During the pandemic, the U.S. lessened restrictions on providers practicing medicine via telehealth in a state in which they were not licensed. While this did cause controversy in the medical community, it also allowed patients who were not able to be seen in their home state to be referred virtually to another provider out of state to have their medical needs met. Since the Public Health Emergency (PHE) has ended, these restrictions are now back to where they were pre-COVID, meaning that providers must now be licensed in the state in which they practice medicine, even if they are doing so virtually. Currently, 30 states in the U.S. restrict inter-state telehealth referrals and practice.
Other forms of allowance were also reverted post-pandemic, such as using certain non-HIPAA-compliant telehealth platforms. This allowed patients easier access to services but did pose concerns in the medical community about technological safety and patient privacy. As a result, the use of these platforms reverted back to its pre-pandemic state after the PHE ended.
Ryan Kelly, executive director of the Mississippi Rural Health Association (MRHA), says that, while the loosened restrictions were necessary during the pandemic, the idea behind reverting those restrictions after the PHE is about state agencies retaining control and governance over who practices in the state. “This is especially true when it comes to enforcement of ethical practices and punishment over malpractice,” he adds.
In Mississippi, Governor Tate Reeves passed a proclamation in March 2020 that loosened several aspects of Mississippi’s interstate telehealth restrictions, including out-of-state physicians being able to treat patients in the state without a Mississippi license. This proclamation lasted until the end of the PHE, and despite the benefits it provided to some patients on the border of Mississippi, in-state practices faced several challenges.
Restructured restrictions would still provide benefits.
“The main benefit of loosened restrictions is that it allowed physicians near state borders to practice medicine via telehealth to patients without having to have a license in the state the patient resides,” Ryan says. Take patients living in bordering towns, like West Memphis or Texarkana, for example. If a patient in Texarkana, Arkansas, preferred to see a provider in Texarkana, Texas, during the PHE, the Texas provider was allowed to see the patient, even though the patient did not have a practicing license in Arkansas, where the patient resides.
Now that this legislation has reverted back to its pre-pandemic state, the Texas provider would have to be licensed in Arkansas to see a patient who is literally minutes away on the Arkansas side of the city. And that’s just one example.
Ryan provided another, more impactful, example for his state of Mississippi: “Today, if a patient lives in Livingston, Alabama, for example, and they live closer to a provider in Meridian, Mississippi (45 minutes away) than a provider in Tuscaloosa, Alabama (58 minutes away), the next closest Alabama city, they could schedule a telehealth appointment with the provider in the closer city of Meridian, but only if the provider had a license to practice medicine in the patient’s home state of Alabama.”
Patients who required treatment that may otherwise be unavailable to them in their home state also benefitted from the restructured policies. “Services such as mental and behavioral health, oncology, psychology, and other specialized services could be offered to patients across state lines, even if those specialty providers were not licensed in the patient’s home state,” Ryan adds.
For the most critical care, several major medical centers in Mississippi (and other states) provide telemedicine services so patients living farther away can still consult a provider. “Although capacity continues to be a factor at times, and the number of providers who can deliver such services via telehealth is limited for certain specialties.”
Ryan says, “There are very few limitations for citizens in Mississippi to have access to these services in-state.”
The loosened restrictions benefitted patients in these niche situations, as many states felt the impact of increased patient volumes. “Our practices in Mississippi felt a great administrative burden lift during the pandemic, and many physicians in Mississippi and those in communities near state borders grew patients as a result,” Ryan says.
Loosened interstate compacts would be an ideal solution.
For patients who wish for second opinions on a diagnosis or who have a preference for an out-of-state provider and/or facility and cannot travel to that provider out of state, a limitation on licensure would indeed be a factor.
“To this extent, if the medical interstate compact were loosened to allow any physician with a license in a state within the compact to be recognized in Mississippi, this would be the ideal solution,” Ryan explains. “Resolutions like this currently exist with the nursing compact, but the physician compact only gives preferential treatment to physicians seeking a Mississippi license if they are in a compact state. It does not give a defacto license to those physicians.”
This change would significantly help those seeking outside counsel for medical needs, especially in states surrounding Mississippi, where patients have the greatest need. Such a change would also allow Mississippi physicians to practice in other compact states without the same inherent limitation. “While this change is not an official position of the MRHA, I can still extrapolate the positives of such a change,” Ryan says.
As healthcare professionals continue to weigh the impacts of the pandemic, it is important to analyze and consider changes that would benefit patients and providers together. There were benefits and setbacks to loosened restrictions during the pandemic, and a restructured policy that lies somewhere in the middle would be the most beneficial to both parties.
“We certainly support patient safety and wish for full compliance with ethical standards,” Ryan says. “But we also recognize the limitation that these reverted legislations place on patient and provider relationships, especially in the instance that they are hindered by such a policy.”