7 ms·

> Telemedicine? No: on May 11, the feds declared an end of the “public health emergency” that allowed telemedicine across state lines. The people holding back

> Telemedicine? No: on May 11, the feds declared an end of the “public health emergency” that allowed telemedicine across state lines. The people holding back telehealth should be uhhhhh asked to reconsider.

zetazzed 3y ago
I have a very conscientious friend who used to drive across state lines to do a video visit from their car with an out of state provider. It's pretty wild to think about what a waste and time sink this is for families with complex illnesses.
- zielmicha 3y ago
  Is there anything that stops patients from lying that they are in a different state (just temporarily)?
  - userinanother 3y ago
    No but insurance might not cover it
  - pdonis 3y ago
    If the telemedicine app can geolocate your IP address it can independently determine what state you are in.
    - chmod775 3y ago
      You can just trust IP geo databases to be accurate down to the country* - and that's only most of them time and not even considering VPNs exist. Sure, if something looks fishy you could then go through the appropriate legal channels to get a more exact location from the ISP, but false positives are going to happen so often, eventually everyone involved might get a bit cranky. * Only the likes of Google have the scale and requisite information to keep more accurate and up-to-date databases, and even those are fallible.
      - viraptor 3y ago
        > You can just trust IP geo databases to be accurate down to the country* You can't trust even that. There's an ISP which shares the IP pool between its child companies (? or some similar arrangement) in Crimea and Poland. We found out when Polish subscribers got affected by sanctions on business with Crimea.
      - 5e92cb50239222b 3y ago
        My home IPs get placed into another country by geolocation all the time (it's probably more wrong than right). My VPN IPs (for which I always use either Finland or the Netherlands) have been geolocated to: three states in the US, Dubai, and several other EU countries. Don't trust it for anything important ever.
  - saghm 3y ago
    At one point during the pandemic, I lived in a different state than two doctors who I saw virtually every few months (due to moving during the pandemic to a nearby city that happened to be just across the border). The state I lived in put fairly short deadlines on how long they'd allow out of state telemedicine, and whenever it came within a few weeks, they reiterated to the doctors I saw that they would _not_ extend the deadline...only to extend it at the last minute anyhow. By the time it finally didn't actually get extended, I had moved back, so I didn't need to actually make this decision, but the sense I got is that the ones who would have gotten in trouble would be the doctors, not the patients, and considering that I knew and liked these doctors (and obviously had a vested interest in them continuing to practice), I wouldn't have risked it for their sakes, despite the inconvenience.
  - spondylosaurus 3y ago
    I regularly see an out-of-state provider via telemedicine and no, nothing stops me from lying and saying that I'm in the same state as the provider. (He knows and doesn't care.) The telemedicine visits themselves are conducted through MyChart. It's definitely not checking my IP or it would've caught me a long time ago, especially since I have to check the "I am currently in <x state>" checkbox every single time I see him :P
xyzelement 3y ago
I don’t totally know where I fall on this question but the obvious (isn’t it?) counter is that cross-jurisdiction telemedicine makes certification very difficult. IE if I am a New Yorker being treated via telemedicine by someone in Alaska or Nigeria, should New York be concerned that I can be treated by someone it would not consider a “real doctor,” and may not even be a doctor in the jurisdiction they are in? You can argue that the market would sort itself out eventually because those who didn’t know how to find useful teledocs would die out, but it’s up you you whether you are comfortable with that.
- happytiger 3y ago
  How about we address problems with laws after we have a problem? You’re using an edge case of a doctor in another continent to illustrate why we shouldn’t allow telemedicine appointment in the same country’s medical system across regions. That argument is classic false equivalence.
  - lazyasciiart 3y ago
    Ok. How about a doctor who loses their license in WA. Can they still practice telemedicine?
  - temp102223 3y ago
    Because then you have microplastics in the most remote reaches of the earth, and still no political will to do anything about it. Imagine if we were restrictive in the first place... The luddites could teach us a thing or two.
- pdonis 3y ago
  > cross-jurisdiction telemedicine makes certification very difficult No, it makes certification by State governments very difficult. The solution to that "problem" is obvious: stop the monopoly that State governments have on certifications. Let patients decide based on whatever information they deem relevant whether a doctor is "certified" to treat them. There are already many private sources of information about doctors.
Spooky23 3y ago
In the context of clinical trials at cancer centers, sure. But for normal doc in the box telemedicine, it’s a recipe for disaster, as shitty doctors will shift or pretend to shift between state lines to avoid license disciplinary actions. There’s so many NPs and PAs in practice now, the state requirements are unlikely to be a big burden for most cases.
- idopmstuff 3y ago
  When you force people to come into the doctor for things they don't actually need an in-person visit for, you're making a lot of them drive there, and driving has risk of serious injury or death. You're also putting them in a room with other patients, some of whom will have contagious illnesses. Probably most importantly, you're causing some of them, who don't have the time or transportation to get to a doctor's office, to miss out on getting health care entirely.
  - Spooky23 3y ago
    That’s not what I said. There’s no need to risk death to drive to the doctor. There’s also no reason to risk death by getting ripped off or getting substandard care from a doctor of questionable ethics and ability. It’s pretty simple - you see an online provider in your state or a state with reciprocity. I used to be familiar with medical frauds. Doctors who “see” 600 patients a day, etc. Online medicine is pretty bullshitty to begin with, but kneecapping the primary controls that we have to address fraud and abuse is not progress. Anything that undermines trust in the name of supposed convenience is a net negative.

