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State-by-State Telemedicine Report Cards Shows Mixed Results

February 1, 2016
by Heather Landi
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While more states have adopted policies improving coverage and reimbursement for telemedicine services, there is also a trend with state medical boards imposing more restrictive regulations which could be a barrier to more widespread use of telemedicine, according to the American Telemedicine Association’s latest state-by-state telemedicine report cards.

“Professional licensure portability and practice standards for providers using telemedicine are some of the biggest challenges for healthcare providers considering telemedicine adoption,” the ATA report stated. “Providers often encounter a patchwork of conflicting and disparate requirements for insurance claims and practice standards that prohibit them from fully taking advantage of telemedicine.”

The ATA released two reports titled 50 State Telemedicine Gaps Analysis, with one focused on coverage and reimbursement and another focused on physician practice standards and licensure.

The Physician Practice Standards and Licensure report takes a look at the complex policy landscape of 50 states with 50 different telemedicine policies and assigns a grade to each state based on existing policy barriers. In all, 20 states received an A in this latest report, compared to 24 in 2014, while 29 states received a B (up from 26 in 2014) and two received a C compared to only one in 2014.

The report focused on coverage and reimbursement painted a better picture as 11 states and the District of Columbia improved their standing since 2014 while two states saw lower grades.

Since the May 2015 update of the physician practice standards and licensure report card, only three states—Alabama, Michigan and South Dakota—have earned higher scores. Alabama made the most significant improvement and the ATA report credits this to the state “repealing their telemedicine rules and observing medical practice parity standards regardless of delivery model.”

However, since May 2015, Connecticut, Delaware, Indiana, Maine, South Carolina and Virginia saw their composite score drop from an A to a B, as a result of “adopted language that enforces different standards for telemedicine compared to in-person practice,” the report state.

And the report highlights Arkansas in particular as, despite the adoption of a private insurance parity law earlier this year, that state joins Texas with the lowest composite score (C), which suggests, the report authors say, that there are “many clinical practice barriers and little opportunity for telemedicine advancement.”

“Our analysis indicates that decades of evidence-based research highlighting positive patient compliance, clinical outcomes and increasing telemedicine utilization have been met with a mix of strides and stagnation in state-based policy,” the ATA report stated.

According to the ATA’s analysis, states are becoming more prescriptive in their requirements for an additional patient informed consent and the types of modalities permitted for appropriate clinical practice when using telemedicine. In fact, “as a result of incongruent guidance and regulation for telemedicine when compared to in-person practice,” the ATA reports that more states have dropped a letter grade than those that have improved since 2014.

According to ATA’s scale, no state received a top score (A) for its licensure policies. “This means that every state imposes a policy that makes practicing medicine across state lines difficult regardless of whether or not telemedicine is used,” the ATA report stated.

The report evaluates telemedicine policies in each state based on licensure and physician practice standards. With regard to physician practice standards, the ATA report measured components of state laws or state Medical board policies related to the three following areas: the policies that permit or obstruct the professional use of telemedicine before, during or after the physician-patient encounter, the requirements for a telepresenter or healthcare provider on the premises during a telemedicine encounter and the requirements for written or verbal informed consent before a telemedicine encounter..

Regarding rankings for physician-patient encounter, 19 states ranked the highest. The ATA report card raised Alabama’s score in this area to “A” when the medical board repealed their “cumbersome” telemedicine regulations this past fall.

Arkansas and Texas ranked the lowest with failing (F) scores due to those states’ “stringent clinical practice rules for telemedicine providers when compared to in-person practice,” the ATA report stated. Arkansas is the only state that requires an in-person visit before most telemedicine encounters.

While there has been considerable state policy activity to improve coverage and reimbursement of telemedicine-provided services by various payers, there also have been changes to health professional standards and licensure requirements, the ATA report states. A few state medical boards are adopting practice standards with higher specifications for telemedicine than in-person care, the ATA noted.

Licensure portability, or the ability for providers to practice out-of-state using one license, is a contentious issue, and currently most states require that physician to be licensed in the state where their patient is located. According to the ATA report, these state-by-state approaches “prevent people from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line.”

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