Telemedicine rule draws fire

A proposed new rule governing the use of telemedicine in Georgia has sparked worries the regulation will hurt access to health care by limiting the ability of nurse practitioners and physician assistants to use the technology.

The Georgia Composite Medical Board, which licenses physicians, is set to vote on the rule Thursday. It would require that a patient be seen or examined by a physician in person or via electronic means before an advanced practice registered nurse or PA can provide care.

Telemedicine enables medical providers to share data and images using video or wireless technology, and make treatment decisions without in-person examinations.

For instance, a cardiologist in Atlanta can examine a 10-year-old heart patient in south Georgia using a high-definition video monitor. He can hear what the nurse hears via wireless Bluetooth technology that sends a signal to his stethoscope. A special camera that sends images to his screen may even help him see better than looking through the small hole of an instrument in person.

Telemedicine’s use has grown quickly, especially in rural areas where specialists may be hours away.

The idea behind the new rule is to ensure that mid-level providers such as nurse practictioners and PAs are being supervised by doctors familiar with using telemedicine technology, said Dr. Jean Rawlings Sumner, the board’s medical director.

“This is a new science, a new technology. You just want to … make sure it’s safe,” she said. “It’s about patient care and quality and safety.”

Taking a conservative approach with new technology is warranted, Sumner said. She added that the board certainly does not want the rule to hurt access to care and has an open mind.

Advocates argue requiring patients to first be seen by doctors will place an additional barrier on access to care and could actually harm patients if they aren’t able to get the care they need quickly enough.

“This is absurd because Georgia law does not require that in any other form of practice, so why would it be required in telemedicine,” said Debbie Hackman, CEO for the Georgia Nurses Association.

The growing use of telemedicine has been fueled by a shortage of doctors in Georgia and elsewhere.

The shortage is especially prevalent in rural areas, where patients may have to travel 50 to nearly 200 miles to see the closest doctor, Bill Rencher, health access program director for consumer advocacy group Georgia Watch, wrote in a letter to the board last month.

Georgia, which has roughly 20,000 doctors, is expected to need 5,000 more doctors than it will have by 2030. Meanwhile, the number of PAs and nurse practitioners have both jumped by close to 40 percent over the past five years.

Under Georgia law, doctors can’t delegate to nurse practitioners or PAs any care they are not licensed to provide themselves, Sumner said. The rule is a way to ensure that a nurse practitioner or PA using telemedicine technology is supervised by a doctor who knows how use it, she said.

But Rencher said the proposed rule goes beyong current law, which does not require that patients be seen by a doctor before a nurse or PA examines them.

He said the rule is also inconsistent with the Georgia Telemedicine Act, which is intended to expand, not limit, care in underserved areas.

Rencher said he considers the rule overkill, given that Georgia law already requires nurse practitioners and PAs to work within certain scope of practice. Mid-level providers must have a written agreement with a physician detailing what they can and cannot do.

Physicians are in the best position to decide what their mid-levels can do and need to be trusted, Rencher said.

Sumner, who supports telemedicine, said the composite board is reading comments on the rule and will keep listening.

“(Telemedicine is) a good thing,” she said. “It’s just about making sure the technology is used in ways patients are well cared for.”

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