zetazzed 3y ago

I have a very conscientious friend who used to drive across state lines to do a video visit from their car with an out of state provider. It's pretty wild to think about what a waste and time sink this is for families with complex illnesses.

zielmicha 3y ago
Is there anything that stops patients from lying that they are in a different state (just temporarily)?
- userinanother 3y ago
  No but insurance might not cover it
- pdonis 3y ago
  If the telemedicine app can geolocate your IP address it can independently determine what state you are in.
  - chmod775 3y ago
    You can just trust IP geo databases to be accurate down to the country* - and that's only most of them time and not even considering VPNs exist. Sure, if something looks fishy you could then go through the appropriate legal channels to get a more exact location from the ISP, but false positives are going to happen so often, eventually everyone involved might get a bit cranky. * Only the likes of Google have the scale and requisite information to keep more accurate and up-to-date databases, and even those are fallible.
    - viraptor 3y ago
      > You can just trust IP geo databases to be accurate down to the country* You can't trust even that. There's an ISP which shares the IP pool between its child companies (? or some similar arrangement) in Crimea and Poland. We found out when Polish subscribers got affected by sanctions on business with Crimea.
    - 5e92cb50239222b 3y ago
      My home IPs get placed into another country by geolocation all the time (it's probably more wrong than right). My VPN IPs (for which I always use either Finland or the Netherlands) have been geolocated to: three states in the US, Dubai, and several other EU countries. Don't trust it for anything important ever.
- saghm 3y ago
  At one point during the pandemic, I lived in a different state than two doctors who I saw virtually every few months (due to moving during the pandemic to a nearby city that happened to be just across the border). The state I lived in put fairly short deadlines on how long they'd allow out of state telemedicine, and whenever it came within a few weeks, they reiterated to the doctors I saw that they would _not_ extend the deadline...only to extend it at the last minute anyhow. By the time it finally didn't actually get extended, I had moved back, so I didn't need to actually make this decision, but the sense I got is that the ones who would have gotten in trouble would be the doctors, not the patients, and considering that I knew and liked these doctors (and obviously had a vested interest in them continuing to practice), I wouldn't have risked it for their sakes, despite the inconvenience.
- spondylosaurus 3y ago
  I regularly see an out-of-state provider via telemedicine and no, nothing stops me from lying and saying that I'm in the same state as the provider. (He knows and doesn't care.) The telemedicine visits themselves are conducted through MyChart. It's definitely not checking my IP or it would've caught me a long time ago, especially since I have to check the "I am currently in <x state>" checkbox every single time I see him :P

xyzelement 3y ago

I don’t totally know where I fall on this question but the obvious (isn’t it?) counter is that cross-jurisdiction telemedicine makes certification very difficult. IE if I am a New Yorker being treated via telemedicine by someone in Alaska or Nigeria, should New York be concerned that I can be treated by someone it would not consider a “real doctor,” and may not even be a doctor in the jurisdiction they are in? You can argue that the market would sort itself out eventually because those who didn’t know how to find useful teledocs would die out, but it’s up you you whether you are comfortable with that.

happytiger 3y ago
How about we address problems with laws after we have a problem? You’re using an edge case of a doctor in another continent to illustrate why we shouldn’t allow telemedicine appointment in the same country’s medical system across regions. That argument is classic false equivalence.
- lazyasciiart 3y ago
  Ok. How about a doctor who loses their license in WA. Can they still practice telemedicine?
- temp102223 3y ago
  Because then you have microplastics in the most remote reaches of the earth, and still no political will to do anything about it. Imagine if we were restrictive in the first place... The luddites could teach us a thing or two.
pdonis 3y ago
> cross-jurisdiction telemedicine makes certification very difficult No, it makes certification by State governments very difficult. The solution to that "problem" is obvious: stop the monopoly that State governments have on certifications. Let patients decide based on whatever information they deem relevant whether a doctor is "certified" to treat them. There are already many private sources of information about doctors.

Spooky23 3y ago

In the context of clinical trials at cancer centers, sure. But for normal doc in the box telemedicine, it’s a recipe for disaster, as shitty doctors will shift or pretend to shift between state lines to avoid license disciplinary actions. There’s so many NPs and PAs in practice now, the state requirements are unlikely to be a big burden for most cases.

idopmstuff 3y ago
When you force people to come into the doctor for things they don't actually need an in-person visit for, you're making a lot of them drive there, and driving has risk of serious injury or death. You're also putting them in a room with other patients, some of whom will have contagious illnesses. Probably most importantly, you're causing some of them, who don't have the time or transportation to get to a doctor's office, to miss out on getting health care entirely.
- Spooky23 3y ago
  That’s not what I said. There’s no need to risk death to drive to the doctor. There’s also no reason to risk death by getting ripped off or getting substandard care from a doctor of questionable ethics and ability. It’s pretty simple - you see an online provider in your state or a state with reciprocity. I used to be familiar with medical frauds. Doctors who “see” 600 patients a day, etc. Online medicine is pretty bullshitty to begin with, but kneecapping the primary controls that we have to address fraud and abuse is not progress. Anything that undermines trust in the name of supposed convenience is a net negative.