Telemedicine Checklist for Freestanding Emergency Centers in Texas

Telemedicine is being used in innovative ways in freestanding emergency centers (a.k.a. FECs or FSEDs) around the country. Still, providers must stay compliant with Texas law and federal telemedicine regulations.

How Is Telemedicine Used in the ER?

Emergency physicians are uniquely qualified to triage patients remotely and recommend the best setting for care, whether that is urgent care, primary care, or an emergency room, and provide life-saving intervention to someone who may not be able to travel for care.

Here are a few of the innovative ways freestanding emergency departments are serving patient communities, including:

• Tele-triage. Virtual patient triage can help ER physicians evaluate patients remotely, which reduces exposure, prevents unnecessary trips to the emergency room, and allows emergency centers to prioritize higher acuity cases.
• Tele-emergency care. In a hub-and-spoke arrangement, emergency providers in rural communities can connect with providers at “hub hospitals” to collaborate on the best possible care.
• Virtual rounds. Telehealth technology helps providers check on emergency patients remotely, minimizing their exposure to contagions and slowing the spread of certain illnesses. Virtual rounds also save time and conserve personal protective equipment (PPE).
• E-consults. Telemedicine helps emergency providers consult with specialists and get expert recommendations for patient care.
• Telehealth for follow-up care. Patients triaged through telehealth technology and not recommended for emergency care or patients recently discharged from the ER, can receive follow-up care remotely. Providers can monitor and assess the patient’s follow-up plan of care using audio or video technology, email, text messages, and even chatbots.

The U.S. Department of Health and Human Services (HHS) provides detailed information to healthcare providers about the latest federal efforts to support and promote virtual health care.

Telehealth Compliance Checklist for Freestanding Emergency Departments

Freestanding emergency departments (FEDs or FSEDs) practicing telehealth must comply with all relevant rules and regulations.

As you embark on or establish your telemedicine practice at a freestanding ER, compare your compliance plan against this telemedicine checklist:

• Practice informed consent and required disclosure by providing the patient with a notice of privacy practices (in English and Spanish) and obtaining a signed telemedicine consent form from the patient.
• Only allow licensed, authorized personnel to provide telemedicine services
• Uphold the same standard of care that would apply in an in-person setting
• Establish a practitioner-patient relationship inside or outside of the telemedicine appointment
• Always use an approved telemedicine method
• Keep complete and accurate telemedicine medical records
• Follow all applicable laws for prescribing, dispensing, delivering, or administering prescriptions and controlled substances
• Do not provide treatment or prescriptions for chronic pain (unless you are refilling an identical prescription, treating an established chronic pain patient, or you have seen your patient in person within the last 90 days)
• Never issue prescriptions for any drugs or devices that terminate a pregnancy (e.g., mifepristone and misoprostol)
• Maintain privacy and security under HIPAA Privacy and Security Rules

FSEDs may also need to work through additional challenges with corporate structure, billing, and reimbursement.

Please note that this list does not take into account temporary waivers of any telemedicine on account of the COVID-19 public health emergency.

Special Considerations for FEDs and Medicare & Medicaid Patients

During the COVID-19 crisis, the Centers for Medicare & Medicaid Services (CMS) gave independent freestanding emergency departments in certain states including Texas temporary permission to treat Medicare and Medicare patients. These additional flexibilities will remain in place throughout the COVID-19 public health emergency.

The healthcare attorneys at Hendershot Cowart P.C. have counseled countless providers and practices on compliance with both Texas and federal healthcare laws and regulations.

Whether you are a freestanding emergency center with an established telemedicine practice – or exploring your telehealth options – call us at (713) 909-7323 or contact us online to help ensure a foundation of compliance and sound business practices.