
limited exceptions

Telehealth Services
 Tweet?
 Social Media
 Explosion of Web 2.0 – live two way communication
 Facebook
 Twitter
 Concerns over Privacy – HIPAA/HITECH issues
 Some states regulate use of email/internet advertising and websites by physicians
 Texas
 Requires physicians to
 Disclose ownership of websites
 In-office contact information
 Licensure
 Qualifications of physician
 Compliant and feedback processes
 Disclosure of any financial interest

Telehealth Services
 Informed Consent
 Telemedicine – different and more crucial
 Must clearly lay out telemedicine encounter
 Describing physician’s name/location
 Disclosures about use of video conference to render services
 Potential risks for using telemedicine
 Equipment failure?
 Some states have enacted laws to require minimum standards
for informed consent for telemedicine services
 Texas, Arizona and Kentucky

Telehealth Services
 Informed Consent
 Telemedicine – different and more crucial
 Must clearly lay out telemedicine encounter
 Describing physician’s name/location
 Disclosures about use of video conference to render services
 Potential risks for using telemedicine
 Equipment failure?
 Some states have enacted laws to require minimum standards
for informed consent for telemedicine services
 Texas, Arizona and Kentucky

Telehealth Services
 PPACA and Telehealth
 Center for Medicare and Medicaid Innovation (within CMS)
 Tests delivery of new payments and delivery arrangements
 PPACA expands rural telehealth initiatives
 PPACA creates comprehensive review of Part D via e-prescribing

Telehealth Services
 Resolving the issues? Where do we go?
 Licensure needs to be addressed – national
telemedicine license?
 Reimbursement?
 Credentialing – uniform system?
 Liability – Standards of care – at originating site?
Distant site?

Telemedicine Defined
The practice of medicine when the doctor and

patient are widely separated using two-way
voice and visual communication (as by satellite
or computer)

How Telemedicine is Being Used
1. Digital Images
a) Digital images are taken and forwarded to another
location
i. Used for x-rays, CAT Scans, MRIs any other digital
image
ii. Used for non-emergency situations
2. Two-way Interactive Television
a) Teleconferencing is used with the patient in the
room
i. Used for face-to-face consolations
ii. Allows “real time” consultations to take place
iii. Used mostly in an rural-to-urban location or for
examination by a specialist

Who is Using Telemedicine
1. Specialist
a) Conferences with a specialist who is not in the area
2. Oncology
3. Mental health care to people in jail
4. Hospice care
5. School health services
a) Allowing school nurses to interact with physicians
6. Home health care
a) Will be a huge area of telemedicine with the aging baby boomers
7. Nursing homes

Future of Telemedicine
1. Telesurgery
a) Using robotic equipment to perform a surgery
b) A surgeon in one location remotely controls a
robotic arm for surgery in another location
c) The military and others have been experimenting
with this
i. http://www.mrcas.ri.cmu.edu/

Advantages of Telemedicine
1. Specialty care is more accessible
2. Video consultations keep cost down for patients who would
otherwise have to travel to a specialist
3. Keeps cost down for hospitals
4. Faster turn around time for evaluation
5. Frees beds of patients who can be monitored from home
6. More convent for doctors to see patients

Disadvantages of Telemedicine
1. The laws and regulations have not caught up
with the technology
2. Reimbursement issues
3. Insurance issues

Louisiana:
Telemedicine Defined
La. R.S. 37:1262
1. The practice of health care delivery, diagnosis,

consultation, treatment, and transfer of
medical data using interactive
telecommunication technology that enables a
health care practitioner and a patient at two
locations separated by distance to interact via
two-way video and audio transmissions
simultaneously.
Louisiana
Requirements for a Telemedicine License
La. R.S. 37:1276.1
A. The board shall issue a telemedicine license to allow the practice of medicine
across state lines to an applicant who holds a full and unrestricted license to
practice medicine in another state or territory of the United States.
B. The board shall establish by rule in accordance with the Administrative
Procedure Act the requirements for licensure under this Section provided the
rules include the following:
(1) The physician licensed under this Section shall not open an office in this state,
shall not meet with patients in this state, and shall not receive calls in this state
from patients.

