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Dr. Marlene Wüst-Smith practiced telemedicine before it became popular during the COVID-19 pandemic. Unfortunately, government restrictions sometimes hinder her ability to practice this innovative health care model.
"I've always been an early adopter of new technologies and practices," says Wüst-Smith, a Pennsylvania-based pediatrician and founder of Physician Outlook, a digital publication dedicated to "restoring the beauty and artistry of the doctor-patient relationship."
Wüst-Smith asserts telemedicine helps physicians build meaningful and productive relationships with their patients and, when appropriately used, also provides a cost-effective triage method.
"With telemedicine, we are often able to keep patients out of emergency rooms and urgent care when feasible and safe to do so," says Wüst-Smith. "When the presenting problem is inappropriate for virtual care, we can coordinate with other professionals and safely address the patient's needs."
Telemedicine offers several financial benefits for both sides of the doctor-patient relationship. With the added capacity telemedicine offers, medical facilities can reduce hospitalization, no-show appointments, and overhead costs. Meanwhile, patients, especially those in remote rural communities, save money on reduced travel and time away from work or school.
Despite these benefits, telemedicine's legality relies on a patchwork of varying state laws. Because state laws differ, telemedicine is tricky, especially given our increasingly digital and global lifestyles.
With a few exceptions, federal and state laws require physician licensure in the state where the patient originates the telemedicine visit. Pennsylvanians traveling out of state can only legally "see" a physician licensed in the state they happen to be in.
If Wüst-Smith has a Pennsylvania-based patient who requests a virtual appointment while waiting for a train at Union Station, what should she do as a doctor?
"If I take this call, I would technically be practicing illegally," Wüst-Smith says.
She isn't licensed in Washington D.C. but is in Virginia. The only way to make the virtual visit legal means asking her patient to opt for a later train, leave the station, and take a short drive across the Potomac. As ludicrous as that sounds, Wüst-Smith routinely tells her families to cross a state border so she can provide care.
Wüst-Smith is currently licensed to practice in 16 states. However, maintaining multiple state licenses is expensive and complicated.
Moreover, Pennsylvania is one of seven states that does not require insurance reimbursements for telemedicine services, meaning that even Pennsylvania-licensed physicians aren't guaranteed payment if they meet patients virtually.
Wüst-Smith says such restrictions interfere with quality patient-centered care.
"It makes absolutely no sense to make it illegal for Pennsylvania physicians not to be able to provide virtual care for a long-term patient because they are traveling or attending college in a state where that physician doesn't hold a license," says Wüst-Smith.
Pennsylvania once allowed residents to access out-of-state doctors. During the COVID-19 pandemic, the state government provided waivers, allowing residents to access doctors outside of Pennsylvania virtually. Eliminating barriers between doctors and patients proved wildly effective.
Telemedicine grew exponentially for two-and-a-half years. Penn Medicine hosted more than a million telemedicine visits during the pandemic's first year--a 9,000 percent increase.
Lawmakers attempted to codify this patient-centered approach to telemedicine. Unfortunately, former Gov. Tom Wolf vetoed the bill, and the waivers expired in October 2022.
Thankfully, expanded in-state telemedicine is back on the table with bipartisan support. By a 197-to-3 margin, the Pennsylvania House passed bipartisan legislation requiring insurance companies to cover telehealth appointments. The Pennsylvania Senate passed an almost identical bill by a 47-to-1 margin.
Recent polling suggests telemedicine is an easy win for lawmakers. Nine out of ten Pennsylvanians believe lawmakers should expand telemedicine and allow patients to see licensed doctors in other states.
As they pivot toward the state budget, Pennsylvania lawmakers must continually strive to expand cost-effective health care resources.
Telemedicine is one such resource. Empowering physicians to connect with their patients, whether in person or on the phone, only strengthens the communication needed to maintain a healthy relationship. Conversely, patients benefit from an expanded pool of medical resources beyond Pennsylvania's boundaries.
"Telemedicine gives us the ability to restore the most important element needed to restore and empower true health--a human connection--which, oddly enough, relies on technology," says Wüst-Smith. "Despite the challenges, I still believe in and love telemedicine."
Elizabeth Stelle is director of policy analysis of the Commonwealth Foundation, Pennsylvania's free-market think tank.