Health

California debates costs of telemedicine appointments

COVID-19 took to give millions of Americans the option to talk to their doctors about their pain and pain over the phone.

But now that more doctors and patients are returning to direct bookings, policymakers across the country are controversial about the amount of taxpayer money they continue to spend on phone bookings. They were the lifeblood of Medicaid and Medicare patients who did not have the skills for video visits, but critics say they do not offer the same level of patient care and are not worth the same price.

In California, the Democratic-controlled state legislature wants a state Medicaid program for low-income earners called Medi-Cal. Continue to pay for phone bookings for the same rates as videos and direct visits. A policy that began during the pandemic. However, Democratic Governor Gavin Newsom’s budget plan has instructed Medi-Cal to lower the rate.

According to the State Department of Health Services, Medi-Cal paid a whopping 2.4 million phone reservations between March 1, 2020 and April 30, 2021.

“Before the pandemic, voice-only visits weren’t an issue,” said Chris Perrone, director of the Improving Access team at the California Health Care Foundation. “No one considered them as telemedicine.” (California Healthline is an editorial independent Foundation publication.)

Federal Medicare programs for older Americans and people with disabilities and most state Medicaid programs rarely paid for telephone visits before the pandemic. However, after doctors closed their offices last year and patients stayed home, Medicare and the Medicaid program in almost every state began paying for phone visits when it became clear that many patients had inaccessible videos. Did. More private insurance companies have also begun counting phone calls as telemedicine visits.

The use of audio and video reservations, commonly known as telemedicine, has exploded during the pandemic. According to the California Department of Health Services, California had about 10,500 telemedicine visits per week for every 100,000 Medi-Cal patients in 2020, compared to about 300 in 2019.

Medicare had a similar explosion. Prior to the pandemic, approximately 17,000 registrants used telemedicine each week. During the pandemic, it reached up to 1.1 million people each week, according to a Medicare spokeswoman.

Most state Medicaid programs have started paying for phone visits during a pandemic, but are considering how to proceed as it declines.New Hampshire Passed the law In March 2020, Medicaid and private sector plans required paying for telephone visits at the same rates as video and face-to-face visits. March of this year Vermont Until 2022, extended emergency rules to pay for phone visits at the same rate as other types of bookings, state walking group It is advisable to make it permanent. Connecticut, Delaware, New York, Colorado And other states have passed legislation that defines telephone visits as telemedicine, all continuing to pay for calls to varying degrees.

Parliament held a hearing in April Medicare You must continue to pay for telephone visits that started in March 2020 but are set to stop after the federal government-declared public health emergency has ended.Independent legislative bodies Recommendation Extend payment for one or two years after an emergency.

Since the audio appointment is new, there is little evidence of its quality. The California Health Insurance Review Program analyzed studies on the effectiveness of telemedicine and found that telephone visits were “at least as effective as face-to-face visits” in general. Several studies that directly compare video and audio visits examined behavioral medicine and determined that the results were similar.

Tallinn Keane planned a telephone visit with a doctor throughout the pandemic due to mental health and other issues. Safety net clinics like her generally didn’t offer phone reservations before the pandemic because public health programs didn’t pay them. Currently, lawmakers are arguing whether they are worth the cost.

(For David Weaver / KHN)

The telephone visit was important for Tallinn Keane, 63, who lost her job as a massage therapist in Venice. Keane couldn’t afford internet services at home and didn’t have a laptop until the Venice Family Clinic offered an old one and a Wi-Fi hotspot to attend the patient forum.

Still, Keane doesn’t like video calls. She has dental problems that make her face uncomfortable in video and learning disabilities that make it difficult to focus with too much visual distraction. It was easy to talk about mental health issues and talk on the phone before and after wrist surgery.

“I’m not good at computers,” Keane said. “It’s another unpleasant barrier to me.”

California State Legislature is discussing the bill, AB 32, As a result, most settings require Medi-Cal to continue to refund at the same rate for phone, video, and face-to-face visits. The bill, passed by Congress, is currently being discussed in the State Senate as part of budget negotiations.

Ann analysis A bill from the California Health Insurance Review Program found evidence that colored patients, the elderly and rural patients were more likely to use telephone visits than video visits during the pandemic.

“The video is clear [appointments] Not all locals and seniors will be available soon, “state legislator Cecilia Agial Curry (D-Winters), the author of the bill. “My number one goal is to make it accessible to everyone.”

Doctors at the Safety Net Clinic, which serves Medi-Cal registrants and uninsured people, report that telephone visits helped maintain patient health during the pandemic. They have proven to be effective for patients with behavioral health problems such as substance use disorders and for patients with chronic illnesses such as diabetes that require monthly check-in. I will.

Dr. Grace Frautsis, CEO of the White Memorial Community Health Center in Los Angeles, used video and phone bookings for the first time during a pandemic. Like all federally accredited health centers, White Memorial was not generally licensed to use telemedicine until then.

“What surprised us most was that more people had access to care because it was provided,” Floutsis said. “I don’t know if that will change that much after the pandemic.”

She said the patient stopped skipping appointments. Pediatrics (currently face-to-face) no-show rates are higher than adult primary care (still virtual). The no-show rate for behavioral health, once high, dropped to almost zero.

The California Healthcare Services Department claims that telephone bookings are not as good as face-to-face or video visits, with 65% of face-to-face or video charges after July 1st or when the federal government begins. I would like to pay for a telephone visit at. The public health emergency is over.

“There are specific limits to the types and quality of services offered,” wrote department spokesman Tony Cava in an email. “It is usually not considered the equivalent of a direct visit, does not require the same level of resources to manage, and does not require special equipment or broadband internet connectivity.”

Despite multiple requests, we did not provide data on the amount paid for the phone reservation during the pandemic.

The ministry’s proposal is that the health center receives a flat rate for each visit by Medicaid patients, so telephone reservations at the community health center are no longer paid. The department kept the door open to work with the health center and the federal government to pay some money for future voice visits.

Bookings for the average California community clinic are refunded for $ 215, but can be hundreds of dollars.

“I think it’s a really valuable service, but I don’t think it’s a really valuable service at its cost,” said Jim Wood, D-Santa Rosa, chairman of the Parliamentary Health Commission. I did.

When his committee considered AB 32, a bill that keeps phone visit charges the same as other visit charges, he discussed costs in April and refunded voice visits at a local clinic five years later. Fixed to stop completely.

Sonoma County’s West County Health Center has already lost money on telephone bookings for Medicare patients and will be hit harder if Medical cuts prices, said CEO Jason Cunningham.

But closing the phone reservation altogether is not an option, he said. By calling, patients can hold family meetings, eliminate patient travel time, and even when the building was closed due to a wildfire last summer, Cunningham said. I was able to continue to operate.

“How can I drive someone for an hour to meet me, wait 20 minutes in the waiting room, and ask my neighbor with a laptop to go home for an hour when he can virtually see me?” Is it? “He asked.

This story was created by KHN (Kaiser Health News), one of three major operating programs KFF (Kaiser Family Foundation).



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