Research & Commentary: North Carolina Considers Opening State Up to Telemedicine

Published June 1, 2018

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. Although telemedicine has existed for years, current technology allows health care practitioners to utilize treatment options not viable in the past. One of telemedicine’s biggest benefits is its unique ability to deliver affordable and effective health care to areas currently underserved, such as rural or economically depressed regions.

The main barriers to expanding telemedicine in many states are government regulations and the draconian reimbursement process. Strict licensing standards are a significant barrier to health care innovation. Far too often, states exert stringent licensing standards and heavy-handed professional discipline that increase health care costs and decrease access.

Over the past year, North Carolina has taken steps to create an environment that fosters health care innovations, such as telemedicine. In 2017, North Carolina lawmakers passed a bill that calls for the North Carolina Department of Health and Human Services (NCDHHS) to study telemedicine practices and how the state should proceed with its telemedicine policy.

Legislators in the Tar Heel State have entered a bill that defines telemedicine as the use of remote patient monitoring to store and forward technology. The bill does not allow the use of “audio-only telephone or teleconference, e-mail or facsimile.” Although this could limit certain telehealth services and increase costs, the bill would begin the long process toward encouraging enhanced telemedicine services.

Additionally, the bill would require a patient’s consent before any telemedicine treatment is undertaken, and it would also necessitate all telemedicine services be held to the same standard of care as in-person treatments. Moreover, it would set a deadline for the NCDHHS study and ensure the study addresses telehealth coverage and reimbursement standards. The study’s authors must also form a plan to ensure there is adequate online connectivity available for service providers to offer telehealth care.

Dr. Adam C. Powell, president of Payer+Provider Syndicate, a health services consulting firm, outlined several ways telemedicine could help decrease healthcare spending in a 2012 Healthcare IT News article. Powell contends the use of remote analysis services, remote monitoring technologies, and mobile health monitoring would enable health care professionals to pool resources and prevent unnecessary and expensive hospital stays and emergency room visits. He also argues telemedicine helps reduce hospital readmission rates, which account for more than $16 billion in avoidable costs each year, according to a 2011 study by the National Institute for Health Care Reform.

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

Telemedicine has the potential to provide routine health care services to more people 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. North Carolina should pass similar legislation, thereby increasing health care access and reducing costs.

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

The Traveling Doctor: Medical Licensure across State Lines
Brittany La Couture of the 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
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 the 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.

Telemedicine: Helping Consumers and the Environment
Over the next 10 years, broadband applications such as telecommuting, distance learning, teleconferencing, and e-materialization will decrease greenhouse gas emissions by one billion tons, the American Consumer Institute finds. This ConsumerGram takes a second look at one of the more promising and fast-growing applications, telemedicine, and identifies several new ways these applications can help both consumers and the environment.                          

Telemedicine: An Inquiry in the Economic and Social Dynamics of Communications Technologies in the Medical Field
Francis Pereira, Elizabeth Fife, and Antonio A. Schuh identify barriers to telemedicine that can be addressed by policymakers, broadband equipment manufacturers and service providers, and key players in the health care industry to exploit the opportunities these new technologies offer.

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 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. 

If you have any questions about this issue or The Heartland Institute’s website, contact Lindsey Stroud, The Heartland Institute’s state government relations manager, at [email protected] or 757/354-8170.