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Research & Commentary: Telemedicine Reform Moves Forward in Pennsylvania

December 20, 2019

In this Research & Commentary, Matthew Glans examines a new proposal in Pennsylvania that would roll back many of the rules holding back the growth of telemedicine.

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. The main barriers preventing telemedicine from expanding in many states are government regulations such as strict licensing standards. In many instances, states control licensing standards, professional discipline, and the various costs associated with procuring licenses. Another issue is the inability of the current system to properly reimburse doctors providing telemedicine services.

States should reduce regulatory barriers to telehealth providers. Some reforms lawmakers should consider include allowing practitioner-patient relationships to be established remotely and requiring health care payers, such as insurance companies, to provide reimbursements for telehealth services at the same rates as comparable in-person services.

In late November, the Pennsylvania Senate approved legislation that would take several important steps towards opening up the Keystone State to telemedicine. Introduced by State Sen. Elder Vogel (R-Beaver), Senate Bill 857 specifically defines telemedicine as “the delivery of health care services provided through telecommunications technology to a patient by a healthcare practitioner who is at a different location.”

SB 857 also sets guidelines for who can provide telemedicine services, and also provides new clarity on how insurance companies provide reimbursement for those services. Under the bill, insurance policies are not allowed to exclude a health care service for coverage solely because the service is provided through telemedicine and the bill also requires a health insurer to reimburse a participating network provider for telemedicine services if the insurer reimburses the same participating provider for the same service conducted in-person. The bill will now move to the House for consideration.

“Telemedicine can help patients get the care they need. It allows for improved access and improved health outcomes in cost effective ways,” Sen.Vogel said in a statement. “Studies show that telemedicine saves time, money, and lives. With the rapidly rising cost of healthcare, and the fact that it is nonexistent in some places, the need for telemedicine continues to grow.”

Currently, 200 telemedicine networks with 3,500 service sites are in operation throughout the United States, according to the American Telemedicine Association. A 2017 report on the global telemedicine market estimates the telehealth market is poised to expand at a compound annual growth rate of 16.3 percent over the next decade, reaching approximately $78.3 billion by 2025, according to Accuray Research LLP.

Telemedicine is popular with patients. Among telehealth patients receiving services on a mobile app, 80 percent preferred telehealth compared to a traditional in-office visit, a 2016 study by West Monroe Partners reveals.

Telemedicine services can have an especially positive impact on patients with chronic conditions, such as diabetes, irritable bowel syndrome, and multiple sclerosis. Chronic conditions affect approximately 133 million Americans, according to Chiron Health. Furthermore, the U.S. Department of Veterans Affairs (VA) was able to reduce “the number of bed days of care by 25% and the number of in-hospital admissions by 19% using home-based video visits,” as noted in a VA study.

Telemedicine and telehealth can 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. Both of the bills being considered in Pennsylvania would expand the use of telemedicine and are good steps toward what should be the state’s ultimate goal: full expansion of telehealth services to all Pennsylvania residents.

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

AHRQ Finds Telemedicine Clinically Effective
https://www.politico.com/newsletters/morning-ehealth/2018/06/01/ahrq-finds-telemedicine-clinically-effective-238848
Politico’s Mohana Ravindranath examines a new study from the Agency for Healthcare Research and Quality that found telemedicine is clinically effective. The study was unable to find conclusive evidence to determine if telemedicine is more cost-effective, however.

The Promise of Telehealth For Hospitals, Health Systems, and Their Communities
https://www.aha.org/system/files/research/reports/tw/15jan-tw-telehealth.pdf
This study from the American Hospital Association examines the potential benefits of telehealth. The study’s researchers focus on how telehealth is being used by hospitals and considers how this important innovation helps patients and providers alike.

Telemedicine Facts that May Surprise You
https://chironhealth.com/blog/telemedicine-facts-may-surprise/
In this article published by ChironHealth.com, Lauren Cranford examines several research studies and polls that prove telemedicine is popular and effective.

Telemedicine … Across State Borders
https://www.cato.org/publications/commentary/telemedicine-across-state-borders
Shirley Svorny, professor of economics at California State University at Northridge, discusses the value of using telemedicine services, how allowing telehealth care across state lines would improve the availability of care, the barriers to telehealth expansion, and some reforms state and federal legislators should consider that would expand telemedicine services.

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.

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 that 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 Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

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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