What's Next for Telehealth: Sustaining and Expanding Access After COVID-19
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2020-11-13_What's Next for Telehealth: Sustaining and Expanding Access After COVID-19
00;00;02;23 [Bill Hoagland]: A good day, everyone, and welcome to the Bipartisan Policy Center and our focus today on telemedicine in rural America. I'm Bill Hoagland, senior vice president here with the center. And I have the pleasure of working with our health team led by, uh, Marilyn Serafini, Katherine Hayes, and Dr. Anand Parekh. Uh, for those of you who may be unfamiliar with the Bipartisan Policy Center, we were established a little bit over a decade ago by four former majority leaders of the United States Senate: Senator Bob Dole, the late
00;00;35;19 Senator Howard Baker on the Republican side, Senator Tom Daschel and Senator George Mitchell on the Democratic side. Senator Mitchell of course, from the great state of Maine, uh, which you will hear shortly, the state of Maine is very well-represented here this morning. Uh, the country is indeed, uh, indeed the world quite frankly, is experiencing a once in a
00;00;59;24 lifetime, uh, pandemic causing untold suffering and death. Uh, doctors, nurses, hospitals, healthcare providers are struggling to provide critical care under some very difficult conditions, but if there is any good and there's not much, but if there's any good to come out of this virus, it is that it has expedited the digital health transformation out there designed to help these providers deliver health care more quickly and efficiently. Uh, COVID-19 I think has put a laser focus on the use of
00;01;38;13 telemedicine for diagnosing, delivery, and treatment through digital health. Now, obviously telemedicine was a tool available prior to the onset of this terrible virus, but based on some recent data, telehealth claims have increased 3500% over this last year. As one of those who
00;02;04;24 grew up in a rural part of our country, where my family continues to farm today, I am personally very well aware of the challenges of providing healthcare in a rural America. BPCs health team has been working in this area over the past many years. Uh, last a year, BPC staff uh, uh, visited various rural healthcare facilities throughout the country, including Maine, uh, with former Senator Olympia Snow, we saw repeatedly the problems
00;02;38;19 that rural America face in accessing care. Uh, the long drives to the doctor's offices, the shortages of both primary care clinicians and specialists and the rash of hospital and clinical closures. We
00;02;54;29 [Bill Hoagland]: Released recommendations from our Rural Health Task Force earlier year. The chaired by former senators, Daschel and Snow and former governors Musgrove and Tommy Thompson. The task force recommended expanding, uh, broadband to rural communities. It's my understanding that nearly a quarter of rural communities and one-third tribal communities lack any form of broadband access. We knew that a broadband will be expensive, uh, and it will take time to implement. So the
00;03;30;26 task force recommended to, uh, to allow rural Americans to take advantage of a tele-health through other means such as a telephone audio only consultations. We are proud here at BPC that some of the task forces’ recommendations have made it into the final legislation, uh, enacted earlier this year, along with the department of health and human services,
00;03;58;05 rural action plan that they issued recently. But that emergency legislation, the cares act and its provisions surrounding tele-health are scheduled to end when the national health emergency ends, which we hope will be soon. But this brings us to the question that we want to address today. And that is what is the future of telehealth? What have we learned from the increase use of telehealth during the pandemic and which new, what new flexibilities
00;04;27;28 should become permanent? Uh, we have, uh, a wonderful group of excellent people here and to address these questions and it’ll be moderated by the Honorable Senator Angus King, uh, let me introduce Senator King. And then the panel, uh, Senator King is, uh, first elected to the Senate in 2012. He's in his second term. He is Maine's first independent
00;04;56;11 United States Senator, and he has played a very significant role in keeping attention on tele-health. He introduced a improving tele-health for underserved communities act in June to provide patients receiving mental health services through certain rural health clinics and federally qualified health centers, uh, from having to have reduced Medicare payments.
00;05;20;20 [Bill Hoagland]: Senator King former governor, has served as a member of our BPC honorary congressional task force on rural health. Most importantly, to us here at the Bipartisan Policy Center. Senator King is a strong believer in bipartisanship and works hard to bring Republicans and Democrats together to find common sense solutions to the challenges facing the country today. Before we turn this over to the Senator, let me introduce the panelists who will be sharing their experience, but also for
00;05;52;16 all the, those who are viewing out there, uh, this discussion, if you wish to submit questions, please submit them through, uh, using the live chat function on your YouTube face book or on Twitter using #BPClive again, it's #BPClive. So, for our panelists, uh, Scott Oxley. Scott is Northern Light Health senior vice president, and is president of
00;06;25;08 Northern Light at Acadia Hospital in Bangor, Maine. Welcome Scott. Dr. Jennifer Lundblad, uh, Dr. Lundblad is president and CEO of Stratus Health, an independent nonprofit organization based in Minnesota, focusing on innovations to improve health. Dr. Lundblad is a member of the National Rural Policy Research Institute Health Panel. She is also an adjunct
00;06;53;15 professor in the division of health policy and management at the School of Public Health at the University of Minnesota. Welcome Dr. Lundblad. And then Dena McDonough our own Dena. She is a BPC's associate director of health policy. Dena joined BPC after serving as manager of payment policy for the American Academy of Orthopedic Surgeons. Prior to that, she was a
00;07;22;18 physician assistant. And, uh, I will say not exactly a rural hospital in orthopedic surgery at Mount Sinai health system in New York City. Um, then Dr. Lisa Miller, Dr. Miller is a practicing primary care physician, uh, for all ages in her hometown of, uh, Norway, Maine.
00;07;47;16 [Bill Hoagland]: She has been one of four physician leads on the COVID-19 hospital incident command team for Stephens Memorial Hospital since March. And finally, but certainly not least, uh, Walter Panzirer is one of three trustees for the Helmsley Charitable Trust is grandson of Leona Helmsley and served as a paramedic, a firefighter and law enforcement officer. This work has led him to, uh, create the Rural Healthcare and
00;08;18;10 Vulnerable Children in Sub-Sahara Africa programs, uh, within the Helmsley Charitable Trust Organization. The Helmsley trust by the way, has been a supporter of our work here at BPC, which we are very grateful of, uh, that support. Uh, thank you, Walter. And with that Senator King, uh, let me turn it over to you and welcome you to this event.
00;08;45;08 [Senator Angus King]: Well, Bill, it's great to be here and I want to thank the Bipartisan Policy Center, although as an independent, maybe I should suggest you change the name to the nonpartisan policy center. Just, you know, just, uh, just saying, uh, but in any case it's wonderful to be here and to join so many people both on the panel and in the audience. This is one of those frequent occurrences for a US Senator, where you're asked to speak to a topic and to an audience, all of whom know more about the topic than you do. Uh, and I humbly realize the level of expertise that
00;09;19;22 we have on the panel and in the audience. But I think, uh, there are some very important issues to talk about today and, uh, challenges and really enormous opportunities. Uh, as you mentioned, one of the few silver linings of this pandemic has been the incredible acceleration of the adoption and expansion of the availability of telehealth, uh, particularly in rural
00;09;46;12 areas.
