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Research & Commentary: Virginia Seeks to Roll Back Restrictions on Telemedicine

January 17, 2019

In this Research & Commentary, Matthew Glans examines a new effort in Virginia to reduce the regulatory burden on telehealth providers.

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 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.

Two new bills being considered in the Virginia General Assembly will dramatically expand the role of telehealth providers in the state and lower some of the regulatory barriers that prevent telemedicine from providing affordable care for thousands of Virginians. The two bills are similar, although not exactly the same. Both bills require insurers, corporations, or health maintenance organizations to incorporate remote patient monitoring services as part of their coverage of telemedicine services. This expansion of coverage would include services like monitoring of clinical patient data such as weight, blood pressure, pulse, medication adherence, and interactive video conferencing.

The bills also require Virginia’s Department of Medical Assistance Services to include a provision in the state Medicaid plan for the payment of medical assistance for health care services provided through telemedicine services, including remote monitoring services. This is a solid step, but there are concerns on the cost of this mandate.

One of the most promising changes the bills would make is licensing reform for telehealth providers, which would allow licensed doctors in good standing with the relevant regulatory agency in their home states to provide telehealth services to Virginia residents. In essence, this would allow some providers to provide telehealth services across state lines.

The bills establish jurisdiction for these rules by deeming telehealth services to occur based on where the practitioner is located at the time of provision. Some critics are concerned about bad actors from other states providing poor care to Virginians, but a more open market would quickly flood out the bad actors with quality providers.

Like all new legislation, these bills are not perfect, they would impose mandates on insurers and new costs on the state Medicaid program, but they are a positive first step toward opening the state to desperately needed care.

Currently, 200 telemedicine networks with 3,500 service sites operate across the United States, according to the American Telemedicine Association, and the number of telehealth providers is only expected to grow. A 2017 report estimated that the global telehealth market is poised to expand at a compound annual growth rate of about 16.3 percent over the next decade, reaching approximately $78.3 billion by 2025, according to Accuray Research. Furthermore, patients prefer telemedicine over in-person services. Among patients receiving telemedicine services on a mobile app, 80 percent preferred telehealth compared to a traditional office visit, a 2016 study by West Monroe revealed.

Telemedicine services can have an especially positive effect 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 recent VA study.

Telemedicine is a viable and beneficial health care option for patients and providers. Therefore, Virginia lawmakers should embrace reforms that reduce restrictions on telehealth care providers so health care coverage is more affordable and accessible.

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 finds telemedicine is clinically effective.

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 Chiron Health, 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,” La Couture wrote.

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 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 the government relations team, at governmentrelations@heartland.org or 312-377-4000.

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