Ranking states in telehealth: Which are the best?

Telehealth has expanded dramatically over the last two years due to the COVID-19 pandemic, and healthcare groups are urging Congress to ensure continued access to telehealth when the pandemic is over.

However, many states have their own barriers to telehealth access, according to a new report.

The report from the Reason Foundation, the Cicero Institute and the Pioneer Institute ranked every state for telehealth access. Many states fall short, the report said. Some obstacles include provisions barring patients from connecting with doctors in other states or recording voice messages with care instructions.

Only three states - Arizona, Florida and Indiana - allow healthcare providers to utilize telehealth across state lines, the report found.

Vittorio Nastasi, policy analyst at Reason Foundation and co-author of the report, said some states reduced telehealth access when COVID-19 public emergencies or executive orders expired.

“States need to adopt a number of telehealth reforms to provide their residents better access to this safe and effective virtual care,” Nastasi said.

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The report also cited New York and California as two of the states with the most restrictions on access to telehealth. Both states, along with others, haven’t joined licensing compacts that allow providers to offer services in other states.

California and New York, along with many other states, have coverage parity mandates requiring insurance coverage of all telehealth services. The report notes that research could show telehealth isn’t the best option for some services, so state laws shouldn’t require insurers to cover those services. The report called for state laws to include the flexibility for insurers to cover telehealth services that can be provided at the same standard of care.

There has been some progress in expanding access to telehealth.

Most states no longer require patients to first see a healthcare provider in person before getting access to telehealth. However, Tennessee breaks from the pack by requiring an in-person visit before telehealth access. Alaska and West Virginia also require an in-person visit before some services.

The report examined a host of other categories, including whether all providers can use telehealth. Some states limit telehealth use to doctors, the report noted. Less than half the states allow nurse practitioners to offer telehealth services without some kind of supervision.

The authors also evaluated states in whether they had payment mandates for insurers to pay the same rate for telehealth services as an in-person visit. Most states have mandates requiring services to pay the same rate for at least some telehealth services as in-person appointments.

The report recommends best practices for state governments to expand access to telehealth services.

States should allow “modality neutral” telehealth services without spelling out a requirement for video, the authors stated. The report found most states have such policies, but some state laws don’t specifically permit remote patient monitoring or the transmission of medical information electronically.

States should also allow simple registration for healthcare providers from other states to offer telehealth services as long as they are fully licensed or registered, the report said.

Telehealth use skyrocketed during the pandemic. The federal government reported a 63-fold increase in telehealth visits among Medicare participants in 2020. The Business Group on Health projected telehealth will remain one of the top healthcare trends in 2022, but the group said virtual health must be integrated with in-person care.

Patients continue to value telemedicine, but a recent survey found consumers had less satisfaction with virtual visits in 2021 than the previous year. Some patients preferred telemedicine for issues like the flu, but others preferred in-person visits for physical therapy or mental health.

Josh Archambault, a senior fellow with Cicero Institute and Pioneer Institute and a co-author of the report, said telehealth is a valuable option for providers and patients.

“While they cannot and should not replace all in-person medical appointments, virtual visits can save patients time and help them avoid germ-filled waiting rooms. Providers can also take some pressure off overburdened systems as they can see patients from an office or home,” he wrote.