Virginia has been leading the way in the U.S. when it comes to telemedicine. It was one of the first states to introduce the complete parity law in 2010. As of 2011, telehealth practitioners can enjoy the full reimbursement for their services equal to that in standard practice.

Virginia officials recognized that the struggling healthcare system required a new model to face the challenges of the increasing need for medical care. The decision to support telehealth proved to be a wise one because Virginia, with its progressive telemedicine policy, seems to have an efficient approach to the national health crisis.

Although some improvements would help the development of telemedicine even further, Virginia can serve as an excellent example to other states. The benefits of remote patient care are too evident to ignore. The current emergency shows that reshaping of the national health system is long overdue.

The Benefits of Telemedicine

Medical professionals have been using technology for treatment and diagnostics for a while now. What telemedicine brought to the table is the idea that a traditional encounter between the doctor and the patient can have an alternative.

Virginia law defines telemedicine as the delivery of healthcare services by using electronic technology or media, including interactive audio or video for diagnosing or treating a patient, or consulting with another physician, while the involved parties are on distant sites. Telemedicine services don't include:

• Emails
• Audio-only calls
• Text messages
• Facsimile transmission
• Online questionnaires

By providing for requesting patients in remote locations, telehealth democratized healthcare. Many people gained better access to primary and specialist care. The patient experience increased with less travel time and the availability of additional services. The communication between the doctors and patients, as well as peer-to-peer consultations, became quicker and easier.

One of the most significant benefits was releasing the pressure off hospitals and other medical facilities. Via telehealth, doctors can determine which patient needs hospitalization or in-person visit, consequently reducing waiting hours and allowing better access to acute and emergency care to those that need it.

Decreasing the per-capita expenditures is also important because the costs for healthcare have been going through the roof lately. The U.S. healthcare system appears to be highly inefficient despite the enormous amounts of money that get poured into it every year.

Telemedicine and Telehealth in Virginia

There seems to be some confusion with the terms telemedicine and telehealth. No explicit federal definition exists that makes a distinction between them. Some states define telemedicine as strictly clinical practice, while telehealth is a broader term that includes health education and disease prevention.

Virginia officials do not differentiate between these two terms. The providers practicing in Virginia can use them as synonyms. Telemedicine does appear more often in legal documents, which implies that it is a more common word, at least among Virginians.

The Rules and Regulations of Telemedicine in Virginia

The Virginia Board of Medicine (VBM) provides extensive and precise guidelines for telemedicine providers. It focuses primarily on the key aspects of professional practice. The Board insists that the standards applying to the traditional model must be replicated in telehealth. With the patient's well-being and safety in mind, VBM advises how to practice telemedicine in full compliance with the current legislation.

Statutory parameters for telehealth do not exist, so the providers must respect all the rules and regulations of in-person practice. VBM's recommendations can serve as instructions on how to interpret these rules from the perspective of telemedicine.

The Board offers comprehensive answers to the most common questions regarding telemedicine practice:

1. Who is allowed to practice telemedicine in Virginia?
2. What is an appropriate doctor-patient relationship?
3. What is the adequate evaluation of the patient?
4. How to keep medical records properly?
5. Is the patient’s informed consent mandatory?
6. Can medication be prescribed via telehealth?
7. How to ensure data security and patient privacy?

Who is Allowed to Practice Telemedicine in Virginia?

Most legislatures, Virginia's included, consider the patient’s location as the place of the virtual visit. This means that the providers treating patients who are in Virginia at the time of the treatment must possess a valid license to practice medicine in Virginia.

Doctors who are based in Virginia and treat patients from other states must be licensed to practice at their patients' originating sites. Licensing might be complicated if providers care for patients in different states, or if they are located near the state borders. The Interstate Medical Licensure Compact (IMLC) is a program that strives to make cross-state licensing easier. Virginia has not joined IMLC yet.

The consultations between medical professionals are exempt from the licensing rule. The physician is allowed to seek advice or expertise of a colleague not licensed in the state. That way, unlicensed doctors can participate in the treatment of Virginia patients, but only if a licensed physician is the primary health provider.

What Is an Appropriate Doctor-Patient Relationship?

VBM recognizes telemedicine as a valid way of establishing a doctor-patient relationship. It does stress that all requirements must be met to provide the highest standard of care. All the state and federal laws that regulate this relationship in traditional practice apply to telehealth.

The Board recommends that the following steps should be taken prior to the initial virtual visit:

1. The doctor should verify the identity and the location of the requesting patient
2. The doctor must disclose their identity, location, and credentials, as well as the details about the delivery models, specifically stating any limitations
3. The patient should provide informed consent that they understand the treatment method and any potential risks

Since emails, texts, facsimile transmission, or audio-only technology are not appropriate telemedicine communication channels, the physician-patient relationship established through any of them is not valid.

What Is the Adequate Evaluation of the Patient?

Before the telemedicine treatment begins, the doctor should evaluate and assess the patient. According to VBM, the evaluation should consist of:

• Physical examination
• Analysis of clinical and medical history if it is available
• Setting diagnosis and identifying underlying conditions and possible contraindications to the recommended treatment

The standards applicable to traditional medical practice in Virginia must be met or exceeded in telemedicine. The evaluation should be appropriately documented. Telehealth evaluation and treatment conducted via emails, audio-only calls, text messages, and facsimile transmission do not meet the Virginia standards of care.

Is Informed Consent Mandatory?

Telemedicine providers in the State of Virginia must not start the treatment without informed consent from the patient. The document should consist of:

• Identification of the patient
• Verified information about the provider's identity and credentials
• Type of service that is allowed via telehealth
• Written agreement from the patient that the provider should determine whether the patient's condition is appropriate for telemedicine treatment
• Information about the security measures protecting the data during and after telemedicine encounters (password protection, encrypted files, etc.)
• Express permission from the patient to forward and share their data with third parties

The evidence of the patient's informed consent should be filed with their medical records.

