Skip to main content

New top story from Time: Telehealth Took Off During the Pandemic. Now, Battles Over State Lines and Licensing Threaten Patients’ Options

https://ift.tt/3kvrWev

Televisits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Throughout, it’s probably seemed like it doesn’t matter what state the provider of these telehealth services is located. But that’s only because most states, along with the U.S. Centers for Medicare & Medicaid Services, temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Now states are rolling back many of those pandemic workarounds—meaning the ability to conduct certain virtual appointments may be nearing an end.

Johns Hopkins Medicine in Baltimore, for example, recently scrambled to notify more than 1,000 Virginia patients that their telehealth appointments were “no longer feasible,” says Dr. Brian Hasselfeld, medical director of digital health and telemedicine at Johns Hopkins. Virginia is among the states where the emergency orders are expiring or being rolled back.
[time-brightcove not-tgx=”true”]

Only about 17 states still have waivers in effect, according to a tracker maintained by the Alliance for Connected Care, a lobbying group representing insurers, tech companies and pharmacies. As those rules end, “it risks increasing barriers” to care, says Hasselfeld. Johns Hopkins, he adds, hosted more than 1 million televisits, serving more than 330,000 unique patients, since the pandemic began. About 10% of those visits were from states where Johns Hopkins does not operate facilities.

The rollbacks come amid a longer and larger debate over states’ authority around medical licensing that the pandemic—with its widespread adoption of telehealth services—has put front and center.

“Consumers don’t know about these regulations, but if you all of a sudden pull the rug out from these services, you will definitely see a consumer backlash,” says Dr. Harry Greenspun, chief medical officer for the consultancy Guidehouse.

Why cross-state telehealth is an issue to begin with

Finding a way forward pits high-powered stakeholders against one another, and consumers’ input is likely to be muted.

Barak Richman, a Duke University law professor argues that laws and policies haven’t been updated to reflect new technological realities partly because state medical boards want to hang onto their authority. These state boards say their power to license and discipline medical professionals boosts patient safety. Licensing is also a source of state revenue.

Providers have long been split on whether to support changing cross-state licensing rules. Different state requirements—along with fees—make it cumbersome and expensive for doctors, nurses and other clinicians to get licenses in multiple states, leading some to call for more flexibility. Even so, those efforts have faced pushback from within the profession, with opposition from other clinicians who fear the added competition that could come from telehealth could lead to losing patients or jobs.

“As with most things in medicine, it’s a bottom-line issue,” says Greenspun. “The reason telehealth has been blocked across state lines for many years related fundamentally to physicians wanting to protect their own practices.”

But the pandemic changed the equation. Even though the initial spike in telehealth visits has eased, use of the services has stabilized at levels 38 times higher than before the pandemic, according to a July report from consulting firm McKinsey and Co. Patients’ experience with televisits coupled with the growing interest by investors is focusing attention on this formerly inside-baseball issue of cross-state licensing.

Meanwhile, patients and their doctors are getting creative, with some simply driving across state lines, then making a Zoom call from their vehicle. “It’s not ideal, but some patients say they are willing to drive a mile or two and sit in a parking lot in a private space and continue to get my care,” says Dr. Shabana Khan, director of telepsychiatry at NYU Langone Health’s department of child and adolescent psychiatry. She and other practitioners ask their patients about their locations, mainly for safety reasons, but also to check that they are in-state. Other patients, of course, are seeing telehealth care providers many miles away, so driving to another state for a virtual appointment will not ever be a realistic option. Khan worries about people whose care is interrupted by the changes, especially those reluctant to seek out new therapists or who cannot find any clinicians taking new patients.

Austin Smith hopes that doesn’t happen to him. After initial treatment for what he calls a “weird flavor of cancer” didn’t help reduce his gastrointestinal stromal tumors, he sought out other options and eventually landed in a clinical trial for a drug to treat his cancer. But it was in San Diego and the 29-year-old salesman lives in Phoenix.

Although he drives more than five hours each way every couple of months for treatment and to see his doctors, he does much of his other follow-up online. And if the rules change? It will mean a lot of inconvenience and time on the road for him compared to his current on-line follow up care but he’ll keep making the drive. “I’ll do anything to beat this,” he says of his cancer.

Where doctors stand

But will doctors, whose patients have spent the past year or more growing comfortable with virtual visits, also be willing to take steps that could likely involve extra costs and red tape? For instance, submitting license applications in another state can take weeks or even months. They must pay application fees and then have to keep up with a range of ongoing requirements such as continuing education, which vary by state.

States boards say their traditional role as medical practitioner overseers ensures that all applicants meet educational requirements and pass background checks. They also investigate complaints and argue there’s an advantage to keeping local officials in charge. “It’s closer to home,” says Lisa Robin, chief advocacy officer with the Federation of State Medical Boards. “There’s a remedy for residents of the state with their own state officials.”

