Health Policy Experts in NJ Agree on Potential Benefits of Telemedicine

Andrew Kitchenman | November 13, 2015 | Health Care
But sides debate billing questions, lack of in-person contact, and letting doctors with no ties to Garden State treat patients here from afar

Dr. Gary Rosenberg, a psychiatrist, talks about a program designed to link pediatricians remotely with behavioral-health specialists.
How would you like to able to see your doctor – without actually seeing your doctor, except perhaps on computer screen?

Telemedicine could expand swiftly in New Jersey with the help of new legislation.

But it is controversial, as supporters and doubters clash over an array of issues including questions related to licensing, fees and whether it can be as effective as traditional doctor-patient consultations.

Supporters say telemedicine can help close significant gaps in access to mental-health and addiction services, facilitate more timely diagnoses of strokes, eliminate many unnecessary emergency-room trips, and provide an option for those who need or prefer to receive more of their healthcare in their homes or offices.

But groups representing the state’s doctors, while acknowledging the potential benefits of telemedicine, want to ensure that it doesn’t replace the provided by physicians who are licensed and located in New Jersey.

Key flashpoints in the debate include whether insurers will be allowed to pay telemedicine providers less than they pay for in-person care; whether patients can be treated by provider they have never met in person, and whether New Jersey will adopt licensure rules allowing doctors from other states to treat patients here without going through the full licensing process.

New Jersey lags behind many states in dealing with telemedicine’s spread.

Twenty-nine other states have laws requiring insurers to pay for telemedicine; most other states have formal state definitions of what telemedicine services are; and about 10 states have adopted a national model policy that allows patients to establish relationships with a healthcare provider through a videoconference rather than an in-person meeting.

Virginia has been a focal point for the growth of telemedicine. The University of Virginia Center for Telehealth has helped connect patients with providers 50,000 times.

“Our telemedicine program has reduced the burden of travel for Virginians by more than 15 million miles, saved lives, and fostered innovative models of care delivery and workforce development,” center director Dr. Karen S. Rheuban wrote in testimony submitted to the New Jersey Senate Health, Human Services, and Senior Citizens Committee.

Rheuban said home-based monitoring has reduced hospital readmissions by 40 percent for patients in her center’s program.

Sen. Joseph F. Vitale (D-Middlesex), who convened a committee hearing on telemedicine last week, said there’s broad agreement that there needs to be “an organized process” for regulating telemedicine in the state. That includes defining what services it covers and how it should be paid for.

Vitale said an important byproduct of telemedicine legislation that he would like to see early next year would be improved access to behavioral healthcare, a term that covers both mental health and addiction services.

As long as “the state is so medically underserved on an outpatient basis for behavioral health and substance abuse disorder, this is very important,” Vitale said.

Dr. Gary Rosenberg is a psychiatrist who’s working on a program to link pediatricians remotely with behavioral-health specialists.

He said telemedicine can help close a tremendous gap between the estimated 20 percent to 25 percent of children who have diagnosable mental conditions and the small supply of psychiatrists. He said this had made pediatricians the frontline behavioral-health providers for children.

“They didn’t know that they were going to end up being child psychiatrists” when they chose to become pediatricians, Rosenberg said.

Jeffrey Boyce, executive director of Evesham-based company InSight Telepsychiatry, said New Jersey will lose telemedicine providers to other states if it doesn’t provide clear rules that will encourage telemedicine’s expansion in the state. His organization is one of the country’s largest providers of remote psychiatry, through the use of psychiatric nurse practitioners who work from home.

Giving patients the option of receiving behavioral healthcare at home gives them “more ownership in the care,” Boyce said.

But Mishael Azam, chief operating officer of the Medical Society of New Jersey, cautioned against going too far in promoting telemedicine. She said it would work best as an extension of the services that New Jersey doctors provide.

“What we’re concerned about is the replacement as opposed to an extension” of what doctors provide, Azam said.

State law shouldn’t allow doctors with no connections or presence in the state to treat New Jersey patients, Azam said. She noted some businesses are built around providers who do nothing but telemedicine, never interacting in person with patients.

“We know that telemedicine is an important and integral part of patient care,” she said. “We just don’t want it to be separated and fragmented” from team-based, doctor-led collaborative care.

[related]Rowan University School of Osteopathic Medicine psychiatry professor Dr. Stephen Scheinthal pointed to a program based at his university as a good example of a state-based approach to telemedicine.

It links South Jersey hospitals and patients with university-based psychiatrists. Patients have in-person meetings before later receiving care remotely. This has directly led to a drop in the rate of commitments for psychiatric treatment, Scheinthal said.

Some doctors also support requiring telemedicine providers to be paid the same amount as those providing in-person care. This would effectively eliminate financial incentives for patients to prefer telemedicine providers and discourage insurers from promoting telemedicine at the expense of conventional medicine.

The insurance industry takes a different approach.

New Jersey Association of Health Plans Vice President Sarah M. Adelman said the state should allow insurers flexibility in how much they pay for telemedicine. Her association, the state’s health insurance trade group, also supports allowing a “reciprocal” licensure process that would allow telemedicine providers in other states to treat New Jerseyans.

New Jersey Health Care Quality Institute President and CEO Linda Schwimmer pointed to examples in Massachusetts and Washington State in which patients had better health and money was saved through the use of telemedicine. The use of a two-way video camera to evaluate the health of residents of nursing homes in Massachusetts reduced trips to emergency rooms, and the remote integration of behavioral healthcare with rural primary-care providers in Washington had what was calculated to be a $6-to-$1 return on investment, she said.

Mary Abrams, health policy analyst for the New Jersey Association of Mental Health and Addiction Agencies, emphasized that Medicaid payments for telemedicine must be high enough to adequately compensate providers.

“New Jersey’s Medicaid rates across the board are known to be among the lowest in the country, and the ability to optimize resources through telehealth is just one more casualty of those low rates,” Abrams said.

Vitale said he would like to have bills addressing telemedicine early in the legislative session that starts in January.

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