The American Telemedicine Association has released two reports grading each state on its support of telemedicine – or lack thereof.
The reports highlight the uneven patchwork of policies and legislation now in place across the country, pointing out the difficulty in establishing a national set of guidelines and standards for one of the fastest growing trends in healthcare.
“We hope these reports serve a dual purpose: to showcase the states that are doing an excellent job when it comes to telemedicine, and to serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state,” ATA CEO Jonathan Linkous said in a press release. “We hope that states will respond by streamlining policies to improve medical practice rules, licensure, healthcare quality, and reduce costs through accelerated telemedicine adoption.”
The 100-page report focusing on coverage and reimbursement bases its rankings on 13 indicators, and ranks seven states – Maryland, Maine, Mississippi, New Hampshire, New Mexico, Tennessee and Virginia – at the top of the list with an 'A.' Twenty-two states scored a 'B' grade, and 19 states scored a C.' Connecticut, Iowa and Rhode Island, meanwhile, received an 'F' score.
"Payment and coverage for services delivered via telemedicine are one of the biggest challenges for telemedicine adoption," the report's Executive Summary states. "Patients and health care providers may encounter a patchwork of arbitrary insurance requirements and disparate payment streams that do not allow them to fully take advantage of telemedicine."
The report notes that telemedicine policy has been a mixture of "strides and stagnation," with no two states offering the same rules and regulations. It goes on to mix positive comments with warning signs.
"Over the past three years the number of states with telemedicine parity laws – that require private insurers to cover telemedicine-provided services comparable to that of in-person – has doubled," the report pointed out. "Moreover, Medicaid agencies are developing innovative ways to use telemedicine in their payment and delivery reforms resulting in 47 state Medicaid agencies with some type of coverage for telemedicine provided-services."
"While there are some states with exemplary telemedicine policies, lack of enforcement and general awareness have led to a lag in provider participation," the report concluded. "Ultimately these pioneering telemedicine reforms have trouble reaching their true potential."
In the 84-page physician practice standards and licensure report, the ATA gave 23 states and the District of Columbia the highest grade, while Alabama came in last with a 'C' grade. Once again, the report noted both "strides and stagnation" in telemedicine coverage across the country.
ATA researchers noted that 15 states have considered proposals to amend health professional standards to account for telemedicine, with varying results, and some state boards are even adopting standards that hold telemedicine to higher standards than in-person care. "These decisions leave telemedicine providers no choice but to navigate the medical practice laws in their state or risk punitive action by their board," the report said.
As for the issue of cross-state licensure, the ATA painted a gloomy picture.
"Licensure portability, the ability for healthcare providers to practice out-of-state using one license, is a contentious issue for healthcare providers whether services are deployed via telemedicine or not," the report concluded. "Most states require that a physician is licensed in the state where their patient is located. However, 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. They also create economic trade barriers, restricting access to medical services and artificially protecting markets from competition."
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