Telehealth reform will expand health care access after COVID-19

The COVID-19 pandemic has disrupted many aspects of daily life but has also accelerated emerging trends and innovations — particularly in the health care sector. For example, social distancing measures and stay-at-home orders led to a rapid increase in the use of telehealth in 2020. 

As Johns Hopkins Medicine points out, telehealth can have many benefits, including: 

• Allowing sick or injured people to stay home and avoid the discomfort of traveling while sick, reducing the number of healthy people they might expose to contagion while traveling to an appointment (this was crucial during the pandemic);
• Making it easier to more frequently monitor the condition for those with chronic conditions; and 
• Allowing family members to more easily join the conversation with the doctor and provide useful additional information. 

Of course, many illnesses or injuries require an in-person visit, but every visit that can effectively be done via telehealth frees up time, space and other resources for those needing in-person visits.

A recent analysis of insurance claims data from a national sample of 16.7 million individuals with commercial and Medicare Advantage insurance illustrates the importance of telehealth during the pandemic. Between May 20 and June 16 last year, total weekly doctor visits declined by 24%. Telehealth helped fill that gap, indeed in Florida during that period telehealth visits accounted for 17.4% of total doctor visits.

Early on in the pandemic, workers at Sarasota Memorial Hospital relied on telehealth technologies to limit exposure by avoiding unnecessary face-to-face interactions. As the hospital’s chief medical officer explained back in March, “If the health care provider doesn’t need to go into the room, and they can evaluate the person through telehealth, we’d prefer that, so we don’t expose extra people and still provide that care.” 

Although the arrival of a vaccine promises to bring an end to the pandemic, increased use of telehealth is likely here to stay. A recent Gallup survey reveals that 34% of Americans have used telehealth and 47% say they are likely to use it in the future. 

Florida has made great strides toward unleashing the potential of telehealth over recent years. Legislative reforms in 2019 created a unified definition of telehealth, authorized a wide range of health care professionals to provide telehealth services and created a registration process that allows out-of-state providers to practice telehealth in Florida. These changes have made Florida a national leader in telehealth policy. But there is still room for improvement, as discussed in a forthcoming report on Florida telehealth by Vittorio Nastasi that will be published by the James Madison Institute.

Building on those past reform successes and seeking those further improvements, Florida lawmakers are looking to make the use of telehealth easier and more effective.  

Given that demand for health care in Florida is growing much faster than supply (see our January 13 Observer column), expanding access to health care for Floridians is crucial. House Bill 6079 and Senate Bill 864 would allow out-of-state health care professionals to provide telehealth services to patients in Florida without registering if they are working in consultation with another health care professional who is licensed in Florida. Many Floridians have out-of-state doctors or specialists from whom they get treatment, and many others need access to a doctor or specialist but face long waits. Allowing sensible access to out-of-state doctors via telehealth would just permit what already happens informally or by people waiting until they travel back up north to get medical help. 

Far too many trips to the doctor in Florida are required just to renew prescriptions, with many older residents on very long-term prescriptions. Health care providers in Florida are currently prohibited from prescribing controlled substances via telehealth. Senate Bill 660 would completely eliminate this prohibition. Senate Bill 700 and House Bill 247 would limit this prohibition to only certain Schedule II controlled substances. Senate Bill 700 also defines a new type of pharmacy establishment, “remote-site pharmacies,” that would be staffed by pharmacy technicians under the remote supervision of pharmacists. This would help expand access to pharmacy services in rural areas.  

Doctors and patients can interact remotely in many ways, and it should be up to them to figure what works best for each interaction. Telehealth can be delivered through several technologies, typically phone calls, video calls and remote patient monitoring. Florida’s definition of telehealth currently excludes audio-only phone calls, emails and faxes. Moreover, Florida’s fee for service Medicaid program only reimburses video calls. Senate Bills 864 and 831 would expand the definition of telehealth to include audio-only phone calls. Senate Bill 700 would expand Florida’s definition of telehealth to include audio-only phone calls, email and faxes, as well as allow for emerging technologies. 

A final key issue in telehealth is how much doctors get paid for a telehealth visit vs an in-person visit. Telehealth has the potential to reduce costs by increasing the efficiency of health care delivery. Consequently, insurance providers often reimburse telehealth and in-person services at different rates. Florida legislators have considered requiring payment parity between these services, which ignores differences in their true costs of delivery and would undermine some of the cost-savings potential of telehealth. 

Telehealth has proven to be an invaluable tool for enabling Floridians to receive much-needed care throughout the pandemic. Florida should continue to be a leader in legal and practice changes that let us use telehealth to its full potential for expanding access to affordable, quality health care.

Vittorio Nastasi is a policy analyst at Reason Foundation and lives in Tallahassee, and Adrian Moore is vice president of Reason Foundation and lives in Sarasota.