Telemedicine went through a dramatic change when the pandemic struck in spring of 2020. All of a sudden, long-prohibited telemedicine was approved, and norms changed.

Fast forward to today, when the pandemic emergency has been declared to be over, resulting in a number of changes to the practice of telemedicine.

What’s complicated is that it works differently from state to state. If you live in New Jersey, can you have a telemedicine provider in New York or Pennsylvania? If you live in New York, can you keep your long-distance cancer provider in Pennsylvania?

Here’s a deep dive and an overview from the law firm Foley and Lardner: A 50-state assessment of laws. What’s approved and what’s not.Foley is a national expert in legal matters relating to health.

We have written about this before, documenting court cases in which patients sought to keep arrangements with out-of-state clinicians, for example, to continue cancer care. Here is the Foley and Lardner overview.

Here’s our piece about the changes for people with specialists far away.

The legal landscape

Foley and Lardner’s piece explains: “Patients and health care professionals have been quick to adopt telemedicine and digital health technologies. In the last five years, the legal landscape for telehealth insurance coverage and reimbursement has expanded in several ways:

• “More organizations are implementing and expanding robust virtual care programs to supplement their traditional in-person offerings. 
• “In rural areas, phone coverage helps those with limited access to broadband internet and in-person care.
• “With telehealth and digital health resources, patients also get a boost in mental health care because these tools help address the imbalance in supply and demand.
• “More states changed their laws to prohibiting exclusive telehealth platform arrangements, increasing competition among software companies and allowing individual clinics and hospitals to make decisions based on what works for them and their patients.
• “There has been progress with payment parity — reimbursing providers at the same rate for telehealth as in-person, but there is still a way to go.

“All of this together is steady progress, and it codifies by law improvements that patients have loved. Unfortunately, the market cannot rely on the health care industry to make these changes voluntarily — the laws passed by individual states serve as the bridge to solidify telehealth-based services as a core health insurance benefit for the patients who use them.”

Usage sinking

As the regulatory landscape changes, usage of telemedicine is sinking from the peaks reached as the pandemic surged in spring of 2020, remakign the regulatory landscape. “While utilization remains above pre-pandemic levels, Q3 2023 telehealth volumes were 54.7% below Q2 2020,” according to a new report by Trilliant Health.

Optum announced that it was closing its virtual care business, launched in 2021, Trilliant noted.

“That announcement was quickly followed by Walmart’s statement that it was closing Walmart Health Virtual Care, also launched in 2021, alongside its primary care business. Lastly, these announcements coincided with the two largest telehealth platform companies – Amwell and Teladoc – disclosing multiple rounds of mass layoffs, strategy shifts, executive leadership departures and continually plummeting stock performances.”