Louisiana
Requirements for a Telemedicine License
La. R.S. 37:1276.1
(2) The physician, when examining a patient by telemedicine, shall establish a bona fide physician-
patient relationship by:
(a) Conducting an appropriate examination of the patient as determined by the board.
(b) Establishing a diagnosis through the use of accepted medical practices including but
not limited to patient history, mental status, and appropriate diagnostic and laboratory
testing.
(c) Discussing with the patient any diagnosis as well as the risks and benefits of various
treatment options.
(d) Ensuring the availability for appropriate follow-up care.
(e) Fulfilling any other requirements as deemed appropriate and necessary by the board.
(3) The board may establish by rule additional qualifications, requirements, scope, and limitations of
the use of telemedicine in this state as the board may deem appropriate.
C. Any physician licensed to practice telemedicine in accordance with this Section shall be subject to
the provisions of this Part, the jurisdiction of the board, applicable state law, and, with respect to
providing medical services to state residents, to the jurisdiction of Louisiana courts.

Louisiana
Telemedicine License
La. R.S. 37:1271.(B)1-5
(1) No person shall practice or attempt to practice medicine across state lines without first complying
with the provisions of this Part and without being a holder of either an unrestricted license to practice
medicine in Louisiana or a telemedicine license entitling him to practice medicine pursuant to R.S.
37:1276.1
(2)Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing
telemedicine as defined in this Part:
(a) The physician practicing telemedicine shall use the same standard of care as if the healthcare
services were provided in person.

Louisiana
La. R.S. 37:1271.(B)1-5
(2)Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing
telemedicine as defined in this Part (CONT.):
(b) The physician practicing telemedicine shall not be required to conduct an in-person patient history
or physical examination of the patient before engaging in a telemedicine encounter if the physician
satisfies all of the following conditions:
(i) Holds an unrestricted license to practice medicine in Louisiana.
(ii) Has access to the patient's medical records upon consent of the patient.
(iii) Maintains a physical practice location within the state of Louisiana or executes an
affirmation with the board that the physician has an arrangement with another physician who
maintains a physical practice location in Louisiana to provide for referrals and follow-up care which
may be necessary.

Louisiana
La. R.S. 37:1271.(B) 1-5
Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing
telemedicine as defined in this Part:
(3) Except as authorized by rule promulgated by the board, no physician practicing telemedicine
pursuant to this Subsection shall prescribe any controlled dangerous substance prior to conducting an
appropriate in-person patient history or physical examination of the patient as determined by the
board.
(4) A patient receiving telemedicine services may be in any location at the time that the telemedicine
services are rendered. A physician practicing telemedicine may be in any location when providing
telemedicine services to a patient.
(5) A physician practicing telemedicine shall document the telemedicine services rendered in the
patient's medical records according to the same standard as that required for nontelemedicine services.
Medical records including but not limited to video, audio, electronic, or other records generated as a
result of providing telemedicine services shall be considered as confidential and shall be subject to all
applicable state and federal laws and regulations relative to the privacy of health information.

Louisiana Telehealth Act (LTA)
LSA R.S. 40:1300.381 - .384
R.S. 40:1300.381 – Title

R.S. 40:1300.382 – Legislative Findings:
(1) As an innovative form of health care, telehealth is extremely valuable
because it enhances access to care, particularly in rural locations and other
medicallyunderserved areas; makes delivery of care more cost-effective; and
distributes limited provider resources more efficiently.
(2) Many patients with limited access to traditional health care can be
diagnosed and treated sooner through telehealth than they would be otherwise,
resulting in improved outcomes and less costly treatments due to early detection
and prevention.

LSA R.S. 40:1300.381 - .384
R.S. 40:1300.381 – Title

R.S. 40:1300.382 – Legislative Findings:
(3) Telehealth services could potentially address a great unmet need for
health care by persons who have limited access to both traditional healthcare
settings and to telemedicine as currently defined in Louisiana law.
(4) If this state is to achieve much needed improvement in health

outcomes, a prudent and responsible policy for doing so would be to balance
patient safety and access to care through expanding access to telehealth services
for the people of Louisiana.

LSA R.S. 40:1300.381 - .384
R.S. 40:1300.383 – Definitions

(1) "Asynchronous store and forward transfer" means the
transmission of a patient's medical information from an
originating site to the provider at the distant site without the
patient being present.
(2) "Distant site" means the site at which the healthcare
provider delivering the service is located at the time the service
is provided via a telecommunications system.

