Telemedicine saw a surge in popularity during the COVID-19 pandemic, as it allowed for social distancing and reduced the risk of infection spread.
According to David Jordan, president and CEO of the United Methodist Health Ministry Fund, 11% of Americans used telemedicine before the pandemic. In May 2021, that figure had increased to 38%, based on data from the American Psychiatric Association.
However, limitations on cross-state care delivery have begun to resurface, potentially affecting patients’ follow-up treatments, mental health therapy, and routine doctor check-ins.
States Restrict Access to Telemedicine
Despite initial enthusiasm for expanded telemedicine during the COVID-19 pandemic, almost 40 states have rescinded emergency declarations and reverted to their pre-pandemic regulations.
A few states, such as Arizona and Florida, have made efforts to streamline the process for out-of-state doctors. Others, like Virginia, are allowing patients to continue existing relationships with physicians.
Due to the confusion created by the unclear regulations, some practices have opted to stop offering cross-border telemedicine altogether. As a result, only patients who can travel to meet in person will be able to continue getting care from that particular provider.
Patients Forced to Travel
Many patients are now forced to travel because they do not have access to specialists in their area. This is a problem for cancer patients who may have to travel long distances for follow-up appointments and treatment. It is also an issue for mental health patients who may be unable to afford the travel costs or take time off work.
For example, Susie Rinehart has a rare form of bone cancer and cannot find the specialist she needs locally. With the new regulations, she must travel from Denver to Boston, where her oncologist is. During the pandemic, her doctor “visits” were virtual.
Dr. Shannon MacDonald, Rinehart’s oncologist, explains that regulations for telemedicine are being enforced far more aggressively than even before the pandemic.
With virtual visits, if the patient is in Las Vegas and the doctor is in Boston, state medical boards would consider Las Vegas to be the location of the appointment. Massachusetts General, one of the hospitals where Dr. MacDonald practices, has instituted a rule whereby the doctor must be licensed to work in the state where the appointment takes place.
Therefore, the Las Vegas patient would not be permitted to work with Dr. MacDonald unless the doctor is licensed in Nevada. The hospital also limits virtual visits to patients in New England and Florida.
Dr. Peter Rasmussen, a neurosurgeon from Cleveland Clinic, is concerned about his patients traveling to get care. Travel is especially problematic during the winter when patients with conditions that impede mobility, such as Parkinson’s disease, must face icy conditions. He explains that a single fall could be “life-ending” for such patients.
In terms of mental health, patients who need psychiatric care face a different challenge: finding a specialist who can treat them when they leave the state. College students, for example, who temporarily move to another state face significant issues because many U.S. counties do not have psychiatrists who work with children or adolescents.
Helen Khuri, a nineteen-year-old with post-traumatic stress disorder (PTSD), was forced to move from Atlanta to Boston to get the treatment she needed. Even though all the visits were virtual, she still had to move to be in the same state as the doctor to be eligible to take advantage of telemedicine.
Distance Is Irrelevant
These regulations don’t take distance into account. So even if a patient is only one mile from their physician, the restrictions apply if it’s across the state line.
Some doctors have patients who travel a few miles across the state border so they can connect virtually. This way, they save the time and hassle of traveling into the city for a faceto- face appointment.
Dr. Ed Sepe, a pediatrician in Washington, D.C., explains that many low-income families will suffer. They have jobs that don’t allow them free time for in-person medical appointments. And telemedicine was helping.
According to Sepe, the geographic restrictions imposed on telemedicine do not make sense. Their exact location should be irrelevant as long as the patient is in the United States.
States Should Consider Easing Restrictions
According to the Federation of State Medical Boards, states can help telemedicine grow by protecting patients from fraud and similar issues. However, they also believe that states shouldn’t impose such stringent restrictions on telemedicine.
The federation proposes that states allow patients who have visited an out-of-state doctor in person to conduct follow-up visits virtually. The same should apply to patients who are moving out of state temporarily but wish to continue working with the same doctor.
Dr. Ateev Mehrotra, a health policy professor at Harvard University, proposed that states could enter into agreements with neighboring states to make it easier for patients to access telemedicine services.
Mehrotra believes states have a wide range of options to resolve these issues. However, until then, many patients will continue being forced to jump through hoops to get the care they need.
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