Make the COVID-19 Telehealth Reforms Permanent
In response to the COVID-19 pandemic, every state initiated some type of temporary reform to the rules that govern how providers deliver telehealth and how patients receive it. These reforms usually allowed out of state providers greater access to practice across state lines as well as allowed patients to use audio-only telephone calls to receive care.
While these reforms greatly expanded access to telehealth during a public health emergency, most were initiated via executive orders or state agency rules and were directly tied to the duration of the public health emergency. The temporary nature of these reforms presents a major hurdle for Americans seeking virtual care as the gains in access they enjoyed during the health emergency will be lost if state legislatures fail to act and enshrine them into law.
To ensure patients can continue to enjoy continued access to telehealth, state legislatures across the country need to take the appropriate legislative steps to transform temporary measures into law. Failure to do so will not only prevent patients and providers from utilizing a method of healthcare delivery they overwhelmingly approved by patients, but any delay could also result in unnecessary negative health outcomes such as increased mortality rates, lower quality of life, and increased hospitalizations.
Before the pandemic, telehealth was becoming an increasingly important part of the U.S. healthcare system. Between 2010 and 2015, the number of telehealth visits “increased from 11,113 to 86,238.” While 2020’s telehealth visits are yet to be calculated, analysts estimated approximately 20% of all visits would be conducted virtually, generating an estimated $29 billion. Aside from the global pandemic, the growth in telehealth utilization has been driven by convenience and an overall lower cost of service.
One of the principal temporary reforms to telehealth that occurred during the COVID pandemic was allowing out of state providers the ability to practice across state lines. Before the pandemic, most states required providers to be fully licensed in the state where the patient was located. This requirement was particularly harmful to patients in states such as Mississippi, New Mexico, and Louisiana as they are experiencing some of the most severe physician shortages in the country that routinely prevents patients from accessing high-quality care and leads to unnecessary negative health outcomes.
In response to the pandemic, governors and state licensing boards from 41 states issued temporary waivers to allow out of state healthcare providers to deliver virtual health services so long as they had the appropriate license in another jurisdiction. As the example of North Dakota and Alaska show, when states liberalize out of state licensing laws for telehealth providers they are better able to deliver health care to rural Americans and those living in areas with a shortage of medical providers.
The other significant temporary reform that was implemented was an allowance that visits could take place asynchronously or via an audio-only telephone call. Previously, states only allowed telehealth visits to occur over interactive audio-visual platforms. This requirement was particularly problematic to the estimated 19 million Americans who lacked fast enough internet to utilize these platforms, effectively excluding them from receiving telehealth. The problem is particularly pronounced in rural communities where 14.5 million Americans do not have access to broadband internet and the seven in ten adults over 65 who have never used a “computer, smartphone or tablet with internet access at home.”
In response to the pandemic, numerous state governors and agencies issued amended rules or orders that allowed telehealth visits to occur over audio-only telephone calls, opening access to the millions of Americans who do not currently have the internet capacity to support interactive video visits. Louisiana was one of the states to initiate temporary reform, with the State’s Department of Insurance mandating “health insurance issuers shall waive any limitation on the use of audio-only telephonic consultations” as a way to expand telehealth access to communities without access to audiovisual platforms.
Despite the overwhelming popularity of telehealth among patients and providers, and its overwhelming growth over the past decade, most of the reforms to telehealth are only temporary, with barriers to access once again erected once individual states declare the public health emergency over. To combat this, and ensure patients can continue to access telemedicine, states across the country need to enshrine these temporary reforms into law. Failure to do so will leave patients worse off and facing significantly worse health outcomes than what is currently available.
Edward Longe is a research associate at the American Consumer Institute, a nonprofit educational and research organization. For more information about the Institute, visit www.TheAmericanConsumer.org or follow us on Twitter @ConsumerPal.
