Regulation and Legislation

In 2019 Congress asked for information to develop comprehensive telehealth legislation.²⁶ Congress asked for public input regarding telemedicine expansion in rural areas, improving outcomes, increasing access to telemedicine, and reducing healthcare costs with telemedicine. More recently, The Center for Connected Health Policy released a newly updated telehealth billing guide to help providers correctly bill for telemedicine and virtually delivered services. This guide addresses the more recent changes in fee-for-service Medicare billing and uses the Center for Medicare and Medicaid Services rules as a resource.²⁷

Another more recent change to the telemedicine landscape is the Emergency Broadband Benefit Program.²⁸ On February 25, 2021, the Federal Communications Commission adopted this federally funded program that aims not only to increase internet access but also affordability in underserved communities. The program should open in late April 2021.

In a policy report for the Cato Institute, Shirley V. Svorny stated that requiring a medical license in each state to practice telemedicine is a significant barrier to care.²⁹ She contends that Congress could eliminate this problem by changing the encounter location to where the provider is located instead of where the patient is located. The provider would then only have to meet 1 state’s licensing laws. Another solution was for individual states to open their market to providers in other states, states to join in reciprocal agreements, or for the federal government to start a new agency to issue national telemedicine licenses. She warned that physician groups would not support these proposals and could present a significant barrier to telemedicine.

Svorny contends that the Interstate Medical Licensure Compact (IMLC) for physicians will not solve the current problem. Although the compact would streamline obtaining multiple state licenses, it does not establish a single license. Currently, 28 states participate in the IMLC.³⁰ The Federation of State Medical Board (FSMB) processed 11,000 medical licenses through the IMLC as of August 2020.³¹ The IMLC established that 1 license was valid in all states within the compact.³²

Currently, 34 states recognize a nursing compact, and 6 states and United States territories are pending recognition. The Nurse Practitioners Organization is trying to establish a compact. Implementation of the compact can begin when 7 states enact compact legislation. Thus far, only North Dakota and Delaware have enacted a compact for NPs.

Utilization, Burnout, and Adaption

In an article regarding the use of telemedicine in rural locations, Stephen H. Hanson, PA-C,³⁹described telemedicine’s benefits in reaching underserved areas and the PA’s role in this healthcare delivery model. Discussion included the need for HIPPA compliant smartphone features and applications to aid in treating patients. Hanson believes that incorporating telemedicine in underserved rural regions would bring specialists to patients and facilitate better population outcomes.

According to a 2019 survey, only 1 in 5 physicians used telemedicine.⁴⁰Surveyed physicians said that telemedicine improves patient access to care, efficient use of time, and helps reduce healthcare costs. However, respondents also expressed uncertainty about reimbursement, CMS restrictions, and leadership support deterring telemedicine use. The survey showed a correlation between the interest in telemedicine use and high rates of physician burnout.

In a 2019 article, Powell et al⁴¹discussed the importance of balancing work and family (or private life) to avoid burnout. Suggested strategies included “allocating resources, changing resources and barriers, sequencing goals, and revising goals.” The research showed that self-care is imperative with the increased stress and workload related to the COVID-19 pandemic. Incorporating telemedicine into medical practices allows a beneficial change in the interaction between provider and patient to alleviate provider stress and monotony.

PA Program Adaption to Pandemic

Students in PA programs faced disruption of their education as the pandemic continued. They were concerned about how they would learn how to conduct a physical examination if not allowed to touch patients or even attend class. The PA program at Rutgers University incorporated e-learning and virtual peer reviews to continue teaching the physical examination classes and other courses.⁴² The students received feedback from other students or faculty members as they practiced physical examination techniques on friends or family members. This method has been successful and is now part of the curriculum. Many PA schools are using similar methods to ensure that PA students continued to thrive in challenging times.

Conclusion

Although telemedicine benefits are evident, barriers to full implementation and continuation of telemedicine still exist. The technology, internet infrastructure, permanent parity in insurance coverage, and provider/patient acceptance are just a few of the barriers.

Legislation enacted during the pandemic must be made permanent. Doing so assures that patients will continue to benefit from the telemedicine services they have come to trust.

PAs can help ease the access to care crisis through telemedicine. For PAs to continue to answer this need, developing a portable PA license is a priority. When states modernize their laws and regulations surrounding PA’s license portability, they will reap the benefit of increased access to skilled healthcare providers.

Melinda Moore Gottschalk, MPAS, PA-C, DMSc, DFAAPA, is adjunct faculty at the University of Mary Hardin Baylor PA Program in Belton, Texas.

Ms Gottschalk has disclosed that she is a medical science liaison for Upsher-Smith Laboratories, LLC.

References

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This article originally appeared on Clinical Advisor

America’s Access to Care Crisis: Telemedicine Provides the Solution