Telemedicine—the use of information technology to remotely diagnose, treat, or monitor patients—can transform health care delivery by making it more affordable and available. The main barriers preventing telemedicine from expanding in many states are government regulations such as strict licensing standards. In many instances, states control licensing standards, professional discipline, and the various costs associated with procuring licenses. Another issue is the inability of the current system to properly reimburse doctors providing telemedicine services.
States should reduce regulatory barriers to telehealth providers. Some reforms lawmakers should consider include allowing practitioner-patient relationships to be established remotely and requiring health care payers, such as insurance companies, to provide reimbursements for telehealth services at the same rates as comparable in-person services.
In February, a five-bill package of reforms was introduced in the Michigan Legislature that would expand telemedicine and bring needed clarity on how these services are defined and reimbursed. House Bills 5412, 5413 and 5414 each address how the state defines telemedicine. Each uses the following new definition:
“Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”
The bills each incorporate the broader new definition into the insurance code and expand the use of telehealth to additional mediums where medical information is stored and forwarded to another party for evaluation. HB 5414 specifically allows telehealth to be used for mental health patients under the Mental Health Code.
House Bills 5415 and 5416 would require coverage for certain telemedicine services. HB 5415 requires the Michigan Department of Health and Human Services to provide coverage for remote patient monitoring services through the medical assistance and Healthy Michigan programs. The use of remote patient monitoring (RPM) to help manage chronic disease has been shown to improve health outcomes including: lowering baseline blood sugar levels for patients with diabetes, reducing mortality for patients with cardiac electronic implantable devices, lowering the readmission rate for patients with congestive heart failure, and decreasing hospitalizations, emergency room visits, and average number of bed days for military veterans with diabetes.
HB 5416 would require telemedicine services be covered under the medical assistance and Healthy Michigan programs and expand the locations from where telemedicine recipients can receive care, known as originating sites. HB 5416 requires coverage if the recipients are either in an in-home or in-school setting or “any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider.”
Recent studies have found that RPM can dramatically improve health outcomes. One white paper from telehealth provider Validic found that RPM reduced 30-day readmission rates for congestive heart failure patients from 28 percent to 0 percent at a Massachusetts hospital. Another study from the American Journal of Managed Care found telehealth patients score lower for depression, anxiety, and stress, and have 38 percent fewer hospital admissions. A 2018 study from the Agency for Healthcare Research and Quality also found telehealth is clinically effective.
Currently, 200 telemedicine networks with 3,500 service sites are in operation throughout the United States, according to the American Telemedicine Association. A 2017 report on the global telemedicine market estimates the telehealth market is poised to expand at a compound annual growth rate of 16.3 percent over the next decade, reaching approximately $78.3 billion by 2025, according to Accuray Research LLP.
Telemedicine is popular with patients. Among telehealth patients receiving services on a mobile app, 80 percent preferred telehealth compared to a traditional in-office visit, a 2016 study by West Monroe Partners reveals.
Telemedicine services can have an especially positive impact on patients with chronic conditions, such as diabetes, irritable bowel syndrome, and multiple sclerosis. Chronic conditions affect approximately 133 million Americans, according to Chiron Health. Furthermore, the U.S. Department of Veterans Affairs (VA) was able to reduce “the number of bed days of care by 25% and the number of in-hospital admissions by 19% using home-based video visits,” as noted in a VA study.
Telemedicine has the potential to revolutionize the delivery of health care services. By doing so, more Americans will have access to quality care at affordable costs. As of now, the pioneering field of telemedicine is not hampered by inadequate technology or a lack of demand, but by government regulations. State legislators should reform outdated licensing standards and repeal regulations that stifle telemedicine. If these commonsense reforms are achieved, telemedicine could transform how health care is delivered to thousands of Michiganders.
The following documents examine telemedicine and various barriers blocking its expansion.
