According to a Spotlight PA article published in Monday’s LNP, “The number of Pennsylvanians who have come to rely on phone and video appointments surged after the pandemic made in-person visits potentially dangerous. And many health care providers and insurance companies quickly embraced telehealth as a necessary way of getting patients needed care. But the state is one of only seven that does not have any law requiring private insurers to reimburse for telehealth, resulting in a patchwork system of care. Access to telehealth depends on someone’s insurance company or their specific insurance plan. Even if a patient has coverage, in some cases medical providers don’t provide telehealth because they have to determine eligibility for each of their patients, an onerous process resulting in uneven care.” Spotlight PA is a nonpartisan newsroom powered by The Philadelphia Inquirer; its partners include LNP Media Group.
One of the few upsides of this terrible and frustratingly prolonged pandemic has been the revelation that virtual visits with health care professionals can be as effective and as worthwhile as in-person visits.
When the weather is lousy, when a physician’s office is 40 miles from home, when a visit to a doctor’s office — and more specifically, a wait in a medical practice’s waiting room — is daunting, it’s been helpful to be able to speak to one’s health care practitioner via a smartphone or computer.
And for those whose immune systems are compromised, and for whom crowded waiting rooms are potentially perilous, telehealth is a godsend. Especially as COVID-19 once again surges in Pennsylvania.
In a column published in LNP | LancasterOnline in April 2020, ophthalmologist Dr. David Silbert noted that patients like telehealth visits: “There is less office wait time; they don’t have to travel; and the patient and the doctor often get to spend more time talking to each other.”
That has been our experience, too. This is why telehealth visits often are described as modern-day house calls.
Moreover, as the Johns Hopkins Medicine website points out, “Telemedicine can give some specialty practitioners an advantage because they can see you in your home environment.”
We’d add this: Sound, science-backed information is critical in a pandemic. And who better to provide that information than a medical professional? The easier the access to that information, the healthier — in so many ways — we all will be.
So we find it hard to understand why Pennsylvania doesn’t have a telehealth-access law already on the books.
Indeed, everyone — lawmakers, medical professionals, insurers — should be working to improve access to regular checkups, as preventive care saves lives.
We were struck by this piece of reporting from Spotlight PA: Pennsylvania is one of only seven states that do not have any law requiring private insurers to reimburse for telehealth. The six other states, according to the National Conference of State Legislatures, are Idaho, Wyoming, Wisconsin, North Carolina, South Carolina and Alabama.
As Spotlight PA reported, state Sen. Elder Vogel, a Beaver County Republican, has been trying for the past five years to pass legislation “that would allow the state to oversee health providers practicing remote medicine and explicitly require insurers to reimburse for it. But each year, the measure has failed.”
“In 2016, it never came out of committee. In 2018, it passed the Senate but died in the House.” Last year, Spotlight PA noted, the bill passed in both chambers but — because everything has to be complicated by politics in Pennsylvania — Democratic Gov. Tom Wolf vetoed it. Why? Because Republican state Rep. Kathy Rapp of Warren County, who chairs the House Health Committee, amended the legislation to prohibit providers from prescribing abortion-inducing medicine via telehealth.
We find it deeply frustrating that this amendment derailed a piece of commonsense legislation that would have greatly simplified the process of getting telehealth in the commonwealth.
Spotlight PA explains the current, complex system: “Because there is no law mandating telemedicine in Pennsylvania, there’s nothing barring providers from practicing it, but insurers are not required to cover it. In other states, laws provide parity between in-person and remote health care services.
“Instead, insurance companies decide what kinds of telehealth appointments are covered based on their own policies and the agreements they may work out with health care networks or individual doctors.”
This process can be burdensome for health care providers that aren’t part of a network, because each patient’s coverage may be different, Kathy Hsu Wibberly, director of the Mid-Atlantic Telehealth Resource Center, told Spotlight PA.
“What happens now in Pennsylvania is a patient will call the office and ask if they can have a telehealth visit and a provider will say no because they don’t want to have to go through all the checks on this particular insurer, and sometimes it’s not even the insurer, it’s plan by plan,” Wibberly said.
Does that sound familiar to you?
Our health care system is filled with excellent medical professionals but it is nevertheless a morass of uneven access to care and vexing inefficiencies. Providing telehealth to everyone, no matter their insurer, seems like a relatively attainable goal in a system facing overwhelmingly challenging problems.
As Sam Marshall, president of the Insurance Federation of Pennsylvania, a lobby for the industry, told Spotlight PA, most insurers now are paying for telehealth.
But, as that watchdog site noted, “without regulations, there’s no guarantee to care.”
“The challenge with it is the payment for the services,” Lisa Davis, director for the Pennsylvania Office of Rural Health at Penn State University, told Spotlight PA. “There has been a tug between the providers — the hospitals and the clinics and the payers — in terms of what is considered to be telehealth and how it will be paid.”
The Pennsylvania Department of State implemented “a temporary policy at the beginning of the COVID-19 pandemic that explicitly allows licensed health care providers to practice telemedicine, but that waiver expires in March,” Spotlight PA noted.
So clearly, legislation is needed, and soon, to ensure that telemedicine remains an option for the many Pennsylvanians — particularly rural Pennsylvanians — who need it.
If it’s going to get the governor’s signature, it needs to be a clean bill, without partisan abortion restrictions attached.
Vogel’s latest telemedicine bill, SB 705, passed in the state Senate in October with bipartisan support. State Sens. Ryan Aument, of West Hempfield Township, and Scott Martin, the Martic Township Republican running for governor, voted in favor of the bill. So, too, did Democratic Senate Minority Leader Jay Costa.
Vogel told Spotlight PA that abortion drugs “have no place in my legislation.”
So many Pennsylvanians would benefit from the passage of a law that would require private insurers to pay for telehealth visits. Please urge your state representatives to support a telemedicine bill that can win bipartisan approval.