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Telehealth for an Aging Population: How Can Law Influence Adoption Among Providers, Payors, and Patients?

Published online by Cambridge University Press:  01 January 2021

Tara Sklar  and
Christopher T. Robertson
Tara Sklar
Affiliation:
Health Law & Policy Program, James E. Rogers College of Law, University of Arizona
Christopher T. Robertson
Affiliation:
James E. Rogers College of Law, University of Arizona
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Abstract

Telehealth continues to experience substantial investment, innovation, and unprecedented growth. However, telehealth has been slow to transform healthcare. Recent developments in telehealth technologies suggest great potential for chronic care management, mental health services, and care delivery in the home—all of which should be particularly impactful for an aging population with physical and cognitive limitations. While this alignment of technological capacity and market demand is promising, legal barriers remain for telehealth operators to scale up across large geographic areas. To better understand how federal and state law can be reformed to enable greater telehealth utilization, we review and extract lessons from (1) establishment of a healthcare relationship, (2) state licensure laws, and (3) reimbursement. We analyze these areas because of the legal ambiguities or inconsistencies they raise depending on the state, which seem to be hampering telehealth growth without necessarily improving quality of care. We propose several solutions for a more unified approach to telehealth regulation that incorporate core bioethics principles of doctor-patient relationship, competence, patient autonomy, as well as population-wide questions of resource allocation and access. Lawmakers should clarify that healthcare relationships may be established outside of in-person meetings, align licensure laws via an interstate compact or federal preemption, and expand Centers for Medicare and Medicaid plans to reimburse telehealth delivery in the home.

Type
Articles
Information
American Journal of Law & Medicine , Volume 46 , Issue 2-3: Emerging Issues in Bioethics , May 2020 , pp. 311 - 324
Copyright
Copyright © 2020 American Society of Law, Medicine & Ethics Boston University School of Law

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39 Id.

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54 See 42 C.F.R. § 410.78 (2011) (defining when Medicare Part B will reimburse telehealth services).

55 See, e.g., Telehealth Modernization Act of 2015, H.R. 691, 114th Cong. (2015) (promoting the provision of telehealth by establishing federal standards for telehealth).

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57 Id.

58 See id.

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60 Id. at 2064-65.

61 Id. at 2065.

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63 See, e.g., Telehealth Services in San Diego, Scripps (Feb. 24, 2020), https://www.scripps.org/news_items/6893-telehealth-services-in-san-diego [https://perma.cc/7LBL-KVDV] (offering online health questionnaires that providers subsequently review and prescribe a written care plan tailored to the patient within 30 minutes).

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65 See Miller, supra note 47, at 17.

66 See Am. Med. Ass'n, Coverage of and Payment for Telemedicine 1 (2015).

67 Id. at 1-2.

68 Am. Med. Ass'n, 50-state Survey: Establishment of a Patient-Physician Relationship via Telemedicine 1-2 (2018) [hereinafter 50-state Survey: Patient-Physician Relationship via Telemed]

69 Ark. Code Ann. § 17-80-403 (2019).

70 Utah Code Ann. § 58-32-101 (LexisNexis 2019); Utah Admin. Code r. 156-83-306 (2019).

71 Utah Code Ann. §§ 26-60-101, 26-60-102, 26-60-103 (LexisNexis 2019); Utah Admin. Code r. 156-1-602(6) (2019).

72 Tenn. Comp. R. & Regs. 0880-02-.16 (2017).

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91 See id.

92 State Telehealth Laws & Reimbursement Policies, supra note 89 (noting that nine states – Alabama, Louisiana, Maine, Minnesota, New Mexico, Ohio, Oregon, Tennessee, and Texas – allow an out-of-state provider to render services via telemedicine in a state where they are not located).

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95 Id.

96 Id.

97 Id.

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105 N.C. State Bd. of Dental Exam'rs v. FTC, 574 U.S. 494, 506-07 (2015) (no antitrust immunity for state professional boards unless directed by the state).

106 42 U.S.C. § 300e-10 (2018).

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108 42 U.S.C. § 300e-10.

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112 State Telehealth Laws & Reimbursement Policies, supra note 89, at 217, 390-91.

113 Wash. Rev. Code § 48.43.735(3)(g) (2020).

114 Telehealth Private Payer Laws, supra note 50, at 14.

115 Jacobson et al., supra note 40.

116 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, S. 2741, 116th Cong. (introduced in Senate, Oct. 30. 2019).

117 Id.

118 See Julia Paradise et al., Medicaid at 50, Kaiser Family Found. (May 6, 2015), https://www.kff.org/report-section/medicaid-at-50-the-elderly/ [https://perma.cc/J8VU-EC3W].

119 Sklar, Tara & Zuraw, Rachel, Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention, 28 Annals Health L. & Sci. 195, 195 (2019)Google Scholar.

120 See Nat'l Conference of State Legislatures, supra note 101, at 13. See generally State Telehealth Laws & Reimbursement Policies, supra note 89, (surveying the telemedicine landscape across all 50 states among several metrics).

121 See id.

122 Nat'l Conference of State Legislators, supra note 101, at 12.

123 Health Homes, Medicaid.gov, https://www.medicaid.gov/medicaid/long-term-services-supports/health-homes/index.html [https://perma.cc/SL85-Y562] (last visited Mar. 20, 2020).

124 See discussion supra Part II.

125 Nat'l Conference of State Legislators, supra note 101, at 12.

126 See Inst. of Med., Comm. on Evaluating Clinical Applications of Telemedicine, Telemedicine: A Guide to Assessing Telecommunications for Health Care 229 (1996).

127 See 50-state Survey: Patient-Physician Relationship via Telemed, supra note 68.

128 See id.

129 See Nat'l Council on Aging, supra note 27.

130 Zimmerschied, supra note 99.

131 See CMS Finalizes Polices to Bring Telehealth to Medicare Advantage, supra note 38.