The regulatory landscape is often playing catch-up to the emergence of new technology and its effect on the practice of medicine. Telemedicine or the delivery of health care services through telecommunication technology is one such area. The use of telemedicine first began as a way to provide access to patients in rural and remote areas, but its use has been expanded to increase access to specialty care services like behavioral health and dermatology, in which there has been a shortage of providers in many areas. Veterans Affairs has been using telemedicine to connect veterans with psychiatrists and counselors to expand the availability of services and also respond to patients who may be uncomfortable or hesitant to in-person encounters. With network adequacy as a concern, some states are allowing health plans to use telemedicine to satisfy network adequacy criteria when it is appropriate for certain services. For example, for some mental health services, telemedicine can ensure access to services in places where local providers do not exist.
Recent action in two states illustrates the dramatic range of possible regulatory approaches to this new technology. One state is attempting to limit its use, the other is encouraging its expansion. Texas recently amended its regulations limiting telemedicine to situations in which there is a pre-existing relationship between the physician or referring physician and patient. In contrast, during its recent legislative session, Colorado dropped its restriction of telemedicine coverage to rural areas and expanded coverage statewide.
Those who wish to limit the use of telemedicine often cite the need to protect patient safety and maintain the standard of care. In particular, when a physician is prescribing medication, some argue that having a pre-existing physician-patient relationship established in-person between the patient and doctor is necessary to maintain the standard of care. They reason that a physician should not be allowed to prescribe medication only after getting a video, telephonic or online account of a patient’s symptoms.
However, with the prevalence of smartphones, videoconferencing capacity, and the ease of exchanging information, technological advances are increasing the ways in which patients can communicate with physicians. While many would agree that telemedicine has its limits, for example, in emergency situations or when a patient needs a hands-on physical exam, it may be a viable and necessary option to access specialists in areas where they are scarce or unwilling to enter into health plan contracts. For some mental health services for example, telemedicine may increase access and also help mitigate stigma that some patients may feel.
As telemedicine becomes more prevalent, some constituencies within the states may push for expanding telemedicine coverage; others will lobby to limit its use. Ultimately, one hopes that state officials will keep the ultimate end-user of these services – the patient – first in mind as they consider policy responses to this issue.