In new policy paper, ACP recommends that performance measures evaluating telemedicine visits adhere to the same criteria as in-person visits
April 21, 2023 (ACP) — Telemedicine use expanded significantly during the COVID-19 pandemic and is here to stay. Now, the question is how existing or new performance measures stack up in this setting.
The American College of Physicians seeks to frame this discussion in a policy paper published April 18 in the Annals of Internal Medicine. The paper focuses on telemedicine in an ambulatory care environment, including via audio and video visits.
“Telemedicine can be a significant benefit to patients, increasing access to care and allowing care to be provided more efficiently. However, as we begin to develop performance measures to evaluate how physicians are doing in performing those services, we need to make sure they are appropriate,” ACP President Dr. Ryan D. Mire said in a press release.
In the position paper, ACP recommends that performance measures that evaluate telemedicine visits adhere to the same criteria as in-person visits. ACP also recommends that existing measures for in-person visits be assessed to determine whether they are appropriate to cover telemedicine visits, and appropriate adjustments should be made and incorporated in the measure's specifications.
“If we are going to use performance measures in telehealth settings, we need to be thorough and look at them through the same lenses as we do for face-to-face settings,” said Dr. Caroline Goldzweig, an author on the paper and a member of the ACP Performance Measurement Committee. This committee assesses the validity of performance measures.
Some existing performance measures adequately capture the quality of care for both in-person and telemedicine physician visits, according to ACP. An example of an ideal quality indicator for both in-person and telemedicine visits is the existing measure to evaluate whether a patient with diabetes has a poorly controlled hemoglobin A1c level. As stated in the position paper, “A hemoglobin A1c greater than 9 percent is not acceptable regardless of the care setting, in-person or telemedicine.”
ACP also recommends that measures be tested for reliability and validity in the telemedicine environment and that they are attributed appropriately, whether to an individual physician, group practice, health system or health plan. “The College won't support a measure if it hasn't been tested adequately in the area it's measuring,” Goldzweig said. “If someone is proposing a new way of measuring quality but only tested at the group or health plan level, we will only support its use at those levels.”
A potential negative consequence of the telemedicine boom is further fragmentation in health care. “If patients are going all over the place to get care through telehealth or in-person visits, we must incorporate all of the data without adding to the administrative burden of a physician,” Goldzweig added.
ACP strongly recommends that telemedicine visits are incorporated into electronic health records systems, so these visits are not standalone encounters that could lead to further fragmentation of care delivery. As noted in the policy paper, some telemedicine companies are identifying ways to incorporate all patient data in one place, but more work is needed to improve continuity.
Physicians should be aware that their patients may be seeking care through telemedicine platforms, Goldzweig said. “Ask about types of interaction and ask that patients share any data that might come from these visits that could support their care,” she recommended.
ACP also recommends that measures be used to evaluate the impact of telemedicine on under-resourced communities that lack digital access.
Goldzweig added: “We want to hear from members about where they are having challenges and what they are seeing out there when it comes to telemedicine and quality of care.”
The position paper, “Performance Measures for Physicians Providing Clinical Care Using Telemedicine,” is available on the Annals of Internal Medicine website.