Jamestown, North Dakota — One of the biggest barriers to providing telemedicine or virtual care services in North Dakota is unsustainability to healthcare providers, according to Andrew Askew, Essentia Health’s Vice President of Public Policy. Possible redemption rate.
Former President Donald Trump has instructed the Medicare & Medicaid Service Center to add more than 80 new telemedicine services to the list of Medicare eligible services and refund them at the same rates as face-to-face services, according to Askew. .. This is called payment. parity. This change has allowed healthcare providers to expand telemedicine.
Contribution / Essentia Health
Prior to the pandemic, telemedicine was actually limited to a small number of services, and patients usually had to go to a clinic or medical facility, Askew said. He said Essentia could not bring virtual visits to patients’ homes until the Medicare & Medicaid Service Center and various states changed regulations to allow it.
“It really took off,” Askew said, referring to telemedicine services. “Today, I think we made about 530,000 visits.”
Bill Heegard, president of Essentia’s West Market, which includes eastern North Dakota and northwestern Minnesota, said Essentia had zero telemedicine visits prior to the coronavirus pandemic. During the pandemic, he said that 5% to 10% of visits to Essentia were from telemedicine, which is probably close to 5% now.
“I think it’s amazing. I’m going to talk about Essentia’s experience, and in three weeks the number of visits per day went from 0 to 3,000,” he said.
Easier access to behavioral healthcare providers
North Dakota Insurance Commissioner John Godfred said telemedicine visits are important in rural states. During the pandemic, visits to telemedicine increased dramatically, he said, especially in people with behavioral health problems.
He said it is easier for people in the urban environment to access behavioral health care providers.
“This will be an important part of our healthcare delivery in the future, because rural people have the opportunity to access professionals, talk to healthcare providers and doctors, and reach similar levels. Because we give them, we pay attention so that they can enter a more urban environment, “Godfred said.
Blue Cross Blue Shield North Dakota, in collaboration with the Healthcare Provider Group and the Blue Cross Blue Shield Association, said that behavioral health is one of the areas where members benefit from visiting telemedicine. Greg Glasner, Chief Medical Officer of Shield North, said. Dakota.
“Currently … the only type of visit that has been shown to produce similar results from telemedicine visits to office visits is problem behavioral medical visits,” Glasner said. “There wasn’t really a high quality study of other types of visits. Do virtual and face-to-face visits really give the same quality results? Good data that one is better than the other? Is not really. “
Heegaard said telemedicine services are a great benefit to people with mental health problems, especially if they live in rural communities. He said people with mental health problems usually need to drive to a healthcare provider in a big city.
He also said that people with mental health problems can set up virtual visits on the Internet, avoiding sharing even with the receptionist about depression. He also said that it allows patients to meet the therapist after non-traditional working hours.
“I think it’s good for both the patient,” he said. “For a state like North Dakota, I think this is a victory because there are so many challenges in terms of distance and the challenge of making those areas of expertise available in certain areas as well. increase.”
Telemedicine refund
Under current North Dakota law, reimbursement of telemedicine services to healthcare providers can be 20% to 40% lower than face-to-face services, said Askew, a public policy officer at Essentia. increase.
“It is interested in providing telemedicine services, not just medical systems and Essentia, and keeps patients in the community rather than sending them out of state for care or accepting some patients. It’s very difficult for a very small critical access hospital. It’s a big city in the state, “he said.
According to Glasner, some visits have different prices, but the prices vary depending on the type of visit. He said some services, including telemedicine, would be equally refundable.
“This is a recent change, because changing the policy requires a so-called perk rewrite process,” he said. “Therefore, there are some behavioral health codes that are equally paid in contrast to telemedicine and office visits. They came into effect on January 1.”
Health providers such as Essentia have inevitable fixed costs, such as funding buildings, opening emergency rooms, and hiring nurses for telemedicine services, according to Askew. Nationwide providers of telemedicine services do not own hospitals and do not provide emergency room services.
“Virtual medical care may seem cheaper to provide by hospitals, but it’s not really the case given the technology and support costs required for telemedicine platforms,” he said.
Godfred said it supports target parity rather than blanket parity. He said an example of eligible parity would be a refund to a provider or behavioral medical service. He said some insurers are already reimbursing healthcare providers with targeted equivalence.
“If we pass a law in North Dakota that behavioral medical services are paid for face-to-face visits, I think we can discuss and discuss it in Congress,” he said. “At the last session, there was a bill calling for comprehensive equivalence, so basically all services provided in telemedicine are paid as direct visits.”
He makes sense that behavioral care providers often have one to four doctors in the office together and refund them through equal payments rather than doing the same in traditional hospitals. I said it was good.
“Achieving comprehensive equivalence means that everyone is thrown into the same bucket and all traditional services are paid as direct visits,” says Godfred. “It removes the incentive that we really need to actually lower the cost of providing health care in our state.”
Askew said North Dakota needs to follow the leadership of the Medicare & Medicaid Service Center and 15 other states, including Minnesota, for refunds to telemedicine service providers.
At the last legislative assembly, Senate Bill 2179 considered addressing the issue of payment equality. The bill was approved by the Senate, but not passed by the House of Representatives.
“In the Senate, the bill was amended to investigate. A kind of essential interim study to investigate the benefits of telemedicine,” Askew said. “In the house, it was modified away from the investigation and actually required two years of equality of payments. This is a kind of pilot program. There is much debate about whether equality of payments was necessary at the time. I think there is. “
It may seem cheaper for hospitals to provide virtual care, but that’s not really the case given the technology and cost of support required for telemedicine platforms.
Andrew Askew, Vice President of Public Policy at Essentia Health
According to Glasner, Blue Cross Blue Shield North Dakota will continue to assess what is appropriate for refunds, the level of service for which refunds are appropriate, and where the visit was made.
He said the solution to payment equality depends on the chair you are sitting in.
“If you are a provider, you think they should be paid in the same way,” he said. “If you are a member, you want to choose cheaper options, so I don’t think they should be paid in the same way.”
He said Blue Cross continues to look at the most cost-effective ways to help its members in order to achieve quality health outcomes.
“If a telemedicine visit turns out to be beneficial, you can get that level of refund to do it,” he said. “If we consider it beneficial for members to visit, with or without cost differences, it is because our job is to provide members with access to care at the highest possible cost. I think this is the way to go. “
If the demand for telemedicine services is increasing, Godfred said it will create an opportunity for healthcare providers and insurers to understand how to repay those services.
“This keeps evolving over time, so I don’t necessarily think Congress needs to legislate it,” he said. “We are in the transition stage of healthcare delivery here, so we will need really good communication between providers and insurers on how to best serve consumers.”
Askew said the North Dakota Hospital Association will convene a telemedicine workgroup to identify and assess the problems and concerns that hospitals face in providing telemedicine services.
“The group will also study ways to better promote telemedicine services, improve access to health care, and actually identify the barriers large and small hospitals face in providing their care.” He said.
