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INSIGHT: Telemedicine Rules Should Be Permanently Eased

May 13, 2020, 8:00 AM

The coronavirus pandemic has vaulted the once-niche field of telemedicine to the front line of medical care. Demand for telemedicine services has soared, and providers of the service are struggling to keep up.

Until this year, a range of strict regulatory requirements prevented its broad use. Now, with these restrictions lifted, millions of people are trying telemedicine for the first time, doctors are finding that they can see more patients and do so more profitably, and countless Covid-19 infections have been avoided as patients receive care without going to an emergency room or a crowded clinic where they will expose themselves or others to illness.

For almost 30 years, I represented the most rural, remote and mountainous congressional district in Virginia. More than two decades ago, the hospitals and clinics in our region deployed telemedicine links to the University of Virginia’s hospital in Charlottesville, which by road is more than four hours away. With a simple trip to the local clinic, my constituents could receive the benefit of expert medical consultation while avoiding an expensive and time-consuming trip to the University’s hospital. Early on, we appreciated how beneficial telemedicine is and how much more beneficial it could be if a range of cumbersome regulatory restrictions were lifted.

With the urgency of the pandemic upon us, many regulatory barriers have been rolled back on a temporary basis, and as the positive experience with telehealth is showing, these changes should be made permanent:

  • Until now, Medicare reimbursement rules required that telehealth only be provided in the setting of a medical office, such as a hospital or clinic. The patient in a local medical facility could then be connected to a distant specialist. With that restriction waived, telemedicine visits can originate from a patient’s home or other location convenient to him. Predictably, the flexibility of this change has greatly accelerated telemedicine use.
  • A vexing feature of the old Medicare rule, that services only be reimbursed if they originated from a “rural” setting, has been temporarily waived. Now, reimbursable telemedicine consultations can originate from anyplace in the nation—rural, suburban or urban. It’s hard to understand why the service was previously so limited. Residents of suburban and urban areas should be as entitled as rural residents to receive the efficiency and convenience of medical services delivered electronically. The old rule also led to some anomalous outcomes. Patients in highly remote counties that happened to be lumped into a Standard Metropolitan Statistical Area were not deemed to be “rural” and were, therefore, denied telemedicine access.

  • Previously, telemedicine consultations were reimbursed at a significantly lower rate than regular medical office visits. They are now being reimbursed at equivalent rates.

  • The Centers for Medicaid & Medicare services has announced that it will not enforce any requirement that the physician using telemedicine have a previous relationship with the patient. Accordingly, any properly licensed doctor or other healthcare professional can provide a reimbursable telemedicine service whether or not they had previously seen the patient.

  • Under the old rule, only HIPAA compatible communication devices could be used for telemedicine, and these devices—computers with special privacy safeguards—were usually found only in medical offices. Now, telemedicine consults can originate from any device, including a patient’s laptop or smartphone, and may use any non-public facing platform, including Facebook Messenger video chat, Skype, Apple FaceTime and Google Hangouts video. Giving patients a choice among platforms increases accessibility, but also underscores the importance of Congress tackling the issues of privacy and cybersecurity as soon as possible.

  • The correction of one legacy requirement is still a work in progress. Many states only allow telemedicine consults if the physician is licensed in the state in which the patient is located. This requirement has placed huge barriers to the effective use of telemedicine in border areas where residents of one state typically receive most of their health care services in another state. These requirements are state imposed, and many are giving active consideration to a waiver for the provision of telemedicine services across state lines.


Some of the old rules undoubtedly were adopted at a time when broadband networks were not as fast and reliable as they are today. With network connectivity limited and high-quality video generally only available over connections in institutional settings, it’s perhaps understandable that regulations restricted the places where telemedicine services could be offered.

All of that is now changed. We live in a broadband-connected world, and while gaps in coverage remain, each year more and more people have the convenience of broadband in their homes and on their mobile devices. The rules have long needed to take these changes into account, and with the arrival of the pandemic, they are at long last occurring.

When Covid-19 is no longer dominating headlines and the temporary waivers of telemedicine restrictions expire, our nation would do well to remember how beneficial telemedicine has been in this time of national emergency and how much its availability and use expanded under the relaxed rules.

With a permanent relaxation of regulations, telemedicine can at last become a widely-deployed, highly-valuable feature of the American healthcare experience.

This column does not necessarily reflect the opinion of The Bureau of National Affairs, Inc. or its owners.

Author Information

Rick Boucher was a member of the House for 28 years and chaired the House Energy and Commerce Committee’s Subcommittee on Communications and the Internet. He is honorary chairman of the Internet Innovation Alliance (IIA) and an attorney in the Washington, D.C., office of the law firm Sidley Austin.

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