During the Arizona Legislative session in 2013, the original telemedicine parity bill for rural areas only received unanimous approval of both the Senate and the House. Then, during the 2016 session, a bill expanding parity to include the entire state received unanimous approval, and it takes effect on January 1, 2018. Telemedicine parity requires insurance companies to reimburse physicians who see remote patients telemedically at the same rate as in-person visits.
Senator Griffin (R – Safford) – the Majority Whip – chaired a meeting of telemedicine stakeholders at the Capitol in Phoenix to discuss adding urology to the list of healthcare services earmarked for parity. The others approved in last year’s bill are: trauma, burn, cardiology, infectious diseases, mental health disorders, neurologic diseases - including strokes, dermatology, and pulmonology.
Those in the majority caucus conference room included physicians and representatives of insurance companies. Also present was Dr. Ron Weinstein from the Arizona Telemedicine Program in Tucson. A pathologist by training, Dr. Weinstein was among the very first advocates for telemedicine in the U.S and is a past-president of the American Telemedicine Association.
On the phone was Dr. Jason Jameson, a Mayo Clinic urologist, who spoke in favor of adding the specialty to the list of those covered by parity. He pointed out there is a shortage of urologists in Arizona, and he cited studies that show telemedicine saved patients an average of 277 miles in driving and $200. And he said that telemedicine represents an important opportunity to improve patient access and care.
Although supportive of extending parity to urology, Senator Griffin warned against piecemeal additions each year. A representative of an insurance company complained about that, especially in the current political climate. Noting that one possible change in the repeal/replacement of Obamacare would be the ability for out-of-state insurance companies to market their coverage in Arizona, he said his company may lose business with another mandate. He suggested that the Legislature’s best course of action was to leave telemedicine reimbursements up to insurance companies and providers who would negotiate in-network rates. If urology were added to the list of covered services, he said the insurance industry would need at least a year to prepare.
A Senate staffer who researched what other states with telemedicine parity were doing suggested one option would be to borrow from a North Dakota bill (SB 2052) which that chamber unanimously approved on the same day as the meeting in Phoenix. A portion of the bill says: “Payment or reimbursement of expenses for covered health services delivered by means of telehealth… may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.” The doctors in the room appeared to oppose that idea.
Dr. Weinstein said he was frustrated by the foot-dragging attributed to Arizona being a “conservative” state. He said the American Telemedicine Association gives Arizona a grade of “F” for rehabilitation and home health because neither one is included in the telemedicine parity law. And he said attendees at a recent Telemedicine Service Provider Showcase (SPS) ask him why that is since Arizona has been on the forefront of telemedicine. Nancy Rowe, the coordinator of SPS, said Arizona is the only state among the 31 with telemedicine parity that limits it to specific services. “Do they [other states] know something we don’t?” she asked.
I spoke to the fact that accessibility to care and physician reimbursement are linked to the incentive to invest in a telemedicine program. Unless there is a potential revenue stream available to them, doctors will watch and wait and sit on the sidelines. The group agreed that further discussions would be helpful.