Will Florida be a Bellwether for Telemedicine Policy?

March 18, 2014
My eyes are on the Sunshine State to see how a recent spat over telemedicine legislation shapes out. Will the doors be opened for out-of-state doctors to practice medicine digitally or will telehealth stay in-house?

Every four years, political pundits, who no doubt got their degrees in advanced mathematics, talk about the importance the state of Florida plays in the presidential election.  With its 29 electoral votes and decidedly swing-state status, indeed, Florida always seems to have a vital role in deciding who will be the President.

Florida is typically what we call a “bellwether state.” Where it goes, the nation goes. Since 1928, it has only missed the presidential victor twice. We all remember the influence it had over the infamous 2000 election.

It’s not just for the biggest political race of them all either. Florida has been cited as the influencer for midterm elections as well, most recently by The New York Times. To be fair, that’s also because Florida has a special election that took place earlier than most mid-term races. Yet even still, to some, the recent congressional race in Florida was cited as a bellwether for the future of the Affordable Care Act.

I bring this up because I am watching the Sunshine State with deep intrigue. Not over the future of the Affordable Care Act, but over the future of telehealth and how it will be used to practice medicine.

Allow me to explain. Two bills are making their way through the Florida House of Representatives and the Senate, both of which would promote telehealth and provide practice standards for telehealth providers. The Senate bill would provide health insurer and health plan reimbursement requirements for telemedicine. Both versions have already passed Committee votes but are still in the proposal stage.

These kinds of standards and regulatory matters are essentially what have held back telemedicine. In some cases there is a lack of broadband and technological barriers, but reimbursement and standards are truly the primary restrictions that have prevented telemedicine from achieving widespread adoption.

In fact, a trio of former U.S. Senators, including former Majority Leaders Tom Daschle and Trent Lott, recently started a high-profile alliance that will attempt to promote policy around telehealth and remote patient monitoring.

The Florida Medical Association (FMA) supports telemedicine. In fact, the idea of telemedicine isn’t really controversial and it’s pretty much accepted in a general sense.

What the advocacy group does oppose however, vehemently, is the House bill as written. That’s because the Florida bill allows out- of-state practitioners who are not licensed in Florida to practice telemedicine and prescribe drugs and controlled substances digitally.  They can do this as long as they register with the State of Florida. The Senate bill, which is more focused on reimbursement, similarly allows out-of-staters to get reimbursement from telemedicine, so long as they register. The restrictions are a little more stringent than the House bill though.

Essentially, the FMA promotes the same brand of telehealth that many others do—as a complementary service. They say that it should be used for patients and physicians with established relationships and clinicians should be required to get a Florida license. Only then, does FMA advocate, for pay parity between face-to-face and telemedicine consultants. The association even polled 606 likely Florida voters and reported that 70 percent of respondents agree with them and would be opposed out-of-state doctors practicing medicine over the internet.

Some may argue though, the problem with that is if there is a physician shortage in Florida, as has been noted, these restrictions wouldn’t exactly allow telehealth to easily address the problem. If the problem is there is a physician shortage in Florida, and you are making it so only physicians in Florida can practice telehealth, then this isn’t really a solution.

If we can agree that telehealth is inevitable in some format, this is where the battle over its usage will be fought. Thirty-four states have some form of proposed telemedicine legislation on their dockets as of today, according to the American Telehealth Association. Some proposals are minor and focus on telemedicine for a particular area of healthcare (such as optometry).

Others, like the Florida legislation, could shape how telehealth evolves in healthcare. Will it be used as a possible replacement to the face-to-face consultation or just as a complementary service? What role will reimbursement play in this?

Time will tell. After all, Florida is a bellwether.

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