Many woke up the first morning of October not knowing that a rare moment of bipartisanship saved their ability to see many of their doctors. House Bill 1861 was signed by Gov. Tom Wolf on Sept. 30, after breezing through the state legislature. The measure extended nearly 500 regulatory waivers and suspensions — emergency measures enacted early in the pandemic — on the day they were set to expire. These waivers enabled hospitals and doctors’ offices to provide care the way they have throughout much of the pandemic, especially telemedicine.
While extending these regulatory changes is welcome news, and we’re thankful Wolf and the General Assembly helped preserve these vital services, the fact that Pennsylvanians are reliant on emergency measures to sustain how they currently seek care underscores the pressing need for long-term changes to regulations. Telemedicine’s availability and accessibility to patients have historically been hampered by cumbersome rules. For instance, under Medicare’s pre-pandemic requirements, telemedicine visits in rural areas could only be paid for when patients left their homes and connected with providers from designated clinical office sites. That really isn’t the point of telemedicine. While requirements like these have changed, other rules remain in place.
Today, without emergency measures and the recent waiver extension, state licensing laws would restrict physicians in many places from telemedically seeing their patients who reside in neighboring states. That would mean a Philadelphia doctor couldn’t see a patient who lives a stone’s throw away in Pennsauken using a video call. In states without such waivers, patients are going through extreme measures to access their doctors, receiving telemedicine appointments in rest stops and parking lots right over the border, just so they are in compliance and reduce the time and cost burdens of traveling to their doctors’ offices
Compounding matters, there is a patchwork of mandates, waivers, and emergency licenses to ensure that telemedicine would be accessible and reimbursable, including House Bill 1861. Combined with the uncertainty of measures being temporary, the current regulatory environment keeps many providers an arm’s length away from using telemedicine, even when it might be clinically appropriate and more convenient for patients.
Telemedicine visits, in the way many think of them — a doctor having an appointment with a patient via phone or video call — are really just the tip of the iceberg. Patients now interact with their providers in a range of ways — via email, text, apps, message portals, remote monitoring systems, and implanted devices. A local example is a program at Penn Medicine that we deployed to use automated text messaging to monitor patients after a COVID-19 diagnosis. It’s been so successful that we are expanding — building a natural language processing chatbot to support patients with hypertension and designing remote access pathways for patients with substance use disorder.
These innovations have the potential to transform patient care from brief interactions to a more connected, continuous relationship that facilitates proactive interventions that also reduce the burden on patients — time and out-of-pocket costs — from having to have to see doctors in person.
It’s time to address the regulatory hurdles impeding telemedicine’s growth and innovation. Licensing laws should be permanently modernized, allowing waivers for providers to see patients in neighboring states.
We know the rise of telemedicine — and making the policy changes needed to foster it permanently — are only the first step of the virtual care sea change. And as the proverb goes, “A journey of a thousand miles begins with a single step.” That goes for the telemedicine revolution, too, we hope. However, without more permanent fixes, the journey may not continue.
Krisda Chaiyachati, MD, is the director of Penn Medicine OnDemand, a virtual acute care service. Eric Bressman, MD, is an internal medicine physician and a fellow in the National Clinician Scholars Program at the University of Pennsylvania.