We Endorse Telehealth Across State Lines

Medicine Unplugged: Your phone, your DNA, your data

By Wayne Caswell

Modern Health Talk strongly endorses telehealth and efforts to break down barriers to wider adoption nationwide. The TELE-MED Act of 2013 (HR 3077) is still not out of committee but is intended to start breaking down barriers related to licensure and payment when medical care is given online across state lines, starting with Medicare providers. Hopefully Congress will pass this bill and then start extending telehealth to all insurance carriers.

Senators John Thune (R-SD) and Mike Enzi (R-WY) are among a bipartisan group of 14 lawmakers who have signed a letter praising the Federation of State Medical Boards (FSMB) for their efforts to break down silos that prevent the widespread licensing and use of telehealth. FSMB has been working on an expedited licensing process for physicians who wish to practice remote medicine across state lines, a key barrier to cost-saving and patient-pleasing telemedicine. [Read more at Senators applaud medical boards for advancing telehealth.]

The issue of electronic consultations between doctors and patients and Internet-based video chats is not new. Telehealth is a welcomed convenience that allows patients to see doctors without traveling or taking time off from work. It also allows doctors to practice online before and after normal working hours and thus serve more people. Whether it’s retired doctors who would still like to practice, physicians who’ve stopped practicing due to family commitments, or docs who simply want to expand the scope of their business, telehealth can increase the pool of available primary care physicians at a time when high demand is making that a critical issue.

Telehealth can and should become an essential alternative for diagnosing common ailments and prescribing treatment, but licensure and payment remain as barriers to widespread adoption, especially when care is given across state lines. That’s because doctors practicing telehealth must comply with laws & regulations of the state in which the patient is located.

A doctor in Texas, for example, may not have a problem using telehealth with in-state patients, even if they live hundreds of miles away, but medical facilities near state borders could face legal issues if the patient lives much closer but in New Mexico, Oklahoma, Arkansas, or Louisiana.

Further, doctors often must first establish a physician-patient relationship in order to prescribe meds. Only 12 states allow electronic examinations to substitute for the initial face-to-face exam.

Payment for telehealth services has been an additional roadblock to wider expansion, but the TELE-MED Act would address that issue, at least for Medicare. Individually, some 15 states have adopted legislation requiring all health insurers to recognize claims for remote services. If an insurance policy covers an in-person medical visit and the physician feels she can treat the policyholder using telehealth, then the insurance company can’t deny payment of that electronic visit.

If the telehealth trend extends across the entire nation, it will greatly improve the cost and availability of medical care, eliminate much of the need for travel, and benefit doctors and patients alike, especially the rural or elderly patients who have a harder time getting to the doctor office. But some doctors oppose telehealth in fear that they would lose business from patients who choose to get their medical care from doctors in another state.

I hope opponents don’t turn this into a States Rights political battle and instead view medical licensing in a similar fashion as automobile driver’s licensing, where each state recognizes the licensing and enforcement authority of other states and where the need for federal intervention is minimized. If you’d like to share your own opinion, please do so as a comment below.

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