Virtual Visits

[GMM2019]

I started a new job fairly recently... the training process has been going well. However, it seems like the plan for me includes a few clinic sessions dedicated to just virtual visits. Of course, no one mentioned this to me during the interview process. I'm kind of bummed out... I don't mind doing the occasional virtual visit, but I don't really want to do a series of these 15 minute visits in a row, one after the other. In a typical schedule for me, I'd cap out at 8 patients per session, but these virtual visits could bring me up to 16 per session. I'm told that these visits are mainly just for established patients with a prior normal exam, like migraine patients, and usually just include refills.

Does anyone else do virtual visits, and what do you think about it? 

I'm being told by physicians that virtual visits can be done across state lines, but I don't know if that applies to me too. Does anyone know about this issue as it relates to PAs? Will I get into legal trouble if I see a patient via video chat who is in another state, without a license for that state? I'm not sure how to double check this and I don't want to risk my license. 

For those that do virtual visits, do you ever order labs or imaging after a consult with these patients? In my specialty, I don't really feel comfortable with getting any testing unless I've seen someone in person. Plus, if someone needs further testing, I feel like they SHOULD be seen in person first. 

Any advice on how to protect myself, legally, with these virtual visits? Like any words of wisdom for the documentation? I come from more of an emergency med background, so consultations with patients via video screen still seems crazy to me. 

This isn't really the way I wanted to practice, but I don't have much negotiating power currently.

 

Edited January 23, 2020 by GMM2019

[ohiovolffemtp]

Not sure how that works - I would check with the medical boards in both the state where you reside and the state where the patient is located.  I do know that radiologists that do remote reading for images taken in a different state need a license in the state where the images were taken.

[thinkertdm]

-check with your institutions legal/quality assurance department about how to protect the clinic (and yourself).  

-check out the Ryan haight act.  Personally, I would recommend never prescribing controlled substances over the internet.  

-have a low threshold for referring back to primary care or to the ed.   

-billing only requires two of three elements, so for billing-you may or may not need much in way of a physical exam.  

-you can also bill for time, especially if it is for a follow up.

-get a phone number in case of equipment malfunction.  

-end each call (and document this) that you advised ed follow up for worsening of the condition 

-I would document your thought process (based on the patient reporting x, and denial of y, I suspect z, low suspicion of b, but cannot move forward with more in depth testing due to this being a telehealth  appt.  I discussed my thoughts with mrs yabba, including the need to follow up with her primary care provider if l,m,n present or symptoms worsen.  I offered to help facilitate scheduling with a provider for follow up)

a bit of documentation now may save your bacon later.