COVID-19 turned the world on its head. As the world came to a screeching halt, healthcare providers and essential businesses were tasked with maintaining function while protecting patients, employees, and customers amidst a rapidly changing health and technological landscape. Telemedicine quickly emerged as a tool to connect patients and healthcare providers without the risks of in-person interaction. Telemedicine is the use of telecommunications to deliver medical care to patients from a distance. It presented several advantages during the height of the COVID-19 pandemic: minimized providers’ exposure to potential COVID-19 carriers, reduced use of personal protective equipment (PPE), and increased availability of healthcare services without the need to enter a busy office or hospital.
Those immediate advantages of technologically delivered care led to a rapid increase in the number of health centers embracing telemedicine. Only 43% of health centers in 2019 reported the ability to use telemedicine, while over 95% of health centers reported using telemedicine during the COVID-19 pandemic. This increase was made possible in part by the Centers for Medicare and Medicaid Services (CMS) eliminating geographic restrictions on telemedicine coverage in March 2020. This alteration, however, did not align with the current measures that were in place to protect patient confidentiality. The CMS had to create an exception to the Health Insurance Portability and Accountability Act (HIPAA) to allow healthcare providers to “serve patients in good faith through everyday communications technologies such as FaceTime or Skype.” Both of these accommodations included a caveat that they are only in place for the duration of the COVID-19 nationwide Public Health Emergency. The U.S. Department of Health and Human Services has extended the Public Health Emergency status for COVID-19 through October 18, 2021, so these exceptions are currently in place and are expected to continue through the remainder of the 2021 calendar year. Unfortunately, these exceptions have created additional licensure-related issues in turn.
For example, state laws look at the patient’s residential address to determine a provider’s eligibility to practice telemedicine for that patient—thus, the provider must typically be licensed in the state in which the patient resides. This kind of law does not present a problem when patients receive medical care in person because patients must travel to the provider’s office, where he or she is licensed to practice. Shortly after the announcement of COVID-19-related travel bans, providers saw 50 to 175 times more patients via telehealth. States recognized this demand and many responded by means of executive orders, which created more immediate change than is possible through legislation. As of June 2021, 26 states in the U.S. still have waivers in place that allow for increased practice of telemedicine over state lines. However, only five of these states have laws in place that allow for permanent, or at least long-term, interstate telemedicine. At the federal level, the Equal Access to Care Act was proposed to authorize “a health care provider who is physically located and duly licensed in one state to provide telehealth services to individuals in one or more additional states in which the provider is not licensed during the COVID-19 … emergency period.” However, the Act has only been introduced and subsequently referred to the House subcommittee on health.
Despite the decline of the number of COVID-19 cases seen early in the summer of 2021, the emergence of the Delta variant through July and early August reinforces the value of adapting telemedicine regulations. States—more than just five—need to acknowledge the value of continuing to allow interstate telemedicine practices. Many of the advantages of telemedicine still hold true in a post-pandemic setting:
Environmentally, our society faces continual issues with the constant production of waste and pollution. Converting non-procedural office visits to telemedicine visits prevents PPE use, saves patients from using fuel travel to the provider’s office, and minimizes office-related waste like the printer paper used for each visit.
Telemedicine presents advantages to every patient. Patients are not required to leave home and can conduct their appointment in any location with internet access. Patients are also easily able to connect with providers located far from their homes.
Technologically, embracing the demand for telemedicine will foster additional development in the delivery of medical care via telecommunications and may more rapidly usher in a new era of medical technology.
While most people are indeed glad to return to “normal” and toss away their face coverings, they should do so with caution. To write off as temporary the developments in telemedicine that occurred in response to COVID-19 would be to throw away what may be one small silver lining of the pandemic.
Joey Johnson is a second-year law student at Wake Forest University School of Law. He earned a Bachelor of Science in Psychology from Wittenberg University in Springfield, Ohio, and worked as a clinical research coordinator at the Cleveland Clinic Foundation for two years before law school. Following law school, he plans to practice patent law.