I’ve been keeping tabs on the news about telemedicine since it was touted throughout the industry as one of the big benefits of having good broadband. One piece of news comes from a survey conducted by Nemours Children’s Health. This is a large pediatric health system with 95 locations in Delaware, Florida, New Jersey, and Pennsylvania. The company treats almost half a million children annually.

Nemours released a report on Telehealth in July. The report was based on a survey of 2,056 parents/guardians of children. The survey had some interesting results:

There is a Need for Telehealth. 48% of the survey respondents said that they had at least one recent experience where there was a hardship in getting a sick child to a live doctor visit. This included reasons such as living in an unsafe community or not having easy access to transportation. 28% of respondents reported two such occasions, and 15% reported three or more. These are the situations for which telehealth is ideal for getting a doctor to look at a sick child when care is needed rather than when the child can be transported to a doctor’s office.

Telehealth Good for Parents. Almost 90% of the respondents to the survey said that telehealth makes it easier for parents to take an active role in a child’s health care. A lot of parents said that somebody other than them takes sick children to see a doctor during the workday, and they love being able to participate first-hand in the discussion with a doctor.

Provider’s Play a Big Role in Enabling Telehealth. 28% of respondents to the survey said they have never been offered a telehealth visit. 12% said they had never heard of telehealth. Respondents who use telehealth said they were more likely to use the service when offered as an option by the health provider.

Reimbursement is Still a Barrier. Two-thirds of parents say that having telehealth visits covered by insurance is essential for considering using the service. There was a big push during the pandemic for insurance companies to cover telehealth visits. There is a concern at Nemours for this to continue when things return to normal.

As further evidence that reimbursement is a major issue, a recent article in KHN (Kaiser Health News) shows that there are surprising issues that are impacting telehealth. The article discusses insurance companies that don’t want to cover telehealth visits where patients and doctors are in different states. This is based on laws in most states and also in Medicare and Medicaid rules that require a licensed clinician to hold a valid medical license in the state where a patient is located.

These laws don’t stop people from voluntarily visiting a doctor in another state, but the law is being raised for telemedicine. This is surfacing as an issue as states start rolling back special rules put in place during the early days of the pandemic.

Johns Hopkins Medicine in Baltimore recently had to cancel over 1,000 telehealth visits with patients in Virginia because such visits would not be covered by insurance. This left patients to find a way to make the physical trip to Johns Hopkins or find another health provider. As someone who has used John Hopkins, this is the place where people from the DC region look to when they need to see the best specialists.

When I first heard about telemedicine a decade ago, the ability to see specialists was one of the biggest cited benefits of telemedicine. These kinds of issues are always more complicated than they seem. For example, state medical boards don’t want to give up the authority to license and discipline doctors who treat patients in the state. Then, of course, money comes into play since medical licensing fees help pay for the medical boards. When insurance companies find it too complicated to deal with a gray legal issue, they invariably take the safe path, which in this case is not covering cross-state telemedicine visits.

Probably the only way to guarantee that telemedicine will work would be with legislative action to clear up the gray areas. Add this to the list of broadband topics that need a solution from Congress.