Telemedicine is trying to lean into the future. It’s complicated.
Nov 19, 2021

Telemedicine is trying to lean into the future. It’s complicated.

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Telemedicine grew during the pandemic and opened access to care for many Americans. But the regulatory environment is changing, especially for doctors providing the service across state lines.

Many of us were online in the last two years in ways we wouldn’t have imagined pre-pandemic.

Like for doctor’s appointments. The pandemic accelerated the widespread use of telemedicine platforms for both mental and physical care, in the U.S. especially. With public health states of emergency in place, doctors could practice across state borders, increasing access for millions of patients.

But now, some states are letting their public health emergencies expire. So, what does that mean for telehealth providers across the country?

Brian Gormley has been covering this for The Wall Street Journal. He said many people adopted the technology out of necessity. The following is an edited transcript of our conversation.

Brian Gormley: Telemedicine has existed for many years. However, over the past year its use has skyrocketed, and people are using it for all kinds of health issues, including mental health is one of the most common reasons that people seek out telemedicine.

Kimberly Adams: So what’s different now about the infrastructure that’s in place to serve people remotely compared to before the pandemic?

Gormley: Right now, there are a growing number of telemedicine startups, so patients have a lot of choices about which types of care they’re going to get online, and from which companies. During the pandemic, many states initially waived their normal restrictions about doctors practicing medicine through telehealth across state lines, and that enabled telemedicine companies to provide a growing amount of telehealth to patients and to deliver it very rapidly.

Adams: So what’s changing about that now?

Gormley: What changed over the past few months is that a number of states that had waived their normal restrictions about doctors practicing medicine across state lines through telehealth have allowed those waivers to expire, while others have allowed them to remain in place. So that has created a more complex regulatory environment for telemedicine companies to navigate.

Adams: So I’m trying to think about what this looks like from the patient side of things. Say you’re someone who did start seeing a mental health professional remotely during the pandemic for the first time because they were able to operate across state lines. What happens now?

Gormley: It depends on where that doctor was. If you had established a relationship with a doctor who was licensed in your state, then I imagine that wouldn’t be interrupted. However, if it happens to have been with a doctor who was out of state and is not licensed in your state, then that relationship could be interrupted, depending on where you are in the rules in the particular state where you live.

Adams: What are some of the states that have actually rolled back these expansions, and what have been the consequences there?

Gormley: Florida was one of the states that allowed its telemedicine waiver to expire. However, it is also one of those states that has provided a expedited licensing process for doctors who are looking to provide telemedicine into their state who are not located in that state.

Adams: Oh, so that’s interesting. So they maybe stopped the ability of people to practice there even remotely without a license, but they’re making it easier to get a license.

Gormley: Right. There’s an expedited process for them to get access to a license, so they can continue providing telehealth services, even if they’re not located in Florida.

Adams: What is the telehealth industry doing to try to figure out what that landscape is going to be moving forward?

Gormley: Some companies are working with doctors to try to get them licenses in as many states as possible, so they have as many doctors as possible to draw on when they are looking to match a patient with a doctor. Some in the telehealth industry would like to see the normal restrictions about practicing medicine across state lines go away and make the waivers that some states enacted permanent, but I don’t see any sign of that coming anytime soon.

Adams: I just keep coming back to this idea that this is technology we’ve had for a while, but it took the pandemic for it to be deployed more broadly. Is this one of these changes that we’re going to look back and say that the pandemic caused this shift and it stayed?

Gormley: I think it will. There’s a certain amount of inertia in the health care system that needs to be broken, and the pandemic has done that on many levels and telemedicine is certainly one of them. And certainly a lot of entrepreneurs and investors are betting that this is a movement that has a lot of legs and will continue for quite some time, now that people realize the range of services that are available through telemedicine and the ability to get treated through this new technology.

Adams: As you’ve been talking to people for these kinds of stories, what’s jumped out to you the most?

Gormley: I’ve been struck by just how important telemedicine has become to a lot of people who would otherwise have difficulty getting access to health care, especially people seeking help for mental health conditions or substance abuse, conditions that might be difficult for them to otherwise get treated through conventional medical care. Telemedicine seems to be one option for them that a lot of people are taking advantage of.

Related links: More insight from Kimberly Adams

Gormley reported a story back in October about the regulatory uncertainty facing telemedicine startups.

We also have a link to some work I’ve done with our American Public Media colleagues at “Call to Mind” on how telemedicine has changed the delivery of mental health care in the U.S. We did a whole show on this called “Spotlight on Virtual Mental Health Care,” where I spoke to people who’ve been doing virtual therapy for decades, including a psychologist on the cutting edge of artificial intelligence-powered mental health care and a social worker who talked about the limits of virtual care.

The Commonwealth Fund podcast “The Dose” also explores this topic with the question: Will online therapy stick around?

Gormley mentioned all those rollbacks of new telehealth rules. Well, JD Supra is tracking those developments at the federal and state levels.

And Healthcare Dive has another story about just how crucial telemedicine has become for patients and providers in the pandemic, but cites data showing many providers are worried they won’t be able to continue to offer telehealth if the old rules kick back in.

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