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Expiring waivers could leave telehealth patients in a bind

Posted at 6:17 PM, Nov 30, 2021

DENVER, Colo. — Telehealth became a valuable tool in the early phases of the pandemic. Doctors believe it’s here to stay, but state regulations could limit the level of care a person receives.

“We went from about two percent of all our visits being telehealth to 70 percent of our patients being seen on telehealth in just a few short weeks,” said Dr. Christopher Sharp, the chief medical information officer at Stanford Medicine and Stanford Healthcare.

When pandemic shutdowns began, doctor’s offices and healthcare facilities like Stanford Medicine took their care online.

“It’s not just one particular specialty or one particular niche that does it a lot, it’s everybody across all specialties,” Dr. Sharp said.

Care that is accessible became important for a number of reasons.

“We provide very specialized care, so our patients may come from a very broad catchment because they have very specialized needs and they may not be able to satisfy their care needs in their local area,” Dr. Sharp said. “Another good example around this would be transplant patients, patients who come and have a transplantation of an organ. It’s very important that those doctors that are already part of their care continue to be a part of their care.”

However, there is one problem. During the public health emergency, all 50 states used emergency authority to waive state licensure requirements for doctors to help patients get care while sheltering in place. This allowed doctors to see patients in states they were not licensed in. Some of those waivers are expiring.

“The way we currently do it, we have to ask patients at the time of their visit, where are you right now because if at the time of your visit you are not in one of these approved states we have to tell you we can’t proceed with your care. And that's very awkward for both patients and caregivers,” Dr. Sharp said.

As of November 8, 27 states and D.C. had ended their emergency declarations, while 23 states continue to have them in place according to a county by the Alliance for Connected Care.

“I would say that these waivers were probably envisioned to be of a couple weeks duration,” said Kyle Zebley, the vice president of public policy at the American Telemedicine Association. He said states were trying to remove barriers to access care, but generally, there are stricter rules in place.

“If you're seeking to deliver care to patients out of the state that you reside in, that you are licensed in, you have to go through the process of getting licensed in that other state,” he explained.

With these hurdles, telehealth still isn’t going anywhere.

“The telehealth industry has seen about a decade’s worth of anticipated growth over these last 18 months,” Zebley said.

Telehealth utilization is about 38 times higher than before the pandemic, according to information gathered in July by consulting firm McKinsey & Company.

Platforms like emergency telemedicine company Hippo Health have seen it first hand.

“Prior to COVID, Hippo was seeing about a 25 percent paid user growth month over month. When COVID hit, we saw a 1,200 percent paid user growth,” said Brent Thor, vice president of business development and operations at Hippo Health.

Telehealth has become a crucial part of care for many patients. As more waivers expire, Zebley said the federal government may play a role in working with states on a solution to treatment across state lines.

“For over 150 years the issue of licensure has been a state domain, a state interest,” he said. “What the federal government can do is encourage states by predicating for instance certain federal funding on the states adopting proactively their own licensing flexibility laws.”

“In the current state, the only way we can keep entirely legal and appropriate around this is to be licensed at the individual doctors level in more than one state,” Dr. Sharp said.