Some doctor groups, such as the American Medical Association, agree. Allowing a change that removes centralized authority from a patient’s home state would raise “serious enforcement issues as states do not have interstate policing authority and cannot investigate incidents that happen in another state,” said then-AMA President-elect Jack Resneck during a congressional hearing in March.

But others want more flexibility and say it can be done safely. Hasselfeld, at Johns Hopkins, says there is precedent for easing multistate licensing requirements. The Department of Veterans Affairs, for example, allows medical staffers who are properly licensed in at least one state to treat patients in any VA facility.

The Alliance for Connected Care and other advocates are pushing states to extend their pandemic rules. A few have done so. Arizona, for example, made permanent the rules allowing out-of-state medical providers to practice telemedicine for Arizona residents, as long as they register with the state and their home-state license is in good standing. Connecticut’s similar rules have now been stretched until June 2023.

Advocates also call for the federal government to enact more sweeping changes, and back legislation pending in Congress that would temporarily allow medical professionals licensed in one state to treat—either in person or via televisits—patients in any other state.

The working models for a future system

Because such fixes are controversial, voluntary interstate pacts have gained attention. Several already exist: one each for nurses, doctors, physical therapists and psychologists. Proponents say they are a simple way to ensure state boards retain authority and high standards, while making it easier for licensed medical professionals to expand their geographic range. The nurses compact, enacted by 37 states and Guam, allows registered nurses with a valid license in one state to have it automatically recognized by all the others in the pact

A different kind of model is the Interstate Physician Licensure Compact, which has been enacted by 33 states, plus the District of Columbia and Guam, and has issued more than 21,000 licenses since it began in 2017, says Robin, of the Federation of State Medical Boards. While it speeds the paperwork process, it does not eliminate the cost of applying for licenses in each state.

The compact simplifies the process by having the applicant physician’s home state confirm his or her eligibility and perform a criminal background check. If the applicant is eligible, the home state sends a letter of qualification to the new state, which then issues a license. To be eligible, physicians must meet all rules and laws in each state, such as requirements for continuing medical education. Additionally, they cannot have a history of disciplinary actions or currently be under investigation. “It’s a fairly high bar,” says Robin.

Such compacts—especially if they are bolstered by new legislation at the federal level—could help the advances in telehealth made during the pandemic stick around for good, expanding access to care for both mental health services and medical care across the U.S. “What’s at stake if we get this right,” says Richman at Duke, “is making sure we have an innovative marketplace that fully uses virtual technology and a regulatory system that encourages competition and quality.”


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Comments

Popular posts from this blog

Bihar: Stages collapse during Congress rallies in Darbhanga, West Champaran https://ift.tt/37QFnks

The stage on which Congress candidate from Jale assembly seat, Mashkoor Ahmad Usman was addressing a rally broke and collapsed in Bihar's Darbhanga on Thursday. In a similar incident, another stage collapsed and took down party leaders Imran Pratapgarhi and Akhilesh Singh along with several party workers who were on the dias, during a Congress rally at Bagahi Deoraj in Champaran.

New Dashboards Give a Window into Muni Service Changes

New Dashboards Give a Window into Muni Service Changes By Kate McCarthy An inspector manages Muni service. New dashboards that help inform changes to Muni service are now live at SFMTA.com/MuniData Many factors inform our decisions about Muni service adjustments. These include making sure changes to service support the SFMTA’s values, which are economic vitality, environmental stewardship, trust and equity. We also evaluate travel patterns. You can now explore these patterns using the new Muni data dashboards  (SFMTA.com/MuniData). When looking at possible Muni service changes, the first thing we do is turn to the Muni Service Equity Strategy for guidance. Using the Muni Service Equity Strategy, we prioritize providing Muni service along routes that more often serve people of color, members of low-income households, and/or those who are dependent upon transit service, including people with disabilities and seniors. We also use ridership data to analyze where riders are boa...

India reports first 6 cases of new coronavirus strain after UK returnees test positive https://ift.tt/3pA0T2j

India on Tuesday reported the first six cases of the new coronavirus strain after six people who had returned from the United Kingdom were tested positive for the new UK variant genome. According to the details, the new coronavirus strain cases were reported from Hyderabad, Pune and Bangalore. Samples of 3 UK returnees were tested and found positive for the new UK strain in NIMHANS, Bengaluru. The other two cases were tested at the Centre for Cellular and Molecular Biology, Hyderabad; while the last case was tested at the National Institute of Virology, Pune.

FOX NEWS: Ohio amusement park shut down after multiple fights break out Kings Island in Mason, around 20 miles north of Cincinnati, closed down 30 minutes early Saturday night after several fights among teenagers occurred, reports suggest.

