Bringing the doctor’s office directly to patients can be convenient for healthy individuals and a huge relief for those with mobility issues. But despite its advantages, telemedicine has to navigate a complex legal web to deliver services to patients.
Now, insurance companies and employers are beginning to develop creative solutions to change that.
By next year, 95% of the nation’s top employers — companies with more than 500 employees — will provide telemedicine coverage as part of their benefits package, according to a new joint study by America’s Health Insurance Plans and the Coalition to Transform Advanced Care — advocacy groups for insurance companies and patients with chronic conditions. Meanwhile, other employers are set to provide telemedicine stations at the office so employees have easy access to physicians.
In 2020, telehealth will be covered by Medicare under the Bipartisan Budget Act.
“Telehealth is one of the fastest-growing care-delivery services in healthcare today, and we anticipate the trend to continue to move in that direction because it allows consumers to access the care they need without ever leaving work, school or their home — saving both time and money,” says Cathryn Donaldson, AHIP's director of communications and public affairs.
While there’s a demonstrated need for telemedicine services — and willingness of employers to provide it, advocates say — telemedicine operations are limited in various parts of the country.
“One of the most significant challenges relates to state licensure of providers,” Donaldson says. “In many cases, providers might only be able to provide services in the state where he or she is licensed, thereby limiting the value of a national network of providers.”
Multiple state physician licensing programs exist to help telemedicine companies expand their practices, but not all states consider them legitimate. Many states require telemedicine doctors to obtain state-specific licensing in order to administer to patients in their area.
The Center for Connected Health Policy catalogs telemedicine laws and regulations in all 50 states and the District of Columbia. While most state-funded health insurance programs cover telemedicine — at least partially — states often have conflicting policies. For example, in Colorado, patients are required by law to have an in-person appointment with a telemedicine doctor before making any digital appointments. In California, there’s a law prohibiting insurance companies from requiring patients to meet telemedicine practitioners in person.
“Inconsistent state laws have made expanding these programs difficult for health plans, particularly those plans that operate in multiple states,” Donaldson says.
Some states limit the services telemedicine doctors provide. In Florida, telemedicine doctors are prohibited from prescribing any controlled substances except when the medication is used for psychiatric disorders, according to the CCHP.
"To help address these challenges, health insurance providers and employers are implementing innovative approaches, such as adding on-site telehealth booths at places of employment from which employees can access a clinician remotely,” Donaldson says.
Telemedicine can boast big benefits for both employers and employees. For example, it reduced annual emergency room spending by $6 billion a year by providing elderly and chronic illness patients with easy access to preventative care, according to the AHIP and C-TAC study.
But there are still barriers. While some people still prefer to see their doctor in person, the study shows it’s not necessarily older people who shy away from telemedicine. Only one of out of 10 people aged 40 and over reported being uncomfortable using telemedicine, according to the study.
“A common misconception is that older Americans may reject technological interventions in their healthcare because they may be less experienced with technology or have motor or cognitive impairments that may hinder their ability to use technology,” the authors of the study write, adding that most in fact are open to using newer technology.
Older Americans benefit the most from using telemedicine because they’re more likely to suffer from chronic conditions, according to the study. Some telemedicine companies offer monitoring services that record patient breathing and heart rate in real time — allowing doctors to be notified immediately in some chronic illness emergencies.
About 80% of Americans older than 65 have at least one chronic condition. More than three in four (77%) have at least two, according to AHIP and C-TAC.
“Telehealth can improve affordable access to quality care by removing traditional barriers, such as distance, mobility and time constraints," the authors write. "It has been shown to be as effective as in-person visits for certain conditions."
