Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options | California Healthline

Perhaps you live in a city that borders on two-state jurisdictions, such as Minneapolis-St Paul, Washington DC-Maryland-Virginia, 

If you live in one state, does it matter that the doctor treating you online is in another? Surprisingly, the answer is yes, and the ability to conduct certain virtual appointments may be nearing an end.  

This story also ran on Time. It can be republished for free.

Televisits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Most states and the Centers for Medicare & Medicaid Services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Those restrictions don’t keep patients from visiting doctors’ offices in other states, but problems could arise if those same patients used telemedicine.  State medical boards don’t want to cede authority, saying their power to license and discipline medical professionals boosts patient safety. Licensing is also a source of state revenue.

Providers have long been split on whether to change cross-state licensing rules. Different state requirements — along with fees — make it cumbersome and expensive for doctors, nurses, and other clinicians to get licenses in multiple states, leading to calls for more flexibility. Even so, those efforts have faced pushback from within the profession, with opposition from other clinicians who fear the added competition that could come from telehealth could lead to losing patients or jobs.

Now states are rolling back many of those pandemic workarounds.  Many states have agreed to interstate medical licensing compacts for physicians, nurses, and some other health care providers

During the past 18 months, the public health emergency for the Covid19 pandemic created a national emergency causing an exponential rise in telehealth visits.  Many states loosened their regulations regarding telehealth visits, including cross-state border visits. CMS (formerly Medicare) loosened it's a restriction only allowing telehealth visits from rural or underserved areas to general usage.  The reasons for this had to do with social distancing and lockdown orders preventing traveling.

Even though the initial spike in telehealth visits has eased, utilization remains 38 times higher than before the pandemic, attracting not only patients but also venture capitalists seeking to join the hot business opportunity, according to a report from consulting firm McKinsey and Co. “As with most things in medicine, it’s a bottom-line issue. The reason telehealth has been blocked across state lines for many years is related fundamentally to physicians wanting to protect their own practices,” said Greenspun.

“The whole challenge is to ensure maximum access to health while assuring quality,” said Barak Richman, a Duke University law professor, who said laws and policies haven’t been updated to reflect new technological realities partly because state boards want to hang onto their authority.

Patients and their doctors are getting creative, with some consumers simply driving across state lines, then making a Zoom call from their vehicle.

“It’s not ideal, but some patients say they are willing to drive a mile or two and sit in a parking lot in a private space and continue to get my care,” said Dr. Shabana Khan, director of telepsychiatry at NYU Langone Health’s department of child and adolescent psychiatry and a member of the American Psychiatric Association’s Telepsychiatry Committee. She and other practitioners ask their patients about their locations, mainly for safety reasons, but also to check that they are in-state.

Allowing a change that doesn’t put centralized authority in a patient’s home state would raise “serious enforcement issues as states do not have interstate policing authority and cannot investigate incidents that happen in another state,” said then-AMA President-elect Jack Resneck during a congressional hearing in March.

Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options | California Healthline