Telemedicine to reduce Medicaid travel costs
Sen. Pete Kelly’s Medicaid reform bill would remove some of the hurdles created by the state’s existing medical laws just in time to take advantage of the state’s growing telemedicine infrastructure.
Kelly said in a March 21 House Finance Committee hearing that one Medicaid reform in his Senate Bill 74 that passed unanimously on March 18 — telemedicine, or telehealth, expansion — is a way of keeping up with the times to reach the best fiscal output for the state.
“It’s like getting out of the buggy whip days and into the days of the automobile,” Kelly told the committee.
Through video and digitally enabled biomedical readings, physicians and nurses in one area are able to provide primary, urgent, psychiatric, and even intensive care to rural patients without needing expensive transit for themselves or the patient. Over computer or mobile connections, care providers can relay remote diagnoses and treatment plans.
Medicaid-related travel consumes loads of state and federal resources, Kelly said, and telemedicine is the 21st century route to cost savings.
“Travel is not necessarily abused, but it’s so poorly used and so poorly coordinated that we use a lot of money,” said Kelly, who added he’s been told $79 million in travel costs weigh down the state’s Medicaid programs.
According to estimates from two legislative reports, telemedicine would save $13.2 million in 2021 by reducing these travel costs. Per person, estimates say telemedicine costs about a third of an in-person visit and one-tenth of most emergency room visits.
The bill would direct the Department of Commerce, Community and Economic Development to compile a business registry of state telemedicine providers, which would extend to Outside health providers for the first time.
Currently, telemedicine providers have to reside in Alaska as well as carry Alaska licensure. The bill would allow Outside doctors licensed in Alaska but living elsewhere to provide care, and prohibit the state Medical Board from penalizing healthcare providers for making digital diagnoses.
Heather Shattuck of Kelly’s staff said the telemedicine provisions of the bill are maintenance, rather than change. Indian Health Services already has similar allowances in its coverage. This bill would bring Alaska’s telemedicine up to speed with the federal rural-focused health providers.
Apart from primary medical care, Kelly’s bill has specific provisions for mental and emotional care, including psychiatrists, psychiatrist aides, assorted behavioral counselors, and even marriage and family therapists. Along with access to primary care, one of the reform’s focuses, behavioral health has been targeted as a cost saving measure. Shattuck said the lack of such services in bush villages isn’t hard to understand for even Fairbanksans.
“In Fairbanks, we have a great shortage of behavioral health providers,” she said, “and if you can imagine this, we cannot get psychiatrists to move and practice in Fairbanks, Alaska.”
Committee members expressed broad support for the telemedicine portions of the Kelly’s bill, but some had reservations that telemedicine could preclude actual physicians. Rep. Scott Kawasaki, D-Fairbanks, said he “would worry if a smaller town wanted to hire somebody but could get it done cheaper via this telehealth bridge.”
Shattuck said Kelly’s office has considered this, but that she doesn’t expect telehealth to suddenly override traditional medicine. It’s more important, she said, to get healthcare to where it’s needed.
“There are communities where you’re never going to get a doctor out there, we see that,” said Shattuck. “I don’t see telehealth completely taking away hands on primary care.”
Federal and state government, as well as private industry, have been beefing up Alaskas telemedicine infrastructure in the last year.
The U.S. Department of Agriculture announced Nov. 19, 2015 that more than $2.3 million in grants has been awarded to six Alaska groups for distance learning and telemedicine programs.
Both GCI and Alaska Communications provide infrastructure for rural healthcare facilities to engage in telehealth. GCI’s TERRA network directly benefits the Yukon-Kuskokwim Health Corp. and Alaska Federal Health Care Access Network for telehealth connectivity.
In July, Alaska Communications partnered with the Juneau Alliance for Mental Health, Inc., or JAMHI, and Sitka Community Hospital to provide the equipment and necessary bandwidth to give rural patients behavioral and primary healthcare access.
Chugachmiut is a Tribal consortium serving the seven Native communities of the Chugach region with health and social services, education and training, and technical assistance.
Akeela provides mental health and substance abuse treatment, as well as rehabilitation programs for inmates in every correctional facility in the state. Akeela has outpatient treatment facilities in Anchorage, Nome, Fairbanks, Kenai, Sutton, Juneau and Seward.
DJ Summers can be reached at [email protected]