Why Aren't More Doctors Using Telehealth?

Telecommunication technology holds great promise in improving both patient outcomes and access to care. So what's the problem?

Telecommunication technology holds great promise in improving both patient outcomes and access to care. It also has the capacity to improve productivity significantly. Using smartphones, e-mail, two-way video, and other tools, doctors can now deliver remote clinical care to the homebound, chronically ill, and those who reside in rural areas. Via telemedicine, they can also deliver care more easily after hours, monitor patient vital signs using secure health and wellness smartphone applications, and conduct consultations with specialists and other providers.

While many early adopters have invested in the technology necessary to enable telemedicine, however, reimbursement models and state licensing regulations present significant barriers to broader adoption, says Gary Capistrant, senior director of public policy at the American Telemedicine Association. "Some payers, especially Medicare, are very meager with telehealth reimbursement and they include artificial restrictions," he says, noting Medicare reimburses just 20 percent of beneficiaries who live in rural areas. Currently, 21 states have laws requiring reimbursement parity for telehealth services and in-person patient visits. "That means there are 29 states that don't," says Capistrant. "The variations from payer to payer can be frustrating to physicians."

Similarly, many state medical boards still require physicians to be licensed on both ends of the patient encounter. A specialist in Pennsylvania, for example, may not be able to treat a patient remotely if he is unlicensed in the state where that patient resides. Likewise, providers who answer e-mails and have the capacity to conduct telehealth exams from their laptop while at a conference or on vacation could easily run afoul of state licensing laws, says Capistrant, all of which limits their ability to capitalize on technology. "We have all these snowbirds, older patients who head to Arizona or Florida during the winter months, who can't be cared for by their physician back home because he or she isn't licensed there," he says. "That causes discontinuity of care."