Congress Should Not Phone It In On Telehealth

The House Energy and Commerce Committee recently advanced the 21st Century Cures Act, a bipartisan effort to bring together the best ideas on how to improve the discovery, development, and delivery of cures in the U.S. health care system. While the bill has many encouraging ideas and Chairman Fred Upton (R-MI) and Rep. Diana DeGette (D-CO) should be congratulated for their leadership on the bill, there is one area where the proposal could go further to support medical innovation: telehealth.

Telehealth allows patients to quickly connect with their doctors from anywhere with an Internet connection, such as their home or office, with a live video online consultation that is on par with what they can receive in person. Telehealth offers enormous convenience to workers who can save the time it would take to drive to their doctor’s office, wait for an appointment, and then drive home. And in some cities where the average wait time to see a doctor can be measured in days, not hours, telehealth allows patients to find available doctors in other parts of the nation so they can have their health needs met sooner. Telehealth is especially useful for patients managing chronic diseases because they can use a combination of remote monitoring and online checkups to receive care more efficiently.

The quality of telehealth services has grown tremendously from its early days. Patients can now expect high-quality video calls with doctors who have their electronic health records at their fingertips. In addition, some telehealth providers are offering kiosks that allow patients access to remote diagnostic tools such as a stethoscope, thermometer, and blood pressure monitor. A larger employer, for example, may find that offering a telehealth kiosk helps keep its employees healthy and reduces sick leave.

The largest barrier to telehealth is not technology, but policy. First, state licensing rules vary by jurisdiction which means doctors often must obtain a separate license for each state in which they practice. This is cumbersome and costly, especially given the fact that there is little substantive difference between physicians licensed in one state versus those licensed in another. An interstate medical license compact would make it simpler for physicians to practice in multiple states, but so far only 8 states have moved forward with the necessary legislation. Second, Medicare will only pay for telehealth services when the patient is located at an “eligible originating site”—such as a rural hospital—which effectively cuts off telehealth services for the vast majority of Medicare patients.

The current text of the 21st Century Cures Act does not go far enough to integrate telehealth into our healthcare system. It only includes provisions requesting cooperation between state medical boards to coordinate telehealth practitioner licensing and requiring the Centers for Medicare and Medicaid Services (CMS) to conduct studies examining how telehealth could be incorporated in the future. This all sounds good in principle, but state medical boards have had plenty of time to coordinate by now, and they have not delivered results. Asking CMS to deliver studies rather than taking real action will only delay the broader deployment of telehealth.

Effectively, the current legislation is a plan for a plan. But the benefits of telehealth are proven, and Congress should act now to sidestep the slow progress that is being made by the states. First, the 21st Century Cures Act could incorporate language from the Telehealth Modernization Act of 2015, introduced by Reps. Doris Matsui (D-CA) and Bill Johnson (R-OH), to create a federal standard for telehealth that all states should abide by. Second, it should include language creating a single, national license for telehealth providers to fast-track the benefits of telehealth to all Americans. Third, it should eliminate the “originating site” restrictions in Medicare and allow Medicare patients to receive eligible telehealth services from any location, including their homes.

Technology will play an important role in revitalizing the U.S. health care system to make high-quality care more effective and affordable for patients. Telehealth offers the potential to improve health care by cutting costs, while increasing quality and convenience, yet this innovative technology has been largely overlooked in Congress’s new health care modernization legislation. As policymakers look for the best ideas to include on how to modernize the U.S. health care system, telehealth should be at the top of the list.


Daniel Castro is the Vice President for the Information Technology and Innovation Foundation (ITIF), and Alan McQuinn is a Research Assistant at ITIF.


Morning Consult