Texans dodged a bullet Wednesday when Gov. Greg Abbott decided to extend the state’s Covid-19 disaster declaration and, with it, to avoid extinguishing one of the few bright lights of the pandemic. Thanks to the extension, Texans can continue the expanded access to telemedicine conferred under the declaration. But the extension is only certain for the next month. Without recertification, the Lone Star State will join the 39 others that have re-erected their pre-Covid barriers to telehealth.
Red tape and restrictions on telemedicine — health care services provided to patients remotely via the internet or telephone — need to be removed to make such care viable, particularly state licensing requirements and insurance reimbursement policies that require in-person visits. During the pandemic, states and insurers overnight did what years of advocacy for telemedicine had failed to accomplish.
Starting in March 2020, Medicare added coverage for mental health and dozens of other services delivered via telehealth, and many private insurers waived or lowered patient co-pays for online or telephone visits. At the same time, every single state offered some sort of waiver in 2020 for physician licensing requirements to make it easier for patients to be seen virtually by health care providers.
Those waivers differed. Some allowed physicians to apply for temporary licenses to practice telehealth with patients in and outside the state; some allowed services to be rendered only by practitioners in surrounding states; some only allowed providers to use telehealth with established patients; and still others limited the types of providers that could serve patients.
Now, though, as the country works its way back to a “new normal,” fewer states are maintaining any of the loosened requirements. If the exemption in Texas expires, only 10 states will provide the waivers that continue to make telehealth more accessible.
The spread of telemedicine wasn’t just a major source of convenience for patients during the pandemic — it almost certainly saved lives. A study published in February, funded in part by the Institute for the Study of Free Enterprise by the University of Kentucky, found that mortality rates decline following the passage of laws that expand insurance coverage to telehealth services.
While telehealth opponents warn of declining care when a doctor is not able to touch or observe a patient directly, researchers cited randomized control trials for diabetes finding the opposite. In fact, they found that telemedicine may actually “increase patient education, improve patient compliance, and provide more and higher quality information to providers.”
That’s because telehealth reduces the time spent traveling to and from appointments, reduces the need for childcare expenses and makes it easier for the patient to follow through with treatments by simplifying the process. It also increases patients’ access to critical information because they can see their own charts and ask questions at any time. Doctors, for their part, can better monitor medical devices at a patient’s residence, and being able to see a patient’s home life can provide new clues about health issues.
The impact of telehealth is even greater in areas where access to primary care providers and specialists is more limited. A 2020 study by our organization Connected Nation, which advocates for expanded access to high-speed internet, showed that, on average, counties where a smaller percentage of households subscribed to home broadband service also had fewer primary care physicians per resident.
A study published the year before by Seton Hall researchers found that providing coverage for telemedicine “reduced disparities in access to health care and in health outcomes,” particularly in rural settings. These outcomes include an increase in routine check-ups and a decrease in hospitalizations.
Telemedicine access in rural areas is particularly urgent given how many hospitals in these places are shuttering their doors. An article in the Becker Hospital Review in March found that 892, or more than 40%, of rural hospitals nationally are at immediate risk of closing. That comes on top of the 140 rural hospitals that have closed since 2010.
When rural hospitals close, patients must drive further. On average, according to the Government Accountability Office, it means driving an additional 20.5 miles for inpatient care and an extra 39.1 miles for alcohol or drug abuse treatment. That makes gas costs increase, and could require more time to take off work and pay for childcare.
Research showing that telemedicine is better for health outcomes is not new. It just took the pandemic to make widespread use — and insurance coverage — of telemedicine a reality.
So why would states be returning to the status quo? The ostensible reasons seem to fall under one of three concerns. First, some states question whether patients are paying more as a result of these waivers — though we are aware of no studies that quantify this to date.The second is the perennial concern that care online is not comparable to what patients receive in person, a supposition that needs further study (but can only be assessed if telehealth continues).
Third, there is concern that eased access to telehealth increases the risk of fraud, waste or abuse. While some studies do cite an increase in medical fraud accusations since states relaxed their telehealth rules, the Department of Health and Human Services Office of Inspector General reported last month that only a fraction of a percent of health practitioners used questionable or “concerning” billing practices in their telehealth services provided to Medicare patients.
In short, the jury is very much out, as there is no strong body of evidence that fears of greater fraud are warranted. Anecdotally, we’ve heard from doctors and mental health practitioners that they’re concerned some of the rollbacks are more about limiting competition across state lines and keeping insurers than in safeguarding patient care.
Whatever the reasoning, navigating the politics and funding streams of our complicated health care system oftentimes takes years to create lasting, positive change. The pandemic forced these changes to take place more quickly. Now that we’ve seen the positive results of that action, let’s not roll back this progress.