Can Telemedicine Boost Medi‐​Cal Access?

This article appeared on The Sacramento Bee on November 20, 2017.
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For years, Medi-Cal patients' access to doctors has been limited, especially for those who need specialty care or live in rural areas.

California's low physician reimbursement rates are partly to blame. The 2017-18 state budget includes a 2.5 percent increase in reimbursements — the first increase since 2001 and totally dependent on new tobacco tax revenues.

There are other options worth considering. Interstate telemedicine would allow an expansion of Medi-Cal services at current reimbursement rates.

If California doctors won't take Medi-Cal patients, why not let out-of-state physicians provide services? Rents and salaries are lower in some states, which is why call centers are in the Midwest.

California could allow physicians licensed in other states to enroll as Medi-Cal providers to offer telemedicine services without obtaining a California license, which is expensive and time consuming.

Why would state legislators block out-of-state physicians? According to the physicians' lobby, the goal of licensing regulations is not to protect them from competition but to ensure high-quality care.

But state medical boards don't protect patients from low-quality care and are notoriously bad at disciplining doctors. Instead, quality assurance comes from efforts by health care providers to protect their reputations and to avoid liability.

The U.S. Department of Veterans Affairs, whose problems providing care have made national headlines, will soon allow its physicians to practice telemedicine in any state. Why shouldn't California do the same for Medi-Cal patients?

The Legislature should end the requirement that out-of-state physicians secure a California license to provide telemedicine care to Medi-Cal patients. Not only would such as change expand options for Medi-Cal recipients, it would let the state experiment with interstate telemedicine, which has the potential to make health care more accessible and less costly for all Californians.

Shirley Svorny

Shirley Svorny is a professor of economics at California State University, Northridge, and an adjunct scholar at the Cato Institute.