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Telemedicine Report Cards Offer Good, Bad News for States

The ATA's annual reports on each states telemedicine efforts show gains in coverage and reimbursement, but setbacks in standards and licensure

By Eric Wicklund

- More states are covering and reimbursing for telemedicine than ever before. Unfortunately, they’re also imposing stricter standards that frustrate efforts to expand the ecosystem.

That’s the gist of the American Telemedicine Association’s latest state-by-state report cards, issued this week. And they offer both good and bad news for telemedicine advocates.

In terms of physician practice standards and licensure, the ATA sees “a patchwork of conflicting and disparate requirements for insurance claims and practice standards that prohibit (providers) from fully taking advantage of telemedicine.” For example, since the first report cards were issued in September 2014, six states have improved their professional license portability and practice standards for telehealth, but 11 states have imposed telehealth standards that differ from that of in-person care.

“(S)tates are becoming more prescriptive in their requirements for an additional patient informed consent and the types of modalities permitted for appropriate clinical practice when using telemedicine,” the report states.

In all, 20 states received an A this time, compared to 24 in 2014, while 29 states received a B (up from 26) and two received a C (up from one). In both reports the District of Columbia is analyzed alongside the 50 states.

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In the past year alone, 25 states have looked at revising telehealth standards, with varying results. A few states, the report notes, “are adopting practice standards with higher specifications for telemedicine than in-person care. 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,” the report stateds. “These decisions leave telemedicine providers no choice but to navigate the medical practice laws in their state or risk punitive action by their board.”

In all, 20 states received an A for their efforts, “suggesting a supportive policy landscape that accommodates telemedicine adoption and usage.” That includes Alabama, which repealed its restrictive telehealth rules and adopted standards that put telehealth on a par with in-person care.

However, in the last six months alone, six states – Delaware, Indiana, Maine, South Carolina, Connecticut and Virginia – adopted new standards that separate telehealth and in-person care, dropping their grades from A to B. And Arkansas joined Texas in getting a C grade, which suggests “many clinical practice barriers and little opportunity for telemedicine advancement.”

The news is better for telemedicine coverage and reimbursement, which sees 39 states with grades of A or B and 12 states scoring either a C or an F. Since 2014, 11 states and the District of Columbia have improved their standing with the ATA, while two states – Maryland and New Hampshire – have had their grades lowered.

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“Over the past four years the number of states with telemedicine parity laws – that require private insurers to cover telemedicine-provided services comparable to that of in-person – has doubled,” the report notes. “Moreover, Medicaid agencies are developing innovative ways to use telemedicine in their payment and delivery reforms resulting in 48 state Medicaid agencies with some type of coverage for telemedicine provided-services.”

In addition, the ATA notes that more states are using telemedicine to make up for provider shortages and improve access to specialty care. In fact, 17 states and the District of Columbia don’t specify the type of provider needed to provide telemedicine as a condition for payment. Among other notables: 27 states have unique patient informed consent requirements for telemedicine encounters, and 22 states don’t require that a healthcare provider – called a telepresenter – be with the patient during the encounter or on the premises.

Unfortunately, “(w)hile there are some states with exemplary telemedicine policies, lack of enforcement and general awareness have led to a lag in provider participation,” the ATA added. “Ultimately these pioneering telemedicine reforms have trouble reaching their true potential.”

As a result, the ATA views overall telemedicine efforts around the nation as a mixture of “strides and stagnation,” noting that while there are more states with grades of A or B, each state has its own distinct rules that make comparisons difficult.

Prepared by Gary Capistrant, the ATA’s chief policy officer, and Latoya Thomas, director of the ATA’s State Policy resource Center, the report on coverage and reimbursement spans 94 pages, with grades based on 13 indicators, while the report on physician practice standards and licensure uses four key indicators and covers 86 pages.

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“These reports provide an important barometer for gauging how each state is performing,” Jonathan Linkous, the ATA’s CEO, said on the organization’s website. “The first step to ensuring that sound policy leads to better healthcare delivery is to understand where gaps in policy exist today and what to do about them.” 


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