The COVID-19 pandemic has significantly disrupted the healthcare system, yet it has also provided telehealth with an opportunity to demonstrate its worth and potential in delivering care and safeguarding public health.
Nonetheless, telehealth encounters challenges and uncertainties concerning medical licensing. The pandemic has emphasized the need for more flexible and standardized medical licensing, leading to positive changes and innovations like emergency waivers, interstate compacts, and new models and standards for telehealth, accompanied by impact assessments to measure their results.
These changes aren't just temporary fixes; they lay the groundwork for a brighter future in healthcare and medical licensing. In this article, we'll examine how telehealth is transforming the industry and what healthcare professionals need to know.
The Benefits of Telehealth
Eases Pressure on the Healthcare System
Access to patient care is a challenge for many people across the nation. Issues like appointment availability and transportation difficulties contribute to this problem.
Scheduling appointments with primary care physicians and specialists can be tough, often resulting in long wait times. Telehealth offers a solution by enabling patients to receive care from the comfort of their homes. This convenience eliminates the need for travel and reduces waiting times.
Diminishes Rural Barriers to Care
Telehealth plays a crucial role in addressing the challenges of providing care in rural areas. One in four rural residents couldn't access needed healthcare. Approximately a quarter of these individuals cited the healthcare location being too far or difficult to reach as the reason.
Telehealth helps overcome these challenges by bridging the distance between rural care providers, reducing patients' travel time, increasing accessibility, and promoting patient-centered care.
Supports Patients with Limited Mobility
Telehealth significantly improves the well-being of patients with mobility issues, such as older adults and individuals with transportation challenges, disabilities, or chronic conditions requiring frequent checkups. Telehealth allows these patients to access healthcare remotely, improving their quality of life.
Accelerates Timely Care
One of the most significant challenges in healthcare is directing patients to the appropriate provider as quickly as possible. Telehealth helps expedite this process, reducing unnecessary trips to emergency rooms, urgent care clinics, or primary care physicians.
Offers Cost Savings
In addition to clinical benefits, telehealth offers financial advantages. Studies have shown that telemedicine visits save costs by diverting patients from emergency departments and lowering the cost of consultations compared to in-person visits.
The American Journal of Emergency Medicine study found net cost savings per telemedicine visit ranged from $19–$121 per visit. Another study found that telemedicine visits cost an average of $38 compared to $114 for face-to-face visits.
Navigating Telehealth Licensing Regulations
Telehealth licensing regulations vary by state and can be complex. However, in general, telehealth practitioners are required to be licensed in the state where the patient is located. During the COVID-19 pandemic, many states issued emergency waivers that allowed healthcare providers to offer telehealth services across state lines without obtaining additional licenses. However, these waivers are temporary. Let’s take a closer look:
Regulations Before March 2020
- Only certain licensed providers can perform telehealth
- Only patients who have a preexisting relationship with providers can receive telehealth
- Telehealth can only be done at prespecified sites (ie, designated rural areas, and certain medical facilities)
- Physicians must conduct telehealth visits from the place of practice
- Telehealth may not cross state lines
- Telehealth visits must be audio-visual (ie, video technology)
- Could be conducted through approved technology platforms only
- Medicare coinsurance and deductibles apply to telehealth visits
- Reimbursements for telehealth services are lower than for in-person services
Changes After CARES Act and CMS 1135 Waiver
- Any type of clinician can bill for Medicare services
- No preexisting relationship will be required
- Telehealth may originate and be conducted from any site
- Telehealth can now be provided to the patient in another state (state-specific restrictions may still apply)
- Audio-visual OR audio-only are allowed
- Expanded approved platforms, including FaceTime, Skype, and Zoom
- Providers may waive cost-sharing for telehealth paid for by federal programs
- All telehealth visits, including audio-only, will be reimbursed as if the service was furnished in person
The Challenges of Telehealth Licensing
As telehealth services have become increasingly accessible and more frequently covered by both commercial and governmental payers, the recognition of telehealth's benefits has grown. However, with the looming expiration of crucial regulatory waivers that facilitated this growth, telehealth providers may face new obstacles.
A primary concern is the potential end of telehealth waivers enacted in response to the COVID-19 pandemic once the public health emergency (PHE) concludes, which is presently anticipated for May 11, 2023.
During the pandemic, the Centers for Medicare and Medicaid Services (CMS) issued numerous waivers to promote access to virtual care. These telehealth waivers removed several limitations on Medicare coverage for telehealth services, enabling coverage for patients outside rural areas and within their homes, expanding the range of practitioners who could bill for telehealth services, and allowing the use of audio-only technology for telehealth purposes.
Another significant issue is the requirement for in-person examinations when prescribing controlled substances.
