Although the advantages of telemedicine are many, including the ability to conduct initial consultations from a central location, its legality and parameters vary greatly from state to state.
“In our industry, technology moves much faster than the law itself, such as we have seen with microneedling and laser treatments,” says Alex Thiersch, J.D., founder and director of the American Med Spa Association (AmSpa) in Chicago.
Advancements in FaceTime, Skype and video conferencing make telemedicine accessible to practices for safe, effective and efficient consults. “However, most telemedicine laws were drafted more than 10 years ago, so they do not address these newer technologies,” Thiersch tells The Aesthetic Channel.
Because the risks and side effects of most medical spa procedures are minimal to none, “I think an argument can be made that a proper assessment and treatment plan could be created by a face-to-face screen consultation,” Thiersch says. “In fact, a handful of states allow for that. There are also a handful of other states that are considering it.”
Currently, telemedicine is generally allowed for existing patients, as long as the clinician is licensed in the state in which the patient resides. But the legality of telemedicine for new patients is largely in flux.
“Therefore, dermatologists [and other aesthetic providers] need to be cautious because the rule has not necessarily been settled,” Thiersch says. “It is, though, implicitly allowed in a few states like California; and Texas allows the physician-patient relationship to be established via telemedicine.”
Still, telemedicine typically cannot be conducted by a nonlicensed healthcare professional. “At a facility, it is far better to have at least someone in the room with the patient who is some sort of licensed professional, such as a nurse, who the doctor from a remote location can rely on to help with the examination,” Thiersch explains.
Most states, however, allow a physician from another state to examine a patient, if that patient is being cared for by a doctor within his or her state of residence. In other words, “A patient can consult with that out-of-state doctor because they are under the care of an in-state doctor,” Thiersch says.
The Interstate Medical Licensure Compact
To facilitate telemedicine nationally, the Interstate Medical Licensure Compact (IMLC) has been created by about 20 states to make it easier for doctors to communicate using telemedicine and to be licensed across state lines. “This represents a strong signal that the trend is moving in the direction of allowing this type of consultation,” Thiersch says.
The trend also encompasses medspas being able to schedule initial consultations at a main site. “This will allow doctors and, potentially, nurse practitioners or physician assistants to be more available to a higher volume of patients,” Thiersch observes. “Thus, if you have multiple facilities, you do not need to have a doctor traveling to each location to see new patients. They can simply be in one facility, on a computer, examining patients.”
Furthermore, telemedicine could permit physicians to better serve out-of-state communities that are rural or underserved. “However, physicians eligible for a Compact license must possess a full and unrestricted license to practice medicine in their primary Compact state,” Thiersch states. “Also, doctors cannot have been disciplined by any state medical board.”
The public also benefits because states are more easily able to share investigative and disciplinary information.
Thiersch advises medspa practices to move cautiously and to check with a qualified local healthcare attorney to ensure that they are abiding by state telemedicine laws. “Typically, it is the state medical board that determines policy, but these laws can vary immensely from state to state,” he says.