How effective is telehealth? Murphy wants to know before locking in pay rates

LILO H. STAINTON, HEALTH CARE WRITER | NOVEMBER 12, 2021

NJ Spotlight News

A doctor waves goodbye to a patient at the end of an online visit.

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Telehealth provided a medical lifeline for millions during the height of the pandemic in New Jersey and nationwide, but how well it truly serves patients is less understood.

Now questions about the effectiveness of telehealth care and its costs — are coming to the fore, as New Jersey lawmakers decide on next steps in the state’s oversight of the booming practice.

This week, Gov. Phil Murphy conditionally vetoed a bill that would have permanently extended the rates paid for telehealth visits to parity with in-person visits. Those rates have been in place since the start of the pandemic in March 2020.

Murphy instead wants reimbursement parity to remain in place through the end of 2023, while the state Department of Health studies the matter and recommends a permanent solution for valuing these services.

Murphy outlined this approach in the conditional veto he issued late Monday, calling on lawmakers to revise a bill they passed in June that would have locked in the same rates for in-person and telehealth treatment. The lead sponsor of the bill, Assemblywoman Joann Downey (D-Monmouth), was weighing the Legislature’s response and will “be working with the senior leadership team to determine what the next steps will be for this legislation,” legislative staff said Wednesday.

Doesn’t want to ‘over-incentivize telehealth’

Murphy acknowledged the benefits of the technology, especially during the pandemic, in his message to lawmakers. “In the short term, the flexibility afforded by expanded access to telehealth has greatly benefited New Jersey residents who may not have the time or resources to receive in-person care when local in-network options are limited,” he wrote.

“But I am concerned that in the long term, pay parity could over-incentivize telehealth, further limiting in-person options. This could be especially detrimental for those in underserved communities,” Murphy added. “Most importantly, we do not yet have a full understanding of whether or how pay parity could negatively affect patients.”

Before COVID-19 changed everything, telemedicine — governed by a 2017 law most consider out-of-date — was hardly a priority for providers or patients in New Jersey. Reimbursements were dictated by contract negotiations between insurance carriers and health care systems and did not generally incentivize its use. But when the pandemic lockdown halted nonemergency doctors’ visits the popularity of telemedicine exploded and state officials quickly acted to encourage providers to expand services and require insurance companies to pay for these visits at the same rate they would for in-person care.

Doctors and other medical professionals — some of whom had raised concerns about telehealth in the past — were eager to lock in these parity reimbursements, which the legislation conditionally vetoed by Murphy would have done if enacted without changes. Introduced in June 2020 by Downey and colleagues, including Dr. Herb Conaway, chair of the Assembly health committee and Gloucester County health commissioner, the bill attracted dozens of supporters and passed with near unanimous support on the last day of voting in June 2021.

Strong support for equalizing pay rates

The measure also was strongly supported by advocates for individuals with disabilities or mental health issues, some of whom struggle to access in-person care. A survey by the Mental Health Association of New Jersey found eight out of 10 people who received virtual mental health services during the pandemic considered them a “great alternative” when in-person options are unavailable. Almost everyone found it safe and convenient, but nearly 60% still said they prefer in-person care.

In his message to lawmakers Murphy noted that, as drafted, the bill calls for “a very heavy thumb on the scale in favor of providers” and could add “substantial” costs to insurance coverage, an increase that is passed on to consumers and taxpayers who fund Medicaid. The proposal could cost taxpayers an additional $50 million annually just to pay for telehealth benefits among state employees, according to a nonpartisan legislative analysis.

Larry Downs, CEO of the Medical Society of New Jersey, said this view doesn’t account for the full financial picture. Insurance companies can control their costs by limiting the benefits they provide, he said, and telehealth gives tremendous opportunities for other savings, like reductions in transportation costs for patients with mobility concerns. “Missed (in-person) appointments cost everyone a huge amount of money,” he said.

Medical society members are “disappointed” Murphy did not sign the bill as is, Downs said, but hopeful the health department review will result in proposals that allow the practice to continue to grow. He said some studies have shown that telemedicine is as effective as in-person care in certain settings, but doctors recognize it doesn’t work for everyone.

“Consumers love the access. Participation for those in high-needs areas, this is where it’s at,” Downs said. “Physicians just want to see their patients in the best way possible,” he added. “I’m hopeful there will be a wider acknowledgement that this is here to stay.”

‘Pay parity is essential’

Also disappointed was Jacob Caplan, advocacy manager for Easterseals New Jersey, which provides services to individuals with disabilities, some of which have been moved to telehealth platforms during the pandemic with “tremendous success.” Participation is up, he said, missed appointments are down and it is time for the state to “fully embrace 21st century healthcare.”

“We also see this as an issue of economic and social justice,” Caplan said, noting that most commercial health plans had offered some telehealth coverage, while Medicaid — whose low-income members could benefit significantly — did not until the state ordered it during the pandemic. “Pay parity is essential to this end,” he said.

Others, including New Jersey Association of Health Plans president, Ward Sanders, who represents insurance carriers, had urged Murphy to conditionally veto the bill to promote efficiency and quality outcomes. Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute and a longtime telehealth advocate, said the governor’s recommendations provide “both flexibility and a thoughtful path forward.”

“The proposed changes in the CV set out a methodology to temporarily extend payment parity to keep telehealth going but avoid unconditionally tying this rapidly evolving area to the existing fee-for-service model of reimbursement that has led to fragmented care and inefficient spending,” Schwimmer said.

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published this page in News and Politics 2021-11-12 03:17:12 -0800