Use of telehealth expanded dramatically in Ohio during COVID-19 lockdowns, and a bill drawing bipartisan support from state legislators would ensure that change becomes permanent.
Its backers hope acceptance of online medical appointments will make health care more accessible and cheaper.
“This new technology, telehealth, can really do that,” said state Rep. Adam Holmes, R-Nashport. He and state Rep. Mark Fraizer, R-Newark, are sponsors of House Bill 122, which would greatly expand the medical services eligible to be provided virtually and require insurance to cover them.
The bill would permanently expand permission for telemedicine use to include psychologists, speech and hearing therapists, physical therapists, counselors and social workers, dietitians, optometrists, chiropractors and several other health care specialties. It would also require insurance, public or private, to cover those services.
“Telemedicine, telehealth, is a tool that has been in our toolbox for decades, but seldom used,” said Gary LeRoy, associate dean of student affairs and admissions at Wright State University Boonshoft School of Medicine. He served as president of the American Academy of Family Physicians in 2019-2020, when the group advocated for expanded telehealth during pandemic lockdowns.
Use of telehealth by AAFP member physicians grew from 13% to 93% by May 2020, LeRoy said. The group successfully lobbied the Centers for Medicare and Medicaid to be reimbursed for telehealth visits, he said. Whether that will be made permanent remains an open question.
“As they often say, as Medicare goes, so does private insurance,” LeRoy said.
Expanding telehealth should be good for patients, doctors and insurance companies, Holmes said.
“Places where we have shortfalls in health care, that’s going to change,” he said. Holmes expects telehealth to “expand like crazy,” even after the pandemic.
Holmes, who represents an area east of Columbus, said in rural parts of his district, libraries and local clinics have become the sites where telehealth technology is available to everyone.
“I’ve already seen firsthand how that capability can be a game-changer,” he said.
Telehealth made up just 0.3% of medical visits before COVID-19, according to committee testimony from Luke Russell, deputy director of the National Alliance on Mental Illness of Ohio. But in the first four months of the pandemic, that jumped to 25%.
A survey found that 82% of patients liked using telehealth, and more than 75% of doctors said it allowed quality care, Russell told lawmakers. A study in 2018 found that telemedicine visits averaged between $19 and $121 cheaper than in-person appointments, he said.
More than one Ohioan in 10 lives in a place with limited access to primary care doctors, according to Russell.
Once people use telehealth, either by video or just a voice call, they usually want to continue it, LeRoy said. It doesn’t replace the face-to-face relationship between doctors and patients, he said, but does expand their contact for regular check-ins.
LeRoy, who also provides family primary care at East Dayton Health Center, said the majority of his telehealth visits have been by phone. Many patients, whether urban or rural, still don’t have easy access to computers or broadband service, he said.
“We don’t want to disadvantage already-disadvantaged populations by putting stipulations on it that it has to be on a computer,” LeRoy said.
Even access to libraries and clinics is still a problem for people who lack transportation, he said, and in those semi-public settings, some patients won’t want to talk about sensitive issues.
Expanded telemedicine should include requiring some in-person appointments still with a patient’s established primary care doctor, LeRoy said. Some medical needs aren’t evident, even by video, he said.
“We can miss a whole lot of things that we could have intervened on early on before things got bad,” LeRoy said.
That’s exacerbated when the provider isn’t familiar with the patient’s history.
“Just making it convenient is not always the right thing,” he said.
Watching the legislation
Holmes and Fraizer introduced HB 122 in February. The current version passed the House 93-0 in April and was referred to the Senate Health Committee, where it had a fifth hearing Nov. 17.
Holmes said he has “heard rumblings” of proposed amendments to the bill but doesn’t think it will change further. He expects it will get a committee vote Dec. 8 and then go before the full Senate.
Groups opposed to the bill — Smile Direct Club, American Teledentistry Association and TechNet — sought to add dentists and orthodontists to those authorized to provide telehealth services.
Parallel to this legislation, the State Medical Board of Ohio has discussed rule changes on expanding telemedicine, said Jerica Stewart, the board’s communications officer. But it hasn’t drafted anything specific.
“The board is watching HB122 carefully and is respectful of the legislature’s process and in understanding board rules must align with legislation,” she said.
The medical board’s priority is upholding standards of care similar to what would be offered in person, Stewart said.
“It also strives to establish guardrails for telemedicine use that protect the most vulnerable, particularly patients being treated with controlled substances and opioid medication,” she said.
What about addicts?
Anita Kitchen, executive director of Families of Addicts, said telehealth is “not great” for people experiencing addiction. If they have phones or computers, they might sell them for drug money, cutting off access to treatment, she said.
“Also, counseling and treatment is more effective in person as it holds a person more accountable as people are more honest face-to-face,” she said.
Barb Marsh, chief operating officer for Dayton’s OneFifteen drug and alcohol outpatient treatment clinic, said the bill is an important step forward in making many COVID-19 emergency changes permanent.
“Our data has shown that those who used telehealth with video were 70% less likely to drop out of care,” she said.
Since early 2020, OneFifteen has provided more than 10,000 telehealth visits, Marsh said.
Clients who lacked the needed technology could come on-site and use a computer tablet to contact remote providers, and the clinic plans to continue that.
“We want people who are in treatment to continue to be able to work, take care of their families, and thrive,” Marsh said. “Many patients do not always have the transportation needed or the ability to take time off from work or from other responsibilities.”
Enforcement waivers and expanded reimbursement have given health care providers 20 months of experience in using telehealth, and it has become a critical and effective means of providing care, she said.
Marsh expects its use to continue expanding and improving, but when the public health emergency ends, additional federal rule changes will be needed.