00;09;46;29 [Senator Angus King]: And that, that is close to my heart, uh, in the state of Maine, because we're predominantly a rural state. uh, as, as, as everyone knows, uh, during the pandemic, we've seen expansions both through the cares act and through the actions of CMS, uh, and DHHS that, uh, have really, uh, facilitated, uh, tele-health both in terms of being able to work from, from home to, to, uh, have home be part of the tele-health picture, uh, at, rather than just a specially set up sort of, uh, uh,
00;10;21;19 health studios. Uh, the, the, uh, expansion of people who can provide the help of practitioners who can provide the help. And finally, uh, the recognition that, uh, in some cases, particularly when there's a lack of broadband, um, telephone, uh, audio only is an important part of this. Um, I don't think it can be stressed enough what an important development this
00;10;47;06 is. And, uh, it, it, it took, I guess it took the pandemic. We all know those of us that have been working on this for years. And I remember visiting early tele-health facilities when I was governor of Maine 25 years ago. Uh, but to see it expand to the level and, and everybody's heard the number, uh, at the beginning of the pandemic 12,000 telehealth visits a week, and by the middle of June, a million telehealth visits a week, uh, that's just
00;11;17;01 an amazing, uh, you know, unbelievable change and, uh, it's provided access. And I think people are now realizing that this kind of access is something that should continue, and we should be sure to enable the policies and the reimbursement policies and all the other pieces, uh, that enabled this to continue again, particularly for people in rural areas. I can't speak for other states, but I know in Maine,
00;11;43;26 [Senator Angus King]: And one of the issues of, of people in our communities, uh, is transportation, particularly seniors. And so saying you can have an appointment at three o'clock on Tuesday in Bangor, uh, is nice for somebody that's in Patten, but that's, uh, that's pretty much an all day trip, uh, and to be able to have the visit via telehealth or, uh, audio, uh, is, uh, is, uh, is a huge expansion of the accessibility, uh, that people have to, to medicine and to the kind of treatment. Um, the
00;12;17;25 other thing that I think is very important about this is the use of telehealth for mental and behavioral health. And we're going to talk about this, uh, but, uh, I can remember, again, twenty-five years ago, being told that that was one of the areas that we thought people thought had real promise, and that has proven to be the case. Uh, there's a wonderful article, by the way, I will share with you in the Washington Post, just this morning, a long article about tele-health
00;12;44;00 and the expansion, and particularly in the field of behavioral health and how important it is to people to have someone that they can reach out to and have contact with, uh, through the telehealth facility. Now, the, the final thing, and in my introduction is broadband. Um, telephone of course, pretty much works everywhere. Why, because this country decided a long time ago that universal telephone service was, uh, fundamental to the, uh, economic, cultural, and social and political wellbeing of the country. We
00;13;18;00 made the same decision about electricity in the thirties, Franklin D Roosevelt’s Rural Electrification Act. Broadband has developed in a, in a much more sort of herky jerky, uneven way where we have terrific broadband, mostly in urban areas, pretty good in suburban areas, okay.
00;13;37;13 [Senator Angus King]: In some rural areas and not at all in others. And I believe this has to be a comprehensive major national priority. Uh, just as rural electrification was just as, as, uh, telephonic communication was because the economy can't work in rural areas, people aren't going to move to rural areas. And for importantly, what we're talking about today, uh, healthcare, uh, is, is based upon a good connection. So, uh, that's sort of
00;14;09;01 a separate issue, but it's really got to be part of, of this discussion because we can be talking about, you know, reimbursement rates and all those kinds of things, but if people can't connect, uh, it ain't going to help them. And so, uh, I think we, we need to be as many as you, as many of, you know, there are all kinds of federal initiatives on broadband and the FCC and department of agriculture and others. We really need a comprehensive look to make this a clear and comprehensible national policy
00;14;38;21 involving the States, the carriers, communities, co-ops, local people, whatever it takes. Uh, we've got to overcome the, the issues of, of broadband. So those are some, uh, preliminary thoughts. And now I want to, uh, call on some of our panel members to make a few opening remarks. Uh, and I'll start with, with, uh, Scott Oxley, uh, who's the head of Acadia, which is a, uh, behavioral health facility, uh, in Eastern Maine, in Bangor, Maine, and, uh, Scott share with, with us what
00;15;11;14 you're seeing what's happening on the ground, uh, in terms of tele-health, uh, particularly in the behavioral field in Maine.
00;15;20;04 [Scott Oxley]: Great, happy to Senator King of, first of all, thank you so much for being with us today and thank you for your support of healthcare in rural Maine and rural America and support for the, uh, for those that are in need of mental health services. Uh, so as the Senator mentioned, um, my role is to serve as president here at Acadia Hospital in a state that has a lot of geography and not a lot of resources. uh, at Acadia Hospital up here in the central part of the state, we take care of
00;15;50;17 about two thirds of the geography and about one third of the population. So, lot of area, again, without a lot of resources to cover. uh, there aren't a lot of beds in the state of Maine for acute care services. So part of our success, part of our strategy and part of our mission is to work very close with folks in the community, community partners, and doing our very best to get to the folks, uh, in, in their local, in their home space, uh, doing our very best to manage their mental illness, which we all know is a
00;16;23;08 chronic illness and like any other chronic illness, it makes all the sense in the world, um, to, uh, help individuals and managing the compliance and their overall quality of life. So, to Senator, to King's point, what are we seeing here on the ground, seeing just a huge, uh, swell in terms of need for mental health services. And it would be physically impossible for us to keep up with that need, uh,
00;16;50;11 not just Acadia Hospital, but the entire state of Maine, uh, without the benefit of telehealth services, uh, telehealth services, uh, does just a fabulous job, uh, connecting to people in need of those services. Uh, it's not only a convenience, but it really breaks away a lot of barriers for those folks that are struggling financially, struggling with their illness to get out of their home and allowing us to connect directly with them. Uh, we've got a lot of experience with telehealth. We support, uh, 17
00;17;23;22 emergency departments in the state of Maine, which we've seen a huge uptick of mental health patients needing services. And they're seeking that service at least initially through the emergency departments. We're also in 42 primary care practices where we also see an increase in behavioral health support, but most recently through the pandemic, we converted most of our outpatient programs, um,
00;17;48;19 [Scott Oxley]: Uh, to the telehealth platform. And at one point we're running nearly 100% of our outpatient programs through a telehealth platform and be happy to share more details later on in the program. Uh, but we see the need for mental health services and the acceptability rates through telehealth really on the increase, which we're, we're very pleased and proud of. So, thank you.
00;18;14;00 [Senator Angus King]: Thank you, Scott. And, and, uh, Lisa Miller is a physician in Western Maine. It's just a coincidence that there are a lot of Maine people on this panel and just, I don't know, at least we're practicing in a small town, Norway, Maine, and in the Western part of the state, again, serving a rural population. And I was on the phone this morning with John Bozeman from Arkansas and the, the, the, these rural states are, you know, they all have the same kinds of issues we've talking about broadband, but, uh, Lisa, uh, how, how do you, I guess, let me ask a basic question.
00;18;48;27 Does it work? Does telehealth work, does it serve the clients? Do they feel well treated and confident in the, in the system? Let me start with that sort of fundamental question.
00;19;04;12 [Dr. Lisa Miller]: It does work, Senator King. I would also like to thank you for having me here today to offer a clinical perspective on a topic that I feel has tremendous impact on the practice of rural medicine. Um, I not only think it works, but I think it's been lifesaving for my patients. Um, the benefits of it run very deep, whether it is through a mental health visit with me or teleconferencing in with a specialist about nuanced medical conditions, the value of tele-health spans every age group
00;19;36;01 and level of medical complexity. I just had a telehealth visit last week, in fact, with a 90 year old patient that went surprisingly well. She wasn't at risk of, of getting COVID from a high risk medical facility, but she said to me, after if I can zoom with my great-grandkids, I can easily zoom with my doctor. In general.
