This op-ed appeared in Commonwealth magazine on March 25th, 2020.
Coronavirus crisis is an opportunity to get it right
GOV. CHARLIE BAKER and his team have been rolling out almost daily emergency orders and guidance to react to the spreading of COVID-19. Many of the health care orders have waived barriers in law that stand in the way of public or patient-focused care. There is a growing acknowledgement that telehealth is a vital tool to serve patients and protect medical providers, and Gov. Baker has taken some important steps to address current obstacles. But more steps are urgently needed to harness the full benefits of technology that allows for clinical “visits” with providers via a video connection or the transmitting of patient data being monitored by a provider in another location.
One order the governor issued now allows all in-network providers to use telehealth in Massachusetts. This cleared up any question about who could use the technology, and by default now the backbone of our medical system — nurses, nurse practitioners (NP), or physician assistants (PA), along with physicians — can utilize telehealth.
Unfortunately, the directive made a poor policy decision to require payment levels to be at the same rate as in-person visits. This eliminates potential savings, bakes in unjustified price variation in the market, and does not acknowledge that telehealth is often delivered at lower cost.
Another missed opportunity is related to Massachusetts law, which prohibits providers like physician assistants (PAs) to practice independently. PAs are trained to provide a number of treatments and services to patients but are required by law to be “supervised” by a physician, and insurers must pay for each visit to a PA at the (higher) doctor’s rate, even if the doctor never entered the room. This unreasonable requirement should be changed, but is unaddressed by any of these orders.
The governor did take a positive step in recent days by opening the door to the provision of telehealth across state lines; unfortunately, he limited it to out-of-state higher ed students studying in Massachusetts. For years special interest groups and state boards have erected barriers to prevent or slow care across state lines unless a provider obtains a full license in the state where the patient is, which in turn has led to higher cost services and limited access to the best providers in the world.
Imagine that a family member gets sick and the nation’s leading expert on treating coronavirus works at the Cleveland Clinic in Ohio. You could not see the specialist unless they went through the time and expense of obtaining a full medical license in Massachusetts. (They could also jump through myriad hoops to obtain a temporary license.) If you are wealthy, you could travel there and pay cash. Low-income residents have no such option. This is discrimination by geography and economic status.
These telehealth and licensing restrictions will be an immediate problem if an outbreak occurs and health care providers get sick in one area or state. More providers will then be needed. The governor’s fix for this problem is to allow new flexibility for providers to move and practice here, and for retired providers to renew their licenses. That said, remote providers are a valuable tool in the fight: they have expertise, can’t get sick from patient contact, and can engage more quickly than relocating.
A disease does not stop at the state border, so our laws need to be modernized to allow providers in good standing to deliver care from their state of primary practice, when medically necessary.
In 2018, the Veterans Administration took an important step to allow veterans to access a provider from anywhere in the country through telehealth.
The governor should follow suit with an emergency order to do the same, without requiring the higher reimbursement rate, and the Legislature should pass a reform law to allow this to be the new normal. This crisis presents a very good opportunity for policymakers to question long-standing barriers to patient-centered care.
Quick action is needed to allow for more flexible telehealth options for care. It should not be a mandate on insurers, but rather clear the runway for providers and insurers to work together to offer more innovative and accessible ways for patients to receive the care they need if the coronavirus spreads.
Josh Archambault is a senior fellow at the Pioneer Institute.