Ohio amusement park shut down after multiple fights break out Kings Island in Mason, around 20 miles north of Cincinnati, closed down 30 minutes early Saturday night after several fights among teenagers occurred, reports suggest. via FOX NEWS https://ift.tt/3wsn8uI

PM Modi lauds IFS officers for their work towards serving nation, furthering national interests https://ift.tt/36HoEzw

Greeting Indian Foreign Service officers on IFS day, Prime Minister Narendra Modi on Friday said that their work towards serving the nation and furthering national interests globally are commendable. Their efforts during the Vande Bharat Mission, which was launched to bring Indians home from abroad during the COVID-19 pandemic as international travel came to a halt, and other related help to our citizens and other nations is noteworthy, Modi added.

FOX NEWS: Bride's father asks stepdad to help walk her down the aisle in sweet viral moment A selfless gesture by the father of a bride was shared on social media in a viral moment of him surprising the girl’s stepfather by asking him to help walk her to the altar.

Bride's father asks stepdad to help walk her down the aisle in sweet viral moment A selfless gesture by the father of a bride was shared on social media in a viral moment of him surprising the girl’s stepfather by asking him to help walk her to the altar. via FOX NEWS https://ift.tt/ZkQ1Rpt

Better Connections from Bayview and Hunters Point to Downtown

Better Connections from Bayview and Hunters Point to Downtown By Enrique Aguilar To better connect southeast San Franciscans with downtown, the SFMTA debuted the 15 Bayview Hunters-Point Express in late January, coinciding with the return of T Third train service. Within weeks, average daily boardings reached 1,000 customers on this new service. The 15 Bayview Hunters Point Express  We added this route based on community feedback from the Southeast Muni Expansion Project in 2018, which prioritized a more direct trip to downtown from the Bayview. With the sudden rise of the COVID-19 pandemic and its disproportionate impacts on communities in the Bayview and Hunters Point, fast-tracking the project became critical to our transit planning. Adding service capacity and a direct connection between these neighborhoods and downtown is a crucial step in supporting the City’s economic recovery and increasing job access for essential workers using transit. Using data from the SFMTA Equ...

Plan Your Next Golden Gate Park Trip with Muni

Plan Your Next Golden Gate Park Trip with Muni By Eillie Anzilotti   A map of San Francisco showing Muni lines that offer direct service to Golden Gate Park, including: The 18 46th Avenue, the 29 Sunset, the 5 Fulton and 5R Fulton Rapid, the N Judah, the 44 O’Shaughnessy, the 33 Ashbury/18th Street, the 7 Haight/Noriega, the 43 Masonic and the 28 19th Avenue. Around each bus route shown on the map, a red zone shows the range within 1,000 feet of a stop, orange shows within 2,000 feet of a stop, and yellow shows within 3,000 feet. Here’s a fun fact: 70% of San Franciscans are within a 15-minute walk of a transfer-free Muni ride to the largest public space in our city: Golden Gate Park.   Especially as COVID-19 has heightened the importance of outdoor recreation and park access, SFMTA has made efforts to update Muni service to get people to Golden Gate Park. As of now, ...

New top story from Time: ‘I Should Be Presumed Innocent.’ Hong Kong Media Tycoon Jimmy Lai Criticizes His Arrest

https://ift.tt/342b8VJ Hong Kong media tycoon Jimmy Lai said he was arrested on “trumped up” charges, pushing back against landmark national security legislation that has raised questions about press freedoms and the future of the democracy movement. “They’re trumped up. I can’t go further on the details,” Lai said in an interview with Bloomberg Television on Friday morning. “Before any evidence, they just claimed and presumed that I’m guilty. This isn’t the way the law is. I should be presumed innocent. We have never supported the independence of Hong Kong.” He said Hong Kong’s future as Asia’s main financial hub was uncertain if there was no respect for the rule of law under the new security measures. “The future of Hong Kong is the future of any other Chinese city,” he added. “Without the rule of law, the international financial center will be finished.” He added that the law sent a “very negative” message to the business community in Hong Kong and overseas. Lai has ...

अगर मैंने आत्महत्या की तो लोगों को पता होना चाहिए किसकी वजह से की - फूटकर रोते दिखे विकास गुप्ता

सुशांत सिंह राजपूत की आत्महत्या हर किसी को एक गहरा सदमा दे गई है और अब सुशांत के करीबी दोस्त विकास गुप्ता ने एक वीडियो में अपनी आपबीती सुनाई है। विकास इस वीडियो में बेहद टूटे हुए नज़र आ रहे हैं from टेलीविजन की खबरें | Television News in Hindi | TV Serials Update in Hindi – FilmiBeat Hindi http:/hindi.filmibeat.com/television/vikas-gupta-reveals-people-want-him-to-commit-suicide-cries-his-heart-out-for-sushant-singh-rajput-090284.html?utm_source=/rss/filmibeat-hindi-television-fb.xml&utm_medium=23.213.205.12&utm_campaign=client-rss