The rapid expansion of teledermatology and AADA standards
Answers in Practice
By Faiza Wasif, MPH, Associate Director, Practice Management, August 1, 2022
Each month, DermWorld tackles issues “in practice” for dermatologists. This month, practice management staff offer tips on teledermatology and AADA standards.
Teledermatology has become one of the most common applications of electronic health visits and telemedicine. While initially utilized as a means of providing dermatologic care to rural areas underserved by dermatologists, teledermatology has quickly grown to become an essential part of care delivery, particularly during the COVID-19 public health emergency. As such, the Academy knows the importance of developing standards for this rapidly expanding field to ensure dermatologists provide high-quality patient care while operating efficient, effective practices.
Developed by the Academy's Teledermatology Task Force at the direction of the Board of Directors, these standards expand upon the appropriate use of telemedicine and create a core set of standards for the Academy to advocate for responsible telemedicine platform technology and telehealth reimbursement. Further, they are based on the following core principles summarized from the Academy’s Teledermatology Position Statement:
The Academy supports the use of telemedicine services provided by board-certified dermatologists, as well as coverage and payment for those services, when several important criteria — noted in the full position statement — are met. The Academy supports teledermatology services designed and dedicated to consistently provide demonstrably high-quality patient care.
The Academy believes that when creating directories of participating physicians or establishing network adequacy, an insurer should not consider telehealth access as a substitute for locally available dermatologists who can provide in-person care and offer the full spectrum of medical and surgical care for skin diseases.
The Academy strongly supports fair and equitable coverage and payment for direct-to-patient and provider-provider consultative telemedicine services provided by board-certified dermatologists when several important criteria — noted in the AADA’s teledermatology position statement — are met.
Patient choice is critical, and patients should be allowed the option to access in-person dermatology services in addition to virtual services when appropriate.
AAD/A position statements
Check out the Academy’s position statements.
The standards were published in the AADA Practice Management Center’s Teledermatology Toolkit in January 2022 and address the following more specifically:
Access to board-certified dermatologists: Patients should have access to care directed by a board-certified dermatologist.
Expanded reimbursement of telemedicine: Telehealth codes should be evaluated by the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) and CPT process.
Patient choice: In-person care should always be offered in addition to virtual services.
Physician-patient relationship: Establish a relationship with each patient before offering direct-to-patient virtual care when possible.
Physician-physician relationship: Physician-to-physician consultative telemedicine services should be utilized and reimbursed to improve access to specialists’ advice for specific patient care questions.
Prescriptions: Platforms should allow for collection of adequate history and physical examination before allowing the prescribing of medications.
Licensure: Platforms should ensure that physicians and non-physician clinicians establish appropriate licensure in the state in which the patient receives virtual services.
Scope of practice: Physicians and non-physician clinicians using teledermatology platforms should abide by the AADA’s supervision recommendations as noted in the Academy’s position statement on the Practice of Dermatology.
Quality assurance: Physicians and non-physician clinicians who participate in teledermatology care take and document ongoing quality assurance training.
Liability: Consulting dermatologists or non-physician clinicians practicing teledermatology ensure they have appropriate and adequate liability coverage for virtual care.
Platform requirements: Teledermatology platforms should offer the ability to collect and review the patient’s medical history and document details of the encounter during the virtual visit; be HIPAA-compliant; have a high-resolution video camera and monitor for live-interactive sessions; and audio-only visits should be accommodated for established patients for which images are not needed. And patients should use a digital camera with a minimum of 800 x 600 pixels resolution for store-and-forward teledermatology.
Payer requirements: Payers should not abandon maximum time and distance standards when determining physician network adequacy; should not offer virtual access alone without an option to obtain in-person care; and should provide covered network access to a board-certified dermatologist in-person when needed.
Direct-to-consumer teledermatology: The AADA does not support teledermatology services that prioritize business interests over the quality and safety of patient care, such as platforms that are not supervised by board-certified dermatologists or do not offer any option for patients to be seen in-person by a board-certified dermatologist when needed.
In addition to developing and publishing these standards, the Academy is now poised to communicate and disseminate them to stakeholders who have a direct impact on long-term sustainability of the teledermatology gains made during the pandemic. These stakeholders include private payers, electronic health record (EHR) vendors, and policymakers. Each plays a vital role in further expanding the reach of teledermatology as well as ensuring these standards become common practice.
As early adopters of telemedicine, dermatologists have led the effort of responsibly implementing virtual care. In doing so, they are not only providing uninterrupted, valuable care for patients but also increasing flexibility for dermatologists which in turn reduces the risk of burnout. And they are paving the way for potential future models of care which may include a hybrid approach that allows for greater access and patient accommodation. Be sure to visit the AADA Practice Management Center’s Teledermatology Toolkit to review the standards and access numerous other teledermatology resources.
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