United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons

Abstract

Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons’ familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.

Positive impact of the pandemic: the effect of post–COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center

“…5,12,19 Consequently, telehealth may have utility that scales in proportion to the degree to which the physical examination versus clinical prodrome dictates surgical candidacy. 9 Additionally, ongoing concerns about data security carry with them commensurate risks of patient privacy compromise. 5,9,19 Many patients also have limited access to or skill with the technologies employed in telehealth, and so they may be unable to take advantage of these platforms.…”

“…9 Additionally, ongoing concerns about data security carry with them commensurate risks of patient privacy compromise. 5,9,19 Many patients also have limited access to or skill with the technologies employed in telehealth, and so they may be unable to take advantage of these platforms. 9,19 These patients often live in more rural regions with more limited access to neurosurgical care and are therefore the patients most likely to benefit from telemedicine consultation.…”

“…This is particularly true for neurosurgical pathologies, many of which benefit from semi-urgent management. 8 The increased availability of telehealth services 7,9 serves as one potential solution that can help to enable delivery of care while limiting the spread of COVID-19.…”

Remote neuro-endovascular consultation using a secure telemedicine system: A feasibility study

“…Several studies have shown that telemedicine is effective in the management of stroke care. [ 3 - 5 , 8 , 9 ] Under COVID-19 conditions, hospital regulations sometimes prohibit technical support from senior neuroendovascular specialists outside the hospital. In addition, the rapid expansion of acute ischemic stroke therapy imposes further work tasks on experienced neuro-endovascular specialists.…”

Reply to GSJ Letter to Editor: Telemedicine in Spine Surgery: Global Perspectives and Practices

“… 3 Many of these mandates are, however, temporary, and several questions remain unanswered. 9 , 10 Collaboration between policymakers, institutions, insurance companies, and healthcare providers is necessary to clarify the legal landscape.…”