Even a noted Mississippi expert on telehealth describes it as a surprise that her state emerged as a leader in securing payment for medical care delivered by phone and computers in place of face-to-face visits.
“As the very state that has the lowest number of physicians per capita, we have got to do things differently,” said Kristi Henderson, the University of Mississippi’s chief telehealth and innovation officer, at a briefing held in the Rayburn office building on Capitol Hill last week. “While we are an unlikely state to be standing here telling you how to do it, we didn’t have any other options.”
As part of a broader effort by trade groups to expand federal reimbursement for telehealth, Henderson had been invited to tell her stories of aiding people in remote parts of Mississippi in managing medical issues such as previously uncontrolled diabetes through remote care. Medicare now pays for certain telehealth services, but gears these toward people living in rural areas. The Feb. 4 event was arranged by the Telecommunications Industry Association, a trade group, and the nonprofit Healthcare Information and Management Systems Society.
Mississippi’s congressional delegation has been at the forefront of efforts to increase use of telehealth. The federal lawmakers are in effect looking to the Mississippi state legislature as a model. Mississippi already has in place state laws that require insurance plans and Medicaid to pay for these services. These measures led the nonprofit American Telemedicine Association to put Mississippi at the top of an elite group of seven states for which it awarded an “A” in terms of coverage for health care delivered at a distance.
Rep. Greg Harper, R-Miss., is spearheading efforts to craft telehealth legislation as part of the House Energy and Commerce’s 21st Century Cures initiative, a legislative package intended to overhaul federal regulation of medical care. Harper’s legislation would expand Medicare’s reimbursement for telehealth. Harper and Sen. Thad Cochran, R-Miss., had introduced companion telehealth bills in the last session of Congress. The senator intends to introduce legislation on this matter again in this session, a spokesman said.
“You can have the greatest technology, which is represented in this room, but if you can’t get paid for it, what’s the motivation to use it?” Harper said. “You have to be able to get reimbursed.” Policy experts caution that there are risks to expanded use of telehealth as well as likely benefits. Harvard Medical School’s Ateev Mehrotra, who appeared as a witness at an Energy and Commerce hearing on telehealth last year, said in a Monday e-mail that there is great potential to this increased use of technology to deliver care, but it also could add costs to the health care system. And the results have been somewhat mixed regarding how well people fare when they get medical care given at a distance, said Mehrotra, speaking as a Rand Corp. representative, before the committee at the 2014 hearing. Some studies have found that telehealth may be equal to or better than care provided in person in some cases. “As with all new technologies and delivery models, it is important, however, not to assume that the technology always improves care. Sometimes telehealth may even lead to harm,” he said.
A potential risk is that by increasing monitoring of people through telehealth, doctors may end up ordering more tests, which can cause unexpected complications, Mehrotra said.
Expanding federal payments for this approach to medical care likely will require further proof in medical studies of its benefits. Henderson said she sees this kind of evidence in the early results of research underway at the University of Mississippi, in which telehealth services have been provided for people with uncontrolled diabetes. So far, none of the participants has had to go to the emergency room or been admitted to the hospital, she said.
“Those are real tangible outcomes that we need to replicate,” she said. “We are going into homes and changing lifestyles and we are turning people around.”