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Study: In-home healthcare expansion requires overcoming market and technical barriers


In a new working paper published Thursday from the Mercatus Center, a free-market-oriented think tank based out of George Mason University, professor Philip E. Auerswald argues that removing labor market barriers and technical barriers to entry are vital for realizing the benefits of in-home healthcare, including telehealth.

Home healthcare, as Auerswald describes it, comprises medical house calls, health agency care, technologies such as remote patient-monitoring devices and telehealth.

“Each of the four elements of distributed health services has progressed rapidly over the past decade, more or less independently of the others,” Auerswald wrote. 

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“As these service models begin to converge and reinforce one another in the decade to come, the disruption of today’s institution-centered modes of health service delivery in favor of patient-centered, largely home-based models is likely to intensify, whether or not such a change is deliberately advanced by policymakers,” he argued.

In his study, Auerswald found that labor market barriers to entry, such as licensing requirements, and technical barriers to entry, such as regulatory approvals and interoperability standards, constitute “the most significant barriers to entrepreneurial entry.”


Auerswald notes that the future of in-home care, though uncertain, is likely to expand beyond what is currently available. Such potential services include e-consults, computer-based cognitive behavioral therapy, digital image-enabled dermatology, and apps for behavioral modification such as smoking cessation, among others.

However, he said, the barriers currently in place prevent unfettered expansion into these arenas. 

In order to reduce labor-market and regulatory hurdles, Auerswald recommended that states reform licensing restrictions to allow nurse practitioners and other nonphysicians to do more in terms of chronic and wellness care, and that the U.S. Department of Health and Human Services “engage in an active dialogue” with health boards and associations about adjusting accreditations to include professionals specializing in mobile care delivery, among other policy changes.

Regarding technical barriers to entry, Auerswald’s recommendations included urging the U.S. Centers for Medicare and Medicaid Services to extend administrative flexibility around greater portability of licensure for telehealth service providers. He also said policymakers should renew their commitment to expanding broadband access throughout the country.

“States and the federal government should work to harmonize definitions and regulations (e.g., licensure and privacy) as they pertain to telehealth service provision, organizing around the practices in pioneering states that have most successfully achieved cost reductions and service improvements through the use of telehealth,” Auerswald wrote.


Although it’s clear that changes must be made to the regulatory landscape to safeguard telehealth access in the long term, stakeholders are not unified in what these changes should look like.

Many legislators, for instance, have advocated for the removal of originating and geographic site restrictions on the use of telehealth in Medicare. But the details of telehealth reimbursement are still unknown.

And licensure remains a thorny issue, with the American Medical Association and other groups calling on CMS this summer to sunset pandemic-era waivers related to scope of practice.


“Given what we have already experienced with COVID, returning healthcare to the home with more telehealth, medical health calls, and peer-to-peer health service provision is highly likely to be a huge trend over the next quarter century,” Auerswald said in a statement provided to Healthcare IT News.

“However, government at both the state and federal levels needs to do more to eliminate burdensome regulations so the labor market and technology industry can innovate,” he added.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.


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