Telemedicine, which involves providing health care services through a variety of electronic mediums including the internet, presents an opportunity to address barriers patients may face in accessing health care. The Star Tribune recently detailed “Doctor on Demand,” a mobile app that provides face-to-face virtual appointments for $40 per 15-minute session. This and other virtual care sites have proliferated rapidly and aim to address both the access and convenience that patients desire in their medical care. According to the American Telemedicine Association, as of April 23, 2014, 21 states and the District of Columbia have telemedicine parity laws, which mandate that private insurance plans cover telemedicine services at reimbursement rates equal to an in-person consultation. Fourteen other states have proposed similar legislation.
Florida is one such state considering legislation to increase the use of telemedicine through broader insurance coverage. The Jacksonville Business Journal recently reported on Florida Senate Bill 1646, or the Florida Telemedicine Act, which defines key telemedicine terms, addresses licensure issues for providers who provide telemedicine across state lines, specifies standards for the delivery of telemedicine, and establishes a requirement for Medicaid reimbursement of telemedicine services. Other currently proposed legislation would mandate parity in private insurance coverage of telemedicine services.
Proponents of the bill assert that telemedicine can address access to care barriers, yet those opposed to the bill raise concerns about the quality of care delivered via telemedicine, particularly from out-of-state providers who may lack accountability for patients in Florida. As proposed, the bill would allow an out-of-state physician, physician assistant, advanced registered nurse practitioner, or pharmacist to deliver telemedicine services without Florida licensure if that provider is consulting with a licensed Florida provider, is affiliated with a hospital or health plan that is licensed or authorized in Florida, or is licensed in a state with licensure requirements that meet or exceed Florida’s requirements. The Florida Senate Appropriations Subcommittee on Health and Human Services voted favorably to recommend the bill with one amendment, which would delete the provisions exempting certain out-of-state physicians from Florida licensure in response to concerns about out-of-state provider accountability.
In an ongoing, HCFO-funded study, R. Adams Dudley, M.D., University of California San Francisco, is examining the processes and quality of care provided by virtual physician websites for minor acute illnesses. In a recent JAMA Viewpoint, Dudley and colleagues described the growth of telemedicine and virtual care websites and the implications for access to care and quality. While these websites meet patients’ preference for convenience, preliminary evidence suggests that these sites may increase the risk of misdiagnosis, particularly in unusual or atypical cases. Additionally, they may impede continuity of care and lead to an increase in unnecessary prescriptions. Dudley and his colleagues suggest that practice guidelines, telemedicine protocols, and standards for physician training could improve the quality of care delivered over the internet. Regulation may also be an effective tool in standardizing telemedicine services to ensure care quality.
Additional information about Dr. Dudley’s HCFO-funded study is available here.