Building an interstate regulatory framework for telemedicine

COVID-19 has made it clear that state-by-state licensure and other roadblocks to telehealth delivery should be left in the past, write Hims & Hers CEO Andrew Dudum and Health Innovation Alliance Executive Director Joel White.
By Andrew Dudum and Joel White
10:44 am
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About the authors: Andrew Dudum is the CEO and founder of Hims & Hers, a consumer-facing digital health company offering telehealth services.

Joel White is executive director of the Health Innovation Alliance, a coalition of health and technology leaders who support policies that use technology and data to make healthcare work better.

Outside of these positions, Dudum and White report no relevant financial disclosures.

How will the coronavirus change the U.S. healthcare system? Nobody quite knows yet, but we do know where we were before this pandemic. Even though the U.S. spends more per capita on healthcare than other rich countries, with over 18% of its GDP going to healthcare — compared to other high-income nations including Australia (9%) and Switzerland (12%) — this doesn’t translate to greater efficiency or better health outcomes.

Despite significant spending, we also lag behind other countries when it comes to core health metrics such as life expectancy, infant mortality and unmanaged diabetes. More than 90% of all Medicare beneficiaries have at least one chronic illness, but the program spends less than 1% of funds on telehealth, or technology to bring the doctor to the patient, versus the other way around. The system is clearly broken for so many people in so many ways, with patients facing skyrocketing deductibles, increasing premiums and limited access to doctors and nurses in rural areas and underserved communities.

The COVID-19 outbreak is undoubtedly one of the biggest challenges our healthcare system has ever faced. To prevent the spread of COVID, the federal government has waived many of the restrictions on telehealth that limit its use during the pandemic. With a nation stuck at home, telehealth has allowed vulnerable populations to continue to receive care. Both healthcare providers and patients are now utilizing telehealth, many for the first time, and experiencing how it can make care delivery easier and more flexible.

Even though the federal government has eased restrictions on access to provide this care, barriers remain. First, all the restrictions will snap back into place once the public health emergency is over. Flexibility should be made permanent. Second, because states license each provider, bringing care to a patient across state lines means providers need to obtain multiple licenses. It would be like you having to get 50 licenses to drive in every state. That makes no sense.

We need to ensure that the benefits of telehealth continue to be accessible to every patient and healthcare provider in the U.S. One way to do that is for the industry – elected officials, private companies, patient advocates, physician groups and others  – to come together and agree on an interstate telehealth framework that lays out the rules of the road, spurs healthcare innovation and enables the provision of care across the U.S.

This framework would enhance the ability for providers to offer improved patient care through technological innovations. Any framework should also:

  • Be modality neutral. Mandating the use of a particular type of technology or modality to deliver care will inhibit the ability to innovate and create barriers to the timely delivery of care. We need to trust providers to use their expertise and training to determine what type of encounter they need to have with a patient in order to meet the standard of care.

  • Include expanded licensure. The Interstate Medical Licensure Compact has begun work towards enabling a more streamlined licensure process across state lines, but we need to do more. Providers need a clear, simple process for leveraging their training and licensure in one state to provide care to patients in need, wherever they are located. Congress should provide for Medicaid incentive payments to states that facilitate interstate licensure, whether through a compact or another model. This will accelerate use of technology by knocking down artificial geographic barriers to care.

  • Pave the way for a national accreditation process to help give states a way to ensure telehealth providers are good actors, while also giving providers clear standards and guidelines for how telehealth will be regulated.

There will be critics who will say that this kind of framework is politically unlikely, too bold or ambitious in terms of its vision for healthcare delivery, but this model has been adopted before. Federal transportation funds helped usher in state adoption of safe highway speed limits, saving millions of lives in the process. If a state decides nothing to facilitate interstate licensure, that is up to it, but it would forego critical bonus funds for low income health needs in their communities.

History has taught us that it’s during crises that society and industry recalibrate, focusing energy and resources on what’s important and building resilience for the future. This won’t succeed without the support of those at the heart of public policymaking, which is why Congress should act to fund states that make interstate licensure a reality.

Intergovernmental agencies such as the National Governors Association and the National Conference of State Legislatures could create an interstate framework for telemedicine regulation that will successfully guide states while Congress develops the funding mechanism to incentivize interstate licensure.

The opportunity for telehealth to expand access to quality care for people has always been enormous – we’re seeing that more than ever during this pandemic. It is critical that we come together to realize the full promise of telehealth during this crisis and beyond.

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