Petty politics and bad regulations make telemedicine difficult

Elizabeth Stelle

Dr. Marlene Wüst-Smith was involved in telemedicine before it became popular during the COVID-19 pandemic. Unfortunately, government restrictions sometimes make it difficult for her to practice this innovative health care model.

“I have always been an early adopter of new technologies and practices,” says Wüst-Smith, a Pennsylvania pediatrician and founder of Physician Outlook, a digital publication dedicated to “restoring the beauty and craftsmanship of the doctor-patient relationship. “

Wüst-Smith says telemedicine helps doctors build meaningful and productive relationships with patients and, when used properly, also provides a cost-effective method of triaging patients.

“With telemedicine, we are often able to keep patients out of emergency departments and urgent care when it is possible and safe to do so,” Wüst-Smith says. “When the problem at hand is not amenable to virtual care, we can collaborate with other specialists and safely meet the patient’s needs.”

Telemedicine offers a number of financial benefits for both sides of the doctor-patient relationship. With increased efficiency telemedicine offerings, healthcare facilities can reduce hospitalizations, no-shows and overall costs. Meanwhile, patients, especially those in remote rural communities, are saving money by reducing travel and time away from work or school.

Despite these benefits, the legality of telemedicine relies on a set of different state laws. Because state laws vary, telemedicine is difficult, especially given our increasingly digital and global lifestyles.

With a few exceptions, federal and state laws require that a physician be licensed in the state in which the patient begins the telemedicine visit. Pennsylvanians traveling out of state can only legally “see” a doctor licensed in the state where they are located.

If Wüst-Smith has a patient living in Pennsylvania who requests a virtual visit while waiting for a train at Union Station, what should she do as a doctor?

“If I took that call, I would technically be practicing illegally,” Wüst-Smith says.

He is not licensed in Washington, D.C., but lives in Virginia. The only way to make a virtual visit legal is to ask the patient to take a later train, leave the station and take a short ride across the Potomac. As ridiculous as it sounds, Wüst-Smith routinely makes her family cross state lines so she can get care.

Wüst-Smith is currently licensed to practice in 16 states. However, maintaining multiple state licenses is expensive and complicated.

Moreover, Pennsylvania is one of seven states that do not require insurance reimbursement for telemedicine services, which means that even Pennsylvania-licensed physicians are not guaranteed payment if they see patients virtually.

Wüst-Smith says such restrictions disrupt the quality of patient-centered care.

“It makes absolutely no sense to make it illegal to prevent a Pennsylvania physician from being able to provide virtual care to a long-term patient because he or she is traveling or attending college in a state where that physician is not licensed,” Wüst-Kowal says.

Pennsylvania once allowed residents access to out-of-state doctors. During the COVID-19 pandemic, the state government provided waivers allowing residents to virtually access doctors outside of Pennsylvania. Eliminating barriers between doctors and patients has proven to be extremely effective.

Telemedicine has grown exponentially for two and a half years. During the first year of the pandemic, Penn Medicine saw more than one million telemedicine visits, an increase of 9,000%.

Lawmakers have tried to codify this patient-centered approach to telemedicine. Unfortunately, former Governor Tom Wolf vetoed the bill and the exemptions expired in October 2022.

Fortunately, expanded state telemedicine is back on the table with bipartisan support. By a 197-3 margin, the Pennsylvania House passed bipartisan legislation requiring insurance companies to cover telehealth visits. The Pennsylvania Senate passed a nearly identical bill by a 47-1 majority.

A recent poll shows that telemedicine is an easy solution for lawmakers. Nine out of 10 Pennsylvanians believe lawmakers should expand telemedicine and allow patients to use licensed physicians in other states.

As they turn to the state budget, Pennsylvania lawmakers must continually strive to increase cost-effective health care resources.

Telemedicine is one such resource. Allowing physicians to connect with patients, both in person and over the phone, only strengthens the communication necessary to maintain healthy relationships. Conversely, patients benefit from an expanded pool of medical resources beyond Pennsylvania’s borders.

“Telemedicine gives us the opportunity to restore the most important element needed to restore and enhance true health – human connection – which, oddly enough, relies on technology,” says Wüst-Smith. “Despite the challenges, I still believe and love telemedicine.”

Elizabeth Stelle is director of policy analysis at the Commonwealth Foundation, a free-market think tank in Pennsylvania. X: @ElizabethBryan