The COVID-19 pandemic forced sweeping changes in how we work, with many workers doing their jobs remotely for much of the past year.
A swift though lesser-remarked-on transformation happened as well in medical care. As lockdowns loomed, state and federal regulators eased restrictions on "telehealth." That led to more virtual visits in Minnesota and elsewhere, with doctors and patients communicating via video or a phone call in lieu of a clinic appointment. A year later, there's a timely debate at the Minnesota Capitol over whether to maintain telehealth expansion measures, which are set to expire 60 days after the end of the peacetime COVID emergency. The answer should be yes, let's keep going. A dispute between two key health care stakeholders — providers and insurers — over payment levels for telehealth care shouldn't derail the legislation to do so.
Telehealth changes during the pandemic have provided convenient new options for patients. Previously, Minnesota patients may have had to drive to a clinic or hospital to use their telemedicine facilities. Now, they can connect from home using a personal device. Including mental health practitioners also is an advance.
Legislation to extend telehealth changes is enthusiastically backed by respected medical providers and organizations, including the Minnesota Medical Association (MMA) and the Minnesota Hospital Association (MHA). If this yearlong experiment wasn't going well, these organizations would be the first to sound the alarm.
The MMA — whose membership includes over 12,000 active and retired physicians, residents/fellows and medical students — tracked telehealth utilization in the state after regulations were eased. In 2019, just 3% of patient visits used telehealth. In 2020, that rose to 28%, according to data released last August. In addition, 83% of physicians surveyed reported that telehealth met patients' needs "acceptably, well or very well."
The MHA also reports that its members are seeing benefits. Among them: "Improved attendance at appointments, with fewer no-shows, particularly for mental health visits," and "the ability for some providers to treat more people by delivering services from their own homes because of the pandemic or by reducing drive time between health care sites."
Rep. Kelly Morrison, DFL-Deephaven, and Sen. Julie Rosen, R-Fairmont are commendably leading the efforts to pass the telehealth bills (HF 1412 and SF 1160) this session. Morrison is a physician, and Rosen has an admirable record of forging compromise and muscling legislation through.
That latter experience will be crucial. The telehealth legislation faces some headwinds. A key challenge is resolving differences between large health care lobbies over payment. The dispute involves "payment parity," meaning providers are paid the same for a telehealth visit as they are for one in a traditional clinic. Before the pandemic, Minnesota was one of six states requiring comprehensive telehealth parity, said Lucas Nesse, president and CEO of the Minnesota Council of Health Plans. Since the pandemic, 14 more states have established parity during the pandemic, with requirements often in effect only for the COVID emergency, he added, citing a National Conference of State Legislatures report.
The MMA points out that doctors' salaries are the same if they see patients via telehealth or a more traditional setting, and technology investments are needed to continue and expand telehealth. The state's insurers and businesses reasonably see telehealth as an avenue to reduce health care costs.
A February telemedicine report points out one potential compromise: "setting payment parity as the baseline while expressly allowing providers and plans to voluntarily negotiate alternate payment rates and depart from the baseline." This solution, or other innovative approaches, are needed to ensure that Minnesota moves forward on telehealth, not backward.