Download a PDF of this Legislative Memo with sources and citations here. 

Key Findings

1. SB 6519 would expand “patient access to health services through telemedicine and (establish) a collaborative for the advancement of telemedicine.”
2. Washington state will potentially face a shortage of 3,000 to 4,000 doctors and 24,000 registered nurses over the next 10 to 15 years.
3. SB 6519 would provide a framework for telemedicine in Washington state. It begins with a “collaborative” hosted by the University of Washington Telehealth Services.
4. SB 6519 has the potential to increase patient options and decrease health care costs in Washington state.

Introduction
Certain geographic areas in Washington state lack primary health care. These are mostly rural areas where patients have no timely access to doctors or physician extenders. SB 6519 would expand “patient access to health services through telemedicine and (establish) a collaborative for the advancement of telemedicine.” The bill has bipartisan sponsorship.

Background
There are basically three types of telemedicine – store and forward, remote monitoring and real-time interactive. Radiologists have used store and forward for several decades to read x-rays taken at a distant site. Remote monitoring refers to obtaining on-going changes in clinical parameters such as heart rate and blood sugar. Real-time interactive is a one-on-one interaction between patient and provider and is the basis of SB 6519. 

Historically, telemedicine dates back to the 1920s, although the modern era began with the National Aeronautical and Space Administration’s (NASA) work with astronauts during space travel.

Twenty seven states, plus the District of Columbia, now have telemedicine laws. 

The Association of American Medical Colleges (AAMC) anticipates a shortage of 150,000 doctors in the next 15 years. Other sources predict a shortage of 200,000 doctors by 2025. The Bureau of Labor Statistics predicts a need for 145,000 new doctors by 2018. Washington state will potentially face a shortage of 3,000 to 4,000 doctors and 24,000 registered nurses over the next 10 to 15 years.

Most of the physician shortage will occur in the primary care specialty and rural communities will be adversely affected the most.

SB 6519
The bill defines “telemedicine” as the delivery of health care services through interactive audio and video technology in real time. It does not include telephone-only, fax or email.

SB 6519 would provide a framework for telemedicine in Washington state. It begins with a “collaborative” hosted by the University of Washington Telehealth Services. The collaborative would be composed of providers and other interested parties. It would report to the legislature and would disband at the end of 2018.

• Reimbursement for the provider would be the same as an in-person visit covered by the patient’s insurance plan or as mandated by the benefit plan in the Affordable Care Act. Visits for Medicaid patients would be covered.
• Basically any recognized and licensed medical facility would be eligible to participate. Hospitals must be Medicare-approved.
• Physicians must be licensed in Washington state.
• The Washington State Health Care Authority must report data and effectiveness of the program by the end of 2018.
• SB 6519 has no fiscal note at present.

Policy analysis
Access to providers is the most important part of our health care system. Receiving timely care is critical to society having a healthy population. It gives patients choices in the type of care they obtain and it gives providers more options to treat sick individuals.

Telemedicine can also decrease the costs of health care. A visit electronically is much cheaper than a trip to the emergency room. Diagnosing minor problems is much safer and less expensive than waiting for the patient’s clinical condition to become severe.

State medical licensure is a separate issue. The bill requires that participating physicians be licensed to practice medicine in Washington state. Ideally, providers would be licensed nationally and telemedicine would not be subject to state borders. This would increase options for patients.

SB 6519 is a good start at expanding telemedicine in Washington state.