Prior to the PHE, the Controlled Substances Act, as amended by the Ryan Haight Act, disallowed the prescription of controlled substances via telehealth without a previous in-person examination, except for a few limited exceptions. In 2018, the Special Registration for Telemedicine Act was enacted, requiring DEA to establish registrations that would enable physicians and NPs to prescribe substances through telemedicine without an in-person exam.
The DEA was mandated to create regulations before the October 25, 2019 deadline, but it never completed this task. When the PHE was declared in 2020, the PHE exception permitted the prescription of controlled substances via telehealth without a prior in-person examination, as long as the prescription was issued for a legitimate medical purpose within the scope of professional practice and subject to state law.
State medical practice laws and telehealth standards will also influence telehealth.
Many states have implemented laws addressing coverage and payment parity for services delivered via telehealth. Simultaneously, other states are revisiting their medical practice laws to better integrate telehealth practices and standards. However, the current landscape remains far from ideal.
Learn more about The Post-Pandemic Licensing Policy Changes
Medical Licensing Policies and Reimbursement
• All state boards, plus the medical boards of the District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine are licensed in the state in which the patient is located, or are registered in the state if they have a registry for interstate practice.
• Alabama, Louisiana, Minnesota, Montana, Nevada, New Mexico, Ohio, and Tennessee issue a special purpose license, telemedicine license, or certificate to practice telemedicine across state lines.
• Colorado, Delaware, Hawaii, Idaho, Illinois, Iowa, Maryland, and Massachusetts require physicians to register or receive a waiver if they wish to practice across state lines.
• Kentucky, Maryland, Virginia, and the District of Columbia offer a form of regional or proximal reciprocity with neighboring states.
• Alaska, Mississippi, and West Virginia offer pro bono or limited referral services for interstate practice.
• California and Texas allow consultative services to be rendered across state lines.
Reimbursement - Medicaid
• All states and the District of Columbia provide reimbursement for some form of live video in Medicaid fee-for-service.
• 25 states reimburse for store-and-forward.
• 34 states reimburse for remote patient monitoring.
• 34 states reimburse for audio-only.
• 17 states reimburse for all three, with certain limitations.
Reimbursement – Private Payer
• 43 states and the District of Columbia govern private-payer telehealth reimbursement policies.
• 24 states have private payer parity laws.
The future of healthcare is at the crossroads of telehealth and medical licensure since it is becoming clear that telehealth plays an important part in current medical practice.
Medical boards and healthcare providers must collaborate to design licensing regulations that promote the expansion of telehealth while preserving the highest levels of patient care.
We may expect continuing advances in healthcare availability, efficiency, and cost-effectiveness as telehealth and novel healthcare solutions are integrated. By addressing the challenges of telehealth licensing and refining telehealth standards, medical boards will play a key role in shaping the future of healthcare.
FAQs About Telehealth and Medical Licensing
How has telehealth impacted medical licensing?
Telehealth has emphasized the need for more adaptable and standardized medical licensure, as clinicians sometimes need to be licensed in numerous jurisdictions in order to deliver virtual services to patients in various regions.
What are the benefits of telehealth licensing?
Telehealth licensing allows healthcare providers to offer remote services to patients, improving access to care and reducing the strain on healthcare systems. It also enables providers to reach patients in rural areas, support patients with limited mobility, and provide timely care while reducing costs.
What are the challenges of telehealth licensing?
Telehealth licensing is complex, with regulations varying by state. Providers often need to obtain multiple licenses to practice across state lines, which can be time-consuming and costly. Additionally, temporary waivers issued during the pandemic are set to expire, leading to uncertainty about future regulations and restrictions.
What is the role of medical boards in telehealth licensing?
Medical boards are responsible for setting the standards for telehealth practice and ensuring that providers are licensed and qualified to offer remote services. They also play a crucial role in developing policies that support the growth of telehealth while maintaining high standards of patient care.
What are the technology requirements for telehealth?
Telehealth services typically require secure, high-speed internet connections, video conferencing software, and devices such as computers, tablets, or smartphones. Some telehealth platforms may have specific requirements or be limited to certain devices or operating systems.
How does telehealth impact healthcare equity?
Telehealth has the potential to promote healthcare equality by expanding access to care for those who live in rural locations, have restricted mobility, or live in underserved populations.
However, addressing the digital gap and ensuring that all patients have access to the appropriate equipment and internet connections in order to benefit from telehealth services is critical.
What is the future of telehealth and medical licensing?
The future of telehealth and medical licensing will likely involve continued growth and integration of telehealth services into healthcare systems. Collaboration between medical boards, healthcare providers, and policymakers will be essential in refining telehealth standards, addressing licensing challenges, and shaping the future of healthcare.