00;19;56;13 [Dr. Lisa Miller]: I would say patients are thrilled to not have to take a full day off from work to get something simple, checked out. It allows us to be more facile as an industry. It's not uncommon to have patients reschedule a patient or cancel last minute, but we're almost always able to offer telehealth very quickly, negating the need to lose that visit to a no-show status. And I understand your concerns about broadband, and I share them. I would say overall telehealth has been a huge
00;20;26;27 win for rural medicines, but it does have its challenges, broadband problems, or technology glitches being one of them. It's also often immediately clear that the patient needs to be seen face-to-face to best sort out what is going on. And we will adjust on the fly for that. The scheduling is complicated and the work behind the scenes to prepare the patient for the upcoming visit requires a heavy lift by multiple levels of support staff. There's also this looming threat that reimbursement streams will go away,
00;20;58;12 or at least not pay as well as in-person visits in the future. The HHS waivers that are currently in place while not perfect, due to inequities in pay rates have allowed us to quickly develop protocols and workflows to complete the important work of telehealth. We would love to see those waivers continue and hopefully expand. These allows allow for both operational and financial benefits. Um, mainly that Medicare payments that used to not be covered are now processed as services that are, so the bottom
00;21;31;00 line is coming from a primary care perspective. We deeply appreciate the importance of getting to know our patients over time. It is this continuity of care that drew us to this field and keeps us in it day to day. This in its essence cannot be replaced. When I walk into a room with a patient that I've seen multiple times in the past, I am not only coalescing data about their present illness, but I'm factoring in their
00;21;58;02 social and occupational histories, their family history, as well as the behaviors that occur when they are both sick and well. It is the richness of this knowledge that deepens that interaction with the patient.
00;22;10;04 [Dr. Lisa Miller]: This is the sole reason why I chose to practice medicine in the first place. In my opinion, this is superior care to a random provider in a distant site, seeing my patient for a single acute visit over a screen. These connections have taken years to develop, but once established, the benefits of tele-health can truly be uncovered. Fine tuning technology, perhaps adding tools that allow for vital sign or physical exam collection will be keys to advancing and expanding this field. Maintaining the human connection is possible and critical for the
00;22;41;22 care and safety of our patients. Pandemic or not telehealth should remain a part of the day to day practice of rural medicine because of the many benefits it provides to all patients. And I thank you for letting me speak to this today.
00;22;55;24 [Senator Angus King]: Thanks doctor. And I hope you'll join in as we go through this discussion, because I think the perspective of someone who's in the, in the trenches, who's practicing medicine and using those tools is incredibly important. Dena, uh, give us a sort of national policy perspective. What, uh, what are we, what are we seeing in terms of maintaining the, the waivers that were put in place during the pandemic? And are they, uh, you know, what, what do you, what do you see as the
00;23;26;10 political situation going forward, uh, to be sure that we don't lose, uh, what's been gained.
00;23;34;01 [Dena McDonough, PA-C]: Yeah, thank you, Senator. And good afternoon, everyone. Um, yeah, we looked at all of these federal, uh, changes and, and potential options as part of our rural health task force work and, and the report, which was released earlier this spring. Um, we included policy options that were largely informed by site visits. I remember the drive from Portland up to Norway Maine, and that weather was really nice. So, um, I can imagine in the snow what it was like, um, but what we heard again and again, was that the frontline providers, um, really felt that telehealth
00;24;07;18 was super important for getting care to their patients. Um, and you know, many of the providers are caring for populations that span really large geographic areas. Um, so this is also compounded by rural hospital closures that continue to occur. So, the task force really drilled down on the legislative and regulatory barriers that are preventing greater utilization of telehealth.
00;24;29;23 [Dena McDonough, PA-C]: And we paid special attention to individuals with high speed internet without high-speed internet access, and those who are uncomfortable using computers and smartphones. So, our recommendations were really more about allowing patients to get care in their homes, allowing the world health clinics to provide those services and allowing telephone use. Um, most of these were implemented as part of the public health emergency, which is great. Um, but as the discussions turning towards what to phase out and what to make permanent, we really wanted to make sure that
00;25;01;11 the unique characteristics of rural America aren't overlooked. So, telehealth is critical for these rural communities, as we'll continue to say throughout this, um, it was pre COVID and will be beyond the pandemic. So, the flexibilities, um, that were put into place during the public health emergency, allowing patients to receive care in new locations, allowing additional providers and those in urban settings to receive care, um, are
00;25;27;28 really going to, um, be important going forward. But as data comes out, uh, over what happened during the shutdown, we really need to dig into what happened, who was taking advantage of , there was a, apparently I think it was 9 million telehealth visits. And one third of those were via audio in the first three months of the pandemic. But we don't know was that were the audio visits, mostly patients in higher age brackets, um, that were just uncomfortable with, uh, utilizing
00;26;02;19 technology or was it working individuals who needed to reach out to their providers, um, particularly for mental health, which is often multiple touch points throughout the week. Um, so knowing who was using audio and who was using services from home, all these little things are gonna be really important going forward to figure out what should come next and
00;26;25;19 what, um, what sorts of regulation and legislation needs to be changed.
00;26;31;05 [Senator Angus King]: Well, I hope you all will continue the work of the task force and give me and my colleagues a, a clear to-do list, uh, in terms of which, which provisions need to be extended. Uh, it would just be crazy to lose the momentum that we've built up, uh, through this period and then sort of say, okay, well now that's over, we'll go back to normal. I think the potential of this technology, uh, and, and, uh, Dr. Miller mentioned, we're going to be at a place where people are going to be able
00;27;02;28 to do their vital signs and other, uh, uh, uh, physical data for the practitioner also from home. So please, uh, be in touch with, with my, my office, uh, Megan DesCamps is on this call, I'm sure. And, and, uh, I've got, I've got a whole bunch of colleagues that are all lined up to work on this and, and, uh, I'll count on you, you all, to keep us, uh, to keep us
00;27;32;08 informed and to keep us moving and not let the, not, not lose the progress that we've made. Um, Jennifer Lundblad, uh, at, at, uh, Stratus Health Rural Health Policy Institute. Uh, give me your thoughts about where we are, where we can go. And, um, how important is this even outside of the pandemic?
