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Iowa telemedicine proves popular in the pandemic - but will it continue?

How much Iowa providers get paid by insurers emerges as big issue

Jun 26, 2020 at 7:00 am
    Dr. Alicia Allen talks with a patient during a June 15 virtual doctor visit in her office at UnityPoint Clinic Family Medicine Northridge in Cedar Rapid. Doctors and patients turned to telemedicine since the beginning of the coronavirus pandemic in Iowa, and Allen sees it as a positive practice that she hopes will become more popular. (Rebecca F. Miller/The Gazette)

    The novel coronavirus pandemic has been a game-changer for telehealth in Iowa.

    Health care practitioners have adopted telehealth in wide swaths over the past few months, prompting a surge in use among Iowans. And those patients embraced the experience, reporting high satisfaction in the level of care provided.

    But once Iowa does emerge from the pandemic, will telehealth be here to stay?

    According to Dr. Alecia Allen, it is.

    “Both from a clinical side and the patient experience side, I don’t see (telehealth) going away,” said Allen, a family medicine physician at UnityPoint Clinic Family Medicine Northridge in Hiawatha. “I don’t see it becoming the main form of how we provide care, but I think it is an optional form of care.”

    Telehealth services for medical and behavioral health care existed long before the novel coronavirus. But for many Iowans, the pandemic prompted their introduction to it. Many practitioners, including Allen, say the service remains an effective way of providing care — pandemic or not.

    “Ninety percent of diagnoses come from history alone,” Allen said. “By visiting with a patient and doing a comprehensive history, I can get a good idea of what’s happening with people while they are in their home.”

    But previously. telehealth was slow to gain traction in the state. Advocates say it’s because virtual health appointments traditionally have been reimbursed by insurance companies at a lower rate than in-person appointments.

    “The reason it hasn’t picked up in the past is because there wasn’t enough payment for the value the provider was putting into it,” said Sen. Liz Mathis, D-Hiawatha. “The time spent with a patient on telehealth is the same time put toward the patient if the appointment was in-person.”

    The pandemic, as well as new policies implemented in the past few months, has opened the door for advocates to push the discussion on payment parity, said Jack Dusenbery, president and chief executive officer of MercyOne’s Northeast Iowa region.

    And with the financial blow many health care systems have sustained because of COVID-19, parity has become the No. 1 issue in Iowa, he said.

    “It’s become more dynamic today, because the last three months have been financially devastating,” Dusenbery said. “It’s hard enough to pay me less, but now, in the future, I have to recover. Physician’s offices have lost millions and to pay me only 50 percent? The mountain is high enough.”

    Insurer continues parity for now

    Telehealth is the facilitation of health and health-related services — including mental and behavioral health counseling and patient education, among others — over a telecommunication platform rather than an in-person visit to a doctor’s office. That includes phone calls, video conferencing and smartphone apps.

    Nationwide, adoption of telehealth services among consumers increased sharply during the pandemic, from 11 percent in 2019 to 46 percent this year, according to a survey conducted in April by Chicago-based consulting firm McKinsley and Company.

    At University of Iowa Health Care, total telehealth visits reached more than 63,000 between early March and the end of May. Before COVID-19, between January and March 9 of this year, there were 726.

    Traditionally, health care providers would receive telehealth reimbursement from insurers at about half the rate they would receive for an in-person visit, said Kim Murphy, vice president of government relations and assistant general counsel at the Iowa Hospital Association.

    That changed in March when Gov. Kim Reynolds ordered insurance companies to reimburse health care providers for telehealth services at the same rate as in-person services — but only until the end of her emergency order.

    After new legislation failed to make it out of the Iowa Legislature before the end of the session, advocates say there’s promise the discussion will continue after the state’s largest commercial insurer said it would continue pandemic-level reimbursement for telehealth.

    Wellmark Blue Cross Blue Shield announced this past week it would reimburse virtual health services at the same rate as in-person services through the end of January — a move made in part to test the waters.

    Scott Sundstrom, vice president of government relations, said officials hope to understand how telehealth could be used in a post-pandemic world.

    “If I have a telehealth visit and I, or other patients, tend to then go in person and see the doctor anyway, that’s not very efficient,” Sundstrom said. “It’s maybe just adding an extra visit, adding utilization and cost.”

    Costs could slow telehealth expansion

    A proposal on telehealth reimbursement considered during the 2020 Legislature would have established floor rates on reimbursement higher than 50 percent, but did not mandate full parity for commercial insurers. Medical telehealth appointments would be reimbursed at 65 percent and behavioral health visits at 95 percent. The bill did not pass before session ended.

    Republicans in the majority in the Senate were hesitant to offer full parity because they were concerned an increased reimbursement rate would mean higher insurance costs for consumers, said Sen. Jeff Edler, R-State Center.

    “When you’re talking parity, it usually means premium increase,” Edler said. “We want to incentivize growth of this, while doing it responsibly. To do this responsibly, we need to keep a cap on the cost for customers.”

    However, Senate democrats argued in the long run, telehealth would decrease health care costs because patients would be more likely to keep their appointments, meaning they would see better health outcomes.

    Missed patient visits did drop significantly throughout the pandemic. At MercyOne Medical Group, no-show rates during the pandemic for specialty appointments ranged between 3 and 4 percent. Typically, the rate is 7 percent, said Angela Conrad, director of operations for MercyOne Medical Group.

    According to the report from McKinsley, people who used telemedicine reported high satisfaction with the experience. The survey found that 76 percent of U.S. consumers say they are likely to use telehealth in the near future.

    “So much of health care is the relationship with providers,” Conrad said. “We know when patients are connected with health care and have a relationship with someone who they think has their best interests in mind, they’re going to access that care before something becomes an emergency.”

    Not only is it a convenient option for medical care, advocates say broadened access in telemedicine is the solution for rural Iowans who live miles away from the nearest doctor and for Iowans in need of mental health services, but without the opportunity to use it.

    But going forward, whether telehealth in Iowa will be here for the long term will depend on whether payment parity continues to be a discussion in policy decisions.

    “I do think telehealth services are here to stay, especially as a younger generation accesses health care in the way they want,” said Murphy, with the Iowa Hospital Association. “More telehealth-based services are popping up, but how it’s able to grow and whether those in need for telehealth will get access will depend on policies to ensure it’s properly funded.”

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