The State of Telemedicine — State by State
The American Telemedicine Association (ATA) has released two thorough and valuable reports on the state of telemedicine in all fifty states.
The first ranks states by policies on physician practice and licensure. This covers informed consent, standards for the physician-patient encounter, and permission for out-of-state practice. (The latter is the special concern of the proposed interstate compact proposed by the Federation of State Medical Boards).
If telemedicine is to be exploited to its maximum potential, it is critical that the highest professional standards be recognized and adhered to. That means out-of-state practitioners need to be able to treat patients via telemedicine.
The report ranks states with an A, B, or C. The good news is that 23 state plus DC get an A. Only one (Alabama) gets a C. So, the state of telemedicine licensure is not as bad as often reported, and it should be very possible to get the remaining states up to standard.
The second ranks states by coverage and reimbursement, using “parity” as a positive measure. This refers to whether a state has laws or policies requiring parity for in-person consultations and telemedicine consultations for private payers, Medicaid, and state-employee health plans. For each of these three payers, the report examines parity for services such as mental and behavioral health, home health, rehab, eligible technologies, geographic restrictions, etcetera.
As in the first report, the states are ranked A, B, C, or F. Seven states get an A: Maine, Maryland, New Hampshire, New Mexico, Mississippi, Tennessee, and Virginia. Three get F: Connecticut, Iowa, and Rhode Island.
I am less enthusiastic about the second report is because it advocates government power to dictate what private plans must cover. What would be more interesting to see is which telemedicine services private payers cover in the absence of a state mandate. Now that so many Americans are also paying out-of-pocket, via Health Savings Accounts and other consumer-driven payment mechanisms, it would be valuable to know how they decide to spend their health dollars directly, when given the choice of telemedicine versus in-person visit.
Nevertheless, both reports contain valuable information, and the ATA is to be congratulated for its hard work producing them.
I always enjoy reading about private insurers experimenting with telemedicine. That said, I don’t necessarily believe forcing all private insurers to cover telemedicine is a good idea. I don’t like mandated benefits in general. Both doctors and patients need the appropriate incentives to use telemedicine where appropriate.