States have made only incremental progress in passing laws that let more physicians practice medicine using video conferencing or other digital methods, according to a new report from a telemedicine advocacy group.
The Center for Connected Health Policy released its overview of telehealth-focused legislation around the country late last month, and the group found that for every state that passed a telemedicine law in 2015, another added some form of restriction on the practice.
Since July 2015, researchers found that 47 states (and Washington, D.C.) currently offer Medicaid reimbursements for video conferencing services, with Utah dropping off the list from a year ago.
Additionally, the number of states offering similar reimbursements for “store and forward” services — a telehealth technique where patient data is electronically transmitted to an intermediate location and stored there before it’s sent to a physician — remains at nine, after Washington approved the practice and Oklahoma disallowed it. Similarly, the group didn’t record any states adding reimbursements for remote patient monitoring technology, which would allow people to remain in their homes rather than staying in health care facilities. Only 16 states currently offer those reimbursements.
“I think the most significant part of this is that we haven’t really seen much at all in terms of changes,” Mario Gutierrez, the center’s executive director, told StateScoop. “In fact, what we see is some states moving forward and some states moving backwards.”
Gutierrez said he’s encouraged by some states making “a little fix here, a little fix there” when it comes to making their health care programs more telehealth-friendly, and he appreciates that the Affordable Care Act has spurred a “transition period in health care.” However, he notes that he was still hoping to see more progress on some of these issues.
In particular, he’s disappointed that more states haven’t taken steps to codify the use of store-and-forward techniques. The group is keeping a careful eye on a New York law passed in January that could let the state’s Medicaid program provide reimbursements for the service, but Gov. Andrew Cuomo’s administration is still finalizing how it will translate the legislation into Medicaid policies.
He’s hoping to see the state take up the technology, joining other large states like California, Illinois and Virginia, to help show lawmakers the value of store-and-forward services.
“It is well-documented as improving quality and saving money, and very mature in the field, particularly around dermatology and ophthalmology, yet we’re still stuck on nine states that reimburse for store-and-forward,” Gutierrez said.
When it comes to remote patient monitoring tech, the group’s researchers noted that only 10 states offered reimbursements for its use in 2013 compared to the 16 today, concluding that there has been some movement on the issue. But Gutierrez lamented that many officials still don’t understand the technology’s value, pointing to the fact that 23 states (compared to 15 a year ago) now restrict the “originating site” for telehealth techniques to health care facilities, limiting doctors with home offices or other nontraditional practice locations.
“By restricting the place where the originating site for the delivery of health care to just medical facilities kind of pre-empts the whole notion of being able to provide care and keep people healthy at home and offer patient portals and virtual care,” Gutierrez said.
However, he noted that one trend in the area encouraged him. Many states once required that patients live in a rural area with a documented shortage of physicians before they could receive Medicaid money for electronic care. Now, only 10 states still have that provision in place — Idaho, Nevada and Missouri have all eliminated those regulations in recent years.
“One of the real advantages of virtual care is it allows you to provide care wherever the patient or individual may be,” Gutierrez said.
Gutierrez is also optimistic about the prospect of more telehealth changes coming at the state level in the next few months. His group found that lawmakers in 44 states have introduced 150 telemedicine bills in their 2016 legislative sessions so far, a trend he attributes to a growing focus on the issue from advocacy groups like the National Conference of State Legislatures.
“There’s much more attention being paid to telehealth in various formats,” Gutierrez said. “We’ve certainly seen it form the kinds of calls we get from certain states for assistance.”
However, to get those bills to actually pass, Gutierrez said his group plans to put a focus on educating lawmakers and advocacy groups about the benefits of telehealth, which he believes are still only loosely understood.
“I think a lot of this is really about education, an increasing awareness as to what connected health and telehealth is all about,” Gutierrez said. “Eventually, my feeling is you’ll reach a critical mass where enough states start passing some forms of common language that other states will follow.”
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