NCMB recently updated two important position statements – Telemedicine and Policy for the Use of Opioids for the Treatment of Pain.
Due to continued enhancements and increased utilization of telemedicine, the Board voted to revisit its Telemedicine position statement in a year, in or around September 2024, to ensure it includes the most up-to-date guidance.
The Board also voted to revisit the opioid position statement after the Federation of State Medical Boards finalizes its draft Strategies for Prescribing Opioids for the Management of Pain policy in May 2024, to consider if additional revisions should be made to the position statement.
Telemedicine
NCMB initially adopted its Telemedicine position statement in 2010, at a time when few NCMB-licensed physicians and PAs had incorporated telemedicine into their practices. The Board reviewed and made minor revisions to the position in 2014 and 2019. Then, in 2020, our state saw telemedicine use mushroom almost instantly in response to the coronavirus pandemic. NCMB’s 2023 Licensee Survey documented our state’s rapid embrace of telehealth, finding that telemedicine use among NCMB licensees soared to 77 percent during the COVID-19 pandemic, up from 16 percent telemedicine use pre-pandemic. The survey documented current telemedicine use at 64 percent.
With telemedicine now a regular feature for a majority of licensees, NCMB saw a need to significantly expand the Telemedicine position statement to address multiple questions and issues that have arisen regarding telemedicine practice. NCMB requested and received input from licensees, telemedicine industry leaders and other stakeholders, which was incorporated in the final version of the updated position statement approved in September. New content in the position statement includes:
• Clarification on when a telemedicine provider treating patients located in North Carolina should be licensed to practice in North Carolina, and when a provider is exempt. Exemptions include 1. Provider-to-provider consultations across state lines where a North Carolina licensee retains responsibility for the North Carolina patients and 2. Episodic follow-up care for patients who are in North Carolina temporarily but have an established clinician-patient relationship with a provider in another state. The latter exemption would cover patients attending college or vacationing in North Carolina.
• Expanded guidance on prescribing to patients after telemedicine consultation
• A new section on the sale of goods or products to patients following a telemedicine consultation
• A new section on continuity of care and referral in emergent situations
Policy for the Use of Opioids for the Treatment of Pain
NCMB adopted the 2016 CDC Clinical Practice Guideline for Prescribing Opioids for Pain in early 2017. CDC updated this document in 2022, providing additional guidance on the intent of the guideline and how it should be used in providing patient care. At its September Board Meeting, NCMB updated its position statement to reflect that the Board recommends the 2022 CDC Guideline as a resource for licensees who prescribe opioids for pain. The position notes that the 2022 version emphasizes the following key aspects of providing pain management care:
• Providing individualized pain care in the setting of a complete assessment of the risks vs. benefits of all available treatment modalities, including but not limited to opioids
• Incorporating patient input into the choice of the various modalities used to treat a given patient’s pain needs using shared decision-making
• Maximizing multimodal therapies for a given patient’s pain care, which could reduce the need for opioid therapy
• Refraining from abruptly discontinuing or rapidly tapering chronic opioid therapy for those patients already on long-term therapy
• Thoroughly documenting the decision-making process behind the initiation, continuation or discontinuation of opioids for any given patient
Read the revised position statements: