The way Dr. Lawrence R. John sees it, necessity is always the mother of invention. And that maxim got put to the ultimate test with the COVID-19 pandemic.
“Lo’ and behold there was telemedicine sitting in front of us,” he said of COVID-19 forcing patients and physicians to embrace telemedicine as a safer alternative to in-person visits over the past three months.
John, a family physician from Pittsburgh, said that the COVID-19 pandemic gave Pennsylvania and its healthcare systems a “real opportunity” to embrace telemedicine practices.
But with a recently vetoed telemedicine bill, and still no regulation or guidelines governing the practice across the state, advocates of telemedicine say they are worried growth will be limited.
Access & Opportunity
In March, at the beginning of Pennsylvania’s COVID-19 outbreak, Penn State Health rolled out its OnDemand platform for urgent care, dermatology care and COVID-19 testing needs to help patients access healthcare while avoiding busy emergency departments and urgent care facilities.
The rapid rollout included some 3,000 providers and staff and more than 4,000 virtual visits a week, Chris LaCoe, Penn State’s vice president of operations, said.
LaCoe called the pandemic the “catalyst” for moving Penn State’s telehealth platform from pilot to practice, but said the opportunity for convenience in medicine will change their approach going forward.
“I don’t see us turning away from it,” LaCoe told the Capital-Star, adding that he believes anywhere from 20-25 percent of visits might become virtual visits in the near-future, including postoperative follow ups.
Prior to COVID-19, Penn State Health already had a telehealth program for patients with amyotrophic lateral sclerosis or ALS.
The regional program connects therapists and physicians with individuals with ALS across Pennsylvania, Maryland, New Jersey and Delaware.
Working in tandem with the ALS Society of Greater Philadelphia, Penn State Health has saved patients between 8,000 to 10,000 miles of traveling for care, LaCoe said.
This is just an example of how “innovative” telemedicine can be for individuals who are homebound or have transportation issues, John said, calling telemedicine a “very successful tool.”
“Telemedicine offers them an entirely new way to get their care,” John said.
Creating access to care for patients in rural parts of the state is part of Penn State Health’s key strategy regionally and nationally, LaCoe said.
The telemedicine veto
In late April, Gov. Tom Wolf vetoed SB 857, a bill that would have required insurers to pay for remote doctor’s visits.
The legislation had bipartisan support for its ability to increase access to care in rural parts of the state. But it ran into opposition from Democrats after the Republican-controlled state House added language l that blocked doctors from remotely prescribing Mifeprex, an abortion-inducing drug.
Wolf, a vocal supported from abortion rights, vetoed the bill with the exclusionary provision.
John said that the Pennsylvania Medical Society was “very disappointed” to see that the telemedicine bill was vetoed.
While the Medical Society does not have an official stance on abortion access and care, the group said that in it’s proposed state, the legislation was “quite acceptable.”
“It was agreeable to us,” John said, adding that the bill would have given physicians across the state more direction and guidelines for telemedicine practices in the future.
Despite their support for the now-vetoed bill, John said future legislation would need to address an issue in telemedicine called payment parity. Payment parity means that insurance companies in that state have to reimburse for telemedicine care in the same way they would for in-person care.
While the bill that passed the General Assembly did not have payment parity provisions, John said he’d hoped the Legislature could “revisit that” so physicians who utilize telemedicine wouldn’t have to worry about how they are being compensated.
Currently, there is no guidance on payment parity in telemedicine in Pennsylvania.
But payment parity isn’t the only issue facing telehealth services in Pennsylvania.
In March, the governor’s emergency declaration opened up rules for telemedicine, specifically for those with Medicare, allowing for Medicare reimbursements.
But once the declaration ends, those wells will dry up, Wolf warned after the General Assembly passed a resolution this week to end his emergency declaration.
The future of telemedicine in Pennsylvania
While a telemedicine bill would have given the practice more credibility throughout the state, and addressed issues such as payment parity and Medicare reimbursement, John said he doesn’t foresee another telemedicine bill making its way to the General Assembly before the November general election.
“We would like to work with this governor,” John said, adding that he hopes the General Assembly can create a telemedicine bill that is veto-proof to help the commonwealth build a telemedicine infrastructure.
Without any governing legislation, healthcare systems throughout the state are on their own to develop and implement the technology into their practices.
At Penn State Health, continuing to develop their telehealth infrastructure is a strategic focus for the next few years, LaCoe said, adding that as the COVID-19 pandemic unfolded, Penn State “became pretty reliant” on the new platform.
While face-to-face visits are still important, John and LaCoe said they believe many care needs can be met through telemedicine.
“We anticipate that the new normal will require some change,” LaCoe said.