- Proposed telemedicine legislation in Montana has stalled, reportedly because legislators are concerned the bill won’t help rural residents access the telehealth services they need.
House Bill 389, which seeks to set telemedicine practice standards in one of the nation’s most rural states, was shot down by a 38-12 vote in the Senate, despite support from both the state’s Board of Medicine and medical society and an earlier favorable vote in the House.
According to Politico, state senators soured on the bill because it focuses on audio-visual telemedicine and bans phone-based consults as a means of establishing a doctor-patient relationship. More than half of the state’s residents reportedly don’t have access to sufficient broadband to support video consults, so a telephone might be their best link to telehealth.
In proposing the bill, State Rep. Kirk Wagoner (R-Montana City) said he wanted to “put sideboards on the practice of telemedicine” in a state that ranks 4th in size but 44th in population and 48th in population density. He told the Great Falls Tribune guidelines are needed to help a state where population centers are few and far between and residents need help accessing healthcare.
But those rural conditions may ultimately doom the legislation.
Montana is one of many states grappling with telemedicine practice standards and the “doctor-patient relationship.” Healthcare officials argue that a doctor and patient have to establish a relationship of trust before a doctor begins treatment, and in years past that relationship was created through an in-person visit. Only recently have states and groups like the American Medical Association come to accept the audio-visual telehealth platform as an acceptable means of creating that relationship.
The same, however, can’t be said for other methods of telehealth and mHealth, including phone calls, e-mails, text messages and online questionnaires. Several states have restricted or banned these services, saying they can’t be used to establish a doctor-patient relationship.
But while following that route, Montana is running right into another telemedicine roadblock: broadband capability.
Other rural states, like Maine, Minnesota, Wyoming, the Dakotas and Idaho, have also had problems expanding telemedicine because of a lack of broadband. And just this month, Alaska legislators passed House Joint Resolution 14, which calls on the Federal Communications Commission to beef up its Rural Health Care Universal Service Support Fund so that rural states can invest in more broadband capability to support new telehealth and telemedicine programs.
“The long-distance delivery of quality healthcare via telemedicine has made great strides in rural Alaska in recent years,” Rep. Bryce Edgmon (D-Dillingham), the resolution’s sponsor, said. “However, we’re about to hit a roadblock. Increasing the FCC support budget will allow healthcare providers in isolated communities to continue expanding local treatment options in ways we never could have dreamed of just a few years ago.”
“Telehealth allows patients in rural parts of Alaska access to state-of-the-art diagnostic tools and treatments that can help the sick and afflicted,” added Rep. Zach Fansler (D-Bethel). “This resolution puts the House on record supporting a proactive solution to a looming problem potentially jeopardizing healthcare for hundreds of thousands.”
This past March, NTCA-The Rural Broadband Association released a new report that laid out how rural communities and health systems could benefit from telehealth and telemedicine – as long as they had access to reliable broadband.
“The continuing advancement of telemedicine and the accrual of its potential benefits to patients, healthcare providers, healthcare facilities and the communities that house them will not be possible without high-quality, reliable broadband infrastructure,” Rick Schadelbauer, the report’s author and the NTCA’s manager of economic research and analysis, wrote. “Moreover, this infrastructure must include both high-capacity fiber-based networks and a complementary layer of fixed and mobile wireless networks.”
“Highly advanced, state-of-the-art telemedicine applications - including some not even yet developed - can only be possible when accessed via a high-speed, reliable broadband network,” he added. “This is particularly critical in rural America, where the highest potential benefits from telemedicine - and the greatest challenges to deploying broadband - can be found.”
One state feeling the pinch is Maine. In August 2015, the state’s freshman senator, Angus King, held a round-table at the University of Maine with dozens of healthcare and technology officials from across the state. King, a former governor, was told roughly a quarter of the state doesn’t have a reliable Internet infrastructure.
"The technology is there, in many ways, although the big gap is in broadband, which is something we spent a lot of time talking about," he told the Maine Public Broadcasting Network. "It really doesn't work unless you have pretty good broadband connections and the very people we're trying to help the most are those that are in rural areas where broadband coverage is spotty."
Back in Montana, the fate of HB 389 isn’t good. Following its defeat, the senate voted almost unanimously to indefinitely postpone the bill. And under “Current Bill Progress” in the state senate’s ledger, the bill is listed as “probably dead.”