Ed. note: This post is sponsored by the American Telemedicine Association.
Maryland and New Hampshire drop a letter grade, while New York, Nevada and others step up.
Since the American Telemedicine Association began its annual reports in 2014 grading states on their telemedicine access, some states have maintained steady grades. But others have seen their grades fluctuate – and not always in the right direction – over the past three years.
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“It’s really exciting to see that lawmakers actually want to do something on telemedicine,” says Latoya Thomas, director of the ATA’s State Policy Resource Center. “States are making moderate improvements.”
In two new 2016 reports topping 200 pages, the ATA took a deep dive into state telemedicine gaps in two broad categories: coverage and reimbursement and physician practice standards and licensure.
On the coverage and reimbursement side, Maryland and New Hampshire saw their grades decline since 2014 for adopting policies further restricting telemedicine coverage. New Hampshire, for instance, dropped from an ‘A’ to a ‘B’ because its Medicaid telehealth coverage legislation includes language restricting telemedicine usage based on geography.
Eleven states – Delaware, Iowa, Nevada, New York, North Dakota, Ohio, Oklahoma, Utah, Washington, Wisconsin and Wyoming – improved their grades by adopting policies that provided increased coverage and reimbursement of telemedicine services. States improved their grades by removing arbitrary restrictions and adopting laws ensuring coverage parity under private insurance, state employee health plans, and Medicaid plans. Since the first report in 2014, more states have above-average grades, including Iowa, which rebounded from an ‘F’ to a ‘B.’
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“These big improvements show lawmakers and stakeholders understand that a lack of coverage and reimbursement is a huge barrier to telemedicine access,” Thomas explains. “Legislators have leveraged model legislation, like that created by the ATA and existing statutes to offer more access. The number of states with parity laws has almost doubled in three years.”
It seems to be more difficult to legislate on the physician practice standards and licensure side of the issue, Thomas said.
Since 2014, grades in this category have only improved in six states: Alabama, Massachusetts, Michigan, Nevada, Pennsylvania and South Dakota. Alabama, for instance, made the most significant improvement by repealing its telemedicine rules and observing medical practice parity standards regardless of the delivery method.
Because of incongruent guidance and regulation for telemedicine compared to in-person practice, 11 states and the District of Columbia had lower grades this year than in 2014. Those states are Arkansas, Colorado, Connecticut, Delaware, Idaho, Indiana, Maine, South Carolina, Texas, Virginia and West Virginia.
Lawmakers are trying to ensure patient safety as they allow increased access to telemedicine, Thomas says. But there seems to be a general lack of understanding around telehealth and its different clinical variations.
“The assumption on the part of some licensing boards and some lawmakers when looking at clinical practice is there’s a one-size-fits-all model,” she states. “Our report highlights that their attempt to impose a one-size-fits-all model has actually stood in the way of permitting telemedicine. It’s actually created more disparity.”
For a state-by-state comparision on the state of telemedine, download ATA’s 2016 reports: