States need permanent reforms to achieve the full benefits of telehealth services
Photo 199201957 © Piotr Adamowicz |


States need permanent reforms to achieve the full benefits of telehealth services

The rapid rise in telehealth adoption during the pandemic was enabled, in part, by emergency regulatory suspensions at the federal level and in nearly all 50 states.

Millions of Americans used telehealth for the first time during the COVID-19 pandemic and public polling consistently finds patients say they remain likely to use telehealth services in the future. A recent survey by Applause found that 63% of respondents who had used telehealth services now plan to increase their use even after the COVID-19 pandemic ends. The rapid rise in telehealth adoption during the pandemic was enabled, in part, by emergency regulatory suspensions at the federal level and in nearly all 50 states, but permanent regulatory reforms are necessary to unlock telehealth’s full potential going forward.

In March 2020, the U.S. Department of Health and Human Services announced that it would lend greater flexibility to healthcare providers, allowing the use of everyday communication platforms to provide telehealth services. Normally, providers must use Health Insurance Portability and Accountability Act (HIPAA)-compliant platforms which often require patients to acquire additional software or devices to access care. But throughout the pandemic, telehealth services have been available over popular apps including FaceTime, Zoom, and Skype.

Minor as such reforms may appear, rolling back regulatory hurdles is an effective way to expand access to health care. But, unfortunately, if you are waiting for federal leadership, don’t hold your breath—HIPAA is the reason why your doctor’s office probably still relies on fax machines for communication.

Fortunately, state-level responses to the pandemic demonstrate that states have the power to clear the way for telehealth. State actions included allowing providers to practice telehealth across state lines and allowing nurse practitioners to work without the supervision of a physician, among others. However, many of these temporary measures are beginning to expire.

One might wonder: if policymakers recognize the need for regulatory flexibility to access care during a pandemic, why wouldn’t the same flexibilities be beneficial under normal circumstances? It wouldn’t take much imagination to see what a permissive regulatory environment can do to improve healthcare. Florida has been leading the way on market-based reform for years.

A recent report published by the Reason Foundation, Cicero Institute, and Pioneer Institute rates each state’s telehealth policies according to a set of best practices that would extend pandemic-era flexibilities permanently. Unsurprisingly, Florida outperforms every other state in the report’s ratings.

Perhaps the greatest benefit of telehealth is its ability to connect patients to providers regardless of their physical location. Nearly every state took temporary actions allowing out-of-state providers to care for their residents during the pandemic. Once these measures expire, those states will return to an antiquated system of state-level licensing schemes that prohibits healthcare providers from practicing telehealth across state lines.

Forward-looking lawmakers in Florida understood that this outdated approach is bad for patients. In 2018, Florida created a streamlined telehealth registration process that allows out-of-state providers to practice telehealth without obtaining a Florida license. Now patients in Florida can access high-quality health care from specialists located across the country without the burden and expense of traveling to another state. Arizona is the only other state to have adopted a comparable registration process at this time.

Permanently eliminating barriers to cross-state telehealth is critical to expanding access, but it is only part of the solution. States should also seek to maximize the number of telehealth providers available by allowing nurse practitioners to provide telehealth services without the supervision of a physician. At least 20 states have taken temporary action to do so during the COVID-19 pandemic. Of course, such flexibility is also beneficial outside of a public health emergency. Enabling nurse practitioners to practice telehealth independently would help alleviate the growing shortage of physicians which is projected to reach up to 124,000 by 2034.

Twenty-nine states, including Florida, have permanently allowed nurse practitioners to work independently. Nurse practitioners are highly skilled health care professionals trained at the graduate level. Empowering them to practice to the full extent of their training is a safe and effective way to expand access to care––especially in rural communities that are most acutely impacted by the physician shortage. Research even shows that states allowing full independent practice have significantly lower outpatient and prescription drug costs.

As these and other responses to the pandemic have shown, states have the ability to act on health care while federal proposals continue to flounder. Telehealth is just one example of exciting developments made possible by private sector innovation and smart governance at the state level. On that front, Florida continues to lead the way, and, hopefully, more states will move to permanently reduce regulatory burdens holding back telehealth services for patients.  

A version of this column first appeared in Real Clear Policy.