The first question you should ask the patient when scheduling and conducting a telehealth visit is where they are physically located – where their current state of residence is. Make certain to chart that patient statement clearly.
Posted in ND Insights Newsletter on Wednesday, October 28, 2020
If the patient is out of state and you are not licensed in that state, you should carefully consider the risk you are taking:
- If the patient’s home state does license naturopathic doctors and you are not licensed there, you would be wise to not offer any telehealth services there unless that state expressly allows out-of-state naturopathic telehealth services by law.
- If the patient’s home state does not license naturopathic doctors then you will be taking the same risk that you would be taking if you were physically present in an unlicensed state. Although you will not be investigated by a Board of Naturopathy in that state (since one does not exist), you could be by other boards for practicing medicine without a license. Risks related to malpractice are also the same as if you were physically present in the patient’s home state.
- Are you prepared to defend a suit in that state?
- Does your malpractice insurance cover it?
- Could you be prosecuted for practicing medicine without a license?
- If the patient is out of state and you are licensed in that state, you should know exactly what your scope of practice is in that state and whether you are limited in the services you can offer.
- Caution: During the COVID-19 pandemic, your state(s) may have loosened restrictions for cross state practice or expedited in-state licensure. These are temporary rules and they typically last only for the duration of the emergency.
- Be forewarned that telemedicine exceptions often have their own nuances and you must carefully understand the rules in each state.
- Example: The out-of-state telehealth exception may only apply to medical doctors (who have virtually the same scope of practice regardless of the state they are in), or in certain health care settings, or only for follow up care, or only for emergency care, etc.
- When utilizing telehealth in or out of state, it is important to determine whether there are rules from your governing agency, or even from paying insurance companies. These rules could include:
- Issues like what services you can and cannot offer.
- Whether there are additional documentation requirements (like start and stop time and recording requirements).
When using telehealth, make sure that all patient communications is protected and confidential and the platform you use is HIPAA compliant. Even if there exceptions in place (e.g., for the pandemic), they are temporary, and you shouldn’t wait to address patients’ long-term needs.
About the Author
Adina Matasaru, principal at Matasaru Law, PC, is an experienced attorney representing clients in complex malpractice defense and prevention, medical ethics and professional license defense. Matasaru has represented naturopathic physicians for more 17 years and is dedicated to the expansion and protection of the profession. She frequently volunteers as a speaker on risk management and medical ethics and advises various alternative healthcare institutions and associations. She is vice chair of the NUNM board of directors. Rebecca Tobias, senior paralegal at Matasaru Law, provided invaluable assistance