The Telehealth of Tomorrow

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Scholar calls on Congress to expand telehealth services in rural parts of the United States.

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The urban-rural health care divide is stark, with urban areas enjoying significantly better access to physicians compared to rural regions. Alarmingly, in rural parts of the United States, one in every five residents lives in areas where a lone primary care health care provider could be accountable to over 3,500 residents. The urban-rural statistic profoundly impacts the overall health of these regions and reveals a substantial disparity.

In a forthcoming article, Fazal Khan, a professor at the University of Georgia School of Law, calls for the implementation of new federal regulatory frameworks aimed at expanding the use of telehealth and reducing discrepancies in health care access within rural areas. Specifically, Khan suggests increasing physician licencing reciprocity—the ability of a physician to practice across state line—and expanding authorization for allied health providers to administer telehealth services.

Telehealth emerged as a promising tool during the COVID-19 pandemic, offering enhanced access to care in rural communities. It also enabled physicians to receive reimbursement for telehealth services without the necessity to meet specific licencing requirements including practicing across state lines—breaking historical boundaries. Many of the pandemic-induced telehealth flexibilities at both the federal and state government levels, however, were temporary and are set to expire by December 2024. The end of these flexibilities will decrease access to care for rural populations, argues Khan.

Khan identifies several barriers to expanding telehealth services.

Stringent Medicare reimbursement rules, for example, dictate the financial viability of telehealth for many physicians, often making the technology cost prohibitive.

In addition, fragmented state licensing and inconsistent scope of practice laws—requirements on the type of care and services licensed health providers can deliver—have long hindered the growth of telehealth, according to Khan.

Khan points to state medical boards as a source of resistance to changing these laws. Khan argues that state-run medical boards, often dubbed “quasi cartels,” aim to uphold their authority over licensure and practice boundaries. He maintains that they do so by resisting the expansion of telehealth—a move that could significantly benefit rural areas.

With only nominal public—that is, non-medical—representation on state medical boards, supermajorities of physicians on these boards hold their own private interests and often make decisions that diverge from public welfare objectives, including increasing access to care in rural communities, argues Khan.

States seeking to reduce pandemic-related flexibilities encounter obstacles, particularly with the Federal Trade Commission (FTC) contesting policies such as West Virginia’s attempt to limit the scope of practice of nurse practitioners. Khan highlights that efforts led by the FTC are challenging state policies that overly restrict scope of practice and access to telehealth, aiming to alleviate concerns about limitations that might impede competition and health care access. These efforts also involve addressing state licensing boards influenced by private interests to underscore the necessity for robust federal supervision in professional licensing systems.

Khan recommends that Congress enact national changes in physician licensing and allied health professionals’ practice constraints. He proposes establishing national physician licensing processes to streamline administrative workflows, offer portability and reciprocity of medical licenses, and set a national standard for telehealth delivery.

Khan also argues that Congress should expand practice eligibility for allied health professionals, including nurse practitioners and physician assistants, based on their education, training, and proven clinical outcomes. These professionals can then leverage AI technologies for better diagnostics and treatment. He notes that prioritizing competency over existing old hierarchies will break outdated barriers protecting only physicians, enhance health care efficiency, and address physician shortages.

Increasing the number of professionals who can provide telehealth services allows federal regualtors to address inconsistencies in telehealth and practice scope across state lines while allowing states to retain control over in-person medical care, Khan explains.

According to many observers, the COVID-19 pandemic exposed the urgent need for telehealth and highlighted the limitations of out-of-state medical license requirements and practice eligibility standards for allied health care professionals.

Without these changes, though, the U.S. health care system will revert back to a pre-pandemic era of inaccessibility for rural populations, concludes Khan.