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By Rose Hoban
After last year’s legislative session, lawmakers set out to examine ways to get more rural North Carolinians increased access to care. One of the possibilities that came up repeatedly was increased access to telemedicine, the ability to get online and have a face-to-face consult with a physician who might be sitting miles away.
During meetings of the Committee on Access to Healthcare in Rural North Carolina which met through the winter and spring, lawmakers heard multiple presentations on the benefits and promise of remote technology. And they heard the results of a separate telemedicine study conducted last year by the Department of Health and Human Services, which outlined what would be required to get North Carolina doctors and patients connecting online.
So, it seemed like a slam dunk that a telemedicine bill floating around the General Assembly would finally create the framework for North Carolinians to have increased access to health care providers via computer.
But this is the General Assembly, and it’s June, the always-chaotic final days of legislators’ annual work session. That’s when bad things can happen to decent bills.
Rep. Donny Lambeth (R-Winston-Salem), one of the bill’s main sponsors, ran into a brick wall just as he was going to present the bill on May 30.
Lambeth had started hearing from people who had problems with the bill. Members of the North Carolina Healthcare Association were worried about informed consent issues. People from the Nurses Association wanted to make sure nurse practitioners would be covered. The Medical Society was worried about standards of care. The Pediatric Society wanted to be sure tele-doctors communicated with the primary care physician. Anti-abortion advocates worried about the ability to remotely prescribe medications to cause abortions something already forbidden in statute.
“I was really surprised, frankly, when I started getting all these emails from groups wanting changes literally at the last minute,” Lambeth said.
So he withdrew the bill and attempted to gather all the stakeholders into one room to iron out problems with the bill.
But a week later, when the bill reappeared in committee, it had become a proposal for yet another study.
That frustrated some of the same people who had raised objections.
“We need to incentivize telemedicine,” said lobbyist Chip Baggett from the NC Medical Society, “You don’t incentivize it by thinking about it.”
It shouldn’t be rocket science. According to the American Telemedicine Association, 35 states and the District of Columbia have already passed telemedicine “parity” laws, which allow for private insurance coverage of the service, and a handful more have proposed bills. Some states have had such laws on the books for years. Oklahoma and California have been able to reimburse for telemedicine since the mid-1990s.
And North Carolina does have some telemedicine services that are being used and reimbursed for. There’s a robust telestroke network and telepsychiatry has improved access to care for patients in remote emergency departments.
But those services are hospital based. What’s still needed is the ability for a patient to be able to dial up their own physician to connect.
“What we need is a fiscal incentive to use telemedicine,” said Latoya Thomas from the American Telemedicine Association. “Consumers want the choice of how, when and from whom they receive their health care.”[sponsor]
Thomas pointed to potential uses for telehealth: medication refills, patients on vacation needing to see their physician, people looking for more convenience.
“Someone who has a child who needs access to health care provider services in the middle of the night would choose telehealth over an emergency room,” she said.
But in North Carolina, that will have to wait another year.
“We just need to decide that this is a good thing and the state is going to reimburse for it at least for the programs that they run and see where it goes from there,” Baggett said.