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Telemedicine Wins Support in N.H.



Valley News Staff Writer
Thursday, August 09, 2018

West Lebanon — New Hampshire legislators say a new state law will make it easier for people to access medical services remotely, particularly in rural areas. But they haven’t yet decided how insurance companies will reimburse providers for such services.

Republicans and Democrats supported the bill, HB 1471, which was sponsored by Bridgewater Rep. Vincent Paul Migliore, whose district includes the Upper Valley town of Grafton, and state Sen. Martha Fuller Clark, D-Portsmouth. Migliore took up the issue after being asked to do so by Littleton, N.H., psychologist Deborah Warner.

When people who can’t drive and have difficulty getting around need to get to a medical appointment, they may have to use a special ambulance service, Migliore said in a phone interview on Thursday.

“It becomes outrageously expensive,” he said.

The law, which allows patients to connect with providers from home as well as from a hospital or another medical facility as state law previously allowed, offers cost savings and saves patients the hassle of having to travel, he said. The law also allows patients to access telemedicine services from a school-based health center or workplace.

“This just makes it perfect,” Migliore said.

Almost perfect, at least. Language addressing how insurance companies reimburse such services was not included in the final bill that Gov. Chris Sununu signed into law in June. Instead, it will be up to a study committee — set to convene this fall — to determine whether insurers will be required to reimburse services delivered through telemedicine at the same level as those provided in person.

“My hope would be that there could be reimbursement parity for telemedicine services with services provided in a health care setting, with some caveats,” said state Rep. Polly Campion, D-Etna, who, like many of her colleagues, supports the expansion of telemedicine in New Hampshire.

Last year, Vermont passed similar legislation, Act 64, expanding the locations from which patients could connect with providers, and requiring insurers to cover the services “to the same extent that the services would be covered plan would cover the services if they were provided through in-person consultation.”

Insurers, however, may have another view, she said.

Anthem and the trade group America’s Health Insurance Plans, both of which had representatives at an April hearing on the bill, did not respond to emails seeking comment on the new law by deadline on Thursday.

Using telemedicine should reduce the amount of administrative support needed to get a patient through an appointment, Migliore said.

“In theory, you don’t have the overhead (and) support structures in place if you utilize that kind of technology,” he said.

On the other side, however, providers have to complete the same amount of paperwork no matter how they interact with the patient, he said.

State Sen. Martha Hennessey, D-Hanover, said she sees the committee’s work as a learning opportunity.

“We probably all have a lot to learn about how to make it best for New Hampshire,” she said.

In the meantime, New Hampshire providers already have been using telemedicine in part to help residents of rural areas reach specialists.

At West Central Behavioral Health in Lebanon, CEO Suellen Griffin said the mental health provider has found telemedicine helpful in connecting patients with a prescriber such as a psychiatrist or an advance practice registered nurse.

For eight hours a week, an APRN formerly employed by West Central who now lives in Ohio, connects with West Central patients for 30-minute appointments to address their needs for medication. The visit is reimbursed at the same rate as an inpatient medication consultation, she said.

“It’s been awesome,” Griffin said.

For West Central, which like other mental health providers is struggling with a workforce shortage, connecting patients with a New Hampshire-licensed clinician in another state remotely “fills a big gap,” she said.

Right now, patients need to come to West Central’s offices in order to connect with the APRN through secure video technology, Griffin said. If patients could somehow access the necessary, secure technology from home, Griffin said, she could see that being useful to patients.

“We’d have to look at it,” she said.

One challenge Griffin has faced in using telemedicine is reluctance among staff. They prefer face-to-face interactions, she said.

“People get (stuck) in old habits,” she said.

But, “if their needs get met, it doesn’t matter to the patients,” she said.

Jeff Dickinson, advocacy director for Granite State Independent Living, said his group supported the bill because it may help residents with disabilities and those who are aging to undergo routine medical monitoring in the comfort of their own homes.

“For the majority of these folks, lack of transportation is a major barrier and telemedicine could ameliorate it,” Dickinson said in an email Thursday. “Down the line as telemedicine technology matures we will be keen to examine how the technology could be expanded into helping with the provision of Long Term Care services.”

State Sen. Bob Giuda, R-Warren, said he supported the telemedicine bill. Such efforts, however, have to go hand in hand with expanding access to high-speed internet to rural parts of the state. To that end, Giuda said he has worked to expand fiber optic networks to the Lakes Region community of Bristol.

“It’s a field that I think we should aggressively pursue,” said Giuda, whose district includes the Upper Valley towns of Haverhill, Piermont, Orford, Dorchester, Grafton and Orange.

The committee tasked with examining reimbursement for telemedicine services is required to file its report by Nov. 1.

Migliore said he expects the committee will find a compromise between insurers and providers.

Given that millennials, as they age, are likely to expect to be able to interact with their providers through technology, it’s a good idea to “iron out the bumps in the road” now, he said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.