The Massachusetts Medical Society appreciates the opportunity to comment on a selection of bills before the Joint Committee on Financial Services related to telemedicine services.
Telemedicine technology has an opportunity to address some of the greatest challenges facing the health care system in Massachusetts, including access, quality, and cost of care. The technologies necessary to realize these improvements are currently available, and many physicians in the
state are ready to incorporate telemedicine into their clinical care. However, the uncertainties of health insurance coverage and reimbursement for telemedicine currently impede its adoption, and consequently, the improvements to the access to and value of care that this technology would bring to the
Commonwealth’s healthcare system and its residents.
Telemedicine directly addresses challenges of access facing Massachusetts patients by allowing them to see their physicians without the inconvenience—or impossibility—of traveling to the office. This technology can address inequities in access to care for patients who have difficulty traveling
to a physician office because of location-, age-, disability-, and/or socioeconomic status-related challenges. Telemedicine can be particularly useful in expanding access to psychiatric care, allowing patients receive crucial treatment in the comfort of their home. Lastly, telemedicine improves
access as it improves efficiency by reducing missed appointments, and increasing the capacity and efficiency of physical workspaces.
Telemedicine can also improve the quality of care provided. Uses of the technology span from the most critical ICU patients who can be closely monitored via innovative technologies available from tele-ICU services to providing 24-7 access to urgent care telemedicine as an alternative to
emergency department visits. Telemedicine can allow for better follow-up care after a procedure by allowing frequent, brief check-ins by physicians and nursing staff, and it can allow for greater care coordination, medication adherence, etc. Such services can also give providers a valuable glimpse into
patients’ home lives, which can improve the therapeutic relationship. Many rigorous studies have demonstrated the increased quality of patients receiving telemedicine care. At Partners Healthcare, studies have shown improved quality outcomes for patients with congestive heart failure[1],
and improved medication adherence when using pill bottle telehealth technologies[2]. A large scale study at the Veterans Health Administration showed significantly better care provided to veterans with a variety of chronic diseases[3].
The Massachusetts Medical Society believes that the single most important step that the legislature can take in facilitating telemedicine throughout the state is to require appropriate insurance coverage and to ensure proper reimbursement for telemedicine services. The coverage requirement- which
would only apply to services that can appropriately be provided via telemedicine- would simply ensure that services that would be covered if offered at an in-person visit would also be covered if provided more efficiently via telemedicine services. This is not a mandate to cover new
services, but rather, a requirement to cover services across modalities, regardless of whether those services are delivered in-person or not. For these reasons, the Center for Health Information and Analysis has determined that a telemedicine bill with a coverage mandate filed last legislative session would
have a negligible impact on costs for insurers.
Coverage alone is not sufficient for facilitating an expansion of telemedicine, as many insurers have covered certain telemedicine services but have reimbursed physicians at a significantly reduced rate as compared to if the services were provided in-person. These reduced telemedicine
rates are not sustainable, and cover neither the overhead costs of the technology nor the physician time. With so many studies showing equality in quality outcomes for medical services provided via telemedicine as compared to in-person, the reimbursement should not be substantially reduced simply because
of a differing modality.
The Medical Society thus strongly supports parity in payment for telemedicine services so that reimbursement is equivalent to in-person services, when they are medically appropriate. That parity is needed to correct the inequities in access to care described above, as reduced reimbursement for
care provided through telemedicine contributes to the limits to access to high-quality care for vulnerable patients across the state of Massachusetts.
For these reasons, the
Medical Society strongly supports House bill 2174, sponsored by Rep. Kate Hogan, which provides coverage for appropriate services provided by telemedicine, and which ensures that those services are reimbursed at a rate no less than the rates for the same services provided for in-person care. Importantly, this
mandate would apply to the MassHealth program (in addition to commercial plans), as MassHealth is currently one of only three Medicaid programs in the country that does not robustly cover telemedicine services.
The Medical Society
also supports the coverage and reimbursement provisions of House bill 578 and
Senate bill 549. While the Medical Society does not have policy on provisions of Section 2, the remainder of the bill would again represent a significant advancement in facilitating telemedicine to the patients of the Commonwealth.
The Medical Society urges the legislature to take an important step in improving the access and value of medical care provided in Massachusetts by reporting out favorably legislation to ensure coverage and parity in reimbursement for services provided by telemedicine.
1 Kulshreshtha A, Kvedar J, Goyal A, Halpern EF, Watson AJ. Use of remote monitoring to improve outcomes in
patients with heart failure: a pilot trial. Int J Telemed Appl.
2010;2010:870959. Epub 2010 May 19
2
http://content.healthaffairs.org/content/33/2/194.full
3 Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, et al.Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health.
2008;14(10):1118–26