00;27;56;18 [Jennifer P. Lundblad, PhD, MBA]: Yeah. Senator King, thank you so much as is a pleasure and privilege to be part of the session today I come at tele-health from two perspectives. First, the national policy perspective, reflecting the recently released Rupri health panel telehealth paper, which is really refocused on how telehealth can contribute to a high-performing health system in rural communities. And then secondly, and in a bit of a complimentary balance to all my fellow panelists from Maine, from a Midwest perspective here in Minnesota, what that on the ground and
00;28;29;03 in the field perspective is as my organization, Stratus Health works with the telehealth leaders in Minnesota has, um, health systems and
00;28;40;07 [Senator Angus King]: Minnesota is Maine without the ocean, just so you know,
00;28;45;08 [Jennifer P. Lundblad, PhD, MBA]: Well, if some people call it Lake Superior, you kind of get that Maine feel if you go up on the North shore of Lake Superior. So, you're exactly right. And what I would say from all of this a bit, uh, picks up on the theme that, that Dena just started. Um, this is the moment to really dig in and deeply understand what's working and what isn't so that we can inform policy and practice going forward when COVID 19 arrived and the payment and regulatory flexibilities were put in place, it was like drinking from a fire hose. Um, people needed to ramp up quickly. There was
00;29;19;22 no time to redesign workflow. It was a crisis mode and, and the result was extraordinary. We've heard a couple of different, um, data and statistics today. And no matter what you look at, we went from something like, um, single digit use of telehealth for most encounters to up to, or 70% of outpatient encounters. The telehealth in Minnesota, we're settling in somewhere around about 25% right now, but this is the time to take the deep
00;29;51;07 look at what has occurred and understand for what patients does this work for, what services for what care, what are the ways that we can be smart about taking advantage of this incredible natural experiment that's been underway to inform policy and practice as we go forward.
00;30;11;17 [Senator Angus King]: Uh, I serve on the Armed Services Committee and we often talk about the after-action review. Uh, and I think that's exactly what we're talking about here is a careful review. As you say, of what worked, what didn't work, what other changes are necessary, what changes do we do we maintain, uh, Walter you've been working in the area of rural health. I remember meeting with you in my office a year or so ago, and, uh, I hope that can occur again at some point. Uh, but, uh, tell me about how
00;30;42;26 you think, how you see telehealth fitting in with the whole, uh, issue of rural health, which you've been working on for some time.
00;30;51;13 [Walter Panzirer]: Absolutely. Thank you, Senator King. Um, first of all, let me give a little bit of background. We, at the Helmsley Charitable Trust were into telehealth for over 10 years. I like to say that we were telehealth before tele-health cool, natural necessity. Um, the Helmsley charitable trust has been in business funding tele-health and rural medicine. Um, for the last 10 years, we have funded over $450 million rural health solutions in the upper Midwest of seven states. Of that, over
00;31;24;27 $110 million alone, just to telehealth. In the last 10 years we have funded, um, we're in over 420 hospitals or critical, uh, emergency pharmacy, those types of telehealth interventions, and being one of the largest telehealth funders in the United States. Um, we see this as a
00;31;51;18 great opportunity right now. We see over the last 10 years, we know what works, we saw, what works and what doesn't work, um, with our partners are on the ground. And so, when the pandemic hit and the upper Midwest, our hospitals and our partners were ready for it. And we see some of the struggles that some of my other colleagues on the panel have spoken to about drinking from a fire hose. And this is such an exciting time now because I really see
00;32;23;15 telehealth on the forefront and telehealth being something permanent because patients that aren't, that used to using telehealth physicians are used to using telehealth. This is, this is a win-win. Um, we've seen long-term on telehealth that we have saved taxpayer and insurance money, millions and tens of millions of dollars on unnecessary transfers, keeping these patients in the, in the smaller, critical access hospitals and giving them the highest level of care there with the aid of not just a telehealth
00;32;56;04 conference, but smart technologies to better monitor the patients and remote patient monitoring and different aspects layered on top of tele-health.
00;33;05;23 [Walter Panzirer]: So, I am super excited about the future. I absolutely am very encouraged by the reimbursement rates being temporarily lifted. And I really concede long term this being a permanent solution to many of the problems we're spacing in rural America, from lack of specialty care, to lack of physicians, PAs - physician assistants, and nurse practitioners, and the other family practice physicians that are running these small little
00;33;38;10 critical access hospitals, besides their practice, getting the necessary support being supported remotely. And it's, I've heard, talked to countless physicians where they, they feel supported, um, in rural America. So I'm, I'm super excited where this is headed, and I'm really encouraged that this, this is a permanent way of doing medicine and the outcomes are awesome from what I've seen. And we can talk more on
00;34;08;08 those through the panel later on
00;34;16;05 [Senator Angus King]: The presentation, when you said the outcomes are awesome. Do you feel like you're getting positive outcomes, uh, that I'll ask you the same question I asked Dr. Miller. It worked?
00;34;30;03 [Walter Panzirer]: Yes. I, I, from what I've seen on the outcomes, um, uh, great, a good telemedicine visit should be no different than an inpatient visit. The outcome should be the same. And we've seen those outcomes in so positive. Um, for an example, Senator, um, I have heard countless stories of patients coming to the local hospital, presenting a stroke, um, being able to have the local physician, which may
00;35;02;12 be sometimes as a mid-level. Sometimes it's a family practice level, have an eConsult with a board certified emergency room physician, bring onboard a neurologist, determine whether the patient is a candidate for TPA and push the lifesaving clot-busting drugs into these, into the patient at this critical access hospital. When traditionally they wouldn't have a neurologist consult, this patient would have to be packaged and shipped to
00;35;32;24 a larger tertiary hospital.
00;35;34;29 [Walter Panzirer]: And a lot of times, especially when you look at neurology and cardiology, if you don't get that life-saving intervention on immediately or in a small time window, that patient is no longer a candidate. So, we're seeing these patients in rural America where you're getting this life saving treatments, where in the past they wouldn't be receiving this lifesaving treatment. So, it would be packaged and sent to the tertiary facility. Most they can do is probably rehab from the stroke. So, yes.
00;36;05;07 [Senator Angus King]: Let me ask a Scott, let me ask your view of the efficacy in particularly in the behavioral health field.
00;36;13;02 [Scott Oxley]: Yeah. Thank you very much. Senator, when we converted a large portion of our outpatient program to telehealth, I was a little concerned about two things, one the efficacy, uh, I wanted to maintain our strong outcomes to know that our work was making a difference in terms of quality of life for our patients, but also from a patient satisfaction perspective, because if we didn't make this a convenient, excellent experience for the patient, they weren't going to engage. They wouldn't get the care that they needed and obviously, uh, their condition
00;36;45;10 would deteriorate. Uh, but, uh, not to my surprise, but to the good work of our team here at Acadia. Uh, I learned pretty quickly that tele-health is truly a team sport. It's not just the folks on the frontline, uh, providing that clinical encounter. Um, making sure they get the treatment that they need, but, um, making sure the patient is ready to engage in the encounter, making it easy to access from a technology perspective, a scheduling perspective.
00;37;13;06 [Scott Oxley]: So, I was just very pleased to see that over time satisfaction rates. What we saw consistently across the board with our internal sampling was there was an excess of an 80% satisfaction rate, uh, with engagement with the service. In fact, many of our patients, uh, prefer tele-health over the live visit because it simply works for them. And the way that they're battling their illness, the issues with stigma with the mental health population allows them to get the service and their privacy
00;37;44;13 of their own home. And then, and then in an environment that they're very comfortable with where they have those local family supports, it's just, uh, an exceptional way to deliver care, uh, for psychiatric treatment. Uh, we've always maintained a diligence, uh, with outcomes and the quality of our service. And not only did we hold our own in terms of, uh, the efficacy of, of the product that we offer, we actually saw a 6% increase throughout
00;38;15;26 the pandemic, as we got deeper into the pandemic. And we converted more of our business to telehealth, we saw the outcomes for us in the quality of our product actually increase. So, uh, from both fronts, from a quality of service, well as satisfaction of service, uh, we, we find that telehealth or telepsychiatry really hits the mark here in our part of the world.