LSA R.S. 40:1300.381 - .384

(3) "Healthcare provider" means a person, partnership, limited liability partnership, limited
liability company, corporation, facility, or institution licensed or certified by this state to
provide health care or professional services as a physician assistant, hospital, nursing
home, dentist, registered nurse, advanced practice registered nurse, licensed practical
nurse, certified nurse assistant, offshore health service provider, ambulance service,
licensed midwife, pharmacist, speech-language pathologist, audiologist, optometrist,
podiatrist, chiropractor, physical therapist, occupational therapist, certified or licensed
athletic trainer, psychologist, medical psychologist, social worker, licensed
professional counselor, licensed perfusionist, licensed respiratory therapist, licensed
radiologic technologist, or licensed clinical laboratory scientist.

LSA R.S. 40:1300.381 - .384

(4) "Originating site" means the location of the patient at the time the service is furnished
via a telecommunications system or when the asynchronous store and forward transfer
occurs.
(5) "Synchronous interaction" means communication through interactive technology that
enables a healthcare provider and a patient at two locations separated by distance to
interact via two-way video and audio transmissions simultaneously.
(6) "Telehealth" means a mode of delivering healthcare services that utilizes information
and communication technologies to enable the diagnosis, consultation, treatment,
education, care management, and self-management of patients at a distance from
healthcare providers. Telehealth allows services to be accessed when providers are in a
distant site and patients are in the originating site. Telehealth facilitates patient self-
management and caregiver support for patients and includes synchronous interactions and
asynchronous store and forward transfers.

LSA R.S. 40:1300.381 - .384
R.S. 40:1300.384 – Telehealth Rulemaking Required

A. Each state agency or professional or occupational licensing board or commission that
regulates the practice of a healthcare provider, as defined in this Part, may promulgate, in
accordance with the Administrative Procedure Act, any rules necessary to provide for,
promote, and regulate the use of telehealth in the delivery of healthcare services within the
scope of practice regulated by the licensing entity.
B. The rules shall, at a minimum, provide for all of the following:

(1) Application of all laws regarding the confidentiality of healthcare information
and the patient's rights to the patient's medical information created during
telehealth interactions.
(2) Application of the same standard of care by a healthcare provider as if the
healthcare services were provided in person.

LSA R.S. 40:1300.381 - .384
B. The rules shall, at a minimum, provide for all of the following:

(3)(a) Licensing or registration of out-of-state healthcare providers who seek to
furnish healthcare services via telehealth to persons at originating sites in Louisiana. The
rules shall ensure that any such healthcare provider possesses, at a minimum, an
unrestricted and unencumbered license in good standing to perform the healthcare service
in the state in which the healthcare provider is located, and that the license is comparable
to its corresponding license in Louisiana as determined by the respective Louisiana
licensing agency, board, or commission.
(b) Each state agency and professional or occupational licensing board or
commission is authorized to provide by rule for a reasonable fee for the license or
registration provided for in this Subsection.
(4) Exemption from the telehealth license or registration required by this
Subsection for the consultation of a healthcare professional licensed by this state with an
out-of-state peer professional.
LSA R.S. 40:1300.381 - .384
C. Nothing in this Part shall be construed to authorize a state agency or professional or

occupational licensing board or commission to expand, diminish, or alter the scope of
practice of any healthcare provider.

Louisiana
Telemedicine: Establishing a
Physician/Patient Relationship
1. Conduct an appropriate examination of the patient as determined by the
Louisiana Board of Medical Examiners
2. Establish a diagnosis through the use of accepted medical practices
including but not limited to patient history, mental status, and appropriate
diagnostic and laboratory testing
3. Discussing with patient the risks and benefits of various treatment options
4. Ensuring the availability of follow-up care
5. Fulfillment of any other requirements deemed by the Louisiana Board of
Medical Examiners as necessary

Telemedicine – Are Providers/Hospitals
Ready?
1. Numerous legal/business/quality issues
a) Three include:
i. Licensure
a. Liability
b. Jurisdiction
c. Insurance Coverage
ii. Credentialing
a. Quality
b. Standards
iii. Business Model
a. Reimbursement
b. Local Docs v. Telemedicine Docs
c. Medical Staff reactions to Telemedicine Issue
d. Cost Issues – Telemedicine v. in-house services

Telemedicine Licensure
1. Louisiana
a) Enacted 2008 Session
b) See La. R.S. 37:1276.1
2. Compare to other states
a) Texas
b) California
c) Kentucky

