Telehealth Technology Outpacing Regulations

By Joshua Beltran, Research Assistant, Center for Health Equity Engagement Education and Research

While advancements in medical and communication technologies have allowed us to reach new heights in providing various forms of medical treatment via telehealth, outdated policies and procedures seem to cause the most limitations for the medium, according to a recent article in STAT, a media outlet focused on health, medicine and scientific discovery owned by the Boston Globe.

Based on points in the article it appears the technology used for telehealth has outpaced the regulations placed on it. In my opinion it seemed not enough forethought was given to how telehealth would eventually develop and expand. For example, the article mentions physician credentialing. Formerly, physicians were limited in their practice to only their state, so only those state laws applied. But now, telehealth physicians can provide service nationwide or even internationally which can lead to complications at the intersection of state and federal laws regarding credentialing.

Another major issue caused by these somewhat archaic policies is in how telehealth is funded, or more specifically how providers are reimbursed. The article uses traditional Medicare as an example of poor telehealth reimbursement. Medicare has limits on qualifying services that use real-time interactive audio/ video, or not qualifying a patient’s home as an originating care site despite it being the place patients use telehealth. These limits impact the financial stability of telehealth.

State laws are gradually making progress, like allowing telehealth in previously restricted areas, but there are still some inconsistencies. Some states specifically reimburse providers for engaging in “store and forward communications” (prerecorded audio or video, email, or text messaging),  while others only recognize services that are delivered in real-time.  As described in the article, this is done to protect integrity of the patient-doctor relationship. This same concern is addressed to the streamlined approach of consent procedures.

Overall, it seems state and federal policies need to find ways to adapt to the technological advancement and expansion of telehealth, and may have to re-examine the nature of the patient-doctor relationship in order for telehealth to flourish. Many patients who use telehealth do so out of necessity because it is one of the few forms of care in their area. If telehealth as a form of healthcare cannot overcome these challenges and expand, we can expect to see an increase in health disparities among rural and underserved areas.