00;38;41;20 [Senator Angus King]: That's, uh, that's exciting to hear, um, let, let me talk, uh, Dena, maybe I can start with you or have some of our practitioners. This is a loaded question, but how about reimbursement rates. Are the adequate, uh, too low, too high? Should they be the same? Shouldn't it? Should there be no distinction between an in-person visit and a telehealth visit? I know at the beginning that the telephone visit was ridiculously low and that was increased and that made a big difference. Um,
00;39;12;13 talk to me about, about that issue.
00;39;15;26 [Dena McDonough, PA-C]: So, yeah. Uh, question, thank you. Um, you know, there, it really is going to come down to outcomes and how the care is provided. What, what patients feel about it as Scott was just saying. Um, when you're talking about some sorts of visits, the leap is much smaller than others. When you're talking about something where the laying on of hands is less important therapy and, and just, uh, maybe, uh, a checkup or
00;39;46;03 a revealing of tests. Um, it's much easier to see that the work going into those services is pretty comparable, whether the person's in front of you or at home. Um, but when you start talking about, um, having to do physical exams, um, you know, there are people, one of the site visits that we went to in Wisconsin, they showed us that they are giving patients a kit that allows them to look at their, look in their eyes, look in their ears, listen to their heart, check their blood pressure. They're doing all of the same vital signs and, and examination, um, using
00;40;22;01 technology. And so, if that's all happening, you know what what's to say that one visit should be paid more than the other. And as someone mentioned, the idea that when you remove the you know, as it is now, where a patient needs to go into a clinician's office and be linked up with another provider, when you have that patient at home, and the distant
00;40;46;22 provider is the only provider they take on twice the burden of setting up that call, making sure that the patient's technology is working. And so, the burden does increase for that provider now. So the way it's done now is this is going to get a little weedy, but the way it's done now is there are different payment rates for, um, for services, whether a patient is, um, in
00;41;13;26 a hospital setting or a doctor's office.
00;41;16;13 [Dena McDonough, PA-C]: And they split those payments. So that if you are in a facility setting, the payment for the service itself is a little lower, um, because the, the overhead and all that burden that I'm talking about is absorbed through a separate, a separate payment. When you have a patient having services from home, they are only getting paid two thirds of what the actual full price would be. So, some of that money is getting lost as we
00;41;46;23 move the patient to the home, even though the work is doubling for the provider. So, there's a couple of different things that need to be looked at. And, again, drilling down on how these services were used, particularly audio versus video is gonna be really important to inform how we reimburse the services going forward.
00;42;07;21 [Senator Angus King]: Well, when we're talking about costs, let's not forget about cost to the patient. Um, the transportation costs, the time costs, the opportunity cost to the patient, I think is, is really significant. I mentioned, you know, Pattten, Maine to Acadia, uh, that's a day, you know, Beth, both ways, that's, that's a day, uh, as opposed to an hour or an hour and a half, whatever the visit takes. So, I think that's, that's gotta be a consideration. And ultimately if we move in this
00;42;37;22 direction, there may be some lower overhead costs. As you say, there may be higher costs for setting up the meetings, but also more or less bricks and mortar, uh, ultimately, uh, now, uh, let me raise a difficult issue using a word that seems to have crept into our lexicon lately - fraud. Is there any additional danger of fraud in these, in this structure where you have calls about keeping track of how long the visits are? And, uh, one of our,
00;43;09;23 one of our audience members raised this question, anybody, uh, want to take a crack at that one? Uh, everybody's quiet on that.
00;43;22;09 [Senator Angus King]: Have there been any, have there been any issues raised that you know, of during this, during this period of, of, uh, improper billing or, or that kind of thing?
00;43;38;18 [Walter Panzirer]: Um, during COVID, I can't speak to the COVID period, but throughout our experience and with our partners over the last 10 years, um, these things, from what my understanding have been built, just like they would be for a normal visit there's proper documentation built in that part of the patient care record. So, you know, with a video conference, you know, seeing the doctor, seeing the nurse, whatever the discipline was, or,
00;44;08;20 or whichever discipline was in there, whether it was a specialist or their family practice physician, that's all documented what was done. Just like I don't see fraud being so much of an issue because it's documented in the patient care record, you can see exactly was done. So that way they can put in the proper codes for billing. I think the risk for fraud is no different than an in-person risk. Um, especially if you have the documentation built in print. And from my understanding, all our
00;44;41;15 partners do have the documentation built in. I'd be astonished to find out that people are having televisits without documentations. I think every lawyer and all these companies in our hospitals would have a stroke if they knew if they had even thought that was going on,
00;45;00;08 [Senator Angus King]: You could treat the stroke via telehealth. Uh, a question that talks about institutional change in order to adapt to this technological change. What about, uh, licensure and across state line practice and state compacts and that kind of thing? How, how has, how has that issue going to be? Is that a, just a matter of time and state law? Um, because you know, the, the internet, doesn't certainly respect state lines,
00;45;31;13 uh, let alone, you know, county medical association lines.
00;45;36;18 [Walter Panzirer]: I could answer that one real quick with us, as you know, with our partner Avera we funded and over seven states and, uh, Avera medical. Um, the Avera hospital group is, is providing telemedicine in over 30 states. And licensure is a problem. Licensure can be difficult. I remember early on things have gotten way better with licensure early on with, with partnerships with the Avera, their physicians would literally have one dedicated person sending out 10, 15 different, um,
00;46;11;15 licensure forms, fingerprints, background checks. It became very cumbersome, very difficult to be licensed in multiple states. Things have gotten better, but I'm sure other people on this panel can speak to it. There are still are challenges. Um, not every state, uh, recognizes a license from another state and some states still make you jump through those hoops that I described, but things have gotten better, but there's
00;46;39;21 still challenges.
00;46;41;06 [Senator Angus King]: Are there other members of the panel want to speak to that, this issue of licensure and, and, uh, sort of those kinds of regulatory barriers? Is that is that the next, the next step in this, in this process? Um,
00;46;55;09 [Scott Oxley]: Yeah, this is Scott. I, I do agree with Walter. I think there's opportunity there, but if you think about this as one component of workforce development, I think we have gotten so much more benefit to date through the use of telehealth by, by allowing us to expand our workforce. We have 57 providers on our medical staff, a combination of psychiatrist and psychiatric mental health nurse
00;47;21;16 practitioners, about 15% of that workforce work
00;47;25;21 [Scott Oxley]: Every day from a state beyond the borders of Maine. So we have nine individuals and eight different states working with us every day to provide a combination of care to both outpatient and inpatient and not just at our hospital, supporting many of the clinics or practices that I referenced in my opening remarks. So, I do agree with Walter, uh, it's a little cumbersome to work through. It hasn't been a showstopper, but so far, the being able to extend, um, our work force, uh, both on an
00;47;58;17 inbound and outbound basis has been such a benefit to us. Um, and we're just happy to have, uh, extra providers available to take care of people from Maine
00;48;10;14 [Senator Angus King]: Dr. Miller, you, you mentioned in your comments that we're moving toward home monitoring of vital signs and others. Do you, do you see that as a potential significant growth area in terms of making telehealth more efficacious?
