Joint Commission ditches ambulatory telemedicine rules

"It's strange to get an email from the Joint Commission," said Nathaniel Lacktman, a healthcare lawyer with Foley and Lardner. But that's exactly what happened on September 14, two days after he posted a blog about the Joint Commission's proposed telehealth standards.

Standards for ambulatory and hospital settings were proposed in May and "flew under the radar," Lacktman said. "I thought they were really poorly drafted and not beneficial to patients or telemedicine providers," he said, "so I wrote a blog about it."

The standards would have required providers who use direct-to-patient telemedicine to confirm the patient's location so it could pair the patient with a provider who meets licensing requirements and regulations, and to discuss treatment—including the medium (video, telephone, and so on)—during the informed consent process.

Currently, there are no federal rules in place for telemedicine, so the task of regulating it has fallen to the states, whose requirements vary. The Joint Commission's standards, Lacktman said, would almost function as federal rules because 77% of healthcare organizations in the U.S. are accredited by the Joint Commission.

Two days after the post went up, Lacktman received the first of a series of emails from the accreditor. First, the Joint Commission asked for a clarification that would say that the field review period had closed for the standards and that the standards were no longer under consideration. Later that day, they sent another email with a slightly different message saying that the public comment period had already passed and the Joint Commission would no longer be moving forward with the ambulatory standards but would welcome comments nevertheless (despite the closed public comment period). The Joint Commission didn't mention the hospital standards, but Lacktman suggested that might have just been a slip in the editor's note and that the intent seems to be to go back to the drawing board overall.

The Joint Commission, for its part, told Modern Healthcare that it decided not to pursue any of the new standards after receiving feedback from a technical advisory panel, standards review panel, and online field survey, which showed that existing requirements were sufficient. The Joint Commission also reviewed those requirements itself, and realized that it had already addressed "many of the quality and safety concerns" related to telehealth in existing standards. The standards, which had been posted on the Joint Commission's website, are no longer searchable.

Lacktman suspects that, in part, the Joint Commission decided not to move forward because of industry reaction. "They must've been getting some real heat," he said. "The last thing telemedicine providers want," he said, "are more rules and regulations that don't push the ball forward for innovations in access to high-quality care."

Telemedicine standards and rules are important because they would ensure that the same quality of care that's given in person is extended into the virtual realm. Telemdicine companies, like Teladoc, have tended to ask for more lax, rather than stricter, regulations—as was the case in Texas, where Teladoc is now allowed to operate after the state ditched a rule that made providers and patients meet in person before virtual care could be administered.

The American Medical Association has also been active lately with regard to virtual care. The organization just published new billing codes for web-based consultations and remote monitoring, which would allow providers to bill for remotely keeping an eye on certain patient metrics, like blood pressure and weight.