By: Miranda Spindt

During the pandemic, the ability to speak with a doctor through mediums such as videoconferencing, phone calls and text messages became vital. While it was extreme circumstances making this necessary, the additional healthcare access it provides is becoming more essential. By 2036, we are projected to have a national shortage of 86,000 physicians making it even harder, especially for rural populations, to get the care they need. Wisconsin has made great strides in expanding access to telehealth services, but we still need to expand access for telehealth across state lines to remove geographic and financial barriers to healthcare for our residents.  

According to a 50-state report of telehealth best practices, Wisconsin has great laws for modality neutrality. This means the state “allows synchronous and asynchronous (interaction with healthcare professionals) explicitly or has a broad enough definition for their use”. Overall, Wisconsin offers doctors and their patients great flexibility in how best they can access and receive care.  

• Patients and doctors can communicate in the way that works best for them, whether that’s a scheduled videochat or texting.  

• Doctors and patients can start their relationship using the modality of their choice, rather than being required to meet for the first time in person. 

• Doctors can use remote patient monitoring to track their patients’ health information such as heart rate and blood pressure using technology, rather than requiring patients to come to a facility.  

However, this flexibility does not extend to out-of-state providers. As the shortage of physicians grows, it will be more difficult to find doctors, particularly specialists, who practice in the same state. If the doctor that someone needs is in a different state, then access to that care will be limited to those who have the time and money to travel to them.  

There are also many situations where telehealth with an out-of-state provider is the best option for a patient. For example, residents who split their time in Wisconsin and another state can keep the same doctor year-round. Those who live along the state border could more easily work with a doctor in cities such as Dubuque or Minneapolis. It also provides extra flexibility if patients need to find an appointment quickly, wants a second opinion, or increases the opportunity to find lower cost services.  

As of right now, there are limited pathways for out-of-state doctors to provide telehealth services to Wisconsin residents.  

Wisconsin is part of multiple state compacts which allows easier mobility of healthcare providers between the compact member states. These are a step in the right direction but still have significant setbacks. It limits out-of-state providers only to those who are in other compact states. For example, the Physician Assistant Licensure Compact only has 13 member states with three pending, not including Illinois or Iowa, and won’t be operational for another two years. While other compacts have larger participation, the most populous states with presumably more providers have yet to participate. Of the eight compacts Wisconsin has joined, six of them do not include California, four do not include Texas, and three do not include Florida. Additionally, the approval process for providers who want to practice in other compact states can still be slow and costly.  

Some progress was made in the 2023 legislative session to create an easier and more universal process. Senate Bill 476 prohibits DHS from requiring a physical Wisconsin address for Wisconsin licensed providers or provider groups that exclusively provide telehealth services in the state to enroll in the Wisconsin Medical Assistance program. This is open to providers of any state but is still very limited. They still must go through a Wisconsin licensing process and this only applies to the Medical Assistance program.  

Assembly Bill 875 proposed an ideal solution by allowing out-of-state telemedicine providers, who are licensed and in good standing, to practice within the scope of their state license in Wisconsin without obtaining a separate Wisconsin license, provided they register with the Department of Safety and Professional Services (DSPS). As of October 2023, eight states have similar laws including Minnesota, Indiana, and Kansas. Unfortunately, the bill did not advance past a committee hearing despite no one registering against it.  

Assembly Bill 541 was similar, but only applied to mental health professionals including psychologists, counselors, therapists, and social workers. This one had bipartisan support in the legislature but was ultimately vetoed by Governor Evers who claimed that he “cannot support legislation that is likely to ultimately reduce healthcare quality and patient protections.” However, he did support this exact policy during the COVID-19 emergency where doctors, who were specifically providing telehealth to Wisconsin residents, were able to do so without obtaining a Wisconsin license. If this was adequate during a public health emergency, it should still be now.  

Just how airline pilots do not lose their ability to fly when they cross state lines, providers do not lose their ability to practice. Telehealth is the future of healthcare access, and Wisconsin should remove unnecessary barriers to telemedicine to ensure none of our residents are lacking due to their geography or income.