The American Telemedicine Association (“ATA”), a strong advocate for telemedicine, recently released two state policy reports which identified gaps (1) in coverage and reimbursement and (2) in physician practice standards and licensure. These unique reports identified and compared state telemedicine policies on a report card, assigning each state grades ranging from A-to-F based on telemedicine reimbursement and physician practice standards.
Noteworthy is the fact that one of the ATA’s two reports, the report that reviewed and compared physician practice standards and licensure for telemedicine in every state in the U.S., found that only one state averaged the lowest composite score – Alabama – suggesting the existence of many barriers for the advancement of telemedicine in the State. The ATA’s review included an analysis of state laws and medical board standards regarding telemedicine. In contrast to Alabama, the ATA gave twenty-three states and D.C. the highest possible composite score suggesting a supportive policy landscape that accommodates telemedicine adoption and usage. These states included: Colorado, Connecticut, District of Columbia, Delaware, Idaho, Illinois, Indiana, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, South Carolina, Tennessee, Utah, West Virginia, and Wisconsin. Twenty-seven other states fell in the middle with room for improvement.
The ATA noted in its report that professional licensure portability and practice standards for providers using telemedicine are some of the biggest challenges for health care providers considering telemedicine adoption. The ATA found that providers generally encounter a patchwork of conflicting and disparate requirements for insurance claims and practice standards that prohibit them from fully taking advantage of telemedicine. Another influential association, the American Hospital Association, has reported that telemedicine can deliver a 15% reduction in emergency room visits, 20% reduction in emergency admissions, 14% reduction in elective admissions, and a 14% reduction in bed days. Over half of all U.S. hospitals now use some form of telemedicine. Further, various research projects across a variety of disciplines indicate that patients monitored via telehealth policies experience improved outcomes. Notwithstanding these reported findings and the fact that both federal and state governments have also been strongly encouraging the adoption of telemedicine services, telehealth policies are still generally in their infancy.
With such widespread acknowledgement of the benefits of telehealth and telemedicine services, Alabama has made some advancements during the past year in terms of promoting telemedicine care. However, such advancements have not been enough to keep pace with other states according to the recently released AHA report.
In January of 2012, Alabama Medicaid approved telemedicine usage but limited it to use by Alabama licensed physicians with a Medicaid provider number. Alabama Medicaid must pre-approve the Telemedicine Service Agreement and counts the physician visit against the 14 covered physician outpatient visits annually. The telemedicine services require the consent of the patient and must be administered through an interactive audio and video telecommunications system with acceptable encryption.
More recently, the Alabama legislature passed a number of new rules regulating the practice of telehealth and the provision of telemedicine services in the State. These rules, effective January 16, 2014, discuss licensing and qualifications for telehealth providers, fraud and abuse, privacy and security requirements, and patient treatment and evaluation. See Ala. Admin. Code 540-X-15-.01 et seq., promulgated to establish standards for the provision of telehealth medical services for medical practices regulated by the Alabama Board of Medical Examiners. However, notwithstanding the recent adoption of these rules, the Rules of the Alabama Board of Medical Examiners still require distant site providers to have Alabama licenses, require the patient to be present at an “established medical site” as opposed to his or her home, and require an in-person evaluation at the established medial site by a “patient site presenter.” Many other states have less stringent requirements in such areas.
With regard to physician-patient encounters, the ATA ranked Alabama, Arkansas, Missouri, Nebraska and Texas the lowest, with failing scores, mainly because they do not allow telemedicine in lieu of an initial in-person exam or to establish a physician-patient relationship in most cases. Evidence of a national movement in a less restrictive direction is reflected by the recent adoption by the advisory Federation of State Medical Boards of a new policy stating that a physician-patient relationship needs to be established for physicians to engage in telemedicine, but that such a relationship can be created “whether or not there has been an encounter in person between the physician and patient.” We will all have to stay tuned to see whether Alabama will respond to this ATA report by choosing to follow national trends in terms of adopting less restrictive requirements for the implementation and use of telemedicine services in the State.
1The ATA’s State Telemedicine Gaps Analysis Report on Physician Practice Standards & Licensure is available at: http://www.americantelemed.org/docs/default-source/policy/50-state-telemedicine-gaps-analysis--physician-practice-standards-licensure.pdf?sfvrsn=6.
Kristen Larremore is an associate in the health law practice with Waller.