Industries on the rise don’t always enjoy an unrestrained ascent into acceptance. There are good times and bad. Regulatory barriers, rough weeks in the marketplace and tough hits in the press can always be expected. But, sometimes, when an industry is doing the right work at the right time, you hit a groove. Such has been the last few weeks for telehealth.
Thanks to a tremendous week in policy making, telehealth is now nearing a “game over” moment in terms of states unilaterally accepting the value and legality of providing care via technology.
Over the course of the last 18 months, nearly every state has upheld that the standard of care for physicians providing care via telehealth should be equal to that provided in person--that robust telehealth technologies can be used to both extend and create a treatment relationship. But a number of states have held on to dated regulatory language and left telehealth stakeholders wringing their hands.
The main culprits: Texas and Arkansas. These states have long been thought of as those with the most dated regulatory regimes, holding on to rules which required prior in-person relationships and other provisions which restricted the type of care that could be provided via telehealth. But this past week, they budged. Thanks to physician leadership collaborating with in-state advocates, a modernized legislative effort is now taking shape in Texas, and the Arkansas Medical Board passed new rules which allow for the creation of a relationship through telemedicine.
On top of this seismic shift, Alaska and Louisiana, which had in-state physician requirements for telehealth, now have new laws eliminating this hurdle--one signed, and one awaiting signature.
Some of these changes will still require some legislative action to get to the finish line, but this movement is being felt as a major victory in the battle for technology-enabled healthcare.
The end of legislative sessions across the nation also brought with it a great affirmation for telehealth providers seeking payment. Arizona’s telehealth payment mandate once had a rural requirement, which has now been struck; Alaska now requires payment for behavioral health services provided through telehealth, and Hawaii removed the requirement for a patient presenter in order for payment to be upheld. Following a year where the number of states mandating payment doubled, Medicaid policies expanded throughout the nation, and CMS created a new ACO designation which specifically called out telehealth--this week was yet another rally cry for the idea of treating telehealth care as equal in clinical value to in-person care.
If that’s not enough, as CMS gets prepared to review a deluge of comments on its draft MACRA rule, you can bet dollars to donuts that the idea of further incorporating telehealth into provider measurement matrices will be a major theme of those offering feedback.
And then, the American Medical Association offered telehealth what can only be described as a clear acknowledgment that telehealth is really just “healthcare.” At its annual meeting in Chicago, AMA’s Board of Delegates approved the Ethical Practice in Telemedicine. The policy affirms that physicians providing care via technology have the same ethical responsibilities as those providing care in brick and mortar environments. These responsibilities include providing competent care, respecting patient privacy and confidentiality, taking appropriate steps to ensure continuity of care and, follow best practice guidelines. As more and more physicians extend their reach through telehealth technologies, this document will, no doubt, be offered as the roadmap for appropriate standard of care.
We are getting closer to a time in our digital healthcare evolution when we will no longer think of telehealth as anything separate or distinct. It will be fully integrated into everyday care delivery. And this last handful of days brought us significantly closer to that moment in time.