Mon, Oct. 14

State-ordered mandate on insurance may result in more affordable health care for rural Arizona

PHOENIX -- A new state-ordered mandate on insurance companies could soon mean more accessible -- and definitely more affordable -- health care in rural areas of Arizona.

The measure signed into law earlier this month, prohibits health insurers from denying payment for medical services solely because they provided through telemedicine. Put more simply, if the condition or treatment is covered, the insurer has to pay whether it was delivered in a doctor's office or through a televised link-up.

Approval came after insurance industry lobbyists, who normally oppose any new mandate, agreed to back the change.

Charles Bassett, who represents Blue Cross and Blue Shield, said his company remains concerned that it will end up paying twice for every hospital visit: Once for the doctor on site and again for the doctor who is brought in electronically to consult.

But Bassett said there are some possibilities for cost savings, particularly when a patient does not have to be transported by ambulance -- or, even more costly helicopter -- to an urban hospital.

"I think it's going to remain to be seen,' he said.

Sen. Gail Griffin, R-Hereford, who sponsored the measure, said this is a small first step. The law will cover only certain rural areas.

Even then, insurers would be required to pay for telemedicine treatment only for seven specific conditions. And implementation was delayed until the end of 2014 to satisfy insurance industry concerns.

But Griffin said she is convinced that there will be no increase in costs. And that, she said, could open the door for even wider use of telemedicine, perhaps even statewide.

For the time being, though, Griffin is content to deal with rural health issues.

"We don't have the services and the expertise,' she said. The technology that's available enables doctors elsewhere to do much of the work.

Daniel Roe, director of the emergency department at Bisbee's Copper Queen Community Hospital, said it's a matter of getting the expertise where it's needed.

"Because we are in such a remote environment we have trouble recruiting physicians to find specialists that would be willing to locate in Bisbee or have a full practice in Bisbee,' he said.

The result, he said, is the hospital has a surgeon "a couple of days a week,' a urologist on Wednesday and managed to just recently hire a pediatrician.

"But we don't have a cardiologist, a pulmonologist, a neurologist, on down the list.

Roe said what that has meant in the past is that patients who show up with chest pains or a stroke had to be sent to Tucson. Now, he said, technology allows his hospital to keep many of those patients in Bisbee.

"It keeps the patient and the families close to home,' he said, which means lower costs for them. But beyond that, treating patients locally means improving the finances at the hospital, the city's largest employer, helping keep the doors open.

With the technology already available, that leaves one issue: finances.

"When I go to Tucson and Phoenix to recruit specialists to run these programs, there comes a time at the end of the conversation when I get asked, 'Do the insurance companies pay for these consults? Am I going to get reimbursed?' ' Roe said.

"I have to tell them the truth, that 'You're going to get paid about half the time,' ' he continued. "That has a serious impact on my ability to recruit them to staff these programs,' as these doctors already have full practices where they live.

That becomes the bottom line behind the new legislation.

As approved, it says that beginning in 2015, all new and renewed insurance policies must include coverage for services provided through telemedicine "if the health care service would be covered were it provided through in-person consultation.'

Roe described a scenario where a pediatric patient comes to the hospital. Rather than ship the child to Tucson, a specialist who might be at Tucson Medical Center comes on the screen, talks to the patient and family and looks at pictures transmitted through a high-definition monitor. He said the remote doctor can listen to the patient's heart through a digital stethoscope and look into the patient's ears and throat with a digital otoscope.

X-rays are sent digitally to the computer at TMC and the doctor can review lab results. At that point the specialist can decide if the patient can be treated in Bisbee or needs to be transferred.

That latter option, he said, is expensive. Roe figured the cost of one ambulance transfer pays for 70 to 80 telemedicine consults. And if the evacuation is by air, the price tag exceeds 200 consults.

Bassett said that's part of the reason insurers agreed to go along.

"There's a great argument that stopping people from having to be air-evac'd out of Bisbee ... you're going to save a lot of money,' he said. "On the other hand, there's two doctors involved in every transaction on telemedicine so you're paying that twice.'

There are restrictions.

The only services which have to be covered through telemedicine are trauma, burns, cardiology, infectious diseases, dermatology, mental health disorders and neurologic diseases including strokes.

And the measure is crafted so that the coverage applies only in the 13 rural counties and the more remote areas of Pima and Maricopa counties, like Ajo and Gila Bend.

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