Telemedicine lagging in Mass.

Backers say legislation needed to set doctor payments


CARSON DOMEY, a 15-year-old from Bellingham with Crohn’s disease, tallied up the number of doctor’s appointments he’s gone to and presented a rough total to lawmakers: more than 250.

 Those appointments, Carson told the Financial Services Committee on Tuesday, resulted in “excessive” time out of school, forced him to miss “typical teenage activities” like sports and social events, and exposed him to germs while he was on medication that suppressed his immune system.

He estimated that more than half of those appointments could have taken place through telemedicine, in which doctors use telecommunications technology to diagnose, treat or otherwise interact with a patient.

“I was fortunate enough in 2016 to pilot telemedicine with my doctor,” Carson said. “I quickly realized from this personal and convenient delivery of care method that telemedicine afforded me more time in my day and caused less stress.”

Rep. Michael Soter, a Bellingham Republican, called Carson an “unbelievable young man” and said legislation to expand telemedicine “means so much to him.”

“The time has come that this has to happen, and I’m hoping that this will be the session that it does happen,” Soter said.

The committee’s hearing on telemedicine bills comes more than a year after House-Senate negotiations on sweeping health care legislation collapsed, leaving telemedicine reforms, financial support for community hospitals, pharmaceutical pricing controls, and more atop the list of unfinished business for the 2017-2018 legislative session.

Sen. James Welch, the lead Senate conferee on last session’s health care bill and now the co-chair of the Financial Services Committee, said after the hearing that he sees broad agreement that advancing telemedicine policies is “long overdue,” but that “some of the technical components and the financial components” need to be ironed out.

“The use of technology to make their lives easier is something that people are now used to, and I think they’re expecting those sames types of services and that same type of access in their health care — obviously only when it’s appropriate, there’s only certain types of visits or certain types of assessments that can be done through telehealth,” Welch, a West Springfield Democrat, said. “When you think about all the potential cost savings that go along with it, I think we as a commonwealth really need to focus on advancing something this session — not only advancing it, but completing it this session.”

Senate President Emerita Harriette Chandler said many Massachusetts providers use telemedicine already, but there’s “no regulatory infrastructure” for insurance coverage, creating financial and logistical challenges. She said telemedicine can be “really essential” for people who otherwise might not be able to access in-person services.

“I’ve carried a bill like this for some 10 years,” Chandler, a Worcester Democrat, said. “We had an opportunity 10 years ago to be the first to deal with and regulate telemedicine, and now we are among the last states to do this.”

Sarah Chiaramida of the Massachusetts Association of Health Plans pointed to a March 2019 report by the nonprofit FAIR Health, which collects and manages health insurance claims data. She said the report showed that Massachusetts already has one of the highest telemedicine utilization rates.

Referencing traffic congestion that can make driving into Boston difficult, Dr. Craig Best said he pictures “a world where doctors spend some of their time working at home, and patients are not forced to come into Boston for highly specialized care.” [Photo: Sam Doran/SHNS]

Chairamida said MAHP supports telemedicine as a potential cost-saving alternative, but opposes language that would require all forms of telemedicine be reimbursed at the same rate as in-person visits, preferring to leave reimbursement decisions to be negotiated as part of a contract between a provider and health plan.

“We strongly oppose any requirement that an in-person rate be utilized for all forms of telemedicine regardless of their form,” she said. “Provision of health care through telemedicine is intended to create efficiencies and cost savings and increase access, and a lot of these new forms are not necessarily the functional equivalent of a face-to-face visit.”

Dr. Craig Best, an obstetrician and gynecologist who serves as president and CEO of the Tufts Medical Center Physicians Organization, said insurance coverage for telemedicine can be “inconsistent and inadequate.” As a manager of doctors, he said he “cannot expect my physicians to open up their clinic schedules and see patients via telemedicine visits without providing coverage for their time, for their services rendered.”

“Insurances will not cover these services unless provided the necessary legislative guidance from you, and providers will not offer these services unless they are covered like face-to-face visits,” he told the committee.

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Katie Lannan

State House News Service
Aside from expanding access to specialists and offering care in a way that fits more easily with patient schedules, Best said telemedicine could also play a role in alleviating the traffic that gridlocks greater Boston.

“Our highways are congested, and it’s hard to get into the city, and we speak of our concern for the environment,” he said. “I can imagine a world where doctors spend some of their time working at home, and patients are not forced to come into Boston for highly specialized care.”