Telehealth is a concept that has been talked about and tinkered with for years. It took a pandemic, however, to begin carving out a place for it in the hodgepodge American health-care system.
Now, pandemic or not, it’s sure to be part of the landscape for the foreseeable future. Medical care providers and patients alike found that virtual appointments, from phone consults to videoconferencing, can serve as a workable alternative to in-person appointments.
And most want that valuable option to remain on the health-care menu.
Helping that happen was the intended purpose of House Bill 1980, which is awaiting the governor’s signature. But critics are making the persuasive argument that the bill would discourage telephone appointments, especially in mental health care, that had been more accessible while COVID-19 curtailed face-to-face encounters.
That is the concern being presented by a coalition of social workers, psychologists and other medical professionals, who are rightly seeking a veto of this bill from Gov. David Ige.
There may be reason to seek some regulation of the way remote appointments are recognized in insurance code, and reimbursed to health-care providers. Overall, telehealth usage escalated rapidly during the pandemic, according to an issue brief published a year ago by the Kaiser Family Foundation: For example, more than 1 in 4 Medicare beneficiaries had a telehealth visit between the summer and fall of 2020.
If these appointments are conducted in a less-than-thorough manner — through a quick phone call or brief video follow-up, for example — that would not be comparable to an office visit, in which personal interactions could convey information more helpfully.
The state would have an interest in keeping telehealth from becoming merely the quick but less-effective modality of care, by setting standards for what constitutes a service to be reimbursed at a given level.
But the final version of HB 1980 that emerged went too far in constraining audio-only phone calls from being considered as an option. In a statement published online, the coalition argued that the bill may delay all phone appointments until the specific service is defined as “covered.”
The concern is valid especially in cases of behavioral health, which skyrocketed during the pandemic. In that category, the bill parses terms under which such services via telephone “may be covered,” such as when telehealth services are “technologically unavailable at the time the patient is scheduled to receive a behavioral health service.”
But while videoconferencing might be deemed available by the insurance carrier, that technology might not be readily accessible or understandable to the patient.
Another caveat: The call may be covered if “the health care provider has provided the patient with an in-person behavioral health service within the 12 months preceding the telephonic service.” This could impede reasonable care for a provider’s long-term patients living remotely.
These are not constraints included in any regulations affecting federal programs such as Medicare or Medicaid, so it’s unclear why the state would need to put this kind of patient-unfriendly curb in statute.
State Rep. Ryan Yamane, the House health chairman who introduced the bill, declined comment. As if handing off a hot potato, he referred the Honolulu Star-Advertiser to the Hawaii Medical Service Association and Kaiser Permanente.
That’s bad form; it’s the elected lawmakers who are accountable for the laws they pass.
Rather than copping out, they need to craft a proper structure for telehealth. Ige can veto the bill and then summon them to work in the interim toward something that works. House Bill 1980, as a vehicle, is sure to break down and leave too many patients stranded.
