‘Antiquated’ Laws Still Hobbling Telemedicine

There is no doubt telemedicine is a growth industry. According to data compiled by Ken Research (as reported by the Institute for HealthCare Consumerism), the “telehealth market” earned $9.6 billion in 2013; that’s up 60% from 2012 ($6 billion). Ken also projects that telehealth revenues will grow to $38.5 billion by 2018.

There are many factors driving the growth of telemedicine. One impetus is this technology’s ability to deliver advanced care in rural and remote areas where equivalent in-person treatments are not readily available. A second reason is the ability of telemedicine to connect various locations to a centralized “expert” hub. This allows top physicians to provide a level of service that, once again, could not be achieved in person due to the lower budgets of smaller medical institutions and their locations. And a third driver is telemedicine’s ability to support new, advanced forms of treatment that had never been thought of previously. One example is letting allowing at-home patients take and discuss their own medical tests via data and videoconferencing links with professionals. (Three common areas for telemedicine use include mental health, ICU and emergency department services.)

Despite these benefits and the improving connectivity among health centers and patients thanks to the Internet’s ever-quickening data speeds, the field is still being hobbled by a range of “antiquated and restricted rules,” says Latoya S. Thomas, director of the American Telemedicine Association’s State Policy Resource Center. Founded in 1993, the nonprofit ATA has over 8,000 telemedicine members from around the world. According to the association, there are currently about 200 telemedicine networks and 3,500 telemedicine service sites in the U.S. alone, and nearly one million Americans are currently using remote cardiac monitors.

“In many cases the laws governing healthcare practices have not kept up with technology and have thus unintentionally stood in the way of telemedicine and healthcare access,” Thomas says. “As well, many lawmakers and regulators—and the laws they create—don’t accommodate for patient-centered, tech-enabled healthcare experiences.”

She cites the state of Arkansas as one of the worst offenders in this regard. “In Arkansas a physician has to see a patient in person for it to be considered a valid medical relationship,” Thomas notes. “Anything else is seen as just not being as good, and thus not worthy of the same level of certification, recognition and support.”

ArkansasOnline chronicled last year’s failed attempt to remedy that, when a bill from Rep. Dan Sullivan (R-Jonesboro) to bring video-based telemedicine (using Arkansas-licensed doctors) into the state was defeated by a vote of 49-21 in the state’s House of Representatives. [https://www.arkansasonline.com/news/2015/mar/20/house-rejects-telemedicine-bill/]

“I think we need to slow this process down,” Rep. Stephen Magie (D-Conway) said in the story, exemplifying the kind of often-uninformed resistance that telemedicine and other advanced technological approaches often encounter with legislators. “Just because it costs less doesn’t mean it’s good medicine,” Magie said. “It may sound good, but I think in the long term, it’s going to sell our patients short.”

Political resistance is not the only obstacle to telemedicine’s growth. “Many healthcare plans and insurance providers refuse to cover treatment if it’s delivered via telemedicine, even if it’s equal or superior to the range of in-person options available to the patient,” says Thomas. “Fortunately, 29 states and Washington, DC, have passed laws forbidding such providers to discriminate against telemedicine claims—and the number is growing.”

Then there’s the issue of turf: The current U.S. model of licensing physicians on a state-by-state basis “means a doctor licensed in California has to also be licensed in Alaska to offer telemedicine services there,” says Thomas. To get around this regulatory handicap, the states need to either strike reciprocity agreements where state medical licenses apply in multiple jurisdictions or work with the federal government to create national licensing. “We are seeing progress on national licensing for nurses and psychologists,” she says. “It’s time to do the same for all health professionals, for the benefit of patients.”

Finally there are vested interests that don’t want to see a move away from strictly doctor-patient in-person visits, for reasons of personal profit. Thomas acknowledges this is a real obstacle for advancing the reach and range of telemedicine.

Nevertheless, she sees “a bright future” for telemedicine, given the cost savings it offers for equal and even superior care for patients (versus in-person options in certain areas). “Physicians and healthcare centers can contact the ATA at www.americantelemed.org to learn more about what telemedicine can offer their patients, and to connect to telemedicine providers to partner with,” she says. “There is no reason in this day and age to not use telemedicine to advance healthcare delivery and provide better patient outcomes while working within budgetary restraints.”

James Careless is a freelance writer with extensive experience covering computer technologies.