We are all too familiar with the many hurdles that stand in the way of the greater proliferation of telehealth. This blog has examined various legal and regulatory stumbling blocks such as licensure, reimbursement, and privacy that continue to stand in the way of telehealth fulfilling its great promise—at least in the United States. Other countries are increasingly embracing telehealth. A recent spate of legislative and other activities, however, point to an evolving environment in which legislators and regulators are beginning to understand and grapple with the many legal and regulatory issues that stand in way of the greater use of telehealth. Here is a sampling of that activity:
The Telehealth Promotion Act (H.R. 6719) was recently introduced in Congress and recommends sweeping changes to how telehealth is reimbursed and promoted with our health care system. Among other things, the bill:
- Requires that Medicare cover health care services provided by means of telecommunications to the same extent as it would services provided in-person;
- Remove the restrictions under Medicare in which only certain health care professionals (physicians, nurse practitioners, physician assistants) could provide telehealth services;
- Removes limitation on what may constitute an “originating site” (where the patient presents) under Medicare;
- Emphasizes that for purposes of reimbursement, licensure, and professional liability, physicians, practitioners, suppliers, and providers of telehealth services are “considered to be furnishing such services at their location and not at the originating site”;
- With certain limited exceptions, requires that state Medicaid programs cover health care services provided by means of telecommunications to the same extent as it would services provided in-person;
- Provides incentives for hospitals to lower readmissions using telehealth;
- Exempts accountable care organizations from the current telehealth fee-for-service restrictions and allows these organizations to use telehealth as an equivalent substitute for in-person care; and
- Provides an increase under Medicare in payments for home health services to better account for the use of remote patient monitoring.
While it may be unlikely that the bill becomes law (after all, few bills ever become law), its mere introduction is a sign that telehealth is now at least part of the Congressional health care agenda in a way not previously seen. By any measure, this represents progress.
While there is quite a bit of activity in the area of licensure, one recent event caught my attention. The Federation of State Medical Boards—an organization representing 70 medical boards—recently held a meeting in which board representatives discussed ways to identify new mechanisms to streamline licensure and expand access to telehealth. Meeting attendees reviewed the various ways in which states are attempting to address the issue, and make it easier for physicians to get licensed in multiple states while satisfying the various states’ interests in the protection of its citizens.
The meeting was part of the Board’s License Portability Project, funded by a grant from the Health Resources and Services Administration, which was developed to reduce the various legal and regulatory barriers (such as licensure) to the greater use of telehealth. A set of recommendations from the meeting will be reviewed and considered by the Board’s House of Delegates later this year. The Board’s recommendations could go a long way in helping usher in a much more streamlined physician multi-state licensing system.
Late last year, several organizations of state lawmakers passed resolutions calling for creating and supporting telehealth legislation primarily to expand insurer coverage of telehealth. These organizations have been driven by what they perceive as inadequate health resources allocated to the poorest populations, and the important role telehealth can play in delivering care to chronically underserved populations.
For example, the National Black Caucus of State Legislators noted in its resolution that “there is a need for state legislative provisions that provide coverage for telehealth comparable to in-person services, ensure quality care, protect patient safety, maintain patient privacy, and promote technology for telehealth service delivery,” and encouraged its membership to collaborate with the health care community to create and support telehealth legislation. The National Hispanic Caucus of State Legislators passed a similar resolution regarding telehealth as have other organizations. Indeed, medical societies (such as the National Hispanic Medical Association) have jumped into the act, and have been emphasizing the importance of telehealth in providing care to underserved populations.
Taken together, the activities I have discussed, along with many others, point to an increasing recognition on the part of legislators and others that it is time to finally come to grips with the many hurdles affecting the greater use of telehealth. You can see this approach in the in the growing number of states enacting telehealth parity statutes, for example. These laws generally require health insurers to pay for services provided via telehealth the same way they would for services provided in-person. While many hurdles legal and regulatory hurdles will continue to exist—as telehealth companies, vendors, providers and health care professionals, I think you should take some comfort in the fact that legislators and regulators are starting to hear your message.