The state legislature since 2015 has explored the concept of telemedicine – i part to improve healthcare access for rural communities. With the onset of the COVID-19 pandemic, the industry’s role in providing care has become increasingly relevant. However, state officials say there’s still work to be done implementing recent legislation to improve industry access, and others are contemplating ways to maintain the financial health of rural hospitals when physical care is needed.
The legislature in 2015 enacted SSB 5175, which requires health insurance carriers to reimburse a health care provider, under certain stipulations, for services provided via telemedicine. A year later, the legislature created the Washington State Telehealth Collaborative with membership composed of elected officials, doctors, hospital CEOs, and practicing attorneys.
Collaborative Chair John Scott told the House Health Care & Wellness Committee at its Oct. 5 meeting that since COVID-19 broke out in March it’s been a “massive moment” for telemedicine, with a decline in total in-person medical visits.
The increased use of telemedicine highlights two issues the legislature has sought to address: reimbursement and proper industry training. Earlier this year state lawmakers enacted SB 5285 which was intended to establish equal reimbursement rates between services offered in physical visits and those in telemedicine. The legislature this year also passed SB 6061 which mandates telehealth training for those who provide that service. Both laws take effect in January, though a proclamation by Governor Jay Inslee implemented SB 5285’s provisions in March.
Scott said that these bills made the industry “slightly more prepared” for the recent shift to telemedicine, “knowing these policies would be implemented within a year.”
However, Health Care Authority Associated Medical Director Chris Chen told the committee there are still challenges with rural telehealth access due to issues such as the lack of technological knowledge among patients. The importance of telehealth for rural communities also highlights the need for greater broadband access. While telehealth services can be achieved through audio-only visits, Chen said more information is available for the patient when done with video.
Some note that even with the greater use of telehealth services, hospitals are still needed to provide healthcare for rural communities. However, many are suffering from financial strain. Health Care Authority Director Sue Birch told the committee that the “financial health of rural hospitals is in peril. We know that COVID has made the rural health systems even more fragile, but we have an opportunity to change all that.”
In Washington there are 118 rural health clinics (RHC) owned and operated by 55 different organizations. There are 39 critical access hospitals (CAH) designated by the Centers for Medicare and Medicaid Services (CMS), which makes them eligible for cost-based reimbursement for Medicare services. Medicare composes much of the “payment landscape” for rural hospitals in Washington.
However, Birch recommends that these facilities move toward “capitated payments,” which are pre-arranged monthly payments agreed upon via contract between the health insurance carrier and the provider. The rates for individual providers often differ by region due to local costs.
Birch said this approach would “create more stable, more predictable payments that are needed now more than ever.”
No further committee meetings are scheduled for 2020.