The Feds Are Supporting Telemedicine

The Federation of State Medical Boards (FSMB) recently passed a model telehealth policy that promotes virtual visits for first-time encounter. This is notable for 2 reasons: first, many state medical boards liberally borrow from the federal boards, and second, this marks a shift from the old model in which patients were encouraged to see providers in person before engaging in telemedicine consults.

It’s encouraging to see the old, arbitrarily restrictive model fade, in favor of one where patients can begin building a relationship with their physician without travel. Indeed, people meet on the internet all the time; why can’t patients meet their care providers the same way?

The old model was arbitrarily limiting access to care, and thus driving up costs and driving down quality. Under the new model, patients should finally be able to login to a web service and be connected directly to a qualified physician that payers will cover. For telemedicine companies like American Well, Doctor on Demand, and others, this is a major coup.

This combination of technology and new guidelines will reduce ER visits, improve access, and ultimately reduce costs. Once it’s easy to get access to preventative medicine, patients will actually partake in preventative care. As a simple example to illustrate this, let’s examine my wellness check up habits.

I’m a healthy young male. I haven’t been to the doctor for a check up in close to a decade and have no intention of going. The process of booking an appointment, leaving my job that I love, and sitting in a waiting room are enough to deter me from ever going to the doctor. But if I could step into a private space and consult with a physician via a video consult for 15 minutes, I might actually get an annual check up. If the physician discovered something concerning and asked me to come, I would actually come in. But I would never come in for an in person visit without an explicit reason to. It’s not worth the pain and headache of going into the doctor’s office unless I have a reason to; the only way to achieve preventive medicine at scale is to make it easy for patients and providers alike.

Ambulances, ERs, and urgent care centers should expect a similar change in their operations. In these environments, specialists can now be reimbursed for first time consults with patients across a range of devices – iPhones, iPads, Androids, Macs, PCs, and even Google Glass. Neurologists can beam into ambulances for strokes, cardiologists for cardiac resuscitations, and trauma specialists for trauma cases. The opportunities are really endless, and my company, Pristine, is proud to lead the way in these new hyper-mobile telemedicine environments.

On the other hand, the new guidelines set forth by the FSMB aren’t all positive. Perhaps most perplexing, the FSMB did  not classify messaging and audio-only phone calls as telemedicine. They didn’t strictly forbid either activity, but they made it clear to payers and providers that live, synchronous video is necessary for reimbursement. In light of the shift to ACOs and value based models, this is perplexing. It’s been suggested that Kaiser Permanente and Group Health physicians reportedly spend up to 2 hours per day interacting with patients through asynchronous messaging.

Despite some setbacks in the new standards set forth by the FSMB, I’m incredibly excited about the future of telehealth across the continuum of care. The new model put forth by the FSMB is just the first of many steps toward a healthcare delivery system in which telemedicine powers the majority of care delivery across the country.

About the author

Kyle Samani

Kyle Samani

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at


  • My family care doctor knows me (my rotten insides :-)) like the back of his hand. This is good old care as we used to have.

    When I call him on the phone, 9 times of out 10, he knows what I’m going through, sometimes, he’ll just say I’m sending a prescription, go and pick it up.

    For me, telemedicine never went away, but I know I’m in the minority.

  • It is one thing to have a relationship with a physician and then call them with a problem, question or concern. It is another, to have never been examined or seen by a physician and expect treatment. Medicine has always been, and continues to, an art. How can the physician who has never seen you actually perform an exam or physical? He/she can’t! They are basing everything on your history only. However, physicians need a history AND a physical exam in order to treat you. Often patients “think” they know what is wrong and the exam is what really dictates care. If we want physicians to be nothing more than someone we talk with on the phone, they become a telemarketer who can write prescriptions. Only people who have never worked in healthcare would find this a good thing.

  • Kim,
    Your view is not shared by all healthcare providers. In fact, I’ve met many physicians who see the huge potential for telemedicine. It really depends on what you’re treating and the type of visit that you’re doing. We all agree that not everything can be done with telemedicine, but saying that nothing can be done using telemedicine misses what’s really happening with the technology and the change in how care will be provided in the future.

  • John,
    I think you misunderstood me. I do believe that there is a use for telemedicine, my problem is when anyone tries to dumb down the physician-patient relationship and the use information of a physical exam all together.

    Once there is an established relationship, lots of providers provide some form of telemedicine, which is fine since the provider has some idea about the patient’s history and a multitude of factors that would assist the provider in knowing that particular patient and when to be alarmed.

    There are some intial visits that could be done with telemedicine, such as a plastic surgery consult for a face lift. The patient is asking for opinion as to whether they are a candidate for a particular surgery, but no treatment is given or required.

    I would love to know how the author’s example of an annual check-up can be done without an examination for anyone who is the age brackett to require an annual physical. In other words, how can a “real” physical be done without a physical exam? That being said, I think a telephone call to your physcician when a woman has urgency, frequency and pressure, with past history of urinary tract infections is completely within what most physicians already do, which is call in a prescription.

    So, I do believe telemedicine has a place. But I disagree with young, healthy males, who have never worked in healthcare, love computers and technology, and have no understanding of what information patient interaction and examination can provide, that telemedicine is the answer. Sounds to me that the ones who benefit are the ones who create the programs and the insurance companies because they would prefer a telemedicine visit than a real visit due to cost – no matter the difference.

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