How to Keep Medical Records Properly?

VBM insists that telemedicine providers must comply with the same rules that regulate traditional practice when it comes to keeping medical records. The physicians should keep clear and precise records on all their patients, not just regular ones.

The complete medical record should contain the following:

1. Complete patient-related communication, including doctor-patient communication, and peer-to-peer consulting if it happened during the treatment
2. All prescriptions issued to the patient
3. Laboratory and test results
4. Evaluations and instructions
5. Medical history and records of past care if they are available
6. Informed consent

Medical records should be available to the patient on request. The provider cannot forward the data to third parties without the approval from the recipient of care.

Can Medication Be Prescribed via Telehealth?

Telehealth providers can prescribe medication in Virginia. Online prescriptions are subject to all the state and federal laws that apply to traditional practice. The practitioner must consider the indication, safety, and appropriateness of each prescription. 

The Board advises the integration with e-Prescriptions to prevent errors. Controlled substances can be prescribed via telehealth, but certain drugs are subject to special federal legislation and restrictions may apply. Each electronic prescription should contain the details of the prescriber so that the pharmacist can contact the issuer for further clarification. The providers should not recommend particular pharmacies, or accept incentives from them in any way. 

How to Ensure Data Security and Patient Privacy? 

Confidentiality, privacy, and security are at the core of the doctor-patient relationship. Telemedicine practitioners must ensure that the information they possess is safe from any third-party breaches or loss. That is why the communication channels that are being used in telehealth practice must be HIPAA compliant. The medical information must be appropriately stored and protected with encryption and passwords.

VBM requires written protocols for documenting, maintaining, and transmitting all records of telemedicine visits. These procedures should address privacy, all medical personnel who will process the information, hours of operation, types of electronic transactions, necessary information regarding the patient, and mechanisms used for overseeing quality.

Reimbursement in Virginia

The parity law introduced in 2010 has been crucial for the development of telemedicine in Virginia. It mandated the coverage for telehealth services to private payers and Medicaid. The residents of the Old Dominion embraced the benefits of telemedicine, and it is one of the most popular models of practice in the state.

Private Payers

Private insurers should reimburse for live video telemedicine services in the same way they cover equaling services in a traditional practice. They are not allowed to refuse coverage solely because it is provided through telehealth.

The fees that apply must not exceed those of in-person treatment. Private payers are not obliged to reimburse for store-and-forward services but may include them in their insurance plans and packages. For store-and-forward services, an office visit between the provider and the recipient is mandatory. Medically necessary remote patient monitoring must be covered.

Eligible originating sites, according to Virginia parity law, are:

• Hospital
• Rural clinic
• Federally Qualified Health Center
• Physician’s office (or an office of other licensed health care providers)
• Community mental health center
• Skilled nursing facility
• Renal dialysis center (independent centers excluded)
• Home (or other location that the recipient considers appropriate)

There should be no difference between rural and urban originating sites when it comes to coverage by private payers.

Medicaid

Virginia Medicaid defines telemedicine and telehealth as real-time or near real-time exchange of medical data using an interactive audio/video communication for diagnosis and treatment.

The state-federal partnership reimburses for live telemedicine services, and it can cover store-and-forward or remote patient monitoring at its discretion. Congestive heart failure, cardiac arrhythmias, diabetes, anticoagulation treatment, and pulmonary diseases qualify as adequate for remote monitoring, according to Virginia Medicaid.

The state-federal partnership program allows the physicians residing outside state borders to offer telehealth services to Virginians as long as they have an appropriate medical license. Virginia Medicaid does not allow out-of-state providers to treat VA patients. The services will be reimbursed to continental U.S. practitioners exclusively.

The organization imposes some restrictions on the originating site, healthcare providers, and the type of services it covers. The following table should provide the necessary information.

The Right Platform for Telehealth in Virginia

The technology is vital in telemedicine practice. Choosing the right platform will allow the practitioner to enjoy all the benefits of telehealth. Allocating the resources better, admitting more patients, and minimizing the downtime are possible only if the software is reliable and effective.

It is important to opt for a user-friendly interface and HIPAA compliant communication tools, as well as to ensure that technical support is available in the case of malfunction.

We at Curogram, offer advanced two-way texting features, multi-user video chat, internal messaging system, and virtual clinics and waiting rooms. They are all designed to make telemedicine services efficient and secure.

Curogram’s front-desk suite provides all the necessary patient communication features, so the practitioners can:

• Reduce patient no-shows
• Improve patient satisfaction
• Increase patient traffic
• Reduce overhead expenses
• Minimize the wasted time on the phone

Our system integrates with all electronic health records (EHRs), so the resources can be directed to patient care instead of manual entries.

During the current national health crisis, Curogram is supporting the providers who decide to open testing sites. We offer comprehensive software and IT solutions that can help with scheduling and payment.

Telemedicine in Virginia During the COVID-19 Pandemic

Telehealth advocates are pushing two bills to expand the coverage for remote patient monitoring in the state of Virginia. Bill 1970 and Bill 1221 are yet to pass. These amendments would significantly improve access to care for many chronic patients in Virginia.

COVID-19 pandemic accelerated specific processes regarding the telehealth laws across the States, so many legislatures are seeking ways to expand the coverage for telemedicine as soon as possible. The initiative to allow interstate telemedicine services gained momentum as many states struggle to provide care for all requesting patients.

Virginia rebuffed the idea of suspending the regulations that barred practitioners from other states to practice telemedicine unless they have a valid medical license for the state of Virginia. Liability concerns are too great to ignore, and the state will not join this program, according to Virginia health officials.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.