AHRQ Finds Telemedicine Clinically Effective
https://www.politico.com/newsletters/morning-ehealth/2018/06/01/ahrq-finds-telemedicine-clinically-effective-238848
Politico’s Mohana Ravindranath examines a new study from the Agency for Healthcare Research and Quality that found telemedicine is clinically effective. The study was unable to find conclusive evidence to determine if telemedicine is more cost-effective, however.
The Promise of Telehealth For Hospitals, Health Systems, and Their Communities
https://www.aha.org/system/files/research/reports/tw/15jan-tw-telehealth.pdf
This study from the American Hospital Association examines the potential benefits of telehealth. The study’s researchers focus on how telehealth is being used by hospitals and considers how this important innovation helps patients and providers alike.
Telemedicine Facts that May Surprise You
https://chironhealth.com/blog/telemedicine-facts-may-surprise/
In this article published by ChironHealth.com, Lauren Cranford examines several research studies and polls that prove telemedicine is popular and effective.
Telemedicine … Across State Borders
https://www.cato.org/publications/commentary/telemedicine-across-state-borders
Shirley Svorny, professor of economics at California State University at Northridge, discusses the value of using telemedicine services, how allowing telehealth care across state lines would improve the availability of care, the barriers to telehealth expansion, and some reforms state and federal legislators should consider that would expand telemedicine services.
The Traveling Doctor: Medical Licensure across State Lines
https://www.americanactionforum.org/insight/the-traveling-doctor-medical-licensure-across-state-lines/
Brittany La Couture of American Action Forum examines the licensing process for doctors in several states and argues for reform. “Though it is important to recognize the right of states to protect the health, safety, and welfare of their citizens, mutual recognition and portability would still largely give states the ability to continue to monitor the care that is provided by physicians licensed in their state while creating incentives for states to build competitive regulatory systems that will attract physicians to those states,” wrote La Couture.
Telemedicine: Changing the Landscape of Rural Physician Practice
http://www.nejmcareercenter.org/article/telemedicine-changing-the-landscape-of-rural-physician-practice/
Writing in the New England Journal of Medicine, Bonnie Darves argues new applications of telemedicine have enabled rural physicians to manage a wide range of acutely ill patients, improve accessibility to specialists, and reduce barriers to care in underserved regions: “With advances in technology, plummeting costs, and governmental health care system partnerships, telemedicine is now used by more than half of U.S. hospitals and has reduced rural practice isolation. Be sure that health plan and hospital credentialing, privileging, licensure, and malpractice issues are addressed before practicing telemedicine.”
Physician Care and Telemedicine
http://heartland.org/policy-documents/physician-care-and-telemedicine
Devon Herrick of National Center for Policy Analysis examines the benefits of telemedicine in providing health care at a lower cost and outlines the current barriers to expansion: “Entrepreneurs are using the telephone, the Internet and personal computers for innovative solutions to traditional problems of health care delivery. These advances are not only making care more accessible and convenient, they are also raising quality and containing medical costs.”
Convenient Care and Telemedicine
http://heartland.org/policy-documents/convenient-care-and-telemedicine
This study examines the contribution of telemedicine and other information technology to innovative solutions to some of the problems patients and health care providers encounter under the traditional model of health care delivery. It also identifies obstacles to progress and the public policy changes needed to remove them.
3 Solutions for Major Telemedicine Barriers
http://www.beckershospitalreview.com/healthcare-information-technology/3-solutions-for-major-telemedicine-barriers.html
This article from Becker’s Hospital Review discusses a recently published study in Telemedicine and e-Health that found three major barriers to telemedicine implementation and use that must be addressed.
Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced?
http://heartland.org/policy-documents/crossing-telemedicine-chasm-have-us-barriers-widespread-adoption-telemedicine-been-
Widespread telemedicine adoption has been stymied by unnecessary technological, financial, and legal barriers for 40 years. In addition, business strategy and human resources have contributed to the delay of implementation. Cynthia LeRouge and Monica J. Garfield canvass recent events and activities in these areas and overall U.S. health care reform that might help to break down these barriers.
Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.
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Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance.
