Healthcare Access Bills Yielding to Demographic Reality

For a real-world example of why aggressive implementation of telemedicine is needed, look to Alaska, where barriers to access are poised to come down, reflecting a nationwide trend.

We’ve known and talked about the physician and nursing shortage in this country for years.

Baby Boomer-aged healthcare providers are retiring along with millions of their contemporaries, creating huge gaps in care access that are occurring just as the Patient Protection and Affordable Care Act expands healthcare coverage to millions of Americans.

This change is manifest along several fronts. If you want a real-world example of why aggressive implementation of telemedicine is needed, for example, look to Alaska. If ever a landscape exemplified the need for remote access to healthcare, it’s Alaska.

The ratios aren’t that bad. There is one physician for every 247 Alaskans, with puts Alaska in the middle of the pack among states. However, Alaska’s physicians have lot more ground to cover. By far the nation’s largest, most rural state, only one-third of Alaska is accessible by road.

The state has five time zones (although only two are used), and is home to 737,000 people, roughly 9.5% of whom are age 65 or older. That’s 1.2 people per square mile, spread across 663,267 square miles, more than twice the size of Texas, and three times the size of California.

By comparison, Connecticut has 332 physicians per 100,000 population, which is 3.6 million residents spread across 5,544 square miles, or about 738 people per square mile, according to U.S. Census Bureau data.

All of this is a round-about way of noting that telemedicine is not some abstract notion in Alaska. It is critical to the health of the people, many of whom have few options for access to healthcare even as the state it remains in the middle of the pack among states in a recent ranking by the American Telemedicine Association.

Motivated by the need to improve care access, the state’s legislature wants to improve on that middling ranking with a bill that would allow licensed Alaska physicians located out-of-state to provide telemedicine services with the same privileges as in-state physicians. The bill has the conditional support of the Alaska State Medical Association. Last week the Federal Trade Commission offered its support after it was asked to review the proposal by State Rep. Steve Thompson, co-chair of the Alaska House Finance Committee.

“By eliminating the ‘in-state’ requirement, SB 74 would likely expand the supply of telemedicine providers, promote competition, and increase access to safe and cost-effective care. It could also reduce transportation costs for Alaska patients and providers,” the FTC comment states. “For these reasons, the elimination of the ‘in-state’ requirement by SB 74 appears to be a procompetitive improvement in the law that would benefit Alaska healthcare consumers, including its most vulnerable populations.”

It speaks volumes when the FTC wades into an issue such as this and makes plain the benefits of removing stifling regulations instead of adding more.

It’s part of a larger trend surrounding care access that is driven by stark and undeniable necessity. Barriers are coming down, not just in Alaska, but across the nation. For the past several years nurses in states across the nation have made tremendous progressing improving their scope of practice, often in the face of stiff resistance from physicians associations.

In Florida, for example, the state’s legislature this month sent to Gov. Rick Scott two bills that are expected to improve access to care in the Sunshine State. One bill lets Florida enter a multistate nurse licensure compact that would allow nurses from other states to practice in Florida. A separate bill allows physician assistants and nurse practitioners to prescribe controlled substances, something the Florida Nurses Association has sought for more than 20 years.

In years past the Florida Medical Association has generally opposed scope-of-practice bills that they perceive as stripping authority from physicians as care team leaders. However, in this case they backed off their opposition when it became clear that the legislature was backing the nurses, who’d made a strong case for improving care access. In exchange, the physicians negotiated new language simplifying prior authorization forms with payers. 

The moral of the Florida story is that special interests that once tried to limit scope of practice to protect their market share now understand that their biggest opponent is demographics. The better course would be to understand the inevitable and cut the best deal you can negotiate. As the old saying goes, if you’re not at the table you’re on the menu.