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Research & Commentary: Pennsylvania Considers Lowering Restrictions on Telemedicine

April 6, 2018

In this Research & Commentary, Matthew Glans examines a proposal in Pennsylvania that would dramatically expand the ability of telemedicine servicers to provide care by clearly defining telemedicine and calling for reimbursement parity.

Telemedicine – the use of information technology to remotely diagnose, treat, or monitor patients – can transform health care delivery by making it more affordable and available. Telemedicine has existed for years, but current technology now allows health care practitioners treatment options not viable in the past. One of telemedicine’s biggest benefits is its unique ability to deliver health care to areas that are currently underserved, such as rural or economically depressed regions.

The main barriers preventing telemedicine from expanding further in many states are government regulation and the inability of the current system to properly reimburse doctors providing telemedicine 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.

A proposal, introduced by Pennsylvania state Sen. Elder Vogel (R-Beaver), would dramatically expand the ability of telemedicine servicers to provide care by clearly defining telemedicine and the wide range of technologies and services it comprises. This would allow for a practitioner-patient relationship to be established remotely. Perhaps most importantly, the bill would also require health care payers provide reimbursements for telemedicine services at the same rate they pay for the same service in person. These reforms would provide substantial benefits to the state’s health care market.

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.

Several states have already passed or considered legislation unleashing the telemedicine market so that providers can use this important new technology to expand their reach. In 2017, New Jersey and Vermont passed new laws providing telemedicine payment parity. In Texas, where telemedicine has historically faced significant backlash, rules were passed in 2017 that enable Texas practitioners to use telehealth services.

Telemedicine has the potential to provide routine health care services to more people at a lower cost than traditional in-person delivery. Unfortunately, unnecessary and burdensome government regulations continue to stifle access to telemedicine services for many Americans. Telemedicine reform efforts in states such as New Jersey, Pennsylvania, Texas, and Vermont are a positive move toward making telemedicine more widely available. Additional states should pass similar legislation, thereby increasing health care access and simultaneously reducing costs.

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

The Traveling Doctor: Medical Licensure across State Lines
https://www.americanactionforum.org/insight/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
http://www.nejmcareercenter.org/article/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
http://heartland.org/policy-documents/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
http://heartland.org/policy-documents/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
http://www.theamericanconsumer.org/2008/03/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
http://heartland.org/policy-documents/telemedicine-inquiry-economic-and-social-dynamics-communications-technologies-medic
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
http://www.beckershospitalreview.com/healthcare-information-technology/3-solutions-for-major-telemedicine-barriers.html
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?
http://heartland.org/policy-documents/crossing-telemedicine-chasm-have-us-barriers-widespread-adoption-telemedicine-been-
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 Lindsey Stroud, The Heartland Institute’s government relations manager, at lstroud@heartland.org or 757/354-8170.

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Health Care
Author
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.
mglans@heartland.org @HeartlandGR