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Research & Commentary: Florida Considers Taking First Steps in Telehealth Reform

March 2, 2018

In this Research & Commentary, Matthew Glans examines the Florida legislature's efforts to encourage the expansion of telehealth in the Sunshine State.

Telehealth – the use of information technology in the diagnosis, treatment, or monitoring of a patient’s condition – can dramatically lower health care costs while increasing access for patients, especially those in underserved areas. Telehealth has existed for years at a basic level, but the technology has now advanced to the point where the full process of diagnosing, analyzing, and prescribing treatment can often be done remotely. One of the main benefits of telehealth is its ability to provide care to areas that are currently underserved, such as rural or economically depressed regions.

The main barriers preventing telehealth from expanding further in many states are government regulation and the inability of the current system to properly reimburse doctors providing telehealth services. Strict licensing standards have become a significant barrier to entry in the health care industry. In many instances, states control licensing standards, professional discipline, and the various costs associated with the licenses.

Florida is now taking its first steps toward making telehealth a more viable long-term option for Floridians. In 2016, the state created a 15-member Telehealth Advisory Council with a mission of finding new ways to improve telehealth services through regulatory reform. A new bill proposed by state Sen. Aaron Bean (R- Fernandina Beach) incorporates some of these recommendations and would move the state’s telehealth industry forward by allowing state workers to use telehealth services.

Bean’s bill encourages the state group health insurance program to offer health insurance plans that include telehealth coverage for state employees while permitting the state Agency for Health Care Administration to pay for certain telehealth services as optional Medicaid services. The legislation would also establish practice standards of care for these providers and addresses one of the key concerns from critics by stating that telehealth may not be used to prescribe controlled substances, including medicinal marijuana.

One area in which the bill falls short of the advisory council’s recommendations is its lack of language requiring reimbursement parity. Until telehealth providers can be assured of equal standing in how they are reimbursed, the market will not reach its full potential and thus will fail to provide needed care to thousands. Future telehealth reforms should include parity in both health care coverage and reimbursement.

Adam C. Powell, president of Payer+Provider Syndicate, a health services consulting firm, outlined several ways telemedicine could help decrease healthcare spending in a 2012 Healthcare IT News article. Powell notes the use of remote analysis services, remote monitoring technologies, and mobile health monitoring enable health care professionals to pool resources and prevent unnecessary and expensive inpatient stays and emergency room visits. He also notes telemedicine helps reduce hospital readmissions after treatment, which cost patients and the industry more than $16 billion each year, according to a 2011 study by National Institute for Health Care Reform.

Telehealth can provide health care services to more people who need it at a lower cost. It is hampered not by inadequate technology or a lack of demand, but by government regulations. Sen. Bean’s telehealth reform efforts are a strong first step in making telehealth more widely available to Floridians, but reimbursement parity must soon follow.

The following documents examine telehealth and various barriers blocking its expansion.

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.

Telemedicine: Helping Consumers and the Environment
Over the next 10 years, broadband applications such as telecommuting, distance learning, teleconferencing, and e-materialization will decrease greenhouse gas emissions by one billion tons, the American Consumer Institute finds. This ConsumerGram takes a second look at one of the more promising and fast growing applications, telemedicine, and identifies several new ways these applications can help both consumers and the environment.

Telemedicine: An Inquiry in the Economic and Social Dynamics of Communications Technologies in the Medical Field
Francis Pereira, Elizabeth Fife, and Antonio A. Schuh identify barriers to telemedicine that can be addressed by policymakers, broadband equipment manufacturers and service providers, and key players in the health care industry, to exploit the opportunities these new technologies offer.

3 Solutions for Major Telemedicine Barriers
This article from Becker’s Hospital Review discusses a recently published study in Telemedicine and e-Health which 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.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit the Heartland Institute’s website and PolicyBot, Heartland’s free online research database. 

If you have any questions about this issue or The Heartland Institute’s website, contact John Nothdurft, The Heartland Institute’s director of government relations, at or 312/377-4000.

Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst. @HeartlandGR