Mississippi nephrologists urge guardrails for tele‑nephrology; board asks staff to review subspecialty telemedicine rules

A delegation from the Mississippi Kidney Council told the State Board of Medical Licensure May 22 that emerging telemedicine and value‑based care organizations are contracting with commercial payers to manage chronic kidney disease remotely and that states must guard against remote models that never see patients in person.

Mark Philippi and other nephrologists said the threat is that a for‑profit value organization could manage patients by telephone or asynchronous checklists and claim care management without providing in‑person evaluation or hospital coverage. They argued that some commercial tele‑nephrology models stop short of responsibilities that local nephrologists now assume, including unreferred inpatient hospital call and treatment of Medicare/Medicaid patients.

Council members recommended a simple standard — an in‑person visit at least once a year for subspecialty internal medicine patients (they suggested applying it first to nephrology and similar practices) — to protect continuity of care and preserve relationships that inform critical decisions, such as start‑of‑dialysis timing and transplant referral. Members cited Medicare rules that already require periodic in‑person encounters for patients on dialysis as a precedent for stronger minimum standards.

Board members and staff responded that the board could open a broader rule review to consider telemedicine and interstate practice risks and asked staff to prepare recommended regulatory language. Executive Director Ken Cleveland said staff can research internal medicine subspecialty options and draft language for the rules and regulations committee; the board agreed the subject warranted a longer regulatory review. No immediate rule was adopted at the meeting.