Research & Commentary: Nebraska Considers Loosening Restrictions on Telemedicine

Published March 7, 2019

Telemedicine—the use of information technology to remotely diagnose, treat, or monitor patients—can transform health care delivery by making it more affordable and readily available. The main barriers preventing telemedicine from expanding further in many states are government regulations and the inability of the current system to properly reimburse doctors who provide telemedicine services.

Strict licensing standards have become a significant problem in the health care industry. In many instances, states tightly control licensing standards, professional discipline, and the various costs associated with the licenses. Many states also mandate patients initially meet with physicians in person before utilizing telehealth services. This undermines the efficiency of telehealth services and forces patients to commute to a location that may not be convenient. Uncertainty over these requirements has led some potential telehealth providers to avoid expanding their businesses and providing care where it is desperately needed.

Like many states, Nebraska faces a health care shortage, especially in rural areas. According to the University of Nebraska Medical Center, 13 Nebraska counties have no primary care physicians available. While the state has seen some improvement in expanding health care availability, there are still large areas of the state that need new health care options.

Fortunately, a new bill is now being considered in the legislature that could help expand telehealth services. The proposed new law, Legislative Bill 29, would allow patient-provider relationships to be established through telehealth for those providers accredited by the state under the Uniform Credentialing Act. The bill would also allow credentialed providers to “prescribe for a patient while providing services through telehealth.”

These reforms would make it easier for providers to offer telehealth services, giving health care professionals the tools they need to supply comprehensive care.

Currently, 200 telemedicine networks with 3,500 service sites operate across the United States, according to the American Telemedicine Association, and the number of telehealth providers is only expected to grow. A 2017 report estimated that the global 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. Furthermore, patients prefer telemedicine over in-person services. Among patients receiving telemedicine services on a mobile app, 80 percent preferred telehealth compared to a traditional office visit, a 2016 study by West Monroe revealed.

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 recent VA study.

Several states have passed or are considering legislation to open their telemedicine markets so health care providers can utilize this transformative technology to reach additional patients. In 2017, New Jersey and Vermont passed laws creating telemedicine payment parity. Texas approved new rules in 2017 to expand telemedicine services, removing barriers and overcoming opposition from special interests.

Telemedicine is a viable and beneficial health care option for patients and providers. It has the potential to provide routine health care services to more people and at a lower cost than traditional in-person delivery. Unfortunately, excessive and burdensome government regulations prevent many Americans from accessing telemedicine services. Telemedicine reform efforts in states such as New Jersey, Pennsylvania, Texas, and Vermont are a positive step toward making telemedicine more available and affordable.

Nebraska lawmakers should embrace reforms that reduce restrictions on telehealth care providers, not stifle innovation.

The following documents examine telemedicine and various barriers blocking its expansion.

AHRQ Finds Telemedicine Clinically Effective
Politico’s Mohana Ravindranath examines a new study from the Agency for Healthcare Research and Quality that finds telemedicine is clinically effective.

The Promise of Telehealth For Hospitals, Health Systems, and Their Communities
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
In this article published by Chiron Health, Lauren Cranford examines several research studies and polls that prove telemedicine is popular and effective.

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
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,” La Couture wrote.

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
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
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
This article from Becker’s Hospital Review discusses a recently published study in Telemedicine and e-Health which 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?
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 the Heartland Institute’s website and PolicyBot, Heartland’s free online research database.

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