00;48;28;11 [Dr. Lisa Miller]: Absolutely. And there are quite a few home health agencies in Maine already doing that. You know, a patient will get discharged from the hospital, uh, very ill and know that they need closer monitoring. And so, they're actually sent home with a kit that Dena had mentioned to monitor vital signs, check weights, if there's a history of congestive heart failure, et cetera. So, it's already happening. But I think that there's opportunities to expand that as we look to other options for
00;49;00;22 telehealth. Um, just the other day I was asking my colleague, you know, what are some of the advantages that you found beyond just the obvious? And she said she has several patients that are literally home-bound that can't get into the office, we'll make appointment after appointment, and they'll no show or their transportation will fall through. And she's been seeing them over telehealth with a home health nurse by their side and the vital sign machine. And she said, it's better care than she's ever
00;49;30;20 provided these patients because before they literally couldn't get in the office. So, it's, it's almost just like in the old days when we did home visits, which is a really wonderful development.
00;49;41;26 [Senator Angus King]: Well, I know one of the notes, let me just, one of the notes that ran across the screen was that there's a recent study that shows a 38% reduction in no-shows, uh, in terms of the difference between telehealth and physical offices. That's gotta be good for the whole system and, and a money saver, and obviously people who don't show up, but maybe need the care. Uh, they're getting more care. Other, other
00;50;11;21 comments? Uh, I think someone wanted to jump in.
00;50;15;10 [Jennifer P. Lundblad, PhD, MBA]: Yes. Thank you. Sorry for interrupting Senator King. I just wanted to add to this question about, um, remote monitoring and just note that we should all be tracking on hospital at home movement. Uh, so in addition to home care, which we just spoke about, um, there has been in, in COVID and with telehealth flexibilities, uh, and, uh,a move to do hospital at home. It's really an opportunity to care for in rural communities. Those with serious illness, it brings care into the community. It reduces social
00;50;46;23 isolation. And so, it's remote monitoring kind of coupled with 24/7 remote nurse monitoring, you think technology. And so, keeping an eye on where hospital at home goes as part of the whole telehealth movement, I think will be an important opportunity going forward in rural.
00;51;03;19 [Senator Angus King]: Well, and that raises the potential of, uh, more in the way of preventive care. Um, I'm convinced that the low hanging fruit in, in healthcare costs is better prevention the one that doesn't occur. Uh, and I think telehealth regular or some kind of a regular physical checkup via telehealth.
00;51;26;12 [Senator Angus King]: People might be more willing to do, uh, particularly if they don't have to take a day off work or if it can be done in the evening. Uh, anything along those lines that facilitates people, uh, utilizing and getting preventive care, I think is going to be beneficial to, to all of us, in terms of our dealing with the overall expenses of the system. Now I'm getting, I'm getting lots of questions, uh, are low volume, rural providers being considered in the development of telehealth quality
00;51;57;11 measures? Do you foresee challenges for rural providers in meeting existing, uh, telehealth quality measures? So clearly that's going to be an issue going forward. Uh, uh, Dena, do you want to take a crack at that, uh, rural health? Are our providers gonna have problems dealing with the quality measure piece of this development?
00;52;22;28 [Dena McDonough, PA-C]: One of the benefits of, I mean, aside from the health benefits and the health care delivery benefits of value-based payment models is, or, and value-based care is the elimination of some of the reporting burden. Um, unfortunately a lot of the programs are really, they, they really aren't meant for lower volume providers. And what we see is when you, aren't seeing as many patients, one bad outcome can really mess up your numbers and can really adversely affect, um, provider payment
00;52;55;16 and, and in a way that is not really fixable by them, they can only do what they can do. And when you're dealing with the, you know, when you're dealing with ratios, um, you know, a little, a little bit of, uh, you know, one really sick patient can eliminate their ability to, um, to meet some of the quality metrics. So, we continue at BPC to raise the issue of how to address issues, particularly for lower volume settings and for these
00;53;26;04 providers, because we really, we want these changes to support them, not to make life harder for them and make it more difficult for them to provide better care for their patients. So, um, we continue to look at quality measures and try to figure out ways that would allow them to improve care, um, that is judged by outcomes rather than the every little thing that needs to be reported, because it just becomes too burdensome and they're
00;53;56;00 not able to keep up with it. Um, it takes away time from actual face-to-face patient time that they are spending on a lot of this reporting. And, and we don't want to make that worse.
00;54;09;10 [Senator Angus King]: Um, Scott, actually, a question for you, we've been talking about telehealth as a, as an overall, uh, provision as an overall concept, but there is a distinction between what we're doing now, visual audio and audio only, um, is, is, is audio only effective and as effective as it, a stepchild of this, of this movement, or is it also an important part because clearly you avoid the whole issue of broadband. Uh, and
00;54;39;24 particularly in behavioral health, I have a friend who does her consultation with her therapist every week on the telephone while walking, I mean, uh, is that, has that proven to be effective? Is that part of your, your, uh, toolkit, uh, at Acadia?
00;54;57;23 [Scott Oxley]: Absolutely. Senator, um, I would say that really at the end of the day, any way that we can improve access to care is a step in the right direction. And our experience with audio visits, uh, is a pretty small piece of our business. To be honest with you, that we've had pretty good success so far with the video component and, uh, you know, accessing a patient, providing to them, their care, getting into their home through video means is, uh, is there a
00;55;28;25 better platform for us to be honest with you for the care of the mental health population, but if it came down to audio or nothing that we obviously prefer access by audio, but at the end of the day, everything we've been talking about and everything that you're advocating for on our behalf as a country really does get to access. It's doing away with those restrictions, whether it's a geographic limitation, a site of service limitation, I don't think it's as we should open up all modalities, as long
00;56;01;13 as we can continue to prove their efficacy, but really, I think the focus needs to be going forward in terms of how we rethink telehealth. It really has to be about continually, continually expanding its access.
00;56;15;18 [Senator Angus King]: Well, I want to just pause for a moment and our panel is, are all involved in tele-health per se, but the, the looming issue in the background is broadband. Uh, everything we're talking about, uh, doesn't work except for the telephone part doesn't work, unless the, uh, the patients, the citizens, particularly rural citizens have access to a decent connection, uh, so they can make an utilize these services. So, uh, this will, uh, per perhaps the center we can do another
00;56;48;17 one of these sessions and talk about the, uh, Rube Goldberg, uh, broadband, uh, federal government response on broadband. And maybe we can try to talk about a more comprehensive response to, to be sure that happens. So, I just wanted to, you know, parenthetically within this discussion, remind everyone of how important, uh, uh, good broadband is to realize the enormous potential of this, uh, of this technology. Uh, uh, Jennifer, what,
00;57;19;14 what do you see? I mean, I, I made a joke about Minnesota and Maine, but Minnesota is a largely rural state, um, are people taking advantage and will this continue after COVID? Do you think this is, uh, a COVID only phenomenon because people don't want to leave their homes or, uh, is, have we unleashed something out of the bottle that's going to, uh, the genie out of the bottle, what's going to continue into the indefinite future and be a
00;57;47;04 basic part of American healthcare delivery system.
