States Continue to Expand Availability of Telehealth

SEPTEMBER 29, 2018
Stephanie Gurren, PharmD Candidate, and Joseph L. Fink III, BSPharm, JD, DSC (Hon), FAPHA
Telehealth has become a viable niche in US health care because it lets patients and providers use technology to seek medical advice and diagnose and treat illnesses.

About 70% of US health care providers use telehealth.1 As a result, it has helped increase health care access and services. Those with limited access to health care, including those who live in rural communities, benefit the most from telehealth. Therefore, some states have fully embraced this revolutionary way of delivering health care, while others have struggled to accept it.

Every state governs telehealth with different policies and regulations. Disparities include coverage and establishing physician-patient relationships. One element of telehealth that varies widely is how states reimburse practitioners for services provided to Medicaid beneficiaries. Nearly 1 in 5 Americans is enrolled in Medicaid, including low-income individuals, families and children, pregnant women, senior citizens, and those with disabilities.2 Most states offer some form of telehealth reimbursement to practitioners treating beneficiaries.

One of the most common ways telehealth is used is through live video communications.

Massachusetts is the only state that does not require telehealth reimbursement for real-time video consultation. But states define video consultationdifferently. For example, New Jersey offers reimbursement only for psychiatry, which includes medication management, patient education, psychiatric evaluations, and therapy. By contrast, California offers reimbursement for medication management, psychiatry, and other services.3 As a result, not every Medicaid beneficiary has access to the same telehealth services. Reimbursements may vary for Medicaid beneficiaries, but telehealth has developed and grown in other areas.

States used to vary widely in how their telehealth regulations and laws defined the establishment of a patient-provider relationship. Texas had required that the patient and provider first establish a relationship with an in-person office visit. Over the past year, Texas has revised its regulations so a patient-physician relationship can be established via real-time audio or video or store-and-forward platforms, which involve physicians sharing clinical information with patients before communicating with them. This information includes general patient data, magnetic resonance imaging results, and x-rays.4 This ground-breaking change in legislation gives many Texans access to health care services that had been out of their reach because of distance, employment, or financial concerns.5

Although there is still room for improvement, telehealth offers new ways to access health care for people, including many who struggle to make health care a priority. 
 
Stephanie Gurren is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.

Joseph L. Fink III, BSPharm, JD, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy.



References
  1. Beaton T. 71% of healthcare providers use telehealth, tele- medicine tools. mHealthIntelligence. mhealthintelligence.com/ news/71-of-healthcare-providers-use-telehealth-telemedicine-tools. Published April 28, 2017. Accessed July 31, 2018.
  2. Who is eligible for Medicaid? US Department of Health & Human Services website. hhs.gov/answers/medicare-and-medicaid/ who-is-eligible-for-medicaid/index.html. Updated August 4, 2017. Accessed July 31, 2018.
  3. What is telepsychiatry? psychiatry.org/patients-families/ what-is-telepsychiatry. Accessed July 31, 2018.
  4. California Telehealth Resource Center. 2016 telehealth reimburse- ment guide for California. caltrc.org/wp-content/uploads/2016/04/ Reimbursement-Guide-March-2016. Published 2016. Accessed July 31, 2018.
  5. Elliott VL; US Senate. Telehealth and telemedicine: description and issues. senate.gov/CRSpubs/757e3b90-ff10-497c-8e8c- ac1bdbdb3aaf. Published March 29, 2016. Accessed July 31, 2018


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