PRACTICE MANAGEMENT By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff
A Review of Key Elements of NCMBs' Telehealth Position Statement with Post-Pandemic Considerations Over the past decade, significant advancements in medical and communications technologies have contributed to the increased use of telemedicine as a component of the practice of medicine. Its use throughout the COVID-19 pandemic helped expand access-to-care, reduce disease exposure to medical professionals and patients, and allowed for screening and management of persons who needed clinical care but would not come in person in compliance with state-issued travel restrictions, individual reluctance out of fear of potential exposure to COVID or otherwise had difficulty accessing in-person care. In an effort to make telemedicine more widely available during the public health emergency, both state and federal authorities made substantive modifications to many laws, rules, policies, and other regulations that govern the delivery of health care through telemedicine technologies. The changes significantly contributed to the growth in its use. Prior to the pandemic, telemedicine visits accounted for a small percentage of total care visits, but within the first six months of the declared public health emergency, total telemedicine visits increased by more than 2,000 percent. Since that time, the number of total telemedicine visits may have waned since the early stages of the pandemic, however, the increased familiarity with telemedicine for patients and providers alike signal
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significant continued use beyond the pandemic. North Carolina Medical Board Position Statement 5.4.1 Telemedicine serves as guidance to licensees and others on the appropriate use of telemedicine technologies for the delivery of medical care to patients located in the State of North Carolina. The Statement provides that the Board is cognizant that technological advances have made it possible for licensees to provide medical care to patients separated by a geographical distance if doing so is consistent with the applicable standard of care. And while standards of care continually shift based on the context in which medicine is practiced, the position statement clearly articulates those licensees providing care via telemedicine will be held to the same standard for care delivered through this modality as if the care was delivered in traditional in-person medical settings. The Board reviewed the Position Statement in March of 2021 made no substantive changes deeming the guidance to be sufficient in light of the growth in popularity and use during the COVID 19 public health emergency. Licensure- As provided in the Position Statement, [t]he Board deems the practice of medicine to occur in the state where the patient is located. Therefore, any licensee using telemedicine to regularly provide medical services to patients located in North Carolina should be licensed to practice medicine in North Carolina. Licensees need not reside in North Carolina if they have a valid, current North Carolina license. Care delivered via telemedicine is considered to be rendered at the physical location of the patient, and therefore, a provider to be appropriately licensed in state where the patient is located. Typically, there is an exception for episodic or follow-up care delivered to an established patient regardless of their location, as well as exceptions for consulting with physicians licensed in the patient’s location or special assessments prior to establishing the physician-patient relationship. A few states have adopted special telehealth licenses and during the pandemic many states have made specific excep-
The North Carolina Family Physician
