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December 2024
Quarterly Article
James René Jolin
Barak Richman
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June 2024
The Future of Population Health
June 2022
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Policy Points:
The COVID-19 pandemic sparked a dramatic increase in the use of telehealth in the United States,1 aided in no small part by a flurry of temporary payment and regulatory changes. These included expansions in reimbursement for telehealth services as well as suspensions of patient privacy regulations and offering liability immunity for practitioners. One additional notable move was to waive certain licensing requirements for providers practicing telehealth across state lines.2, 3 Most of these temporary physician licensure waivers are either poised to expire or have expired already.
During the COVID-19 public health emergency (PHE), certain patient populations were more likely to receive interstate telemedicine visits. Patients living near a state border and receiving specialized care only available in selection locations—such as oncology and pediatric patients4,5—were more likely to receive a telehealth visit in another state. College students with an established care relationship with a mental health provider also benefited because they did not have to disrupt treatment when traveling to school or returning home during breaks.6 For this population, expanded access to mental health providers as a result of telemedicine is particularly essential given that three million students attend college away from their home state per year and approximately half a million college students lose access to psychiatric care each year because of licensure barriers.7 During this period of licensure flexibility, patients could enter clinical trials held in another state that supported the US Food and Drug Administration (FDA) and its effort to decentralize clinical trials and to reduce barriers to participation.8
Given the many patients who benefited from interstate telehealth, advocates argue for permanently reinstituting the permissive telehealth rules adopted under the PHE or instituting permanent reforms of physician licensure, either at the state or federal level, to facilitate interstate telehealth. However, as we detail in this piece, political realities make this approach likely unfeasible. Therefore, alternative approaches that are narrower in nature are likely needed to improve access to interstate telemedicine for particular populations without disrupting the current state-based licensure regime.
This article explores a menu of possible incremental policy measures that could expand access of interstate telehealth to key patient populations. We focus on physician licensure in this article because it represents the largest debate in health care licensure at present, but we acknowledge that similar issues also exist in the licensure regimes for other clinicians such as social workers and psychologists. We organize our list of reforms according to their breadth and ambition, beginning with modest reforms that states can pursue unilaterally, then multistate initiatives that would both require and improve coordination among states, and finally with narrowly targeted federal reforms. For each reform, we outline its strengths and weakness with the aim of advancing pathways for patients to benefit from interstate telehealth.
