- The latest report cards from the American Telemedicine Association show an upswing in support for telemedicine across the country, with a few bumps in the road.
The ATA’s reports – one focused on coverage and reimbursement and the other covering physician standards and licensure – show more passing grades for states than in years past. But some states are still making it difficult for providers to embrace telemedicine, and the fact that each state has its own rules is just adding to the confusion.
In a press release accompanying the reports, ATA officials focused on the positives, and said telemedicine is gaining momentum.
“There is promising news overall for patients, providers and businesses using telemedicine and other digital health platforms,” said Latoya Thomas, director of the ATA’s State Policy Resource Center. “These reports show that insurers, state lawmakers and Medicaid agencies see telemedicine, and other digital health platforms, as affordable and convenient solutions to bridge the provider shortage gap and enhance access to quality healthcare services.”
“As federal and state lawmakers reevaluate the current health policy environment, they cannot ignore telemedicine’s potential as a valuable and cost saving tool,” added Gary Capistrant, the organization’s chief policy officer.
In the 110-page telemedicine coverage and reimbursement report, seven states – Connecticut, Florida, Hawaii, Idaho, Rhode Island, Utah and West Virginia – have improved their grades in the past year with telemedicine-friendly legislation, while Delaware, South Carolina and the District of Columbia took a step backward with more restrictive policies or reduced coverage.
Since the ATA began issuing annual report cards in 2014, 10 states have added telemedicine parity laws, and for the first time every state offers some form of coverage for telemedicine in its Medicaid program – though New Hampshire gets a failing grade because its Medicaid telemedicine coverage is similar to Medicare’s overly restrictive language. Twelve years ago, the number of states offering coverage for some type of telemedicine was only 24.
According to the ATA report:
- Twenty-one states now cover remote patient monitoring.
- Fifteen states cover store-and-forward, or asynchronous telemedicine.
- Five states – Idaho, Missouri, New York, North Carolina and South Carolina – prohibit telemedicine via cellphone video.
- Nineteen states don’t specify the type of healthcare provider allowed to use telemedicine, enabling specialists to take advantage of digital health platforms. The most popular forms of specialist telehealth services currently are telemental health, teledentistry, telerehabilitation and substance abuse counseling.
- 16 states and the District of Columbia permit only nine healthcare provider types or less to use telemedicine.
- Montana allows only physicians to use telemedicine.
- Twenty-seven states and the District of Columbia require patient consent prior to using telemedicine.
- Thirty-four states do not require a telepresenter to be with the patient during a telemedicine visit.
The ATA tempered its conclusion with a nod toward ongoing barriers.
“While there are some states with exemplary telemedicine policies, lack of enforcement and general awareness have led to a lag in provider participation. Ultimately these pioneering telemedicine reforms have trouble reaching their true potential,” the report concluded.
(Ironically, that exact same wording was used in last year’s ATA report cards, as was the comment that the nation, on a whole, is accepting telemedicine with “strides and stagnation.”)
“Other areas of concern include states that have adopted policies which are limiting in scope or prevent providers and patients from realizing the full benefits of telemedicine,” this year’s report card also stated. “Specifically, artificial barriers such as geographic discrimination and restrictions on provider and patient settings and technology type are harmful and counterproductive.”
Overall, the ATA gave nine states an “A” for coverage and reimbursement, while 33 states received a “B” and eight states scored a “C.” The two states that had scared an “F” in last year’s report card, Connecticut and Rhode Island, moved up to a “C.”
The ATA also saw some concern in how states are handling licensure and practice standards. According to the 89-page report, more states are getting better grades, but no state is getting an “A.” Altogether, 25 states considered proposals to revise standards and licensure requirements during the past year.
“More notably a few state medical boards are adopting practice standards with different, and sometimes higher, specifications for telemedicine than in-person care,” the report noted. “Specifically, these boards have considered legal guidelines requiring an initial examination be conducted in-person and a physician-patient relationship be established in-person. Boards have also considered other telemedicine barriers including requirements for a telepresenter, in-person follow up exam, and additional patient informed consent. These decisions leave telemedicine providers no choice but to navigate the medical practice laws in their state or risk punitive action by their board.”
Finally, the ATA praised the Federation of State Medical Boards’ proposed Interstate Medical Licensure Compact, which would give clinicians an expedited licensing process to practice in multiple states; 18 states have signed on to the compact, which becomes active this year.
“Licensure portability, the ability for healthcare providers to practice out-of-state using one license, is a contentious issue for healthcare providers whether services are deployed via telemedicine or not,” the ATA pointed out in its report. “Most states require that a physician is licensed in the state where their patient is located. Yet, a state’s unwillingness to adopt a policy enabling licensure portability prevents people from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line.”
Altogether, 21 states scored an “A,” while 28 states received a “B” and Texas scared a “C” in composite grades for physician practice standards and licensure. The composite grade was based on grades given to each state for its policies on physician-patient encounters, telepresenters, informed consent and licensed and out-of-state practice.
And while Texas ranks at the bottom of the curve, as it did last year, it’s worth noting that state lawmakers are reportedly close to introducing compromise legislation that would improve access to and coverage of telemedicine in the Lone Star State.