Sync vs. A-Sync: Understanding the Two Types of Telehealth Good Faith Exams

The Good Faith Exam (GFE) is the non-negotiable first step in compliant medical aesthetic care. It’s the documented medical evaluation establishing the provider-patient relationship and confirming a treatment's appropriateness. Traditionally, this happened in person. But with the rise of telehealth, GFEs can now often be conducted remotely.

However, "telehealth GFE" isn't a single concept. There are two distinct models: Synchronous (Sync) and Asynchronous (A-Sync). Understanding the difference is critical, not just for workflow efficiency, but for ensuring you are operating legally within your state's specific regulations. Choosing the wrong model based on convenience over compliance can lead to serious penalties.

What is a Synchronous (Sync) GFE?

• The Concept: Real-time, live interaction between the provider and the patient using audio-visual technology.
• How it Works: Think of a standard video call (like Zoom, Doxy.me, or integrated EHR video features, ensuring HIPAA compliance). The provider (MD, NP, or PA under appropriate supervision) connects live with the patient. They discuss medical history, assess the patient's concerns visually via video, ask and answer questions in real-time, determine the treatment plan, and document the encounter.
• Pros:
  • Closest to In-Person: Allows for direct, dynamic conversation and visual assessment (within the limits of video quality).
  • Immediate Clarification: The provider can ask follow-up questions instantly based on the patient's responses or appearance.
  • Builds Rapport: The live interaction can help establish a stronger initial provider-patient connection.
• Cons:
  • Scheduling Dependency: Requires coordinating a specific time slot that works for both the busy provider and the patient.
  • Technology Reliability: Dependent on stable internet connections and functional video technology for both parties.
  • Time Commitment: Requires dedicated, uninterrupted time from the provider for the live call.

What is an Asynchronous (A-Sync) GFE?

• The Concept: "Store-and-forward" technology; the interaction does not happen in real-time.
• How it Works: The patient submits their information through a secure, HIPAA-compliant digital platform at their convenience. This typically includes detailed medical history questionnaires, high-quality photographs of the areas of concern, and potentially short videos demonstrating expression or movement. The provider then reviews this complete package of information at a later time, makes their medical determination, documents the assessment and plan, and communicates it back to the patient (often via secure message, email, or a brief follow-up call if needed).
• Pros:
  • Maximum Convenience: Patients and providers complete their respective parts whenever it fits their schedule. Highly efficient.
  • Thorough Information: Patients can take their time filling out forms accurately and providing high-quality images.
  • Efficient Provider Workflow: Allows providers to review multiple A-Sync exams in batches during dedicated administrative time.
• Cons:
  • Lack of Real-Time Interaction: No immediate back-and-forth Q&A. Clarifications require follow-up messages or calls.
  • Assessment Limitations: The provider's assessment is entirely dependent on the quality and completeness of the information and images submitted by the patient.
  • Potential for Miscommunication: The lack of live interaction can sometimes lead to misunderstandings if questions or instructions aren't perfectly clear.

The Deciding Factor: State Law is KING

Here is the most critical point: The legality and requirements for using Sync vs. A-Sync telehealth for GFEs vary significantly from state to state.

• Establishing the Relationship: Many states, including California, have specific regulations about how a provider-patient relationship can be established via telehealth, especially when it leads to a prescription or medical order (which includes aesthetic treatments). Often, these states require a synchronous (live video) interaction for the initial GFE to properly establish this relationship.
• A-Sync Restrictions: Some states may explicitly prohibit the use of A-Sync methods for the initial GFE, potentially allowing it only for follow-ups with established patients under certain conditions.
• Technology Standards: States may also have specific requirements for the security and functionality of the platforms used for both Sync and A-Sync telehealth.

You absolutely MUST consult your state's medical board, nursing board, and any specific telehealth regulations to determine what is permissible for conducting GFEs in your jurisdiction. Assuming that because the technology exists it must be legal is a dangerous gamble.

Making the Compliant Choice (with MedSpire's Guidance)

While A-Sync offers compelling convenience, compliance must always come first.

• Know Your State's Rules: This is non-negotiable.
• Choose Compliant Technology: Ensure any platform used meets HIPAA standards and state requirements.
• Document Meticulously: Regardless of the method, the GFE documentation must be thorough and meet all established medical record-keeping standards.

Navigating these state-specific telehealth rules is exactly where an expert partner becomes essential. MedSpire Health connects clinics with medical directors who are not only clinical experts but are also deeply knowledgeable about the specific regulatory landscape in states like California. Our partners help you implement GFE processes—whether in-person, Sync, or A-Sync (where legally allowed)—that are efficient and fully compliant, protecting your practice and your patients.

Ultimately, the goal of the GFE is patient safety and establishing appropriate care. Whether conducted live or via store-and-forward, the chosen method must uphold that standard and adhere strictly to the letter of the law in your state.