Federation of State Medical Boards
Telemedicine Licensure
1. The Federation of State Medical Boards (FSMB) is a national non-profit organization whose
membership includes 70 medical licensing and disciplinary boards in the United States, and
the U.S. territories.
2. Mission is for the FSMB to support state medical boards (1) as primary vehicles of medical
licensure and discipline and (2) in developing and using consistent standards, language,
definitions and tools.
3. FSMB weighed in on Telemedicine Licensure issues and determined that a set of standards
for expedited licensure determination
4. The report sets forth the expedited licensure process for physicians meeting identified and
accepted standards and is dependent upon the development of a standard medical license
application and acceptance of established standards for primary source verification of
physician core credentials, including identity, medical education, postgraduate training,
examination, and disciplinary history.
5. The issue to be addressed was portability – physicians realized that licensure was a barrier to
access to various states
6. FSMB – addressed issue of standardized licensure applications - recommended

FSMB Requirements
Expedited Licensure – Portability
Requirements for Expedited Licensure from FSMB:
1. Full and unrestricted licensure (in all jurisdictions where a medical license is held);
2. Free of disciplinary history, license restrictions, or pending investigations (in all jurisdiction where a
medical license is or has been held);
3. Graduation from an approved medical school or hold current Educational Commission for
Foreign Medical Graduates (ECFMG) certification;
4. Passage of a licensing examination acceptable for initial licensure within three attempts per
step/level and within a seven (7) year time period;
5. Completion of three (3) years of progressive postgraduate training in an accredited program;

and/or,
6. Current certification from a medical specialty board recognized by the American Board of Medical
Specialties (ABMS) or the American Osteopathic Association (AOA). Lifetime certificate holders
who have not passed a written specialty recertification examination must demonstrate successful
completion of the Special Purpose Examination (SPEX), Comprehensive Osteopathic Medical
Variable Purpose Examination (COMVEX), or applicable recertification examination.

Telemedicine Licensure Issues
Louisiana
1. La. R.S. 37:1276.1 – Initial legislation is a great start at catching up with
technology
2. Needs to be revised however as statute leaves open several issues:
a) Jurisdiction
i. What jurisdiction is out of state physician licensed pursuant to La. R.S. 37:1276.1
subject to in a lawsuit with La. Patient?
b) Liability
i. Is out of state physician licensed pursuant to La. R.S. 37:1276.1 covered under La.
MMA?
c) Coverage
i. What coverage does out of state physician licensed pursuant to La. R.S. 37:1276.1
need?
a. How will they by qualified under PCF?
d) Corporate Practice of Medicine issues – See LSBME website for current position
of CPM
e) Aiding and Abetting – Are hospital’s liable for contracting with physicians who
don’t comply with La. R.S. 37:1276.1?

Telemedicine Licensure Issues
Louisiana
1. How do we solve these issues?
a) La. R.S. 37:1276.1 – leaves open ended rulemaking by LSBME
i. Any other rules and the Louisiana Board of Medical Examiners establish
ii. LSBME could establish rules addressing jurisdiction, liability, coverage, CPM, etc.
b) Legislature can amend La. R.S. 37:1276.1 to address these issues as well
i. Jurisdiction
a. Statute could be amended requiring any physician to submit him/herself to
jurisdiction of Louisiana
b. Statute could delineate jurisdiction by location of patient – not physician
ii. Liability
a. Statute could be amended to designate physician licensed pursuant to La. R.S.
37:1276.1 would subject himself to MMA
iii. Coverage
a. Statute could be amended to require any physician licensed pursuant to La. R.S.
37:1276.1 to qualify with the PCF
b. Statute could require minimum coverage standards for insurance purposes

Telemedicine
Credentialing Issues
1. Appointment, Reappointment and Delineation
of Clinical Privileges
2. Physicians +
3. Heavily Regulated ,CMS, state, TJC

Areas of Frequent Litigation
Credentialing Issues - Telemedicine
1. Contractual Challenges
2. Bylaws
3. Host of Other Theories

Telemedicine Credentialing
1. Was Secondary to Licensure
2. TJC Medical Staff Standards – Required sites receiving

telemedicine services to credential and privilege , including
radiologists, pathologists, consultants (See MS.4.120)
3. 2004 “ New JCAHO Standard” to reduce the burden on

patient location sites

TJC Standards for
Telemedicine Credentialing
(MS.13.01.01) - Applies to Licensed Independent Practitioners
(LIPs) at Originating sites Licensed independent practitioners who
are responsible for the care, treatment, and services of the patient
via telemedicine link are subject to the credentialing and privileging
processes of the originating site.

