A national crisis requires a national response
Many of the shortcomings that our nation’s health infrastructure faces during the coronavirus pandemic require enormous effort and expenditures to remedy.
But there’s a straightforward — and free — fix for one of them.
Since last spring, physicians and other health care professionals have taken many steps to keep themselves and their patients safe, including conducting visits via video conferencing when possible.
In less than eight months, telehealth has boomed across the United States, increasing clinicians’ capacity to deliver timely care to patients. In fact, during the COVID-19 pandemic, Ascension has completed more than 1.5 million virtual visits which spanned across multiple specialties and visit types. Johns Hopkins Medicine has seen similar transformation, with a 1000-fold increase in telehealth volume since March. It should be noted that each of us works at these organizations.
But one thing is still missing: the ability for clinicians to practice medicine across state lines during a public health emergency, which can help to improve patients’ access to the care they need when it matters most.
During the COVID-19 pandemic, Johns Hopkins physicians have provided telemedicine visits to more than 54,000 patients who live in states other than Maryland. In many parts of the United States, it’s common for a person to cross state lines for a health care appointment. A patient in New Hampshire might get cancer care in Boston and primary care in their home state. A mom in Delaware or New Jersey might take her kids to a pediatrician in Philadelphia. A senior in Kentucky might drive to Cincinnati for doctor appointments.
During the pandemic, it’s vitally important for those people to stay engaged with their care team, even when they cannot physically visit with them.
But a patchwork of state licensing laws, in too many cases, still prohibits timely, convenient and coordinated virtual or remote care. While some governors have waived legal restrictions that prohibit the cross-state practice of telemedicine for the duration of the pandemic, a number of states still have providers who are unable to offer telemedicine services to their patients who live in other states.
In some instances, clinicians must pay fees, provide fingerprints, apply for temporary medical licenses or permits or document an association with an in-state provider. These inconsistent and varied state responses have caused confusion and unnecessary delays in the provision of care for patients.
There are many good reasons for these state licensing laws during normal times. But during the COVID-19 emergency, it makes sense to allow Americans to see their primary care and specialty physicians via telemedicine, no matter what state they live in.
We need federal action that will permit access to care that existing state licensing laws preclude.
The bipartisan Temporary Reciprocity to Ensure Access to Treatment or TREAT Act (S. 4421, H.R. 8283) would provide temporary license reciprocity for health care professionals in all states for all types of services during nationwide public health emergencies.
If the TREAT Act is enacted, all health care providers licensed in good standing in any state would be able to practice in every state for the duration — and only for the duration — of a public health emergency.
There is recent precedent for such legislation.
In 2018, Congress allowed clinicians working within the U.S. Veterans Affairs (VA) health system to practice both in-person and telehealth across state lines, as long as they were licensed in good standing in their home states. Why not allow the simple solution passed by Congress to improve veteran care be our guide during a public health emergency?
Congress should include the TREAT Act in its end-of-year legislation. This no-cost measure is a common-sense solution carefully tailored to meet a national health emergency of this magnitude. Lives — and the health of our nation — depend upon it.
Dr. Brian Hasselfeld is medical director for Digital Health and Telemedicine at Johns Hopkins Medicine in Baltimore. Dr. Baligh Yehia is senior vice president of Ascension and president of the Ascension Medical Group in St. Louis, MO.
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