Is It Safe To Access Telehealth From A Provider Out-Of-State?

Millions of Americans began using telehealth during the COVID-19 pandemic and, for many, they were able to use telehealth to obtain care from a physician in another state. The ability to see physicians in another state via telehealth was possible due to temporary flexibilities. In many states those flexibilities have expired and many patients are losing access to providers in other states. Should access to these out-of-state providers remain? Is patient safety a concern with patients getting out-of-state care?

We sought to find out by obtaining complaint and disciplinary data from Florida and Idaho, two states that have been allowing their residents to access care from providers in another state. We found few patient complaints or disciplinary action related to out-of-state telehealth. Our results may help allay concerns and inform how states should regulate telehealth across state lines.

Prior to the pandemic, Florida passed a law allowing across-state-line access as long as the out-of-state provider registers with Florida. Idaho has allowed it during the pandemic by executive order without registration. In Florida, providers must submit an application and show they have an active, unencumbered license in another state with no disciplinary actions in the previous five years. Registrations started in October 2019.

Number of Telehealth Registrations in Florida Growing Quickly, With Few Complaints

Florida has approved ~14,000 out-of-state providers to provide telehealth to Florida patients, most being medical doctors and mental health providers. In the first two and half years that Florida has allowed out-of-state telehealth registrations, there have been no cases that have resulted in discipline for a provider offering services to Florida patients. Only 16 complaints have been filed, and 90 percent of those that have been closed have been found to have had no care violation, with only one resulting in a letter of guidance to the provider. For comparison, during the same time period the rate of complaints for in-state providers related to telehealth care was similarly low.

Figure 1. Number of Approved Out-of-State Telehealth Registrations in Florida

Meanwhile, data from the Idaho Division of Occupational & Professional Licenses showed that during the pandemic no final disciplinary action was taken against a provider for care delivered over telehealth. Idaho offers a much smaller sample size, but highlights that disciplinary action is not common with telehealth across state lines.

Lessons for Ongoing Debate About Out-of-State Telehealth

The experience of the two states reveals some interesting trends. First more and more providers are interested in offering this kind of care. Based on complaints data, there have been few complaints, and none have resulted in disciplinary action. These early results do not support the concern that there will be substantial disciplinary concerns with across-state-line telehealth.

Our findings can also inform the debate on whether asking clinicians to register is critical. Several states have followed Florida’s lead and ask out-of-state clinicians to first register. It is unclear if this registration process is a necessary standard. While consumer protection is always a concern, these early results show that patients are not flocking to regulatory agencies to complain, and, among the complaints that have been submitted, the vast majority are dismissed as unfounded. The registration process does create an administrative burden for clinicians that may be unnecessary.

Despite the attention telehealth has received during the pandemic, few states have implemented robust laws allowing out-of-state clinicians to provide care in their state. Four states with clear pathways are Arizona, Delaware, Florida, and Indiana. In many other states that allowed easy access to across-state-line telehealth early in the pandemic, most have now eliminated that access.

Pilots don’t lose their skills when they cross a state line, and neither do health care professionals. As more Americans are mobile, being able to stay in touch with providers who know the patient’s history and have their trust may help to keep continuation and coordination of care. As policymakers review their current laws to best help their state be ready for another pandemic, or to improve access to affordable care, Florida and Idaho offer lessons on across-state-line telehealth for consideration.

This piece was co-authored by Dr. Ateev Mehrotra a professor of health care policy and medicine at Harvard Medical School. Find Dr. Mehrotra on Twitter here.