By John Hood
RALEIGH — North Carolina has become a national leader in such policy areas as tax reform, school choice, and transportation funding. Unfortunately, we lag far behind in providing telehealth options to patients.
That’s the finding of a new study written by Josh Archambault for the Cicero Institute. Archambault, a longtime health-policy researcher and former legislative staffer, graded all 50 states on the policies they’ve enacted — or failed to enact — to foster telehealth innovation.
The report gave North Carolina a failing grade. There’s a regional dynamic, it seems: the four lowest-ranked states on the list are Virginia, North Carolina, South Carolina, and Tennessee.
Before exploring the findings further, let’s define our terms. Telemedicine is the practice of delivering services through telecommunication that would normally be performed in a clinical setting. Digital health is an emerging sector of software, hardware, and online platforms that keep patients informed and empower them to improve their health in a variety of ways, including diet, exercise, and treatment compliance. Telehealth is a broad term encompassing telemedicine, digital health, and related fields.
None of this is entirely new. As my former John Locke Foundation colleague Jordan Roberts explained in a recent policy guide, physicians began using the telephone soon after it was invented in the 1870s. It was a handy tool for checking on patients and offering timely advice during emergencies.
More than a century later, the introduction of personal computers, databases, and the Internet changed the behavior of both medical providers and patients. Because most payment systems assumed in-person services, however, the changes fell far short of revolutionary.
The COVID-19 pandemic was the turning point. Compelled to move interactions online, providers, patients, and, to some extent, payment systems had to adapt. Telehealth is no panacea and has some inherent limits. Barriers remain, only some responsive to policy reform. Still, there’s no rewind button to push. Telehealth is here to stay — and it should be.
In his report, Archambault identified four state policies that maximize its benefits and minimize the costs. First, state laws and procedures should reflect a broad understanding of telehealth, a trait he calls “modality neutral.” That means both synchronous (real-time) delivery of services as well as asynchronous (recorded) content and interactive systems to assist patients. It also encompasses audio, video, online text, and other formats.
Second, state laws and procedures shouldn’t compel patients to begin their consumption of telehealth in just one way. “Imagine someone experiencing a behavioral health crisis in the middle of the night,” Archambault wrote. “They might strongly prefer to start communication by text or in an asynchronous manner before being comfortable switching to a video call or in-person visit. Providers should be able to accommodate that preference so long as the standard of care can be met.”
Third, states shouldn’t impede the ability of patients to obtain telehealth services from providers who live in other states. “As Americans become increasingly mobile,” he observed, “being able to stay in touch with providers who know the patient’s history and have their trust is imperative to better health outcomes.”
Finally, the promise of telehealth will never be realized as long as nurse practitioners lack the legal right to deliver services as independent providers. Scope-of-practice reform is a longtime interest of mine, and properly included in Archambault’s grading system.
Because our laws are among the nation’s most hostile to nurse practitioners, it’s no surprise that he gave us an “F” here. Unfortunately, we fare little better on the other three criteria. Archambault recommended that North Carolina rewrite telehealth laws to define the relevant terms more clearly, expand the practice beyond mental health, and specify that the provider-patient relationship can start in any mode. He also suggested either making it easy for out-of-state professionals to register as a service provider here or adopting a reciprocity policy that treats other states’ licensures as sufficient qualification.
Which states are doing telehealth right? Arizona, Colorado, Delaware, Utah, and Florida top the list. North Carolina should join them there.
John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy with American history (FolkloreCycle.com).
