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Testimony on House Bill 1849: Telehealth

Good morning, Chairman DeLucca and members of the House Insurance Committee. I am Larry L. Light, vice president of government affairs at the Pennsylvania Medical Society in Harrisburg.

Let me begin today by thanking the Committee for hosting this hearing. Also, let me offer thanks for all that you have done in the past on issues of concern to the patient-doctor relationship. I realize that your work often receives little thanks, but is deserving of such praise.

We’re here today to discuss House Bill 1849. This bill would provide for health care coverage for telehealth.

To begin, let me tell you that telehealth is an emerging aspect of health care, and there is evidence that it is gaining momentum and interest.

House Bill 1849 considers telehealth as an interaction between a health care professional and a patient through the use of

• video camera transmission,
• computer video transmission,
• electronic health monitoring device,
• and, other telecommunications devices that deliver health information concerning a patient to a health care professional.

Telehealth promises to revolutionize the management of chronic disease. With reliable monitoring, patients can go home sooner after a hospitalization and stay at home longer. Always-on monitoring can detect any change in vital signs or other clinical indicators when they occur. This means that the patient and health professionals remain connected even while the patient is comfortable in his own home. But, even beyond their homes, wireless broadband can enable patients to live active and productive lives with the confidence that their chronic diseases are being silently monitored at all times.

And, indications are that the cost savings of telehealth can be a significant. In a 2001 Penn State University study, remote home health monitoring for a single group of diabetes patients cut costs for hospital care by 69 percent. We expect that future advances in technology and telecommunications will make it even cheaper and easier to monitor health remotely.

The Pennsylvania Medical Society has a long tradition of supporting legislation that benefits patients. The Pennsylvania Medical Society also supports legislation that would reduce health care costs without harm to patients or physicians. For those reasons, the Medical Society supports House Bill 1849. However, we believe that House Bill 1849 does not go far enough to create a climate in Pennsylvania that will foster the rapid deployment of the use of telecommunications to improve patient care.

The Medical Society would encourage the inclusion of mandatory reimbursement for telemedicine along with telehealth services. Telemedicine involves the real-time interactive treatment of a patient by a physician through the use of a telecommunications network. Telemedicine is successfully used in Pennsylvania and elsewhere. However, a major barrier to its use is the cost for equipment and telecommunications and the lack of insurance reimbursement.

Let me give you some examples of how telemedicine could be used in Pennsylvania.

The Pennsylvania Medical Society recently completed a project funded by a grant from the Pennsylvania Department of Community and Economic Development to explore the use of broadband by Pennsylvania physicians. Through this grant, we’ve learned some important information that is useful in your work on House Bill 1849.

As you know, Pennsylvania has one of the largest rural populations in the nation. The majority of Pennsylvania physicians, especially specialists, practice in urban areas. As a result, many rural Pennsylvanians do not have easy access to specialists. For example, according to our research, over 3 million Pennsylvanians live more than 25 miles as the crow flies from the nearest high-risk pregnancy specialist. That is about one quarter of Pennsylvania’s population.

Over 800,000 Pennsylvanians must travel more than 25 miles to reach the nearest dermatologist. Even then, patients wait months to get an appointment. Such travel deters many patients, especially Pennsylvania’s seniors, from seeking life-saving treatment.

Telemedicine could help these situations.

Telemedicine could enable physicians in urban areas to treat patients remotely. Presently, telemedicine is largely funded by grants. Reimbursement is spotty. The start-up cost is significant with little hope of recouping the investment through future reimbursement. If used appropriately, telehealth and telemedicine could be valuable tools for both patients and their doctors.

I do want to point out that telemedicine has its limitations. It may not always be appropriate for all patients. Everyone is different. And, it shouldn’t replace a direct examination of a patient when a direct examination is needed.

And, we also need to be sure that Pennsylvania laws are not broken. Physicians or other providers using telehealth or telemedicine to deliver health care services to Pennsylvanians must carry a Pennsylvania license to insure that patients are protected should a medical liability issue arise.

To summarize, the Pennsylvania Medical Society supports House Bill 1849 and would encourage expansion of this bill to include mandatory insurance reimbursement for telemedicine services. We request the additional requirement that those health care professionals using telemedicine or telehealth to deliver health care services to Pennsylvanians be licensed in Pennsylvania.

Once again, I thank this committee for the opportunity to present this testimony.