2 doctors weigh in on Beacon Hill negotiations
FOR DECADES, Massachusetts has been known for having the best health care in the world. As doctors who’ve practiced medicine for a combined 40 years in the Commonwealth, we have seen firsthand how our state has enjoyed the best hospitals and best doctors and providers to deliver the highest standard of care. Our biggest challenge? How to ensure those exceptional services can be accessed by every patient who needs them.
Then came COVID-19 – which threatened our nation’s health care system like no time in modern history. Instead of collapsing, our health care system reinvented itself. The rapid and effective use of virtual care (telehealth and other services) allowed us to continue to provide care to patients while the threat of coronavirus kept them at a distance. Patients with behavioral health needs, many of which were exacerbated by the pandemic, were able to still see their mental health providers. Patients with acute stroke could get rapid evaluations in a local emergency department but be transferred for advanced care if necessary. Unlike in-person visits to shops, restaurants, and bars which were abruptly cancelled, much needed virtual visits to medical specialists could continue unimpeded. Regular medical care is like car maintenance, when it is postponed or ignored conditions deteriorate rapidly.
Virtual care isn’t new. Last winter it represented less than 1 percent of physician visits nationwide, but nationwide by April primary care phone and video visits in Medicare spiked to over 1 million visits per week, and here in Boston, Mass General Brigham clinicians completed more than 1.3 million virtual visits over five months. At Baystate Health, that number was nearly 300,000. Even today, as in-person care has resumed, virtual care remains an integral part of ongoing treatment in Massachusetts.
Virtual care benefits countless individuals in Massachusetts who struggle to see a doctor, including those who live in rural communities with little access to transportation or whose jobs or finances make it difficult to travel long distances. It benefits homebound seniors with limited mobility and working parents who struggle to find time to take their children to the pediatrician. For these people, virtual “house calls” have been, well, just what the doctor ordered.
Sometimes virtual care is preferable to in-person care, such as when creating more privacy for the treatment of sensitive or stigmatized health conditions. For those without reliable internet access struggling with mental illness and substance use disorders, virtual visits by phone have been a lifeline in a time of social isolation.
Will doctors like us be able to provide these necessary services once the pandemic subsides? That’s a question the Massachusetts Legislature is debating right now.
A small group of Senate and House lawmakers are reconciling competing bills that would determine the future of virtual care in Massachusetts. Thus far, the Commonwealth has taken appropriate steps to ensure the success of telehealth by video or phone during the pandemic – lifting a number of restrictions on access. However, legislators are debating whether insurance would be required to cover certain telehealth services and not others – and whether practitioners that deliver them will be compensated fairly by either private insurance or MassHealth, the state’s public insurance program.
Another issue is whether patients would be required to have an initial in-person exam before they can be prescribed medication by their doctor – which could defeat the purpose of telehealth and make Massachusetts the only state in the nation to mandate such a visit.
At a high level, the central theme of this debate appears centered around the role of telemedicine in a post-pandemic world – how do you balance the clear benefit of and convenience and access enabled by virtual care with the need to maintain high quality standards, ensure fair payment, and safeguard patient privacy in an increasingly technology-based world.
As doctors, the answers to these questions seem clear. As we continue to battle the pandemic and well after it ends, virtual care is going to be central to health care delivery across the country and part of our “new normal.” Rather than legislating where, when, if, and how patients can see their provider, we should be capitalizing on the incredible progress we’ve made in expanding access to health care these last several months. This means adopting a legislative framework that does not draw bright lines and does not provide unnecessary limitations that would constrain our collective ingenuity and capacity to innovate. Massachusetts has always been a global leader in health care. We can’t let this opportunity to continue that leadership pass us by.
Our hope is that the Legislature adopts a generous, flexible, and long-term approach to ensuring optimal access to care for our patients.
Dr. Lee H. Schwamm is vice president of digital health virtual care at Mass General Brigham and a professor of neurology at Harvard Medical School. Dr. Edward Feldmann is the chair of the department of neurology and professor of neurology at the University of Massachusetts Medical School-Baystate