Lawmakers, Medical Boards Grapple with Telemedicine Guidelines

How much you benefit from telemedicine may depend heavily on which state you live in.
How much you benefit from telemedicine may depend heavily on which state you live in.
Telemedicine policies vary significantly throughout the United States.

Different states have different state laws concerning things like insurance reimbursement for telemedicine services, and states also implement policies, rulings, and modifications having to do with technology and the state of telemedicine adoption throughout the healthcare sector.

Technology is still outpacing policy, but on both the state and the federal levels, lawmakers are realizing the potential for telemedicine in terms of keeping healthcare costs under control, so more of them are sponsoring or promoting legislation that aims to bring the law closer into alignment with technological possibilities.

In addition to reimbursement for telemedicine services by insurers (including private insurers as well as Medicare and Medicaid), legislation is tackling issues of physician licensing across state borders, particularly in light of different definitions of “telemedicine” in different states. Practicing telemedicine across a state border can be a major headache for a healthcare provider, who is faced with the choice of gaining licensure in other states or requiring that out-of-state patients receive all healthcare on-site even if in-state patients regularly use telemedicine services.

The Interstate Licensure Compact: Potentially A Big Deal
In 2014, the Federation of State Medical Boards (FSMB) proposed an interstate licensure compact to assist with issues of providing telemedicine services across state lines. Currently 11 states have signed on to the compact: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, and Wyoming.

What the FSMB compact does is create new options for doctors who want to be licensed in multiple states. With the compact, doctors can fill out one set of paperwork and apply for licenses in any state that has signed on. There are also provisions for doctors to apply for expedited processing as long as they show proof of board certification as a specialist and are not under investigation by their state medical board.

The compact also has created a commission to serve as the application clearinghouse and as a source of information about any disciplinary or legal actions by state medical boards. That way, if a doctor’s license is revoked in one state, it can easily be revoked in other states that are part of the compact.

On the Federal Level
On the federal level, legislators are trying to expand telemedicine access for Medicare patients. Medicare has been providing telemedicine services for years, but they have been limited to patients living in designated underserved or rural areas, and had to be delivered not to a patient’s home, but to a clinic close to the patient.

A bill introduced in the US House of Representatives by Devin Nunes (R-CA) and Frank Pallone (D-NJ), HR 3081, would allow licensed Medicare providers to treat Medicare beneficiaries using telemedicine across state lines. The Veterans Administration (VA) already allows VA doctors to treat veterans across state lines via telemedicine, and that program has been considered a success, helping more veterans gain access to the care they need with shorter wait times and at lower cost.

Support for HR 3081 is strengthening, and the bill boasts bi-partisan support. The ways in which telemedicine can improve efficiency of healthcare delivery and broaden access to care are obvious, and studies of medical outcomes have shown that telemedicine is as effective as in-person care. Groups like the American Health Information Management Association and the College of Healthcare Information Management Executives have also sent letters of support to the bill’s sponsors.

Opposition to HR 3081
There are, however organizations that do not support HR 3081, and they include two big ones: the American Medical Association (AMA) and the FSMB. The AMA has mixed feelings on telemedicine, and in June they tabled ethical guidelines for telemedicine that focused on issues like ensuring patient privacy with telemedicine.

The FSMB believes that the multi-state licensure compact is the way forward when it comes to expanding provision of telemedicine across state lines. In addition to the 11 states that have already joined the FSMB license compact, legislatures in eight more states are considering signing on, and the state medical and osteopathic boards in nearly 30 other states have voiced support for the compact.

But the American Telemedicine Association (ATA) has concerns about whether the FSMB compact will reach to all 50 states. And even if it does, says the ATA, the requirement that physicians pay license fees in each state in which they want to practice could end up being a major obstacle. Even today, according to the ATA, physicians spend around $300 million to be licensed in multiple states.

The Rise of Payment Parity Laws on the State Level

More than half the states have laws addressing insurer payment for telemedicine services.
More than half the states have laws addressing insurer payment for telemedicine services.

One of the other major issues standing in the way of expansion of telemedicine has to do with payment parity. Payment parity means that telemedicine services are reimbursed by insurers just as in-person services are reimbursed. Telemedicine markets everywhere benefit from well-crafted payment parity laws, because physicians benefit, as do patients, and the providers of telemedicine technology and software. Payment parity laws have gained significant traction in recent years, with 29 states plus the District of Columbia having enacted statutes. These laws not only address parity of reimbursement for telemedicine services, but also whether additional telemedicine services like patient monitoring will be reimbursed.

How Providers Cope in States Without Payment Parity Laws
Many, but not all of the states with telemedicine “payment parity” laws have actual equal coverage between in-person and telemedicine care. The problem is, when true payment parity doesn’t exist, hospitals or providers receive less money than they would if they were treating someone in person, and that can create a negative incentive for providers to use telemedicine services. In those states, telemedicine adoption may lag behind other states, where patients enjoy the convenience and cost savings of telemedicine services. But even in states with no laws addressing payment, providers can reach out to health plans and patients and attempt to convince insurers that reimbursing telemedicine services is in everyone’s best interest.

In just the past year, lawmakers, professional organizations, and other policy-making bodies have started to tackle the issues that have been holding back telemedicine expansion. More states are enacting payment parity measures, both the FSMB and federal legislators are determining the best way for doctors to legally practice telemedicine across state lines, and in general the policy world is catching up to the world of technology. That could bode well for increased telemedicine usage as 2015 moves into 2016.

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