TJC MS.13.01.01
(MS.13.01.01) - Element of Performance for MS.13.01.01

A 1. All licensed independent practitioners who are responsible for
the patient’s care, treatment, and services via telemedicine link are
credentialed and privileged to do so at the originating site through
one of the following three mechanisms:
1. The originating site fully privileges and credentials
the practitioner according to Standards MS.06.01.03
through MS.06.01.13; or

TJC MS.13.01.01

2. The originating site privileges practitioners using
credentialing information from the distant site if the distant
site is a Joint Commission accredited organization. The
distant site practitioner has a license that is issued or
recognized by the state in which the patient is receiving
telemedicine services; or

TJC MS.13.01.01

3. The originating site may choose to uses the credentialing and privileging decision from the distant
site to make a final privileging decision if all the following requirements are met:
1. The distant site is a Joint Commission accredited hospital or ambulatory care
organization.
2. The practitioner is privileged at the distant site for those services to be provided at the
originating site.
3. For hospitals that use Joint Commission accreditation for deemed status purposes:
The distant site provides the originating site with a current list of licensed independent
practitioners’ privileges.
4. The originating site has evidence of an internal review of the practitioner’s
performance of these privileges and sends to the distant site information that is useful to
assess the practitioner’s quality of care, treatment, and services for use in privileging and
performance improvement. At a minimum, this information includes all adverse
outcomes related to sentinel events considered reviewable by The Joint Commission that
result from the telemedicine services provided; and complaints about the distant site
licensed independent practitioner from patients, licensed independent practitioners, or
staff at the originating site. (See also LD.04.03.09, EP 9)

TJC MS.13.01.01
1. The distant-site practitioner has a license that is issued or recognized by

the state in which the patient is receiving telemedicine services.

TJC LD 04.03.09
Standard:
Care, treatment, and services provided through contractual
agreement are provided safely and effectively

TJC LD 04.03.09
Elements:
For hospitals that use Joint Commission accreditation for deemed
status purposes: The originating site has a written agreement with
the distant site that specifies the following:
1. The distant site is a contractor of services to the hospital.
2. The distant site furnishes services in a manner that permits the
originating site to be in compliance with the Medicare Conditions of
Participation.
3. The originating site makes certain through the written agreement that all
distant site telemedicine providers’ credentialing and privileging
processes meet, at a minimum, the Medicare Conditions of
Participation at 42 CFR 482.12(a)(1) through (a)(9) and 482.22(a)(1)
through (a)(4). (See alsoMS.13.01.01, EP 1)
Example – Applying
1. Dr. X is a credentialed specialist at distant site
General Hospital A
2. Originating site Small Hospital B, if it choices,
may require Dr. X to be privileged and
credentialed in order to treat patients in B via
telemedicine or
3. Hospital B may use Dr. X’s credentialing data
from Hospital A if it is a TCJ accredited
hospital
Examples Cont.
1. Hospital B may use Hospital A ‘s credentialing
and privileging information:
a) if A is TJC accreditated,
b) if X is privileged by A for the services performed
at B,
c) if B has evidence of an internal review of X’s
performance of these privileges and sends to A ,
X’s performance data from B that is useful in A’s
quality reviews of X and in X’s re-credentialing
TJC Credentialing
1. Reduces credentialing and privilege burden for
the originating site
2. Recognizes that the distant site has the key
information for which it based its privilege
decisions
3. Acknowledges that originating site might not
have experience to credential/privilege certain
specialties

Where are we headed?
1. Telemedicine is only going to expand
a) Use of Internet and other technologies
b) Diagnostic Services – via telemedicine
c) Remote monitoring
d) Remote surgery
2. Legal/Business/Quality Issues will need to be
addressed on an ongoing basis

Questions Please contact:
CONRAD MEYER JD MHA FACHE
Health Care Section - Chehardy Sherman
One Galleria Blvd Suite 1100
Metairie, La. 70001
(504) 830-4141
cm@chehardy.com


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LOUISIANA ACADEMY OF MEDICAL

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

 Effective 7/15/2010 – TJC revised standards to bring in line with

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Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

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The practice of medicine when the doctor and

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Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

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Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE

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R.S. 40:1300.383 – Definitions

Conrad Meyer JD MHA FACHE

R.S. 40:1300.383 – Definitions

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B. The rules shall, at a minimum, provide for all of the following:

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B. The rules shall, at a minimum, provide for all of the following:

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C. Nothing in this Part shall be construed to authorize a state agency or professional or

Conrad Meyer JD MHA FACHE

Conrad Meyer JD MHA FACHE