By Tara Bannow

The Bulletin

For the past five years, Oregon law has required private health insurance companies to pay for medical services rendered through two-way video conferencing.

But there’s a catch. That conferencing, in order to be covered, can only happen between two medical facilities, such as provider’s offices or hospitals. In other words, even patients who have the necessary technology in their homes, workplaces or schools haven’t been able to get insurers to cover video conferencing in those places.

That’s going to change at the beginning of next year, when a new law takes effect that requires insurers to cover the services regardless of where the patient is located. The law is expected to greatly expand telemedicine — the use of electronic communication to provide medical care — across Oregon.

“This is a really exciting time for telemedicine,” said Cathy Britain, the executive director of the Telehealth Alliance of Oregon, a nonprofit that seeks to expand the use of telehealth, a broader term that refers to using electronic communication to not only provide medical care, but also education and health care administration.

Until now, video conferencing has largely been restricted to doctors at rural hospitals and clinics consulting on cases with their counterparts at larger hospitals — mostly in Portland — to learn whether a seriously ill patient should be transported there. The practice, by and large, has not caught on among smaller practices or for care that’s more routine.

There are plenty of scenarios where video conferencing could save patients time and money, said Dr. Miles Ellenby, the medical director of Oregon Health & Science University’s Telemedicine Network. Consider the parent of a diabetic child in Bend who has to check in with a pediatric endocrinologist in Portland every three months, for example.

“You maybe miss a day or two of work, your child might miss a day or two of school, the gas expense, the hotel expense, for a 20- to 30-minute appointment to see a provider you have an established relationship with, under a circumstance where the physical exam is not that critical,” he said. “That type of care can happen over video.”

Senate Bill 144A — which the Oregon Legislature approved in its most recent session with the support of major health insurers, hospitals and doctors — requires that insurers cover any service over video that its policies would otherwise cover in person. It doesn’t require providers to offer video conferencing, but advocates say removing the barrier to reimbursement is likely to push some providers to do so.

In the future, competition may push more providers to adopt video conferencing, Britain said.

“I think the patients are pretty savvy about the fact that they can get health care this way,” she said, “and are probably going to be pushing their providers to deliver it in this manner, or probably look for another provider.”

The bill also only mandates coverage for services that can “safely and effectively” be provided over video. A major concern with telemedicine is the proliferation of companies that have doctors all over the country willing to video conference with patients any day or time, Ellenby said. Those services are known to prescribe antibiotics to patients with sore throats without performing a throat culture, which is necessary to diagnose strep throat, a bacterial infection. The over prescribing of antibiotics is a significant concern in medicine as it contributes to antibiotic resistance.

“Good telemedicine is good medicine and bad telemedicine is bad medicine,” Ellenby said. “You can provide bad in-person care just like you can provide bad telemedicine care.”

Those doctors also don’t have access to patients’ medical records, which limits their ability to provide effective care, Ellenby said. Eventually, he said he hopes clinics will have providers who are able to perform video conferencing whenever patients need it, even if it’s 2 a.m. In those situations, the providers would easily be able to pass along information to the patients’ primary care providers.

The law still only applies to private health insurance plans, not to Medicare, Oregon’s Medicaid program, the Oregon Health Plan and most self-insured plans. Unlike its predecessor, however, this one includes the self-insured plans offered through the Public Employees’ Benefit Board and the Oregon Educators Benefit Board.

So far, it doesn’t appear that many Central Oregon providers offer telemedicine, at least outside of hospitals.

St. Charles Health System has technology that allows providers in its more rural hospitals located in Prineville, Madras and Redmond, to communicate with those in its largest hospital in Bend about critical cases, said Todd Shields, director of outreach and support services for St. Charles Bend and Redmond. St. Charles is also considering expanding those services to hospitals in John Day and Burns. The Bend hospital also partners with OHSU’s Telemedicine Network, which enables its providers to collaborate with specialists in Portland through video conferencing.

Mosaic Medical, a nonprofit community health center with locations throughout Central Oregon, is currently allowing patients at its rural Prineville clinic to monitor their vital signs at home using blood pressure monitors, oxygen saturation monitors and scales that use wireless technology to transmit their readings to the clinic.

The temporary project is happening thanks to a federal grant, but Mosaic’s leaders have said they hope to continue the work after the current grant runs out.

However, Mosaic isn’t currently doing any video conferencing with patients, said spokeswoman Ginny Streeter.

A statewide registry of providers offering telemedicine is expected to be launched next year by the Telehealth Alliance of Oregon, said Robert Duehmig, an Alliance board member and deputy director of OHSU’s Office of Rural Health. Currently, there is no way to tell how many providers use the technology statewide.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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