Healthcare costs should be a hot topic du jour in the legislature, but frankly, it is not. It is for me though. I was steamed when I learned during testimony that a bill before us, SB 83, would actually increase the cost of healthcare overall.
What particularly burned me was that the legislation pertained to telehealth – an innovation that should help bring down the cost of healthcare. SB 83 would require payers to pay the same for a telehealth visit as they do for an in-person visit.
When a provider can see more patients via telehealth in a given timeframe, when telehealth doesn’t involve a front desk clerk checking in the patient or the billing specialist checking the patient out, when telehealth doesn’t require a medical assistant to see the patient initially to take their vitals, when there’s not an exam room that needs to be cleaned and disinfected, when there’s not a fancy waiting room with reading materials and a TV, when there’s no snow to plow in the parking lot, when the overhead costs are minimal with telehealth, why on earth would we demand the provider be paid the same?
Now that all pertains to the cost of doing business, but here’s the real kicker.
One of the providers testifying explained that instead of just seeing the patient twice per year in-person, the parity payments would allow the provider to see the patient an additional four more times per year via telehealth, for a total of six visits. Without the parity payments, according to the provider, the payments for the telehealth visits were inadequate (the provider was paid 60% of what she was paid when she saw the patient in-person). Because of this, she might see the patient once by telehealth per year. If the bill passed, she would hope to see the patient four times via telehealth.
Let’s do the math. For simplicity’s sake, let’s say the charge for the in-person visit is $200. Right now, two in-person visits would come to $400 per year. Add in a telehealth visit at 60% of the in-person charge (so $120) for a total of $520 per year. If the law passes to require parity of payments and the provider sees the patient as proposed, twice in-person and four time via telehealth, the total jumps to $1200 (6 x $200). From $520 to $1200.
Now, one could argue that the more frequent visits should result in better health outcomes and reduce the need for more extensive and expensive specialty care. That is indeed generally true – more preventive care saves in the long run.
But here’s what I propose. If 60% of the in-person charge is inadequate for the business model to keep the in-person side of the ledger afloat at the provider’s clinic, how about a compromise? How about a 75% payment or even a 90% payment for telehealth – and how about if we let the free market figure that out?
When we require parity of payment for a service that costs less to deliver, we are price gouging the public.
I love our providers. I’ve got physicians and other provider types in my family, but that doesn’t change the fact that at some point, we’ve got to stand up for Alaska consumers who are paying among the highest costs for healthcare in the world.
You can hear my comments at the hearing here.
