Telehealth coverage could be 'game-changer' for rural Iowans

Bill would require insurance benefits whether in office or remote

DES MOINES — Delivering health care to “medical deserts” in rural Iowa could get easier with passage of legislation expanding access to telemedicine.

“This is the way it’s going to be done in the future,” said Amy Campbell, a lobbyist for groups supporting House Study Bill 572, which would require a health insurer to provide the same benefits for covered services whether they are provided in person or remotely by telehealth.

HSB 572 is being offered by Rep. Peter Cownie, a Republican from West Des Moines where there are numerous health care providers, including many specialists, for patients.

“But there are a lot of small towns and rural areas where not every hospital has every doctor you might need,” explained Cownie, chairman of the House Commerce Committee.

Cownie and Rep. David Heaton, R-Mount Pleasant, chairman of the House Health and Human Services Appropriations Subcommittee, visited Iowa Specialty Hospitals in Clarion. Making rounds with hospital personnel, they observed hospital providers and patients visit with medical professionals in the University of Iowa Health Care’s Virtual Hospitalist Service. With an iPad and a secure connection between the hospitals, the virtual hospitalist reviewed the patients’ care plans.

Gaining coverage of telehealth services would be a “game-changer,” said Michael Hurt, chief medical officer at the Clarion hospital.

One of the most obvious benefits is that telehealth “allows patients to be treated locally” rather than travel to UI Health Care in Iowa City, a three-hour drive from the north central Iowa community of about 2,800 people, Hurt said.


Keeping care local helps patients avoid traveling, taking time off from work or being away from their families.

It also expands rural Iowans’ access to health care, especially in specialty areas such as psychiatry, Cownie said. He and Hurt believe numerous services will become available to Iowans regardless of address if health insurers provide the same reimbursement whether they are delivered face-to-face or via video conferencing.

“It’s a lot easier to find a psychiatrist in Iowa City or Des Moines to provide access” than in rural Iowa, said David Adelman, a lobbyist for UnityPoint Health.

Iowa has been dealing with a psychiatrist shortage for years. Eighty-nine of the state’s 99 counties have a mental health professional shortage, according to the federal Health Resources and Services Administration.

Sometimes patients in Iowa are going farther over the internet than Iowa City for their telehealth. Patients at some southern Iowa community clinics “meet” with a psychiatrist in Kansas City or another in Hawaii, Campbell said.

For others, the connections are closer. Many community clinic staff members split their time between locations.

“But they can’t be in all places every day,” said Campbell, who lobbies on behalf of the Iowa Primary Care Association that represents 14 federally qualified health centers, including Eastern Iowa Health Center in Cedar Rapids, Iowa Association of Rural Health Clinics and AARP — all supporters of HSB 572. So staff members who have gaps in their schedules can hold telehealth sessions with patients at another clinic.

It’s easier for a rural Iowa resident to fit a telehealth session into his or her schedule than take time off from work to travel to an urban hospital. Telehealth can help hold down health care costs, Adelman said.


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That’s one reason UnityPoint Health supports HSB 572, said Sabra Rosener, its vice president for government and external affairs.

“It will be positive for our patients and a cost savings to health programs if private insurance companies recognize the substantial benefits of telehealth services,” she said, adding that Medicare and Medicaid already pay for telehealth.

Wellmark Blue Cross Blue Shield is registered as undecided on the bill, but is “generally supportive,” according to a representative of the company. Although there would be costs, the company sees the possibility for savings or to control costs.

In many cases, Campbell said, telehealth not only expands access to specialties but to routine care. Iowa has one of the lowest physician-to-population ratios in the country, meaning there are shortages of primary care physicians and specialists.

Telehealth has also expanded the availability of counseling for substance use and addictions. Providing mental health services is a compelling argument for Cownie.

“This is a direct way to get mental health services,” he said. “I haven’t heard a better answer.”

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