Telehealth is reaching more patients than ever, but it's hindered by parity laws

Telehealth consultation
The survey's results are available as a mobile app that Epstein Becker Green plans to keep current as more laws are passed. (Getty/AndreyPopov)

Awareness, availability and utilization of telehealth has expanded appreciably over the last few years. In turn, the web of laws and regulations governing telehealth has expanded as well.

As the most recent telehealth survey from law firm Epstein Becker Green (EBG) demonstrates, telehealth is bigger than ever, though it still has plenty of room to grow—particularly in supplementing mental health care.

Support from Congress and the Centers for Medicare and Medicaid Services has facilitated the expansion of telehealth for Medicaid beneficiaries and some covered under Medicare, EBG wrote in a release. In addition, more than 6,000 veterans now receive virtual care through the Department of Veterans Affairs, and children can receive telehealth services at school in certain states.

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States have also become more receptive to telehealth as they work to deal with the opioid crisis. Indiana, Michigan and Missouri are just three of several states that have introduced or passed legislation allowing remote prescribing for substance use disorder treatments.

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But going into 2019, barriers remain. For instance, 11 states have yet to pass telehealth parity laws.

Medical boards in these states still have a “very traditional view of what medicine is,” according to EBG’s Amy Lerman, who led and oversaw the survey. Those who hold that view may feel medicine “should be a physician and a patient sitting in a room across from each other; that’s the only way they can uphold the standard of care,” she explained.

Plus, many of the remaining 39 states' laws only go so far, though “there is a ton of pending legislation,” Lerman said. For instance, Alaska, Michigan and Utah are amending their parity laws to include additional specialties or categories of providers. 

In fact, Lerman said, a lot of the traction over the last year has occurred among groups other than doctors who want to serve patients virtually, such as nurses and social workers. Some state boards of nursing and social work have even issued guidance around the issue.

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At the federal level, “Medicare, from a coverage and reimbursement standpoint, is still a big wild card,” Lerman said.

Payers, including Medicare, are hesitant to expand telehealth coverage too quickly—lest utilization of telehealth services spike, sending costs through the roof, she explained. While this is understandable, it’s also important to realize the many benefits telehealth can bring to patients.

“We have a lot of beneficiaries who are attempting to ‘age-in-place,’ and be in their homes, surrounded by friends and family,” Lerman said. “Wouldn’t it be nice if they weren’t always having to run to doctor’s offices for every little appointment?”

EBG released the results as an app for iPhone, iPad and Android, which it will update as the legal landscape changes.

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