Wherefore Art Thou, Telemedicine?

A bunch of doctors on a Zoom call

The history of telemedicine in the U.S. has been quite the interesting one. Advances in technology that began in the late 1990s ushered in the potential of remote care medicine. Telemedicine, and the broader term telehealth, offered a number of advantages. It could expand access to quality care, reduce transportation barriers and costs, and improve efficiency of services. Buy-in was difficult as traditional in-person workflows were preferred. But that suddenly changed when the pandemic struck. The benefits of telemedicine became readily apparent during the pandemic, and overnight, barriers to use were removed. It seemed as if telemedicine had finally proven its worth and merit.

(Bold followed the telemedicine industry closely during the pandemic–read about it here.)

Unfortunately, however, telemedicine’s day in the sun may have come and gone. The landscape for telemedicine after COVID is much different today than it was before. States have re-established the same barriers to telemedicine that existed prior to the pandemic. And soon, federal protections and waivers may expire, reducing the benefits of telemedicine in its wake. In the process, millions of Americans will face hardships that are truly unnecessary in the name of patient safety and protection. This is why it’s essential that we reexplore telemedicine after COVID in a more just and objective manner.

“Throughout the pandemic, telehealth has proven to be a vital tool for Americans to receive timely and quality care from their own home. For rural communities in particular, telemedicine has helped remove barriers to care, expand access to specialists and improve health outcomes.” – Tim Walberg, Republican Congressman, Michigan

Pre-pandemic Versus Post-pandemic Telemedicine

One of the most important pieces of legislation passed during the pandemic involved the CARES Act. In this act, Congress granted the Centers for Medicare and Medicaid Services (CMS) the authority to waive telemedicine restrictions. Not only did this remove geographic restrictions to telemedicine use. But it also expanded home services through telemedicine as well as overall care access. Most states followed suit, also removing telemedicine restrictions across state lines. And in the process, the many benefits of telemedicine were realized. Lower costs, better access, better efficiency, and in some instances, better care. But that apparently wasn’t enough to support telemedicine after COVID.

In recent months, 40 states as well as Washington D.C. have ended the emergency declarations permitting expanded telemedicine. That means that once again providers wanted to care for patients out of state face several hurdles. Some states require telemedicine providers to be licensed in the state where the patient resides. Others prohibit it in its entirety, even when adequate providers don’t exist for patients. And federal Medicare protections are set to expire as well in the coming months without new legislation. In essence, telemedicine after COVID is no better off than it was before the pandemic. Despite the benefits of telemedicine that were demonstrated during COVID, regulations are quick to revert back to their old ways.

“It’s bigger than just telemedicine. There’s a missed opportunity there to level the playing field.” – Dr. Ed Sepe, Pediatrician from Washington, D.C.

Rationales Behind Current Telemedicine Laws

The reason states as well as the federal government have failed to support easy access to telemedicine has good intentions. Specifically, both have established regulations in the spirit of promoting patient safety and preventing healthcare fraud. With licensure requirements and privacy protections, there are certainly risks. However, some suggest the benefits of telemedicine are not that great and that in-person care is superior. These perspectives were not supported during the pandemic. Telemedicine improved access to care, consistency of care, and even quality of care in the majority of cases. Regardless, this myth persists and accounts for some of the rationale involving restrictions of telemedicine after COVID.

Someone on a call with their doctor
The benefits of telemedicine seem to have been forgotten once the lockdowns lifted–what gives?

In addition to these explanations, there may well be others influencing laws overseeing telemedicine after COVID. Preventing interstate access to providers via telemedicine naturally benefits local healthcare systems and organizations. Those systems with fewer telemedicine resources or healthcare experts could lose business to other systems. Thus, some likely lobby state policymakers to maintain the pre-pandemic status quo. These are the same pressures states face in relation to advancing healthcare privileges for nurse practitioners. Despite ample evidence showing quality of care is superb using nurse practitioners, many states still limit their capacities. In fact, some states do not allow nurse practitioners to provide telemedicine services.  These political factors also explain in part why the benefits of telemedicine are no longer being promoted.

“There’s so many ways that these issues can be addressed.” – Dr. Ateev Mehrotra, Health Policy Professor, Harvard University

Recognizing Needs and Pursuing Solutions

While politics and change resistance may pose obstacles, it’s important that we appreciate the benefits of telemedicine. The U.S. currently has a tremendous healthcare provider shortage that will only worsen in coming years. Rural and poorly populated areas lack adequate healthcare services, limiting access to thousands. This is particularly true for mental healthcare and for those needing advanced high-level expertise. And without question, changes in telemedicine after COVID have reduced the ability to remotely monitor patients and provide preventative care. These are pressing needs of the nation when it comes to healthcare. And reinvesting in telemedicine is essential in providing solutions to these issues.

With this in mind, there are a number of options to expand telemedicine while continuing to provide patient protections. One of the easiest solutions is for states to form regional alliances and pacts to offer these services. This could be accomplished by sharing the same licensing and credentialing requirements and privacy practices. States could also establish clear criteria for the use of telemedicine after COVID. Permissions should be granted to those in need of expert care and to those who lack local providers. Likewise, the benefits of telemedicine should also be extended to those who have already established remote patient-provider relationship during COVID. And lastly, federal policies and legislation should be passed that create national frameworks for widespread telemedicine use. As we face unprecedented challenges in healthcare as a country, telemedicine offers potential answers. It’s important that we embrace it and adopt policies and practices that are based in fact and not fiction.


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