Telehealth Pivot Called “Fastest” in Mental Health History
Lawmakers Still Stuck on Telehealth Law Changes
12/3/20 5:02 PM
DEC. 3, 2020....As the COVID-19 pandemic took hold in Massachusetts, telehealth transformed from "a dusty back road that no one took" into a 16-lane highway, Dr. Kenneth Duckworth said Thursday.
"I will say that this is the fastest pivot in the history of mental health, to my eye," said Duckworth, the chief medical officer for the National Alliance on Mental Illness and behavioral health medical director for Blue Cross Blue Shield of Massachusetts. "That is to say, practitioners flipped a switch within, really, a couple days, realizing that without infecting their patients or exposing them to risk, they could do clinical work in the mental health space and addiction space."
Duckworth was among several speakers to join a Massachusetts Health Policy Forum webinar to discuss what still needs to be learned about telehealth and its future in a post-pandemic world.
"Is it perfect? No. Will we improve? Yes," Health and Human Services Secretary Marylou Sudders said. "Is telehealth here to stay? Absolutely."
Sudders characterized the abrupt pivot this spring from in-person health services to digital delivery as "lumpy-bumpy" at the outset but said the health care system worked together to smooth things out. She said MassHealth patients have had more than 5 million visits through telehealth since the start of the pandemic.
The secretary said she had her own annual physical via telehealth this year, and it was "one of the most stress-free exams I've ever had."
Lora Pellegrini, president of the Massachusetts Association of Health Plans, relayed a different experience.
Pellegrini said that when she had an eye infection earlier this year, she had three telehealth visits with an ophthalmologist, got two different diagnoses and ended up going to an emergency room. She said it's important to understand what services might not be appropriate for telehealth, and to be aware of instances where there's potential for higher costs if a patient requires an in-person visit after a telehealth one.
The House and Senate have been in closed-door negotiations for four months on differing versions of a bill that seeks to build telehealth permanently into the state's health care landscape. The two bills take different approaches on payment parity between telehealth visits and in-person services.
The Senate bill would require reimbursement rates for telehealth to match in-person rates for two years. The House bill includes permanent coverage at in-person rates for behavioral telehealth services, while primary care and chronic disease management telehealth visits would be covered at in-person rates for one year.
Pellegrini said the health plans back the House's approach to behavioral telehealth rates "because we're doing it in large part anyways."
"But this question about what we pay, the promise of telehealth early on was this was going to be a great technology, a great way to start to lower health care costs," she said. "If we're paying the same, we're not going to really achieve that vision. We believe that telehealth can be offered at a lower rate because you don't have the same brick-and-mortar concerns, staffing concerns that you may have if somebody's coming into your office."
Lead House conferee Rep. Ron Mariano told the News Service Thursday that negotiators are "close" on the telehealth bill, with "about two, three issues that we're working on."
"We've solved some of the bigger things. It's mostly a lot of little stuff, actually," the Quincy Democrat said.
Both the House and Senate versions of the telehealth bill allow insurance coverage for audio-only telehealth calls, instead of just calls that use video.
Dr. Kiame Mahaniah, the CEO of Lynn Community Health Center, said 85 percent of his organization's telemedicine visits are conducted over the phone.
"We're having tremendous difficulty with not only the technology, but just having people be able to access a space where they're able to have these conversations," he said. "I'm still a practicing physician and I see mostly people in recovery, and the amount of times they have to go to their car and sit in their car in order to have a conversation with me is pretty astounding."
Mahniah said there have been issues around available bandwidth or access to technological equipment, and that it's difficult to provide instructions for telehealth visits to patients who are illiterate.
He said that undocumented immigrants, typically one of the groups most affected by inequities, are not facing as steep a challenge with telehealth because many use similar technologies to keep in touch with family in their home countries.
"It's been mostly really our generational American poor who are having difficulty with the equipment and the bandwidth," he said.
Mahniah said that if insurance coverage for audio-only telehealth calls went away, "it would probably take us two to three years to figure out the problems of equipment and bandwidth before we can move from telephone."
[Sam Doran contributed reporting]
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