00;57;50;19 [Jennifer P. Lundblad, PhD, MBA]: Yeah. Thanks. Thank you, Senator. I think we have unleashed something. Uh, I'll comment first on that, on the broadband issue that you raised, which is such an important one, because Bill reminded us as we got started, that, uh, there's still 25% of the country in primarily rural places that do not have broadband access, and that's even higher in certain communities, particularly in our tribal communities. And so when we think about broadband access, it's not only about bringing broadband to those communities, but it's about making it affordable for the patients and families there, sometimes it arrives, and it's simply not in the ability of
00;58;25;17 those patients to pay for that. So, we often think of technology as an equalizer, but sometimes it really exacerbates the disparities that exist. And so, as we do broadband, it's very careful to construct our policies that make it to really work.
00;58;39;13 [Jennifer P. Lundblad, PhD, MBA]: Um, but in terms of your question about whether we think it's, we've unleashed something, I do, you know, pre COVID, we often thought of telehealth and rural as accessing specialty care that wasn't available locally, that will continue to be true. That's what Walter, his group has done such a great job of out of the Helmsley Trust, supporting that. But now we're also in addition to accessing specialty care that isn't available in remote communities, we're talking about how primary care teams and family practice teams deliver care in rural communities and do that. So
00;59;12;16 it's the local care that's being delivered via telehealth. And I think both parts of that are going to stick. They're going to have some staying power. Um, that'll certainly, as I said, in my earlier comments kind of settle in at a different rate and a level, and as we better know which patients and which services and what care is right, and lends itself best to telehealth, we'll have some best practices. We'll be able to redesign both the workflow and the practice and have the policy support around that. But I think it's
00;59;40;03 here to stay. And I think it's not just that remote accessing specialty but delivering care locally.
00;59;47;23 [Senator Angus King]: Walter, do you agree? I mean, this is something you've been working on for a long time, or do you see this as a, as a permanent change in the healthcare landscape?
00;59;56;16 [Walter Panzirer]: I hope so. I hope it is a permanent change. The only thing that I'm optimistically cautious though. We're at a point right now where healthcare can, or telehealth can either take tremendous leaps forward or several steps back. Um, reason why I say several steps back is because it goes back to quality. We need to make sure there's gold standard quality care initiatives being done, because all it takes is a couple of bad actors, a couple of really big mistakes. And can we put a kibosh on the
01;00;29;04 whole telehealth? Um, like I always said, it's based on quality and just to dovetail a little bit on the quality aspect, we've been big on quality. Um, the Helmsley Charitable Trust I've recently launched a Helmsley Telemedicine Education Center to educate providers, educate, um, mid-levels to even educate, um, hospital executives on how to implement telehealth,
01;00;59;29 how to do it right because we want our experiences.
01;01;06;00 [Walter Panzirer]: And so we don't have mistakes that set telehealth behind me today because the last thing I want is for someone to come in with a cheaper solution, so to speak and not a quality solution, and either do harm to patients or do the whole movement of telehealth, because I think this is the great equalizer across our rural divide. And really, it's
01;01;35;28 not a rule issue too. I can see this type of programs and what the physicians have spoken to about using it in primary care and behavioral health, all throughout urban centers and suburban centers. Um, it's, it's all about getting people access timely access to the quality care, which everybody deserves. And so that's not a rule issue. Yes, it's exacerbated in the rural areas, but it's just as much as our urban colleagues,
01;02;06;11 just as much of our suburban citizens, everybody deserves quality and quality access. This will level the playing field eventually if done correctly.
01;02;18;18 [Senator Angus King]: Yeah. And I think the point that Jennifer made about cost is very important. You can have a great fiber connection in the middle of the city, but if you can't afford a hundred dollars a month or whatever, it's going to cost you, uh, it may as well not be there. So, I think cost has gotta be part of this. And remember, I, I started talking about the universal telephone service and there was a recognition there that, that it was a basic service and that there needed to be some subsidies in order to be sure that it was in fact, uh, universal. Now we're
01;02;50;15 all cheerleaders. This has been a great session of everybody saying yes. Um, anybody on the panel, uh, Dena, maybe I'll make you the, the devil's advocate, uh, what, what's the opposition? What are the arguments that, uh, people will make? What are the arguments we're gonna encounter in the Congress? When we try to go ahead and make permanent some of these provisions, are they going to be from, uh, physicians, from hospitals, from, uh, broadband providers? Who's, where's the, uh, what, what, what,
01;03;20;12 what are the negatives that we're going to encounter otherwise? Uh, this is something we ought to be able to do next week,
01;03;27;02 [Dena McDonough, PA-C]: Right. I think, you know, the big one is the money, right? Like this costs money. And, um, without really good data showing that the outcomes are going to save money over time. Um, we have to figure out how it's going to get paid for. So, the, the main concern and, and what's tied into the fraud and abuse issue is that people don't want over utilization of services. Um, so we, we need to be really circumspect, uh,
01;03;57;14 circumspect about how we roll these things out so that, um, when we first get started, we don't make a, make a mistake that then shuts everything down. We want to be able to keep going forward. So, we want to have data to back up what we're doing. Um, and to show that the, you know, the, the problem is, is a lot of times when you're dealing with healthcare, the, the savings are 20, 30 years down the road. And that's just not, um, not front of mind when you're talking to
01;04;27;05 legislators. So, um, so that's the big problem. And I, and I just want to highlight, because we are continuing to have an issue in rural areas about maternal mortality and neonatal mortality and the cost associated with that. Um, we've got to find innovative ways to get obstetric and neonatal care to these areas of the country. Um, and you know, more than half of rural counties, don't have obstetricians largely because of the cost of those services in, in those areas. So now you have variables such as
01;04;58;03 transportation and taking time off work that influence health care. And there's a clear link between early and regular obstetric care and maternal and neonatal outcomes. So again, we have to ask whether telehealth can help save money and, and improve
01;05;12;13 [Dena McDonough, PA-C]: Health of rural communities. And that'll go a long way in justifying the cost.
01;05;19;27 [Senator Angus King]: Um, we have a few minutes left and I want to remind our audience that if they use #BPC, they can send questions directly in which if you see me leaning forward, uh that's so I can read the questions that are coming across, uh, on my screen. Uh, I think, uh, cost clearly is an issue and, and the trouble is it's hard to quantify the savings. Uh, I think, and as I mentioned, there are savings to the patients, uh, that would never be part of the qualification. All the calculation would be well, what does it cost for the hardware and the
01;05;52;09 broadband and the, and the visits and the practitioners. But, uh, if you're talking about societal savings, I think they, they could be considerable, uh, Dr. Miller in, in, in your practice. Uh, have you seen any effect on no shows versus, uh, people who make their make their appointments because that's, uh, that, that could be a significant factor.
01;06;15;15 [Dr. Lisa Miller]: Yeah. We actually see improvements with the telehealth visits, um, in terms of no shows. And part of that, I think is it's just easier to schedule on the fly and get people in quickly, and then they're getting more point of care, um, treatment. But I also one other group that I'd like to point out in the same vein, um, as Dena with maternal mortality rate is the patients that we take care of with opioid use disorder. We're seeing a lot of patients in that group use telehealth
01;06;48;25 services. And I, I feel that they're particularly vulnerable to the dire consequences of this pandemic. Um, currently in our practice, we're having them seen over group visits for their counseling, but also, um, some telehealth visits for their, um, medication assisted treatment. And it's just a really important group, not to forget, because I feel in this time of social isolation, that that problem is only going to get much worse as
01;07;15;18 time goes on.
