Jonathan Linkous, CEO of the American Telemedicine Association: Fixing Medicaid Must Include Telemedicine
As Congress grapples with the future of Medicaid, lawmakers should focus on improving access to telemedicine, which can reduce health care costs by allowing physicians and other providers in one location to treat patients in another part of the country.
The good news is that each state’s Medicaid plan now covers telemedicine to some degree. That’s up from only 24 states in 2005. Trends are also improving for more comprehensive coverage, such as adding dental services, and more options for where patients can seek care, including homes and schools.
The overall situation is promising for patients, providers and employers using telemedicine. The findings of a new report from my organization suggest that insurers, state lawmakers and Medicaid agencies all perceive telemedicine as an affordable solution to bridge the provider shortage gap and enhance access to quality health care services.
But the challenge — and this is where the government’s guidance is needed — is that each state has its own set of telemedicine regulations and standards, which inhibits cross-state use of telemedicine.
State Medicaid plans still lack complete coverage for many services that can effectively be provided via telemedicine. Remote health services in some states that are proven to be both effective and cost effective are often not available to Medicaid beneficiaries next door.
Also, while health systems and provider practices have finally started to offer more efficient and better services for patients across wide regions using telemedicine, the variation in each state’s regulation and standards for telemedicine services causes confusion and inhibits consumer access. This patchwork of conflicting requirements for insurance claims and practice standards prohibits patients, providers and health systems from fully taking advantage of telemedicine.
States require that a physician is licensed in the state where the patient is located. The lack of licensure portability, the ability for patients to receive services from health care providers in another state or when the patient is traveling, is a contentious issue for health care providers, whether services are coming via telemedicine or not.
A state’s unwillingness to adopt a policy enabling licensure portability “prevents people from receiving critical, often life-saving medical services that may be available to their neighbors living just across the state line,” says the report.
It is this dichotomy — greater validation and use of telemedicine but also ample obstacles to its widespread adoption — that policymakers must correct as they plot the future of Medicaid.
Much of telemedicine had its genesis in the U.S. space program. Neil Armstrong and fellow astronauts wore medical telemetry and cardiac monitoring devices during moon landings, and that continues in space today.
Telemedicine has spread rapidly since and is now becoming integrated into the operations of hospitals, specialty departments, home health agencies, private physician offices as well as consumer’s homes and workplaces. The benefits of delivering certain health care functions via telemedicine are that it increases patient access to health care services, allows for 24/7 access and reduces costs.
Cost reduction is major consideration in Medicaid, which covers approximately 70 million people. As the largest government health benefit program, it serves more than 20 percent of the population, providing health care for the poorest and most medically vulnerable Americans.
The massive government program costs more than $500 billion annually, with the federal government paying 63 percent. Congressional lawmakers are wrestling with how the program should be changed, with some governors pushing for greater control over their Medicare programs.
President Donald Trump recently told Congress, “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”
With a few meaningful changes, telemedicine can provide that much-needed flexibility by ensuring improved access and reduced costs.