Tear down Walls to Telemedicine

Michael F. Cannon

THE GENERAL ASSEMBLY is considering legislation to expand access to the nation’s top medical centers and reduce the cost of health care. Though all Virginians would benefit, the biggest winners would be patients with low-to-moderate incomes, those who live in rural areas and those who have rare diseases requiring highly specialized care.

Unfortunately, special interests are trying to prevent these patients from seeing anyone but Virginia doctors — even when the best doctors are out-of-state.

Virginia law allows residents to travel across state lines to receive treatment at Johns Hopkins University or any other leading medical center. Anyone who proposed building a wall around the commonwealth to prevent Virginia patients from seeking care at top medical centers in other states would be laughed out of Richmond. Yet Virginia erects a virtual wall that blocks patients from receiving care from those same doctors via telemedicine.

Telemedicine has made the cost of accessing care from distant providers plummet. Blocking telemedicine reduces quality. It’s time for regulation to catch up with the technology.

Telemedicine allows patients to get care from doctors or nurses via Skype or other web-based applications. It can improve the quality of care, such as by connecting patients with rare diseases to distant specialists, and by reducing delays in the diagnosis and treatment of strokes, which has the potential to reduce disability and save lives.

It can also reduce the cost of care. The New England Journal of Medicine reports, “Numerous organizations, from academic health centers to startups, now offer low-cost virtual visits (less than $50 per visit) around the clock for the ‘most common, most irritating, most inconvenient’ conditions. By contrast, it takes an average of 20 days to secure a 20-minute appointment with a physician that with travel and wait time consumes two hours.”

Economist Shirley Svorny writes that telemedicine can improve outcomes in “diabetic monitoring and care[,] delivering care to Parkinson’s patients, mental health services and many other situations.”

Yet even though it is legal to drive to the Mayo Clinic for care, in most cases Virginia makes it illegal to receive telemedicine services from Mayo Clinic doctors.

At a time when patients are buckling under sky-high health care prices, this virtual wall imposes unnecessary travel, time and forgone-income costs on patients. Wealthy patients may be able to shoulder those needless costs. Low- and moderate-income patients can’t, and those costs are highest for rural patients: Northern Virginia residents can drive to Johns Hopkins in as little as one hour, but from Lee County it’s eight hours each way.

Svorny advocates tearing down this virtual wall. The General Assembly is considering legislation based on her proposal to allow Virginia patients to receive care from top doctors around the nation without leaving home.

Yet special interests — including the Medical Society of Virginia, which lobbies the General Assembly on behalf of Virginia doctors — have chained themselves to the virtual wall.

While the special interests say they just want to ensure patients receive high-quality care, their proposals would continue to block Virginians from receiving telemedicine from Johns Hopkins, the Mayo Clinic, the Cleveland Clinic, M.D. Anderson Cancer Center and Memorial Sloan Kettering Cancer Center. They would condition Virginians’ right to access the best medical care on the whims of lawmakers in other states.

These special-interests proposals have nothing to do with quality. They are efforts to prevent Virginia patients from seeing anyone but Virginia doctors — even when there are higher-quality doctors elsewhere.

Lawmakers should call the special interests’ bluff by tearing down the virtual wall and at the same time giving patients an unlimited right to sue out-of-state telemedicine providers for medical malpractice. If a New York doctor harms a Virginia patient, let the patient sue him in Virginia courts, without the time limits and caps on damages that the MSV insists should weaken the rights of patients harmed by Virginia doctors. The special interests can have no sincere objection to telemedicine legislation that gives Virginia patients greater protections from out-of-state doctors than they have from Virginia doctors.

Telemedicine has made the cost of accessing care from distant providers plummet. Blocking telemedicine reduces quality. It’s time for regulation to catch up with the technology. The General Assembly and Gov. Ralph Northam should ignore the special interests and tear down this wall.

Michael F. Cannon is director of health policy studies at the Cato Institute, a think tank located in Washington, D.C.