As telehealth expands, so too does the need for hospitals and other health care facilities (collectively “hospitals”) to credential telehealth providers. Commonly asked telehealth credentialing questions include the following: (a) are there particular requirements for credentialing telehealth providers as part of disaster privileging; and (b) must clinical privileging forms be specific to telehealth?
Earlier this week, the Joint Commission provided an updated FAQ touching on both questions. This FAQ can be accessed here. As part of its response, the Joint Commission states:
Licensed Independent Practitioners (“LIP”) CURRENTLY credentialed and privileged by the organization, who would now provide the same services via a telehealth link to patients, would not require any additional credentialing or privileging. The medical staff determines which services would be appropriate to be delivered via a telehealth link. There is no requirement that ‘telehealth’ be delineated as a separate privilege.
For volunteer LIPs that are NOT currently credentialed and privileged by the organization, disaster privileges may be granted to volunteer LIPs by following the requirements outlined in the Emergency Management chapter of the accreditation manual. (Emphasis added).
Although this FAQ suggests a fairly flexible approach to credentialing telehealth providers, hospitals will want to be mindful of certain considerations that will require a more deliberate approach to telehealth credentialing – both in the short term during the period of emergency and in the longer term as telehealth becomes a more permanent component of the clinical landscape.
- One universal truth in the provision of telehealth services is that providers must be able to comply with the same standard of care that would be applicable to in-person services. Not all clinical services can be provided virtually; certain services will still need to be provided in-person. Hospitals and health care providers should carefully vet what services are/are not appropriate for telehealth. These determinations should be outlined in an applicable telehealth policy or process. Any such limitations may also need to be reflected on applicable clinical privileging forms depending on the content of those forms.
- Similarly, some states and licensing boards, as well as payors, have placed limits on particular clinical services that may/may not be provided through telehealth. This is routinely true, for example, with respect to certain pain management services and related prescriptions. Such limits can also be found in various state emergency orders related to COVID-19. As above, health care providers should address these limitations as necessary in the applicable telehealth policy. Consideration should also be given to any conflicting content in the clinical privileging forms.
- Depending on the nature of the telehealth services to be provided, and the technology to be utilized, particular training is often required to effectively/safely provide telehealth services. These requirements should also be considered in relation to applicable telehealth policies and incorporated as necessary into related credentialing requirements/forms.
- In addition to general training, certain states and licensing boards also require other preconditions be satisfied prior to the provision of telehealth services. For example, multiple states require that psychologists enter into a written agreement with patients prior to the provision of telehealth services, addressing various matters such as the identification of behavioral health resources geographically proximate to the patient. While these requirements may not dictate a change to clinical privileging forms, they typically will require provider education and a process change to workflow that is unique to exercising those particular clinical privileges.
- Lastly, with respect to those health care providers who provide services exclusively through telehealth, hospitals and medical staffs should consider what changes, in the longer term, may be necessary to accommodate and/or differentiate such practice. Given the anticipated increased involvement of such providers, consideration should not only be given to delegated credentialing but also to appropriate staff category, opportunity for virtual involvement of such providers on the medical staff and other limitations/needs given the unique nature of this practice.
Telehealth is here to stay. While flexibility has been critical to ramp up these services quickly, hospitals and health care providers should begin to consider a longer term approach, and in so doing, should develop and amend governing documents, telehealth policies and credentialing forms accordingly.