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 the licenses. Another issue is the inability of the current system to properly reimburse doctors providing telemedicine services.
Over the past year, Massachusetts has been a model for how states can responsibly introduce and expand telehealth services. In February, Massachusetts approved coverage of telehealth services for its 1.9 million Medicaid members who seek access to “psychologists, psychiatrists, psychoanalysts, clinical social workers, behavioral health nurses, nurse practitioners, and professional counselors.”
To date, Massachusetts lawmakers have introduced four bills that would expand the use of telemedicine. These bills are modeled on similar legislation introduced in 2018 that failed to pass. The current bills state that insurers may “not decline to provide coverage for health care services solely on the basis that those services were delivered by way of telemedicine by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telemedicine.”
The four proposed billsHouse Bills 991, 1001, 1002, and 1095—would require health insurance companies to provide coverage for telehealth services. According to the National Law Review (NLR), these insurers include: the Massachusetts Group Insurance Commission; Medicaid-managed care organizations in Massachusetts; Individual, group blanket or general insurance policies; hospital service plans; medical service corporations; health maintenance organizations; and preferred provider arrangements.
There are some major differences between the bills. NLR notes HB 1095 allows, but does not require, Medicaid-managed care organizations in Massachusetts to cover services delivered via telemedicine. On the other hand, HB 1001 only requires insurers to cover behavioral health services delivered via telemedicine.
Currently, 200 telemedicine networks with 3,500 service sites are in operation across 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 about 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 effect 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 and telehealth can provide routine health care services to more people at a lower cost than traditional in-person delivery. Unfortunately, unnecessary and burdensome government regulations continue to stifle access to telemedicine services. Each of the bills being considered in Massachusetts would expand the use of telemedicine and are good steps toward what should be the state’s ultimate goal: full expansion of telehealth services to all Massachusetts residents.
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.
