HCD 404 Module 1 Telemedicine and Telehealth Scenario Paper Example

Keeping the Video On: A Rural Clinic's Plan to Expand Telemedicine Across State Lines

Student Name

BS in Health Care Administration and Policy, Arizona State University

HCD 404: Advanced Concepts in Health Care Delivery

Instructor Name

Month Day, Year

Keeping the Video On: A Rural Clinic's Plan to Expand Telemedicine Across State Lines

The Scenario

Four small primary care clinics in northern Arizona, run as one network, began video visits during the COVID-19 pandemic. Leaders now want to make them permanent and extend them to patients who live part of the year in Utah, New Mexico and Colorado. The board has asked whether the plan is legal, whether patients want it and whether it will save money.

Licensing

Medical licenses are issued by states, and the general rule is that the patient's physical location during the visit, not the clinician's, decides which state's license is needed. A visit with a patient spending the winter in Utah is therefore a Utah visit. The clinic has three options. Its physicians can obtain additional state licenses, which is slow and costly when repeated for each clinician. Physicians can use the Interstate Medical Licensure Compact, which offers an expedited pathway to licenses in participating states but still requires a license in each one. Or the clinic can rely on state telehealth registrations, which a few states offer to out-of-state clinicians, though rules differ. Nurse practitioners and other clinicians face separate rules. The practical recommendation is to license a small team in the two states where most traveling patients go, rather than every clinician everywhere.

The Patient Experience

For rural patients, the gains are real: no long drive, no time off work and easier follow-up. Evidence suggests that telehealth is generally comparable to in-person care across many clinical areas, though results depend on the condition and the type of technology (Shigekawa et al., 2018). Some visits do not translate well. A physical examination, vaccination or procedure requires a clinic visit, and patients without reliable broadband or devices may be left behind. During the pandemic, communities with higher poverty rates used telemedicine somewhat less than wealthier ones (Patel et al., 2021), a pattern a rural network should expect to see among its own patients.

Core Issues: Substitution, Cost and Equity

The board hopes video visits will save money by replacing office visits. The evidence is cautionary. In one study of commercially insured patients with respiratory infections, only about 12 percent of direct-to-consumer telehealth visits replaced other visits, while 88 percent were new use, and net spending rose by $45 per telehealth user (Ashwood et al., 2017). The clinic's model differs, since visits would be with patients' own clinicians, but leaders should not assume savings. Payment rules matter too: Medicare's pandemic-era flexibilities have been extended several times by Congress, and the clinic should plan for the possibility that some will lapse.

Recommendation

The plan is worth pursuing for access and continuity of care, but it should be justified on those grounds rather than on expected savings.

References

Ashwood, J. S., Mehrotra, A., Cowling, D., & Uscher-Pines, L. (2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs, 36(3), 485-491. https://doi.org/10.1377/hlthaff.2016.1130

Patel, S. Y., Mehrotra, A., Huskamp, H. A., Uscher-Pines, L., Ganguli, I., & Barnett, M. L. (2021). Variation in telemedicine use and outpatient care during the COVID-19 pandemic in the United States. Health Affairs, 40(2), 349-358. https://doi.org/10.1377/hlthaff.2020.01786

Shigekawa, E., Fix, M., Corbett, G., Roby, D. H., & Coffman, J. (2018). The current state of telehealth evidence: A rapid review. Health Affairs, 37(12), 1975-1982. https://doi.org/10.1377/hlthaff.2018.05132