But doctors are generally allowed to practice medicine only where they have a license. This means they cannot treat patients across state lines unless they also have a license in the patient’s state, and most physicians have one or two licenses at most. This has led to what Ateev Mehrotra, a physician and professor of health policy at the Brown University School of Public Health, calls an “inane” norm: A woman with a rare cancer boarding an airplane, at the risk of her chemotherapy-weakened immune system, to see a specialist thousands of miles away, for example, or a baby with a rare disease who’s repeatedly shuttled between Arizona and Massachusetts.
While eligible physicians can currently apply to practice in states besides their own, this can be a burdensome and impractical process. For instance, let’s say you are an oncologist in Minnesota, and a patient from Kansas arrives at your office seeking treatment. The patient will probably want to do follow-up appointments via telehealth when possible, to avoid having to travel back to Minnesota.
But if you are not yet licensed to practice in Kansas (and you probably are not), you can’t suddenly start practicing medicine there. You would first need to apply to do so, either through the Interstate Medical Licensure Compact (designed to streamline the process of obtaining a full license in another state, but at a price of $700 per year) or with Kansas’s board of medicine directly. Maybe this poses too great an administrative hurdle for you—you work long hours, and how will you find time to compile the necessary paperwork? Doctors can’t reasonably be expected to apply for licensure in all 50 states. The patient, then, either loses out on care or must shoulder the burden of traveling to Minnesota for a doctor’s visit. The only way to access telehealth, if that’s what the patient prefers, would be to cross into the state and log in—an option that might still be preferable to traveling all the way to the doctor’s office. These obstacles to care have led to a growing belief among health-care providers, policymakers, and patients that under certain circumstances, doctors should be able to treat their patients anywhere.
Lately, telehealth has proved to be widely popular, too. The coronavirus emergency in 2020 served as proof of concept, demonstrating that new digital platforms for medicine were feasible—and often highly effective. One study showed that telehealth accounted for nearly a quarter of contacts between patients and providers during the first four months of the pandemic (up from 0.3% during the same period in 2019), and among Medicare users, nearly half had used telehealth in 2020—a 63-fold increase. This swift and dramatic shift came about because Congress and the Centers for Medicare and Medicaid Services had passed legislation to make more telehealth visits temporarily eligible for reimbursement (the payments a health-care provider receives from an insurance company for providing medical services), while state boards of medicine relaxed the licensing restrictions. Now, more providers were able to offer telehealth, and more patients were eager to receive medical care without leaving their homes.
Though in-person care remains standard, telehealth has gained a significant place in US medicine, increasing from 0.1% of total Medicare visits in 2019 to 5.3% in 2020 and 3.5% in 2021. By the end of 2023, more than one in 10 Medicare patients were still using telehealth. And in some specialties the rate is much higher: 37% of all mental-health visits in the third quarter of 2023 were telemedicine, as well as 10% of obstetric appointments, 10% of transplant appointments, and 11% of infectious-disease appointments.
“Telehealth has broadened our ability to provide care in ways not imaginable prior to the pandemic,” says Tara Sklar, faculty director of the health law and policy program at the University of Arizona James E. Rogers College of Law.
