Prior to COVID-19, the option to use telehealth services in Montana was essentially non-existent. State regulations simply didn’t allow it. As the crisis hit, some were waived or repealed. House Bill 43, which passed the Montana House unanimously and is now moving through the Senate chamber, would make telehealth available permanently.
The idea takes some getting used to. As not only a researcher and data scientist, but also the parent of a special needs child who has used telehealth services several times during the pandemic, I can attest to the quality of the service, as well as the ease of using it on many levels.
Telehealth allows for a patient-provider relationship even though both parties are not required to be physically together. Like so many things we have experienced during the pandemic, technology bridges the divide.
In less than a year, the uptake of telehealth services in Montana across all populations, including Medicare and Medicaid beneficiaries, has been impressive. According to a report by the Centers for Medicare and Medicaid Services, 27% of all Medicare primary care visits in Montana are now completed using telehealth.
The positive results speak for themselves. Fewer people skipping appointments. Hard-to-reach populations receiving more care. Not coincidentally, individuals with health issues don’t need to worry as much about transportation — one of the biggest barriers to care — or time off of work, childcare, or even catching COVID while sitting in a doctor’s waiting room.
If Montana passes telehealth legislation, it would join a growing host of states, including Colorado, Idaho, Missouri, and Utah, which are turning temporary regulatory changes into permanent law.
According to the U.S. Department of Health and Human Services, as of last September, fewer Montanans had their health care needs met compared to their neighbors in Idaho and Wyoming. When it comes to primary care and dental care, only one-third of Montanans have their needs met, whereas more than half of Idahoans and Wyomingites do. The outlook on mental health is more dire, with only 11% of Montanans getting care, compared to 24% of Idahoans and 31% of Wyomingites.
However, two important issues should be kept in mind. First, it remains to be seen whether any new policies would be permissive, and not restrictive, which is necessary to realize the full potential of telehealth. Montanans should not need permission to enjoy the benefits of health care innovation. The legal definition of telehealth must be as broad as possible to ensure innovators can continue to improve health care delivery without the intervention of legislators.
Second, the issue of payment parity — whether telehealth and in-person care should cost about the same — could be a double-edged sword and must be handled carefully. Although requiring it would encourage more providers to offer telehealth, it could also undercut one of the key benefits: lower cost.
According to one study, the average cost of a telehealth visit ranges from $40 to $50, compared to $136 to $176 for in-person acute care visits. The lower cost is helpful to people receiving care, but is also one of the biggest barriers to telehealth adoption, because providers earn less per visit.
If legislation were to mandate that insurers treat all health care the same way, and therefore encourage them to set telehealth prices artificially high, Montana would lose some of the important gains made during this pandemic. If telehealth is cheaper to provide, then prices should reflect that.
Telehealth offers an incredible opportunity to deliver affordable, accessible and effective health care. Legislators and regulators should continue to remove barriers that stand in its way — and also guard against adding any encumbering new ones. Ultimately, improving affordable access to quality health care, particularly for those in underserved areas, benefits all of us.
Kofi Ampaabeng, PhD, is a senior research fellow with the Mercatus Center at George Mason University. He recently testified regarding House Bill 43 before Montana’s Senate Committee on Public Health, Welfare and Safety.