Research & Commentary: Washington State Continues Efforts to Expand Telemedicine

Published January 31, 2020

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.

Over the past year, Washington State lawmakers have passed several new laws that begin the process of creating a framework under which telemedicine providers can enter and operate in the state. Last year, two bills were approved that establish training procedures for health care providers using telemedicine and clarify the credentialing process for providers. This year, the legislature is expected to consider several new telehealth proposals, including new rules that would mandate telehealth parity, and the use of telemedicine in Washington schools.

Washington can examine the experiences of other states that already provide telehealth services as a guide. In Georgia, two new laws provide good models for other states considering telehealth services. Both laws address many of the uncertainties and concerns telehealth providers typically experience.

The first new law, introduced as Senate Bill 115, allows health care providers in other states to treat Georgia patients if these providers meet all applicable state telehealth laws. The reforms also limit providers to telemedicine and do not allow them to provide in-person care. Although some are concerned doctors from states with lower licensing standards would provide lower quality care, competition will quickly weed out bad actors, ensuring most patients receive quality care.

Indeed, a 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.

The second reform, Senate Bill 118, clarifies how the state defines telehealth and sets new guidelines for how telehealth providers are paid. SB 118 establishes telehealth as occurring in the state where the patient is located for licensing purposes. It also defines remote monitoring as telemedicine and widens the scope of telehealth technologies to a wide array of communications mediums; ensuring future developments will be included.

The new law also addresses the important issue of payment parity because SB 118 requires payers to cover telehealth services “on the same basis and at least at the rate that the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact.” It also bans annual or lifetime caps on reimbursement and any insurer from requiring telehealth over in-person care.

California is also leading the way for telehealth expansion. Indeed, the California Department of Health Care Services (CDHCS) recently released new guidelines that make several major steps towards expanding the use of telehealth in Medi-Cal, California’s Medicaid program. The new guidelines allow health care providers to determine what type of telemedicine services to use in conjunction with Medi-Cal, so long as they meet Medi-Cal guidelines. This includes both real-time audio-visual communication or asynchronous communications where medical information is stored and forwarded to another party for evaluation.

Several states have passed or considered legislation unleashing the telehealth market so providers can employ this technology. In 2017, New Jersey and Vermont passed laws providing telemedicine payment parity. In Texas, rules were passed in 2017 that enable Texas practitioners to use telehealth services.

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 millions of Americans.

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 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
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, 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,” 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 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 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?
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.


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