Today we delve into a health care bill that has managed to garner bipartisan support in a divided legislature.
House Bill 1029, which aims to expand telehealth services, was passed unanimously by the House Health, Insurance and Environment Committee last week before making it through the full House this Wednesday on a 58-6 vote. It is now on its way to the Senate.
Its success resulted from the backing of a diverse group of stakeholders, including some who are often on opposing sides of health issues. Physicians and representatives from a hospital association, psychiatric and medical societies, and a health plan all testified in support of the policy.
The bill would change the way that telehealth services are reimbursed. Currently, in counties with populations below 150,000, insurance companies must pay for telehealth visits the same way they pay for in-person appointments. This proposal would end the population limit, making telehealth reimbursable statewide. It also would bar health plans from requiring in-person visits when telehealth is deemed an appropriate alternative.
By way of background, telehealth is an increasingly popular health care delivery method that remotely connects doctors and other health care providers with patients in a different location. It encompasses video consultations, electronic transmission of information such as X-rays and EKGs, and remote observation of a patient’s vital signs. It can occur through computers, tablets or smartphones that use a secure network. HB 1029 originally used the term “telemedicine,” but it was amended at the committee hearing to replace all uses of that term with the more inclusive “telehealth.”
The bill’s strong backing was aided by a number of amendments, including one that would delay the starting date for changes from 2016 to 2017. This means that health plans would not have to re-review their current offerings. The amendment also clarified that health plans will be required to equally reimburse only “participating” – or in-network – providers of telehealth services.
Despite smooth sailing to this point, the bill has pros and cons that could spur a debate in the Senate.
On the positive side, it could increase access to health care for many Coloradans and could also result in savings of both time and money for consumers. Samantha Lippolis, Telehealth Manager at Centura Health, described it as a way to stretch a scarce resource: primary care providers and hard-to-find specialists.
A number of physicians testified about patients in both urban and rural settings who had benefitted from videoconferencing and other remote-technology services. The patients included a woman who lives four hours from the specialist treating her for complications from surgery. Dr. Clay Watson said that he is able to meet with the woman via an iPad in her local surgeon’s office. He said those appointments are the only time he is able to be “in the same room” with her surgeon.
Dr. Fred Thomas, Director of Telehealth at Children’s Hospital Colorado, said that behavioral health consultations would be one of the best fits for telehealth services.
While no one testified against the bill, there are potential concerns, including the possibility that telehealth would encourage a greater use of health care services and therefore cause an increase in overall spending. Additionally, the technology costs could be prohibitively expensive for some providers. Telehealth services also depend on consistent broadband connectivity, including in rural areas where that can be problematic.
In addition, a variety of questions remain, including how to determine the appropriate level of malpractice liability for telehealth providers and whether insurance companies can use telehealth physicians to count toward their reported numbers of in-network providers.
Rep. J. Paul Brown (R) posed a question about costs. If telehealth services are cheaper, he asked, why should insurance companies have to pay for them at the same rate as in-person care? Could requiring equal reimbursement prevent potential cost savings to the state? We expect this issue may come up again as the bill progresses to the Senate.
While details and nuances remain to be explored, HB-1029 effectively serves as a case study for how to earn bipartisan support. CHI will continue to follow its progress.