The policy dimensions, regulatory landscape, and market characteristics of teledermatology in the United States

Abstract

The COVID-19 pandemic has spurred healthcare systems across the world to rapidly redesign their models of care delivery. As such, this pandemic has accelerated the adoption of teledermatology in the United States. However, it remains unknown whether this momentum will be maintained after the pandemic. The future of teledermatology in the United States will be significantly influenced by a complex set of policy, legal, and regulatory frameworks. An understanding of these frameworks will help dermatologists more effectively adopt and implement teledermatology platforms. In this article, we review the current state of teledermatology in the United States, including policy dimensions, the regulatory landscape, market characteristics, and future directions.

Teledermatology During COVID-19: An Updated Review

“…This payment parity has reversed the side effect of decreased physician compensation for TD services. In addition to saving money, asynchronous TD visits are generally shorter than in-person appointments, saving waiting and visit times for the patient and allowing physicians to schedule more appointments [ 13 ]. Although shorter visits are thought to sacrifice quality of care, TD appointments are thorough due to the fact that store-and-forward TD allows physicians to review patient photos and history before their visit [ 2 ].…”

“…Unlike the aforementioned challenges faced by TD, the legal barrier of malpractice associated with telemedicine has not been resolved with the COVID-19 pandemic. With the increasing popularity of practicing telemedicine across state lines during COVID-19 [ 13 ], it is important to note that not all malpractice insurance covers telemedicine, and some malpractice insurance does not cover practice across state lines [ 53 ]. A common lack in malpractice insurance forces dermatologists to confront the medical liability risks of TD.…”

“…Historically, dermatologists in the US have faced challenges regarding reimbursement, as TD reimbursement policies traditionally vary from state to state [50]. Overall, Medicare reimbursement is typically US$15 for virtual patient check-ins, compared with US$22-$148 for in-person visits, depending on the level of care [13]. The reduced reimbursement for TD visits has generally driven clinicians away from practicing virtual care before the pandemic.…”

The Impact of COVID-19 on Teledermatology

“…In all states, laws were relaxed that required that telemedicine physicians had preexisting in-person relationships with patients before any prescription could be written for patients following virtual visits ( 9 ). Some states have even relaxed or eliminated interstate licensure limits which barred physicians from providing care to patients who lived outside of their jurisdictions, thus providing patients with increased options for care ( 12 ). For example, New Jersey provided a temporary waiver of telemedicine rules to allow for out of state licensed physicians to continue, and perhaps expand, patient care ( 13 ).…”

“…encryption), but with COVID-19 policy relaxations, the necessity of HIPAA-compliance was reduced. Specifically, CMS waived enforcement of HIPAA health privacy violations against providers acting in good faith ( 12 , 14 , 15 ). Many platforms for telemedicine visits had previously opted out of these agreements, which left the liability for security and privacy breaches solely on the physician ( 14 ).…”