Alaska has 17 medically underserved areas (MUAs) that would stand to benefit greatly from increased access to health care at lower costs than in-person visits. In fact, all Alaskans would benefit greatly since we have some of the most expensive care in the country. Granting licensing recognition for out-of-state medical professionals with licenses in good standing to practice telemedicine in Alaska has the potential to help health care consumers in MUAs as well as patients with chronic conditions or disabilities, patients needing consultations with specialists, and patients desiring continuity of care.
Though Alaska loosened licensing restrictions during the 2020 pandemic to allow out-of-state providers to practice telemedicine in the state, these changes ought to be made permanent: allow providers licensed in good standing in other states to register here and proceed with providing high-quality telemedicine to Alaskan patients. Minnesota, Florida, and Maine did so prior to the pandemic. Arizona, as part of its universal licensing recognition bill passed in April 2019, has since recognized 340 medical providers to deliver in-person care to Arizonans, and Arizona is poised to pass a revolutionary telehealth bill that would allow all healthcare providers with valid licenses in other states to practice telehealth in Arizona. Alaska should seriously consider following suit to increase access and reduce costs of health care.
Though Alaska telehealth services are comparatively robust for Alaska-licensed providers due to early adoption, a glaring oversight means that only providers with an additional Alaska license can provide telemedicine services to Alaskans now that the pandemic emergency declaration has expired. This is particularly important because Alaska has no medical school, and as of 2017, just 14 percent of Alaska’s physicians who completed residency between 2008 and 2017 were practicing in medically underserved areas. Alaska, as of 2020, only had 835 active specialists in the state, including only 14 oncology specialists and 36 cardiology specialists — most of which are based in Anchorage, which imposes significant travel costs to patients in rural communities and MUAs. If out-of-state-licensed physicians in good standing were granted license recognition to practice telemedicine in Alaska, patients would have more choices for high-quality providers and be able to get convenient follow-up care, no matter their geographic location, transportation barriers, and cost barriers to seeing a doctor.
Nationally, the COVID-19 pandemic spurred an increase in telehealth utilization by 11,718% for Medicare beneficiaries the week ending April 18, 2020, compared to the week of March 7th of that year. Telehealth reduces the time, effort, and cost of seeing a doctor while increasing access to specialists and making follow-up with chronic or elderly patients more convenient. Though not ideal for every situation, many patients prefer the convenience of virtual visits and state that the quality of care is comparable to in-person visits. 68 percent of patients rated their satisfaction with telehealth visits as a 9 or 10 on a 10-point scale, with lower scores usually resulting from a brief technical difficulty that was resolved. Telehealth allows patients to have quick consultations for relatively minor issues without enduring costly travel to see a doctor, which benefits the patient; instead of leaving potential health problems to be addressed during an annual visit, doctors can assuage or validate concerns as they appear, improving overall patient health.
Telehealth licensing recognition has been implemented in other states, some in response to COVID-19 and others prior to the pandemic due to the benefits it offers to patients. Minnesota, Florida, and Maine allow out-of-state physicians in good standing (and all medical professions in Florida) to provide telehealth services with only a registration fee. In Minnesota, the fee to register is a mere $75, while in Florida and Maine the fees are more but less than a full-fledged license in the state.
Precautions can be taken when granting license recognition to out-of-state providers for telehealth to ensure the policy change won’t result in incompetent providers scamming and harming patients. In Minnesota, Florida, and Maine, for instance, registration to provide telehealth is contingent on having an active, unencumbered license in another state; the requirement for “unencumbered” ensures a requisite background check is clean. Thus providers with their licenses revoked or restricted can not register to provide telehealth services. For those concerned about malpractice, Florida requires that liability coverage for telehealth services be equal to or greater than the liability coverage held by Florida’s in-state providers. All of these states additionally require that all services be within the provider’s scope of practice. In-state physicians can also rest assured that out-of-state providers won’t use telemedicine as an opportunity to set up an in-state physical practice without enduring proper licensing; Minnesota requires that telehealth-registered providers from out of state agree not to open a practice in the state unless they were to move there and obtain a full Minnesota license.
Alaskans have seen the benefits of telemedicine during the COVID-19 pandemic, and one should wonder whether these regulations were really necessary to begin with. Will the state restore burdensome and expensive licensing hurdles and consequently reduce access to health care, increase costs, and harm patients? Or will Alaska allow providers, good enough to practice in other states, to practice telemedicine in Alaska permanently?
PS: Hear the benefits of telemedicine straight from Governor Dunleavy.