When the American Telemedicine Association handed out its latest report cards in January 2016, most states got passing grades for telehealth-friendly measures adopted to help speed telemedicine’s integration into the overall spectrum of health care.
However, two states got the lowest composite scores for measures that seem designed to protect traditional medical practitioners from competition from telemedicine. Arkansas and Texas were singled out for certain measures deemed hostile to telemedicine’s expansion within their state borders.
Both Arkansas and Texas require patients to have an established relationship with a health care provider before a telemedicine encounter between the two can occur. Texas also requires an in-person follow-up visit at least once a year.
Alabama Shows Big Improvement
In ATA’s previous report card, released in May 2015, Alabama was lumped together with Arkansas and Texas, all of which were graded F on their regulations governing encounters between health care providers and patients. In a remarkable turnaround, Alabama’s grade on this criterion went from an F in May 2015 to an A on ATA’s latest report card. This about-face came when Alabama scrapped its telemedicine-specific rules and decided instead to treat telemedicine the same way it treats other forms of health care delivery.
ATA’s appraisal of state standards, laws, and regulations governing telemedicine come from two separate reports. One grades each state and the District of Columbia on criteria related to physician practice standards and licensure, while the other focuses on coverage and reimbursement.
Grades Change for Other States
While Arkansas and Texas remain at the bottom of the heap on the basis of their regulations involving patient-provider encounters, a number of other states saw their grades rise or fall based on changes in their treatment of telemedicine under state laws or regulations.
ATA’s “State Telemedicine Gaps Analysis: Coverage & Reimbursement” report compares telemedicine adoption in every state based on 13 criteria. The most recent report reveals that 11 states and the District of Columbia have adopted measures that improve coverage and reimbursement of telemedicine services since ATA’s first such report was issued in September 2014. Those states include Delaware, Iowa, Michigan, Nevada, New York, North Dakota, Ohio, Oklahoma, Utah, Washington, and Wyoming. The states with the lowest composite scores in terms of coverage and reimbursement are the neighboring New England states of Connecticut and Rhode Island, both of which got failing grades.
Report on State Practice Standards
In ATA’s companion report, “State Telemedicine Gaps Analysis: Physician Practice Standards & Licensure,” three states — Alabama, Michigan, and South Dakota — earned higher composite scores because of policies that encourage telemedicine’s use. However, seven states saw a drop in their composite grade because of policies that treat telemedicine differently than traditional health care. Going from an A to a B were Connecticut, Delaware, Indiana, Maine, South Carolina, and Virginia. And Arkansas tumbled from a composite grade of B to a C, joining Texas at the bottom of the heap in terms of practice standards and licensure regulations.
In an explanation of Arkansas’ F grade on the physician-patient encounter criterion, ATA notes that the state’s Act 887 requires a pre-existing relationship between physician and patient before a telemedicine encounter. Such a relationship can be established through an in-person examination, personal knowledge of the patient and his/her health status, in consultation with or referral by another health care provider with an existing relationship with the patient, or via an on-call or cross-coverage arrangement with a patient’s regular physician.
Texas Regulations Evaluated
In its evaluation of Texas’s grade on that same criterion, ATA points out that a face-to-face telemedicine encounter in lieu of an in-person consultation can only occur when the patient is located at an established medical site and a qualified telepresenter is present. According to the ATA, Texas says a physician-patient relationship may not be established “through an online questionnaire or questions and answers exchanged through email, text, chat, or telephonic evaluation or consultation.”
In the key area of state practice standards and licensure regulations, 20 states got a composite grade of A, 28 states and the District of Columbia earned a B, and Texas and Arkansas were at the bottom of the list with composite scores of C.
The breakdown of composite scores in ATA’s most recent state-by-state evaluation in terms of policies governing coverage and reimbursement showed plenty of room for improvement. Only eight states and the District of Columbia earned an A, while 30 states got a composite grade of B. Another 10 states got a C grade, and Connecticut and Rhode Island both got Fs, as previously mentioned.
2016 Trends in Telemedicine
In a related development, Foley & Lardner LLP, an international law firm headquartered in Milwaukee, issued an upbeat assessment of the outlook for telemedicine’s growth in 2016. The law firm, which offers a wide array of business and health law services, focuses on five telemedicine trends that it believes will help to transform health care in the year ahead.
Reimbursement and Payments
The law firm’s report predicts that both private and public sector insurers will continue to expand their coverage of telemedicine services as consumer demand for such services increases. In a report released two years earlier, the law firm had pointed to the lack of parity on reimbursement as the primary obstacle to telemedicine’s growth. However, it now applauds the advances made at the state level on this issue and predicts even more significant progress in 2016.
Foley’s report also notes that health care providers seem increasingly receptive to payment models other than traditional fee-for-service reimbursement. Examples of such alternatives include institution-to-institution contracts and a greater willingness by patients to pay out of pocket for the convenience of telemedicine services.
International Ties
Foley & Lardner predicted that a growing number of U.S. health care providers and hospitals will forge relationships with overseas medical institutions, which will help to spread American health expertise abroad. The foreign demand for Western medical care, which could be provided via the technologies of telemedicine, should also help to promote telemedicine’s expansion.
The law firm’s report also predicts that state governments will continue to lead the way in telemedicine expansion. The report cites a study by the Center for Connected Health Policy that showed more than 200 pieces of telemedicine-related legislation was introduced in 42 states during 2015. Foley & Lardner expects this trend to continue in 2016.
Retail Clinics
Yet another avenue of growth for telemedicine is expected to come in the form of retail clinics and employer-funded on-site health facilities. The report cites a Towers Watson study that found that more than 35 percent of employers with on-site health facilities already offer telemedicine services and another 12 percent plan to add such services in the short-term future.
ACOs and Telemedicine
The growing popularity of Medicare’s accountable care organizations (ACOs) is also expected to help drive the expansion of telemedicine. ACOs were introduced as a way to improve the quality of health care given Medicare beneficiaries while at the same time reducing the cost of delivering such care. Foley & Lardner thinks that telemedicine fits well with the ACO model and will likely be increasingly deployed to help meet ACO goals.
If you’d like to read more about telemedicine and related issues of interest to health consumers, check out our blog.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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