At the end of 2019, national law firm Foley & Lardner released their 50-state study of telemedicine in the United States. The study tracked commercial payer statutes governing the telehealth field and sharded their findings, “to better understand the current state of affairs and advocate for change to improve access and meaningful coverage of telehealth services.”
This article will review the survey and its findings on the state of telemedicine across the country.
State Telehealth Laws
According to the study, 42-states have some version of a commercial payer statute on the books. These regulations are generally designed to promote consumer access to healthcare by using telehealth tools, whether it’s a remote patient with no local access to a specialist, or a busy urbanite unable to leave work to wait in a crowded waiting room.
Over the past five years these laws have increased, but what they mandate varies by state. While many require health plans to cover telehealth services, four currently do not (Florida, Illinois, Massachusetts, Michigan).
While telemedicine laws have expanded, requirements addressing reimbursement or parity in telehealth coverage have not. The study found that 16 states currently have laws addressing telehealth reimbursement, but of those states, only 11 require payment parity. Payment parity laws typically mandate that reimbursement amounts are the same for a medical visit conducted via telehealth as it is in a clinical practice site. Foley & Lardner point out, “providers outside those states may still have an uphill battle when seeking similar reimbursement rates for in-person and telehealth services.” Here are the current states with parity laws on the books:
- New Mexico
Foley & Lardner predict that more states will soon be added to this list. The study found that the language in the California and Georgia law, “represents some of the best-in-class model language” for telemedicine parity. These laws set parity as the baseline and allow providers and payers to negotiate up from that point.
While the number of states requiring parity in payment for telehealth, the study noted that the trend is leaning toward increasingly favorable treatment of telehealth services in payer rules. For example, only five states still maintain some sort of restriction on the patient’s originating location. Additionally, 25 states now have rules, which prohibit a healthcare payer from charging the consumer with a deductible, coinsurance or copayment for telehealth at a higher rate than if the same consultation were given in an office setting.
Asynchronous telehealth has grown across the United States, according to the study. Asynchronous telemedicine, or store-and-forward video conferencing, transmits a digital record for review. Then, during a second transmission, the file is sent to another end-user. This service is typically is used for care coordination between specialists or to transmit clinical test results. Synchronous telemedicine is a two-way link in real-time, often between a patient and provider. A prior article from Merritt Hawkins suggests and increase in asynchronous telehealth is one of the top industry trends for the coming years.
The study also found remote patient monitoring is increasing across the country. This practice allows self-monitoring of a patient’s health with a digital monitoring tool offsite from the hospital or medical practice. These tools are most often used for:
- Cardiovascular, diabetes, respiratory or other chronic disease monitoring
- Monitoring of at-risk age brackets (infants, the elderly)
- Tracking medication or medical adherence
- Wellness monitoring
This finding was mirrored in a recent report from ResearchandMarkets.com that predicts a 19.8% market share growth in remote monitoring from 2017 to 2023. The report says some of the drivers of the growth of this service include the aging population, a rise in chronic disease, the challenge of providing care in rural areas, provider shortages, and the need to cut costs. The study states, “RPM will also become a component of care coordination and patient engagement beyond the chronic condition and post acute care models. Over time, RPM will become a vital tool for providers to improve the health of all patients.”
Understanding Telemedicine State Laws
The types of laws most often enacted across the 50-states include:
- Telehealth Commercial Coverage Laws
These regulations require health insurers to cover the medical services offered via a telehealth appointment in the same way they would reimburse if it were provided in a traditional clinical visit. The laws don’t mandate the offering or use of the virtual visit, so the benefits package essentially remains the same.
- Telehealth Payment Parity Laws
Payment parity is different from coverage laws in that these rules require payers to reimburse clinicians for services delivered virtually to be paid at the same rate as those provided in a traditional setting.
Foley & Lardner caution, “For a state to promote meaningful adoption of telehealth, much depends on the language of its statute.” They suggest that the statute is irrevocably connected to the growth of the telemedicine services in the state, including innovation and entrepreneurship opportunities in software and hardware development.
The law firm suggests there are two important considerations when drafting telemedicine laws:
- Should the law cover telemedicine services to the same extent as an in-person visit?
- Should the law cover additional virtual care services like remote patient monitoring even if that service could not be offered in an in-person visit?
Telehealth legislation can also include language to protect consumers from cost-shifting when healthcare payers impose higher deductibles or other costs on services provided via telemedicine. Foley & Lardner recommends that payment parity laws do not prevent payer and provider from negotiation over differing payment rates for in-person telehealth, but that these discussions should be voluntary in nature. They suggest:
“Nor are payment parity laws intended to prohibit health plans and providers from the freedom to develop and enter into at-risk, capitated or shared savings contracts, all of which are conducive to the benefits offered by telehealth.”
Telemedicine in Your Practice
OrthoLive offers orthopedic practitioners a way to capitalize on the convenience and benefits of telehealth. We have a HIPAA-compliant telemedicine app designed specifically for orthopedics. It’s a low-cost, secure option to keep your practice competitive amid growing demand for the convenience of telehealth. Talk to our team about an online demo so we can show you exactly where telehealth fits within the scope of your practice.