A Missouri House bill would allow Medicaid patients to telecommute with specialists, saving them the cost of travel.
With the advancement of medicine, specialists have become increasingly concentrated in cities, Rep. Jay Barnes, R-Jefferson City, said.
While this has created innovative medical hubs in urban areas, patients in rural areas who require specialist treatment must endure long and costly travel, Barnes said. Because of this imposition, some of these patients opt to skimp on the care they need.
So he has sponsored House Bill 319, which would change Medicaid reimbursement regulations for telehealth services. Telehealth services would be an easy fix to this problem because they would allow a specialist to videoconference patients in the comfort of their own homes, Barnes said.
"There's a way for Medicaid to save money and get better results for recipients by allowing remote access to medical practice from their homes," Barnes said.
In order for Medicaid to reimburse providers for telehealth services, they must be rendered at an approved "originating site," and an eligible health care provider must be present to administer the videoconference. House Bill 319 would add schools and the MO HealthNet recipient's home to the list of originating sites. The measure would also add clinical social workers and health care providers practicing in rural health clinics to the list of eligible health care providers. MO HealthNet is a state program that purchases and monitors health care for low income and vulnerable citizens.
The Missouri Telehealth Network supports the measure and the expansion of telemedicine, senior program director Rachel Mutrux said, calling the services "proven methodology."
"Because we have been doing this for so long, we have proven the effectiveness of telehealth," Mutrux said. "It's clear that it's a much more cost-effective way to treat a patient."
Rep. Kip Kendrick, D-Columbia, has also filed a bill aimed at expanding telehealth services, specifically in schools. His measure, House Bill 340, has not been assigned to a committee, but he said he was "totally behind" Barnes' bill.
"What happens right now is many people go without care," Kendrick said. "If they are to receive care, they have to find transportation or Medicaid helps arrange transportation to a specialist in an urban area."
David Winton, a lobbyist who represents the Missouri Association of Rural Health Clinics, said non-emergency medical transportation is a large expenditure of the state's Medicaid program. MO HealthNet requested a budget of almost $41.5 million for these services in 2015. Telehealth services could help decrease these transportation costs, he said.
"Believe it or not, we still do home visits in Missouri," Winton said. "There's some patients with serious health conditions that make it difficult to travel, even to a doctor's appointment."
Telehealth services could replace home visits for a patient who is recovering from a surgery, has a compromised immune system, is morbidly obese, has a psychiatric condition or other cases where the individual is unable to leave their home, Winton said.
Kendrick, a former social worker at Boone County Family Resources, said the addition of social workers to the list of eligible health care providers and adding patients' homes to the list of originating sites would greatly increase MO HealthNet patients' access to care.
Allowing social workers who are familiar with their clients' needs and already in their proximity to administer the videoconference from a tablet device or a laptop would remove the inefficiency of time and costs of some home visits, Kendrick said. Winton said the fact social workers are located in every part of the state could greatly reduce administration costs.
"Clinical social workers are the largest licensed mental health professionals in the state," Winton said. "They play a critical role in delivering mental health services to patients in Missouri and across the nation."
Telehealth services could also be a more effective method of collaboration among medical specialists, Winton said. If a patient receives an MRI, their results are sent to a specialist who, without any interaction with the patient, compiles a report for the primary care physician.
Another example is if a patient has a skin rash; a high resolution photo of the rash is sent to a dermatologist for review. Telehealth services could be an expedient and more effective method of medical collaboration.
"We are not changing anybody's scope of practice," Winton said. "We are not giving somebody the authority to provide a service that they would not otherwise have the authority for. This is about using telehealth as a tool to provide the services that you are already capable of providing in the most effective and efficient manner."
Kendrick said House Bill 319 had no opposition at a Feb. 10 public hearing. Executive session was completed and the Health and Mental Health Policy Committee voted to pass it with an amendment on Wednesday.
Both Winton and Mutrux said the measure is a step toward allowing telehealth to reach its full potential of providing health care to individuals in Missouri and across the nation.
"I view telehealth as one of those tools that we've just barely scratched the surface on," Winton said. "Telehealth will continue to allow us to move further into the realm of greater cooperation, greater coordination of care, which will ultimately improve care."
Mutrux said she believes the future telecommunication services will become a standard in providing efficient, effective and affordable health care universally.
"Sometimes, you'll go in to see your doctor, and sometimes you'll see the doctor from the comfort of your home," she said.