Millions of Americans used telehealth for the first time during COVID, but state regulations could soon strip that away. Emergency regulatory suspensions made it possible to expand telehealth services, but without permanent reform, patients will lose access to care as the clock on those temporary suspensions runs out.
A new report, Rating the States on Telehealth Best Practices: A Toolkit for a Pro-Patient and Provider Relationship, published by the Reason Foundation, the Cicero Institute, and the Pioneer Institute rates the telehealth policies of every state against the practices that would make those pandemic-era flexibilities permanent.
The greatest benefit of telehealth is its ability to connect patients to providers regardless of their physical location. Patients can access the best specialists around the country without the burden and expense of traveling. But an antiquated system of state-level licensing schemes prohibits health care providers from practicing telehealth across state lines.
It takes very little imagination to see the benefits of a flexible regulatory environment. For an example that began before COVID, look to Florida, which adopted a valuable permanent reform in 2018.
That year, Florida created a registration process that allows out-of-state providers to practice telehealth in the state without obtaining a full Florida-issued license. The process isn't perfect, but it helps propel the Sunshine State to the top of the telehealth rankings. The system applies to all health professions, and it does not require action from other states. There are nearly 11,200 actively registered out-of-state telehealth providers in Florida—only Arizona has a comparable program.
In 2020, Florida passed another valuable bill. This one allows advanced practice registered nurses (APRNs) to open independent practices. Many APRNs acted quickly to gain authorization. In 23 states, APRNs are required to work under a physician's supervision. These supervision requirements reduce access to care and arbitrarily limit the number of primary care professionals available, especially in rural areas. Over 5,300 APRNs have branched to independent practices since the Florida Board of Nursing began processing applications in October 2020.
Taylor Ann Drew is an APRN who runs a direct primary care (DPC) practice—that is, a subscription-based service for health care—in Tallahassee, Florida. Rather than relying on third-party payers and traditional reimbursement models, patients can get unlimited access to a DPC provider for a flat monthly rate. There are currently more than 1,600 DPC practices across the United States. Drew believes the success of her practice depends on its ability to work independently from a physician.
"Direct primary care is the perfect model for telehealth because you don't have to bill for it. Patients pay a monthly fee and ask me as many questions as they want—it's up to them and how they want to guide their health," says Drew. Her patients text her when they have questions, giving them virtually seamless access to expert advice. Under this system, patients are less likely to put off calling the doctor. And in many states Drew wouldn't be able to run or own this business.
Drew's practice is just one example of the innovations that regulatory flexibility makes possible. As emergency regulatory suspensions face expiration dates, millions of Americans could lose access to the telehealth they have appreciated throughout COVID. Lawmakers should make those changes permanent—and look to states like Florida for ideas for further reforms.