Telehealth access, ease of service varies by state

As millions of patients tried telehealth for the first time during the past two years, federal officials and governors temporarily lifted restrictions that limited their access to virtual care. But many of these restrictions on such practices as speaking with doctors across state lines, recording voice messages with care instructions, and mandating insurance coverage have been reinstated at the state level.

A new joint report from Reason Foundation, The Cicero Institute, and Pioneer Institute breaks down the disparities by rating every state’s telehealth policy for patient access and ease of providing virtual care. Nationally, according to the report, several states hardest hit by the pandemic have the most restrictive telehealth laws — including New York, California, and Connecticut, which have not signed up for interstate licensing compacts and have coverage parity mandates that offer no flexibility between insurer and provider.

“Once the public health emergency declarations started to end or executive orders were withdrawn, many of the new flexibilities for providers, insurers, and patients were lost overnight,” says Vittorio Nastasi, policy analyst at Reason Foundation and co-author of the report, which is titled “Rating States on Telehealth Best Practices.” “States need to adopt a number of telehealth reforms to provide their residents better access to this safe and effective virtual care.”

6 best practices

In order for states to experience the full potential of telehealth, the report’s authors offer six best practices they say states should consider adopting:

• Support “modality neutral” options: Allow use of all kinds of telehealth — including live video, remote monitoring, or recorded messages — to establish a patient-provider relationship.
• Support access to care: Allow all kinds of providers to use telehealth to create more team-based care, and stop charging facility fees for services that can be delivered from anywhere.
• Support provider access to telehealth: Allow telehealth access across state lines with, according to the report, a “simple registration for those holding a license or registration in good standing to help with the continuation of care and increase access in rural communities.”
• Do not arbitrarily limit provider tools: Patient care is limited when in-person visits prior to telehealth care or specific technology methods (such as real-time video) are required.
• Do not mandate coverage for everything: “Passing insurance coverage parity mandates that require paying for all services, since research has shown mixed outcomes for certain services over telehealth, can lead to wasteful spending,” according to the report.
• Do not mandate payment rates: Requiring all telehealth visits to cost as much as an in-person visit particularly “hurts vulnerable patients” and small companies.

“While they cannot and should not replace all in-person medical appointments, virtual visits can save patients time and help them avoid germ-filled waiting rooms,” co-author Josh Archambault, a senior fellow with Cicero Institute and Pioneer Institute, writes in the report. “Providers can also take some pressure off overburdened systems as they can see patients from an office or home.”