Telehealth Across State Lines Called Fix for Workforce Shortage


October 7, 2021 3:07 pm

Allowing doctors and other providers to easily practice telemedicine across state lines would combat the nationwide health-care staffing shortage ignited by the Covid-19 pandemic.

“Workforce is an issue,” Deanna Larson, CEO at telemedicine provider Avel eCare, said at a Thursday hearing of a Senate Commerce, Science, and Transportation panel. Larson serves on the board of directors of the American Telemedicine Association. “It’s very important to us that geography is not limiting where we can see individual patients,” Larson said.

The health-care industry is facing a staffing crisis due to the increasing demand of caring for Covid-19 patients, pandemic-induced exhaustion, greater use of sick leave, and employees choosing to resign or getting fired over vaccine mandates. Hospitals are paying inflated wages to meet patient demand, burdening an already drained industry.

There’s also the “twin crisis” of having both “an aging population, and an aging workforce that’s diminishing trying to care for it,” Kyle Zebley, the American Telemedicine Association’s vice president of public policy, said in an interview.

Some states have “virtually no mental health providers or specialists in certain areas,” Zebley said. “Obviously, having access to the rest of the nation’s health-care professionals would help improve access to care.”

Licensing a Barrier

Whether a provider can practice telehealth across state lines depends on both federal and state policies, according to the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services. 

Some states have agreements that allow for an expedited process for physicians to practice using a single license. Other states require providers to get a new license, which can be a time-consuming and expensive process, Mei Kwong, executive director of the Center for Connected Health Policy, said in an interview.

“Licensing is really a barrier,” and makes it harder for people in rural areas to see specialists like dermatologists, Larson said. Some states require physicians to be fingerprinted on site, which can be difficult for a busy physician.

Physicians could be likely to get multiple licenses if they live close to a border, Kwong said. But, for “one patient who lives in Florida,” it’s less likely a provider would “go through that entire process,” Kwong said.

While many states eased restrictions during the pandemic, those accommodations are beginning to peel back, Zebley said. Practicing across state lines is a polarizing issue, and raises questions about how physicians should enforce “contentious practice of medicine issues like abortion, birth control, euthanasia, or prescription of marijuana,” Zebley said.

‘Telehealth Cliff’

Being able to access health-care remotely “is a matter of life and death,” Sen. Brian Schatz (D-Hawaii), said at the hearing. 

Schatz is part of a group of 50 senators advocating for the CONNECT for Health Act (S. 1512), which would make permanent several of the telehealth flexibilities granted during the public health emergency, including removing geographic restrictions. The bill has bipartisan support.

The passage of the CARES Act last year enabled doctors and other medical providers to initiate telehealth care with a patient in their home. The Social Security Act generally keeps Medicare from reimbursing those visits unless they’re for patients in rural areas, or if they originate at a qualifying site like a hospital or nursing home. 

Those exceptions will end when the public health emergency ends unless Congress takes action, leading to an approaching “telehealth cliff,” Schatz said. 

If a patient still has to “get a ride and schlep some place, it defeats the purpose, at least partially, of telehealth in the first place,” Schatz said.

Telehealth also helps keep patients’ illnesses from escalating, Larson said. 

“If we can’t immediately see an individual when they start to feel ill or have a situation going on, if we’re waiting, now that individual is probably going to be seen in an emergency department,” Larson said. “We can prevent much of that.”