- Telehealth parity and interstate licensure are on the agenda in Nebraska, as state officials look to combat healthcare access problems in this decidedly rural state.
Lawmakers have announced two separate bills that aim to make telehealth easier in the state. One would require private payers to reimburse healthcare providers who use telehealth at the same rate they get for in-person services. The second would have the state join the Federation of State Medical Boards’ Interstate Medical Licensure Compact, which creates an expedited licensing process for providers wishing to practice across state lines.
"As we consider the shortage of doctors and practitioners throughout the state, we're going to need telehealth," Sen. Mark Kolterman, R-Seward, the lead sponsor of both bills, told the Associated Press.
Nebraska’s Medicaid program already supports telehealth parity. This bill would expand that requirement to private insurers.
Some 32 states and the District of Columbia have legislated some sort of parity for private payers, according to an August 2016 health policy brief prepared by the Robert Wood Johnson Foundation and Health Affairs, though those rules vary by state. Twenty-three states legislate full parity, while the remaining nine allow payers to include certain factors in reimbursement.
“By reimbursing at the same rates as in-person services, states support the growth and development of telehealth, while encouraging more and more physicians to use it as a method of care,” the brief states in its argument for telehealth parity. “Furthermore, if reimbursements for telehealth do not align with in-person services, the cost savings projected for telehealth will never be realized because providers will stay with in-person services to recoup their costs.”
“Without parity, there are limited incentives for the development of telehealth or for providers to move toward telehealth services,” it notes. “If there are no incentives to use telehealth, then providers will continue to focus on in-person care, which will keep healthcare costs high, continue to create access issues and possibly provide lesser standards of care for chronic disease patients who benefit from remote monitoring.”
In contrast, the brief notes, argument against parity include:
- Telehealth technology hasn’t proven its value yet, and may lead to unreliable or substandard care;
- The platform may skew the balance of quality care, creating “a greater inequity in the quality of care available in rural areas;”
- Because telehealth appointments are often one-time encounters, there are concerns that the data from such a visit won’t make it into the patient’s medical record, creating gaps in care and in some cases putting pressure on the patient to verify the encounter;
- There are concerns about patient privacy and the security of medical data in a virtual environment; and
- If telehealth does prove to save money, that should be factored into reimbursements alongside the risks and the potential for lower quality of care.
Massachusetts lawmakers faced a similar battle last year, when efforts to include parity in a new bill were met by stiff resistance from the insurance industry.
"It's mostly a vehicle for making sure that people who want to do telemedicine on whatever terms they make up and charge what they want will get away with it," Jim Kessler, general counsel for Health New England argued. "If you mandate certain services and reimbursements, you're taking away the whole negotiating ability of health insurers to benefit consumers."
Nebraska’s effort has the backing of the Nebraska Association of Health Underwriters, among others.
"Telehealth is kind of the wave of the future as far as accessing the health system," Craig Currier, a lobbyist for the Omaha-based insurance industry trade group, told the Associated Press.
The second bill, meanwhile, would put the Nebraska on track to join 18 other states who have joined the IMLC, including neighboring states Iowa, Colorado, Kansas, South Dakota and Wyoming. Michigan is currently debating joining the compact, which preserves each state medical board’s licensing and regulatory rights but streamlines the process for applying for multiple licenses.
Pennsylvania became the 18th state to join the compact last October.
“In the world of apps and telehealth, the interstate compact allows qualified, licensed physicians to follow this new technology across state lines,” Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania, said following the bill’s signing into law. “Equally important, as many rural areas of Pennsylvania face physician shortages, is the ability for doctors to move back and forth across state borders.”
Not everyone agrees that a compact is a good thing, however. Ohio legislators shot down the proposal last year, citing concerns with “additional bureaucracy and lack of operational clarity.” Missouri, meanwhile, has supported compacts for nurses and physical therapists but has conspicuously avoided doing the same for physicians.