Category: The Future of Telehealth Regulation

Pursuing an Interstate Medical Telemedicine Registration Compact

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by Tara Sklar

Because I believe strongly in the benefits of telehealth, I have obtained licenses in six states through the Interstate Medical Licensure Compact. Doing this took months, cost thousands of dollars, and still leaves me unable to care virtually for patients in 43 states. The process is so cumbersome that less than 1% of physicians use it.

This quote is from a January 2024 op-ed by Dr. Shannon MacDonald, a radiation oncologist at Mass General Brigham who uses telehealth to provide specialty care across state lines. Her frustration is felt by many providers and patients who view the patchwork of state-specific licensing requirements as a major obstacle hindering telehealth’s widespread integration into the health care ecosystem.

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The Life-Changing Benefits of Lifting State Licensure Restrictions for Telemedicine

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by Shannon M. MacDonald

“M” was diagnosed with a rare skull-based cancer.  A one-in-a-million diagnosis, he was given little information about his diagnosis and told he must seek care outside his home state.  “M” worked full time, was the primary caretaker for two young kids, and could not fathom how he could travel to another state for treatment. He did not come to his scheduled out-of-state appointment. It was just too difficult. “M” was fortunate to have an older daughter who became involved in his healthcare, but she worked full time, had three young kids, and lived in a state far from her dad.  Flying to join her father to help coordinate health care in person would have meant time away from work, obtaining childcare, and the expense of a flight and hotel.

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Advancing Access to Health Care Through Federal Medical Licensure Reciprocity for Clinical Trials

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By Helen Hughes and Mark Sulkowski

As physicians who have dedicated our careers to clinical research and to the advancement of telemedicine respectively, we’ve witnessed first-hand the transformative power of technology in health care. However, despite our progress over the last four years, there remains a glaring barrier to the potential of telehealth in the United States: the complex, state-based system of health care licensure. This system significantly restricts patient access to specialized care, especially for those who could benefit from participating in clinical trials. It’s time for Congress to enact legislation allowing for federal reciprocity of medical licensure, a move that could revolutionize clinical research in this country.

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Advancing Healthcare Equity: Federal Licensure Reciprocity for Physicians Caring for Transplant Patients and Donors

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By Rebecca Canino, Anne R. Links, and Fawaz Al Ammary

In the face of a growing organ donation crisis in the United States, characterized by a decline in donors and a surge in transplant waitlists, it has become increasingly clear that existing regulatory barriers impede access to critical transplant services. One solution lies in dismantling the artificial barrier of state-based medical licensure, a move that holds the potential to significantly enhance access for both donors and recipients of organ transplants. During the COVID-19 Public Health Emergency (PHE), the United States Department of Health & Human Services demonstrated flexibility by superseding state licensure mandates, thereby allowing providers with valid medical licensure in one state to care for patients in all states. This resulted in tangible improvements in outcomes for donors and recipients alike and prompted a notable surge in telemedicine usage, which not only streamlined evaluations but also mitigated the financial burdens (approximately $5000 per donor) and the logistical complexities associated with in-person consultations, particularly for out-of-state living donors.

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Equity Implications of Telehealth Policy on Medication Abortion Care Service Delivery

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by Dana Northcraft and Natalie Birnbaum

Since Roe v. Wade was overturned in June 2022, fourteen states and two territories have banned the provision of abortion care altogether.[i] Still, abortion rates in the United States are on the rise. This is in part due to the expansion of care delivery through telehealth for medication abortion (TMAB), which now accounts for 19% of abortion care delivery.

Although TMAB improves accessibility to patient populations nationwide, access is not spread evenly. TMAB is prohibited in ten states and one territory in addition to the  states/territories with abortion bans.[ii] While some bans are explicit, others result from aggregate regulatory roadblocks that make care impracticable. These barriers to care most commonly impact Medicaid populations, populations living in rural or low-income urban areas, non-English speaking, and BlPOC communities. Research suggests that telehealth utilization more broadly has been lower amongst people in racial and ethnic minority groups than in groups of non-Hispanic White people.

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Stuck in the Middle with You: Licensing Reforms for Cross-State Telehealth

Carmel Shachar Leave a comment

This post launches a Digital Symposium on The Future of Telehealth Regulation, edited by Carmel Shachar, Assistant Clinical Professor of Law and Faculty Director of the Health Law and Policy Clinic at the Center for Health Law and Policy Innovation. The symposium continues the conversation from a working group held in June 2023 titled “Achieving Telehealth’s Potential”, out of which a Consensus Statement for two feasible policy paths forward emerged. The working group was funded by a grant from the Commonwealth Fund. The symposium will run in Bill of Health until September 9, 2024.

by Carmel Shachar

Part of what makes telehealth an exciting new modality for delivering care is that it is geographically unconstrained. This proved to be an important feature during the pandemic, when connecting patients to physicians across the country during a time of health care shortages was challenging. Telehealth’s divorce from geography remains important, especially for patients who struggle to find appropriate providers within their local communities. Cancer patients may need to find an oncologist who specializes in their particular cancer.  College students going back and forth from home to campus may struggle to keep a consistent therapist as they shuttle between two states. Patients with rare diseases may find that they need to access specialists at academic medical centers.

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