A new report rates every state’s telehealth policy for patient access and ease of providing virtual care

Which States Have the Best Telehealth Practices?

A new report rates every state’s telehealth policy for patient access and ease of providing virtual care.

By Pete Mercer

Despite the challenges that COVID-19 has created for the entire world in the past two years, it has also presented

a unique opportunity for people that still needed access to healthcare. Millions of people in the U.S. tried telehealth for the first time because of the pandemic, made easier by changes federal officials made to the Medicare program as well as governors waving certain barriers to advance health access with flexible provider licensure for new uses of telehealth.

After public health emergencies started to end and executive orders were withdrawn, much of the flexibility that users enjoyed for months disappeared almost immediately. Even the new laws passed by certain states only made incremental changes without a sort “best practices” roadmap. Telehealth was a dynamic solution during an unprecedented time, which makes all of the new challenges with utilizing more frustrating and confusing than before. A new report from Reason Foundation, Cicero Institute and Pioneer Institute rates every state’s telehealth policy for patient access and ease of providing virtual care. With this in-depth report on the current state of the telehealth landscape throughout the country, this may provide some relief for healthcare providers and patients alike.

In a media release regarding the report, Josh Archambault, senior fellow with Cicero Institute and Pioneer Institute and co-author of the report, wrote, “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.”

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Best practices for telehealth

This report laid out certain best practices for what telehealth should and shouldn’t do, giving policymakers a better picture of a successful telehealth program. These best practices included the following:

ʯ Do support modality neutral options

Allowing different avenues of access for users is a critical component of a successful telehealth policy. Not only does it further help to establish trust in a patient-provider relationship, it gives the patient the agency to decide what works best for them.

ʯ Don’t arbitrarily limit provider tools

Part of the challenge of providing telehealth opportunities is the inherent limitations that come with providing a diagnosis and treatment over a virtual channel. Any further unnecessary limitations of provider tools only exacerbate the existing challenges of telehealth, while creating new ones altogether.

ʯ Do support access to care

The greatest opportunity with telehealth is increased access to those who are either unable to go to an in-person appointment or looking for a convenient and easy way to schedule a doctor’s appointment. Either way, it’s important for all kinds of providers to utilize telehealth to allow for more team-based care, while prohibiting facility fees from being charged for services that can be delivered from anywhere.

ʯ Don’t mandate coverage for everything

Passing insurance coverage parity mandates that require paying for all services, since research has shown mixed outcomes for certain services over telehealth, can lead to wasteful spending. A mandate also inhibits innovation in care delivery.

ʯ Do support provider access to telehealth

Patient accessibility is crucial to the success of a telehealth program, but it’s just as important to improve provider access. Including providers that possess a license or registration in good standing will help with the continuation of care, as well as increase access in rural communities.

ʯ Don’t mandate payment rates in law

A payment mandate will actively work against any improvement in accessibility. Enforcing a payment parity mandate that requires telehealth visits to cost as much as an in-person visit will hurt vulnerable patients and small businesses that are trying to provide a virtual care option.

Which states have better telehealth policies?

Overall, most of the United States does not require an inperson visit to a physician’s office and there aren’t many barriers to the preferred modality for access. Most states don’t allow providers to cross over states lines. Arizona, Florida, and Indiana are the only three states that allow all providers to easily practice telehealth across state lines. The other 47 states have arbitrary barriers that limit patient’s access to specialists and available appointments based purely on residency.

Arizona and Utah both have the least restrictive telehealth policies, as both don’t require an in-person visit, are modality neutral, and allow for providers to cross state lines, even if Utah is less lenient with the out-of-state policies.

As it stands with this report, Tennessee has the most restrictive telehealth policy. While most states have removed the requirement that a patient must see a provider in-person before using telehealth services, Tennessee is the only state that still requires an initial in-person visit.

Alaska and West Virginia require an in-person visit before certain services can be provided. The report says, “Alaska regulations limit a physician’s provision of services based ‘solely on a patient- supplied history received by telephone facsimile or electronic format.’” For the state of Virginia, the report says, “the statewide telehealth plan definition does mention remote patient monitoring and store-and-forward. However, there are separate definitions for teledentistry and store-and-forward technologies for dentists.”