NPs Role in Telehealth Protection

Telehealth may offer a range of new opportunities for nurse practitioners (NPs) looking to provide accessible, affordable dermatologic services and grow their practice. However, that potential comes with certain risks. Susan Kendig, WHNP, JD, outlined key issues that need to be addressed to optimize this service platform in her session on legal issues presented at the 3rd annual Society of Dermatology Nurse Practitioners Symposium, held April 23 to 24, in Nashville, Tennessee.

“Face-to-face consults are still the gold standard for consultations, but telehealth really does work,” said Kendig, a women’s health integration specialist at SSM Health-St. Mary’s Hospital, St. Louis, Missouri, and director of policy for the National Association of Nurse Practitioners in Women’s Health in Washington, DC. “The caveat is that you have to be careful with it [telehealth].”

Her list of precautions included:

• Know the regulations. First, determine whether your state scope of practice regulations allows NPs to be telemedicine providers. If so, get a clear understanding of the rules and regulations that define how NPs can practice as telehealth providers. Update your knowledge regularly. For example, some states are now reviewing the scope of practice in terms of where the provider is practicing (at home vs in a practice setting) as well as what NPs are allowed to do. Federal requirements are also in flux. During the pandemic, Medicare allowed medical professionals to use telephonic communications. Now, it generally requires a way to visualize the patient, Kendig noted.
• Review state licensure requirements before launching a telehealth service that crosses state lines. “There are different rules and regulations about how NPs engage in telemedicine across state lines,” Kendig said. “These are really important because many malpractice insurance plans will not cover you if you are engaged in unlicensed activities. You also may have to have a rider to add coverage for telemedicine.” She also pointed to some best-practices to mitigate risk of unlicensed practice—including stopping patients from sending photos across state lines.
• Document and discuss each intervention. “You need to communicate each step of the treatment plan in writing as well as verbally,” Kendig said. “You also need to document that you have done so. You cannot guarantee that the patient will understand completely, but the documentation is important—many of the lawsuits I examined had a complaint that the patient was not aware of what might happen.
• Learn when to look for “zebras.” Kendig cautioned against anchoring biases and diagnosing based on prior experience. She warned not to jump to conclusions that a patient may have an unusual condition, but to watch for these signs to consider a different diagnosis.
• Make sure to record training. This is not a best practice specific to telehealth, but Kendig pointed out that it is not enough to learn new skills. It is worth documenting the method of training—mentorship, certification—and the number of procedures performed.

Reference:

Kendig S. Legal considerations for dermatology NPs. Presented at: 3rd annual Society of Dermatology Nurse Practitioners Symposium; held April 23-24, 2022, in Nashville, TN.