Last week, the American Medical Association (AMA) issued a new report regarding coverage of and payment for telemedicine (CMS Report 7-A-14). The report recognizes the telemedicine is a “key innovation in support of health bill reform, being used in initiatives to improve access to care, care coordination and quality, as well as reduce the rate of growth and healthcare spending”.

Given the pace of healthcare reform, it is slighting ironic that the AMA uses, as background for it’s new report, a report issued in 1996 by the Institute of Medicine (IOM) entitled “Telemedicine: A Guide to Assessing Telecommunications for Healthcare”.

The AMA report addresses the three major issues for telemedicine:

  1. Technology;
  2. Reimbursement coverage; and
  3. Licensing and the establishment of an appropriate physician-patient relationship.


The report states that there are now three broad categories of telemedicine technology:

  • Store and forward (asynchronous)
  • Remote monitoring
  • Interactive or synchronous (real-time) services

The report does not approve or disapprove the efficacy of any technology. I believe it is appropriate that the AMA leave the issue of appropriate technology to the States and to commercial and government insurers regarding reimbursement policies. However, I also think it is important that the AMA has acknowledged that telemedicine can be delivered in more ways than simply real time interactions.


The report summarizes the existing reimbursement options or programs and provides examples of reimbursement policies by various insurers. Those summaries are available in the report.

Licensing and Physician-Patient Relationship

The AMA, correctly, acknowledges that licensing should be an issue for the respective medical boards of the states and territories and imposes a single national federalized system of medical licensure.

The AMA states that “a valid patient-physician relationship must be established before the provision of telemedicine services” through:

  • A face-to-face examination “if a face-to-face encounter would otherwise be required in the provision of the same services not delivered via telemedicine”;
  • A consultation with another physician who has an ongoing physician-patient relationship;
  • Meeting standards of establishing a physician-patient relationship is part of evidence based clinical practice guidelines developed by major medical specialties.

I believe the AMA therefore supports the fact that a face-to-face consultation or patient encounter is not a prerequisite for providing telemedicine services in situations in which the relevant standard of care does not necessarily require an actual physical visit. The AMA recognizes that appropriate specialty societies could establish standards of care for the delivery of telemedicine.