01;07;17;19 [Senator Angus King]: Yeah, we're, we're suffering a, uh, an epidemic or several epidemics. Of course, COVID is the major one, but we have an epidemic of suicide and epidemic of depression, uh, an epidemic of, of, uh, drug issues. So, uh, those are all issues that we, we really need to deal with. Uh, Jennifer, did you have some thoughts on, uh, where the, where the opposition might come? What, what the, uh, what the obstacles are to fully realizing the potential here?
01;07;48;06 [Jennifer P. Lundblad, PhD, MBA]: As I was listening to Dena, I was also thinking about, uh, another debate, I guess I'll call it that we can predict, which is about network adequacy. So as we've seen and have demonstrated the effectiveness and success of use of telehealth, and as we're looking at how we define network adequacy, I can predict some of the policy debates might be around, um, Care and services can be brought entirely remotely to a community. And that, that counts as being an adequate network for a health plan, for example, and then that tension with what really should be local. Should we
01;08;21;19 always have primary care and EMS and public health locally, which is what the blueprint health panel would say are essential local core services. So I predict that there'll be some tension around network adequacy, and when we'll tell a health supplement, and when we'll tell the health supplant what's available in rural communities, I think there's going to be a fair amount of policy debate around that.
01;08;44;25 [Senator Angus King]: Well, uh, we're not quite finished. We have some more questions, but I just didn't want to forget. Um, I think this is going to be a very live issue in the next Congress. Uh, and I think it's a cross cutting issue. I think it is a bipartisan or a nonpartisan issue, uh, particularly because so many of my Republican colleagues represent rural states, uh, where these issues are so, uh, so critical for their own citizens. So, I think this may be, uh, should be one of those areas where we able to, uh, get out of the gridlock. That's afflicted us recently and, and
01;09;19;03 hopefully, uh, make, uh, make some real progress, at least in making the COVID related provisions, permanent, uh, examining, as you've mentioned, what has not worked and other areas where we should make those changes. So I want to be sure to invite the, the panel as well as the audience, uh, to be in touch with my office, with, with my colleagues, with your own Senator, wherever you are your own house of representatives
01;09;46;18 member, uh, because I think this is going to be, as I say, a very, uh, a front burner issue when the next Congress, and, uh, we're going to need all the input and expertise we can get. So I urge everyone to take advantage of this, of what I consider a very open door for, for good policy making that can, uh, make a difference into the, uh, into the indefinite future, even, uh, beyond the pandemic. Uh, other thoughts from our panel as we, as we close in Walter. Uh, what, what,
01;10;17;20 uh, what, what do you have for a closing argument?
01;10;21;29 [Walter Panzirer]: Well, like, uh, like I said, the future is bright. Um, I'm very optimistic. I'm very optimistic with the future of telemedicine. Um, really, I'm really excited and hoping to see the rest of the world rest of the United States catch on to what we have done into the upper Midwest and what we've learned in the upper Midwest. We've made mistakes learn from our mistakes. We were partnered with Rupri just about
01;10;58;09 all the groups that people have mentioned. I'm here to try to make best, best practices and telemedicine, I think, has to be here to stay. We can talk through reasons why, whether it's workforce development and the lack of workforces in rural areas, you have to supplement the physicians and other specialties with telemedicine, because you cannot get a psychiatrist.
01;11;26;24 For example, in these rural communities, we can't even get psychiatrists in our urban communities. There's such a shortage. And this, this is the only adequate equitable way to level the playing field and to give people who call rural America home, the same access to our urban counterparts. I always say your zip code should not determine your outcome. And
01;11;56;14 unfortunately, where you live can determine your health outcomes. It can determine life or death at times, and that's not right. And this, this is one of the many tools to level that playing field to give everyone equity. And I'm encouraged. We've been at this 10 years, and I'm really encouraged that this is front and center. Yes. It took a pandemic to bring it front
01;12;25;20 and center. That might be the only benefit of this pandemic. We've have had economic problems, social problems, everything because of this pandemic. But really this pandemic has forced telemedicine to the top and forced a focus on telemedicine because, um, it's a necessity now, and hopefully people will see it as a necessity in the future to level the playing field.
01;12;50;24 [Senator Angus King]: Well, I'm going to give you the last word unless somebody else has a need to make a contribution. Uh, any, uh, any thoughts, anything that we've missed, uh, thus far, um, in which case, uh, Walter and I just want to go across the panel. Uh, Jennifer, Dena, Lisa, Scott, and Walter, thank you so much for, for all the work that you've done. And, uh, I think my last comment is a bit of homework, which is, uh, send to us your
01;13;22;03 two or three top legislative priorities for the next Congress. Uh, this is a chance to, to make a difference. And, and, uh, uh, as I told her, I right before your meeting, I had a Zoom meeting with a group of seventh graders in Maine. And, uh, they asked about what's the most important responsibility and right. What's the most important right? And responsibility of citizens. And I said, it all comes down to the first three words of the constitution. We, the people, we, the people the most important, right, is the right to
01;13;54;11 vote and participate in our government. The most importantS responsibility is the responsibility to vote and participate in our government. And I'm offering an invitation only to our panel members, but especially to the, to the knowledgeable members of the audience, uh, to give us the real life situations, uh, the real life issues and problems, uh, and things that we can address here in Washington, or that we can work with, uh, uh, DHHS and
01;14;22;21 CMS, uh, on the regulatory side, uh, to be sure that this works and that it works to provide, to meet the promise that it has of expanding access and quality care to people across the country, but also in areas that where there is a need, uh, like behavioral and mental health, uh, huge potential.
01;14;42;25 [Senator Angus King]: And I want to thank everyone for participating and especially thank the Bipartisan Policy Center for, uh, giving us this opportunity. And, uh, we're going to continue with this work. I look forward to hearing from many of you, and maybe we can do this again, uh, at some point in the future and all sit on a stage together. Thank you very much. And, uh, good day, uh, have a wonderful day for everyone. And, uh, uh, we're gonna keep, keep working together to, to, to solve this problem and to make this technology work for the American people. Thanks again. See
01;15;15;02 you later.
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In response to COVID-19, the United States has seen a dramatic expansion in the use of telehealth services—including in Maine. While this has ensured continued access to care during the pandemic, the legislative and regulatory changes that made this possible are not permanent. As the nation moves forward, policymakers and health care providers alike must consider the investments and changes needed to sustain access to 21st-century quality health care through telehealth to meet the needs of Americans today and in the future.
Join us on November 13 for a discussion with Sen. Angus King (I-ME), Maine health care providers, and BPC experts on the benefits of telehealth during the pandemic and what things look like for the future of telehealth in Maine and throughout the country.
Featured Participants
Moderated by:
Sen. Angus King (I-ME)
Panel discussion with:
Jennifer P. Lundblad, PhD, MBA
President & CEO, Stratis Health
Member, RUPRI (Rural Policy Research Institute) Health Panel
Adjunct Assistant Professor, University of Minnesota School of Public Health
Dena McDonough, PA-C
Associate Director of the Health Project, Bipartisan Policy Center
Dr. Lisa Miller
Family Medicine Physician, Western Maine Health
Scott Oxley
President, Northern Light Acadia Hospital
Walter Panzirer
Trustee, Helmsley Charitable Trust
Additional participants to be announced
In light of restrictions related to the COVID-19 pandemic, BPC events have shifted to all remote formats, such as video teleconferences or calls.
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