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Research & Commentary: Telehealth Steps Across State Lines to Connect Patients and Providers

March 30, 2022

In this Research & Commentary, Matt Dean looks at a way for patients and mental health providers to connect virtually across state lines through a multistate compact for telehealth-mental health

On March 24th, 2022, Utah became the sixth state to join the Interstate counselors compact. The unique multi-state agreement will allow patients and their mental health providers to connect for counseling sessions virtually, even if they are not in the same state. Once ten states join, the agreement becomes effective, and patients can begin treatment. Patients in any member state will then be able to connect with any provider in a member state.

The compact will be good for patients, providers and their states. Many patients find the convenience of telehealth reason enough to replace in person office visits.  Nearly 80% of telehealth patients responded that they have a favorable opinion of the services in a recent telehealth patient survey. Visits can be completed in fifteen minutes from anywhere, as opposed to losing time from work, which costs American workers $38 billion annually in lost wages.

Providers and patients have more access to one another, while states enjoy a competitive advantage for professionals within a sector that is nearly 40 times larger than it was in Jan 2019.

The emergence of telehealth as a necessary replacement for in person treatment gave telemedicine a baptism by fire as practice standards changed overnight to allow for patient visits to happen virtually. In 2020, as nonessential medical procedures were postponed in hopes of slowing the spread of the coronavirus, telehealth (which is also sometimes referred to as telemedicine) was forced to immediately scale up to provide connections between patients and providers who were separated by lockdown orders. Not only were patients prevented from seeing their doctor by the lockdowns, but the prevalence of people reporting anxiety or depressive disorder jumped from one-in-ten before the pandemic, to one in four by mid-2020. The pandemic was creating a crisis in mental health, while preventing its treatment.

After in person nonemergency visits resumed, many patients justifiably feared coming to hospitals and clinics as the virus raged across America. Protecting frontline emergency workers became the highest priority of policymakers who were given models showing a pandemic rivaling or eclipsing the worst pandemics in US history. Telehealth visits became the alternative to bringing millions of sick and healthy people together. Now, state laws are being considered to replace temporary emergency use of expanded telehealth with state-specific laws tailoring their future use.

TELEHEALTH BEFORE AND AFTER COVID-19

Telehealth is the use telephones, tablets and computers to remotely connect medical providers with each other or to patients. Telehealth is most commonly defined as video and audio telecommunication, but some legislation expands that to telephonic communications as well. Telehealth began in surgical suites and emergency rooms to bring the expertise of specialty physicians to complex surgeries and procedures. Over time, telehealth was expanded to replace some face-to-face primary care visits for the convenience of the patient. Patients in remote areas, or those who lacked the ability to travel could see their doctor or mid-level provider from their home. Through 2019, telehealth grew slowly beyond early adopters. Then came COVID-19, and telehealth was given a trial by fire. In just a few short months, telehealth services skyrocketed from just 2.8% of all healthcare services, to over 70% of services in the first 90 days of 2020. Federal and state emergency executive orders immediately sidelined restrictions on telehealth. Telehealth utilization has expanded from 11 percent of US consumers using telehealth in 2019 to 46 percent of consumers now using telehealth to replace cancelled healthcare visits.

Turf wars between providers, that for over a decade worked to restrict the growth of telemedicine, were declared over. Suddenly, providers were forced to make it work. The success of telehealth has been recognized as one of the positive outcomes of the tragedy of the pandemic. Patients enjoyed the convenience of being able to see their doctor from home. Physicians could prioritize face-to-face visits for only those visits that could not be done remotely. It was clearly more convenient for both in many instances.

Military spouses with state-based licenses to practice often pay a heavy price with moves across state lines. The compact specifically provides military spouses with the ability to continue working through moves with their enlisted spouse. Wisconsin Senator Joan Ballweg, who serves as the national chair of the Council of State Government’s committee on state compacts said, “Military spouses work hard to earn professional credentials and establish themselves in licensed occupations while also being willing to sacrifice their professional lives in support of their spouse so they can serve our country.”  The Council of State Governments (CSG) has been essential in providing unique legislative support to make this compact happen.

