AcuteCare Telemedicine Blog


Telemedicine Legislation is Moving; In All Directions

The use of telemedicine and telehealth is increasing becoming the subject of debate in state legislatures all across the country, making the delivery of medical care via telecommunication technology a priority legislative issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming are moving legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

Ron Bachman, a foremost expert on health care consumerism, consumer-centric Medicaid and Medicare, the uninsured population and mental health, predicts an estimated half a billion smartphone users worldwide will be using a health care app to connect to a healthcare giver by the end of 2015. An emerging, technology-using generation is becoming increasingly comfortable with using mobile devises to access their medical care through smartphones, tablets and laptops. Entrusted with an increased responsibility for paying the rising costs of healthcare, these new consumers are embracing disruptive technologies to command lower cost, more convenient, higher quality, consumer oriented medical care. “It is impossible to stop a mega-trend,” says Bachman. “Telehealth is the cutting-edge future of health care worldwide. Telehealth, in its various forms, will provide convenient medical services because consumers will demand it.”

In another recent Harris survey, more than half of Americans indicated that they want to use telemedicine to connect with a physician, and they also think it should cost less than an in-person visit. It is an indication that consumers identify telemedicine as a different means by which to deliver care not a different type of healthcare. Data consistently indicates that telemedicine can deliver quality healthcare outcomes comparable to in person office visits while lowering consumer costs for routine care. Emergency Room (ER) treatment tops the list as the most expensive, least efficient and most frequently utilized way to provide non-emergent care, with an ER visits costing from $1,500 to $3,000 on average. Visits to a Primary Care Physician (PCP) can coast from $130 to $190. A telemedicine visit can cost as little as $40. With the popularity among voting consumers growing there is little wonder why state lawmakers are aggressively marching telehealth legislation forward.

In a recent Forbes article entitled, “Telemedicine Is a Game-Changer for Patients, The System,” contributor Bill Frist points out that there are multiple barriers to the widespread uptake of telemedicine with the most prohibitive being regulatory policies at the state level. The laws in many states either severely limit or completely ban the practice of telemedicine. In Frist’s opinion, for consumers to gain the most benefits from telemedical technology legislation must address four persistent barriers to complete telehealth adoption:

The legislation needs to provide payment parity by requiring insurers to reimburse licensed health care providers for services delivered remotely at the same rate they would pay if the visit were in-person. This assures there would be no financial incentive to favor face to face care over telemedical services. The caveat that it cost the same acknowledges the value of the telephysicians expertise and the indirect costs of providing this service. Cost savings would still be realized through a reduction in lost workforce productivity and less reliance on emergency medical services.

For quality assurance, any legislation should establish that the same standard of practice applies whether the services are delivered in person or remotely.

Proposed legislation should prevent the use of additional rules requiring in person visits before or after telemedicine encounters or the presence of care facilitators during an encounter. Such restrictions effectively eliminate the possibility of most telemedicine models from operating.

State licensure requirements should allow exemptions for telemedicine.

The legislation that is passing through some states is attempting to encompass many of these points. The Arkansas House of Representatives was able to pass a new bill (SB133) that is more restrictive than one that had been previously voted down. While the bill does not meet all goals of an open telemedicine market for consumers and provider alike, it will allow telemedicine practitioners to be licensed as doctors in Arkansas, waives the requirement for a pre-existing, in-person relationship with the patient in cases of emergency and demands that telemedicine be reimbursed by Medicaid and private health plans.  Arkansas lawmakers, like those of many states, are finally willing to open the door to a new healthcare delivery model by way of modern technology, if only a little.

Other states have also passed or are considering telemedicine legislation that would expand telemedicine within their states. There appears to be little consistency in the various offerings except for a tendency towards over-regulation and complexity. Telehealth is exactly the type of innovation that can solve many of the challenges currently facing the healthcare system. Elected representatives must move more vigorously to craft legislation that serves to promote this innovation while limiting litigiousness and overregulation.


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