Telemedicine Can’t Cross State Lines
Forty years ago when I first started in medicine, there were no CT scans or MRIs. In the next forty years, I foresee cancer as an illness of the past, and life expectancy will be over one hundred years old.
Scientific advancements will push medicine ahead, improving quality of life in increments, slowly taking two steps forward and one step back. The pandemic caused us to take one step back, but from this, we learned lessons that will move us two steps closer toward that future.
Telemedicine patient visits were a step forward, especially for those with minimal access to healthcare. With the pandemic, this technology moved to the forefront, assuring those susceptible to disease could avoid long lines and contagious clinics to receive medical information and advice safely at home.
State and federal laws were relaxed during the pandemic to allow telemedicine meetings. Some included nationwide discussions I attended, where exhausted doctors in New York advised those in California trying to save infected COVID-19 patients. This proved to be an asset to physicians and patients.
Now that the pandemic has been declared over, laws have returned to normal, with one, in particular, forcing us one step backward: In most states, doctors cannot meet with patients online through telemedicine visits unless they are licensed in the state where the patient resides.
This is not a problem for most people because they visit local physicians. But what if you have a specialist doctor who provides advanced medical care that might not be available locally? There are “Centers of Excellence in Healthcare” at Harvard, Sloan Kettering, MD Anderson, Stanford, UCLA, Cedars-Sinai Los Angeles, and others where clinical trials provide research data. We derive evidence-based information from these centers used to direct future medical care, moving us forward.
It is not uncommon for some of these patients to be weakened by their illness and unable to travel, while others might not afford travel expenses. Telemedicine visits are an asset.
Complicating this problem are smaller northeast states with adjacent borders, or larger cities lying on the edge of two states, forcing doctors to have costly licenses in all surrounding states to provide telemedicine visits.
Additionally, should you go on vacation or be out of state on a business trip, you can only legally consult with your physician via telemedicine if your doctor has a license in that state.
The laws threaten physicians with loss of license if their computers cross state lines to provide medical care.
Dr. Shannon MacDonald is a radiation oncologist at Harvard School of Medicine and provides care at Massachusetts General Hospital. She is courageously suing the state of New Jersey for the right to provide telemedicine care to her patients. Here is a link from her legal team referring to her recent OpEd in the Wall Street Journal:
https://pacificlegal.org/boston-doctor-blasts-telehealth-restriction/
(Because there are variations in the legal wording amongst states, please check here the wording for your state:
https://pacificlegal.org/30-states-telehealth-rules/)
Interestingly, laws have been carved-out allowing NFL team doctors to practice in states where they are not licensed, and the same goes for VA doctors who travel from state to state caring for our veterans.
Therefore, state legislators or the federal government must find a way to rectify this problem by enacting uniform laws allowing doctors to practice interstate telemedicine, which would benefit patients.
Let’s ensure that in forty years, cancer will be an illness of the past, and life expectancy will be over one hundred years old.
Gene Dorio, M.D.
Dr. Gene Dorio is a geriatric house call physician in Santa Clarita, California. He is past President of the Los Angeles County Commission for Older Adults and presently an Assembly Member of the California Senior Legislature.
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Good point.
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