Heartland supports the efforts to make permanent many of the emergency telehealth measures put in place during the early days of the pandemic. Telehealth was designed to expand access, and the numbers certainly speak for themselves. According to a recent survey from the Covid19 Healthcare Coalition, 80% of patients express satisfaction with their experience, and more than 70% anticipate utilizing telehealth after the pandemic.

After peaking in April 2020, patients are returning to in-person visits, but also about 25% are choosing to replace in-person visits with telehealth. Current utilization of telehealth services has stabilized but reflects a change that is unlikely to decrease demand long term for telehealth services.

Telehealth can never replace in person doctor visits. Mental health consults are greatly expanded through telehealth. Importantly, it is sometimes preferable to have a face consultation with a mental health provider, and telehealth can better allow those providers to prioritize office visits for those patients who need to be seen.

Lastly, telehealth can provide fast, direct access and limit unnecessary travel and contact for frail elderly, or other patients with preexisting conditions making it difficult to travel.  Last year, 3.6 million Americans didn’t go to the doctor because of transportation issues.

The results have shown that telehealth can be a great addition to care for more people and if delivered in the right way, can free up clinic time and resources for those who need to be seen and treated in person.

The telehealth counselor compact demonstrates how legislatures can work together to expand access to mental healthcare to meet the challenge presented by the COVID-19 mental health crisis. 

 

The following articles provide more information about telehealth reform.

 

Mckinsey & Co, Telehealth: A quarter-trillion-dollar post-COVID-19 reality?

Telehealth: A post-COVID-19 reality? | McKinsey

Forbes,  Don’t Dam the Telehealth Flood

Don't Dam The Telehealth Flood (forbes.com)

MHealth, COVID-19 Telehealth Delivery Reaps High Patient Satisfaction.

https://mhealthintelligence.com/news/covid-19-telehealth-delivery-reaps-high-patient-satisfaction

McKinsey & Company, Telehealth: A quarter-trillion-dollar post COVID-19 reality?

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality#may29

The COVID-19 Healthcare Coalition Telehealth Impact Study Work Group: Patient Survey Analysis

https://c19hcc.org/telehealth/patient-survey-analysis/

American Hospitals Association, Social Determinants Telehealth Impact

http://www.hpoe.org/resources/ahahret-guides/3078

Council of State Governments, Counseling Compact

https://counselingcompact.org/

https://counselingcompact.org/wp-content/uploads/2021/06/Compacts-Universal-Recognition-Explained-Final-Counseling-Compact.pdf

US Department of Human Services, US Surgeon General Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-19 Pandemic

https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html

Kaiser Foundation, Adults Reporting Symptoms of Anxiety or Depressive Disorder During Covid-19 Pandemic

https://www.kff.org/other/state-indicator/adults-reporting-symptoms-of-anxiety-or-depressive-disorder-during-covid-19-pandemic/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Kaiser Foundation, The Implications of COVID-19 for Mental Health and Substance Abuse

https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

US Health & Human Services, Assistant Secretary for Planning and Evaluation, Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs Video Service

telehealth-hps-ib.pdf (hhs.gov)

Heartland Institute, Matt Dean testifies in Colorado on their bill to join the interstate telehealth compact for mental health

https://www.csg.org/2021/08/03/new-csg-compacts-project-benefits-military-spouses/

Forecasting for COVID-19 Has Failed

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447267/

Healthcare Dive, Travel to healthcare appointments haven’t improved in eleven years

https://www.healthcaredive.com/news/travel-to-healthcare-appointments-wait-times-havent-improved-in-11-years/549024/

 

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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 and other topics, visit the Heartland Daily News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Matt Dean at mdean@heartland.org or 312/377-4000.

Author
Matt Dean is Senior Fellow for Health Care Policy Outreach at The Heartland Institute.
mdean@heartland.org