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 November, South Dakota lawmakers introduced several bills that would expand telehealth to improve access to mental health services. These bills will be sent to the South Dakota Legislature’s Executive Board, which will decide which bills will be submitted when the legislative session opens in January 2020.
The first bill, Senate Bill Draft 197, would specify the parameters for how the state defines telehealth services. The bill defines telehealth as interactive audio-video communications, asynchronous (store-and-forward) communications, and remote patient monitoring platforms. Asynchronous communication is another method of communication where both parties can interact with each other at different times, including email and secure messaging, instant messaging, secure file exchanges, and over a health app. The bill would also name certain mediums as the sole method of telehealth contact, including phone, fax, text, and email.
SB 197 would also clarify where telehealth officially occurs by defining the originating site as “where a patient is located at the time health care services are delivered.” The bill would also allow providers to use telehealth to prescribe controlled substances to new patients, under limited conditions. These reforms would end some of the uncertainty faced by providers considering expanding telehealth services and would encourage providers to deliver these services to South Dakota patients. These bills could be improved even more by emulating a new law in Georgia, which allows health care providers in other states to treat Georgia patients if these providers meet all applicable state telehealth laws.
The second bill, House Bill Draft 198 directly addresses the state’s mental health care shortage by enabling care providers to use telemedicine, including real time video communication, to conduct a mental health examination of a patient detained or placed on an emergency intervention. This would provide a dramatic expansion of mental health care across the state.
Brittany La Couture of American Action Forum argues major reforms are needed to expand telehealth, which is hindered by excessive rules for licensing. “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,” La Couture wrote.
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. Both of the bills being considered in South Dakota 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 South Dakota 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.
