- New Jersey’s landmark telemedicine legislation could be running into a roadblock.
The New Jersey General Assembly’s Appropriations Committee has amended Assembly Bill 1464 to limit to three years the provision that telemedicine be an accepted means of establishing the doctor-patient relationship. After that, the legislation would require physicians and their new patient to first meet in person before moving to a telehealth platform.
The change was pushed by physicians’ groups who fear telemedicine – especially large telemedicine companies from out-of-state – will hurt solo physicians and small practices.
That amendment caught the eye of the ERISA Industry Committee (ERIC), a national association that advocates exclusively for large employers on health, retirement and compensation public policies. The committee had presented written testimony in favor of the bill prior to a June 12 public hearing, but withdrew its support on June 16 after reviewing the amended bill.
“[T]hree years after enactment, this legislation would now become a major impediment to patients who wish to use telemedicine, rather than a step forward in expanding access,” Adam J. Greathouse, an associate in health policy for ERIC, said in a written addendum to New Jersey’s General Assembly Appropriations Committee. “This new provision actually makes the legislation worse than the status quo. If that sunset provision remains in the bill, major employers can no longer support it, and members of the Assembly should not advance ACS 1464.”
The doctor-patient relationship is a tricky issue in telemedicine, with some physicians and physicians’ groups arguing that a doctor should meet in person with a new patient before switching to telehealth. The debate clogged efforts by the American Medical Association to draft ethical rules for telemedicine until last year, until the organization OK’d a document that’s favorable to telehealth.
With its passage of new telemedicine regulations earlier this year, Texas became the last state to specifically do away with laws requiring doctors and first-time patients to meet in person before using telehealth. The move pleased telemedicine advocates who argued the in-person requirement prevents underserved populations from accessing telehealth.
“Telemedicine minimizes the time spent attending a healthcare provider visit, making telehealth a great value to working parents, caregivers and others struggling to balance work and family demands,” Greathouse wrote. “It also provides access to care for rural and urban underserved populations, retirees, the elderly, disabled employees and those with language barriers, chronic conditions or transportation barriers that may otherwise not have access to care. These benefits of telemedicine will be greatly diminished if it can only be used by those with preexisting patient-provider relationships.”
“There are many people that do not have established relationships: people that have recently moved for work, college students, those in need of a specialist, or those that simply never have been to a healthcare provider,” he added. “The step forward in healthcare that telemedicine can provide will be unavailable to these individuals” if the bill is passed as amended.
The amended bill could endanger a sweeping set of telemedicine regulations poised to bring New Jersey in line with almost every other state.
Among other things, the bill would require state health plans and private plans that cover state employees to reimburse at the same rate as in-person care, and prevent those plans from mandating an in-person visit before telehealth use. It would also allow out-of-state healthcare providers to treat New Jersey residents via telehealth as long as they have a reciprocal medical license; New Jersey lawmakers enacted a rule in 2014 allowing doctors from other states to treat patients in New Jersey as long as the medical license they hold in their state aligns with New Jersey requirements.
The bill also directs the Board of Medical Examiners to study the Federal of State Medical Board’s Interstate Medical Licensure Compact, which establishes a streamlined licensing process for providers wishing to practice across state lines. Within six months of the bill’s passage into law, the board would issue a recommendation on whether New Jersey should join the compact.
The compact, which went live earlier this year, now comprises 18 states, with five more states – Maine, Rhode Island, Michigan, Texas and Tennessee – and the District of Columbia now contemplating legislation to join.
The bill specifically excludes “audio-only telephone conversation, electronic mail, instant messaging, phone text or facsimile transmission” from the definition of “telemedicine,” preventing phone-based telehealth consults and some store-and-forward services. On the other hand, two-way audio communication is allowed when combined with store-and-forward technology.
Several groups, including representatives from the Inspira Health Network, testified during the June 12 session that store-and-forward services should be allowed. This prompted some of the legislators to say they would be open to amending the legislation further down the road.
“From the outset of this legislation the ultimate goal has been expanding access to affordable healthcare while ensuring high-quality care and patient safety,” Lead Assembly sponsor Pamela Lampitt (D-Burlington) said, according to NJSpotlight.com. “While we sought to be as permissive as possible with the type of technologies that may be used, it was also important that we balance technology with the need to maintain standard of care.”