February 7, 2014
You may be familiar with the Verizon Wireless commercial describing the use of cloud technology and telehealth to increase access to healthcare for people living in rural and remote areas. For those unfamiliar with the term, the U.S. Health Resources and Services Administration defines telehealth as the
use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
The adoption of telehealth can also increase access to healthcare for people who are underserved due to a shortage of sub-specialty providers. These individuals may live in remote, rural, or population, dense urban centers. On the provider and payer side, the adoption of telehealth can improve productivity, decrease costs, and increase service levels. Despite these benefits, however, interstate licensure issues; the absence of uniformity in legal definitions of telehealth across states; and restrictive Medicaid and Medicare reimbursement have slowed the adoption of telehealth.
Interstate Licensure Issues
Byzantine interstate licensure structure and policies present a significant barrier to the adoption of telehealth. The inability of physicians to provide healthcare across state lines using telehealth technology impedes telehealth’s widespread adoption. For example, the District of Columbia and many other jurisdictions require physicians who practice interstate telehealth to hold a full and unrestricted medical license before providing diagnostic, treatment, or consultation to a patient living in their respective jurisdictions. So, if a District resident needs a consultation from a sub-specialist in California because herhealth issues keep her homebound and unable to travel, she cannot receive the consultation unless the sub-specialist is licensed in the District and California: the physical location of the patient and the physical location of the medical practice.
Little Uniformity in Legal Definitions of Telehealth
Healthcare industry experts and stakeholders have long lamented the differing definitions of telehealth among states. In a recent press release, Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio), noted that 50 different definitions and rules for telehealth “leave providers and patients in a state of uncertainty.” For example, some jurisdictions require physicians to see and examine patients in person before they can treat them remotely. On the other hand, some jurisdictions require an in-person visit only when medication is prescribed.
Restrictive Medicaid and Medicare Reimbursement
Excluding private insurers, the bulk of healthcare costs are paid by Medicaid and Medicare. As a result, restrictive government reimbursement policies also hamper telehealth adoption. While 44 state Medicaid programs reimburse for telehealth services, no two jurisdictions are alike. Accordingly, telehealth reimbursement policies vary dramatically. Medicare reimburses for telehealth services but reimbursement is limited to telehealth services for patients living in a designated rural Health Professional Shortage Area or in a county outside of a Metropolitan Statistical Area.
Encouragingly, there are signs that these and other legal and regulatory barriers to telehealth adoption will weaken. One of the biggest harbingers of change arrived in late December from the House Energy and Commerce Committee: the Telehealth Modernization Act of 2013. The Act should, among other items, provide guidance for states in changing their licensing laws; help standardize terminology around telehealth nationally; and promote expansion of telehealth reimbursement among federal programs like Medicaid and Medicare.