When evening falls, Brian Hunt makes his way to a comfortable chair in a sunroom on the south side of his house near La Cygne, Kansas. But he’s not settling in to relax. He’s going to work.
Hunt is a doctor who works the overnight shift admitting and monitoring patients through video connections at half a dozen hospitals scattered across Kansas. Sitting in front of his computer, wearing a headset and microphone, he greets a 63-year-old woman who’s just been transferred to Newton Medical Center from the smaller town of Marion. She’s been having difficulties with speech and movement on her right side.
“Hi. Can you hear and see me OK? Excellent. And how young are you?” Hunt asks her.
He briefly engages the patient in small talk to put her at ease. Then he begins examining her with the help of the nursing staff on-site in Newton.
“What I’m going to do first of all, if the nurses want to, is listen to your heart and lungs real quick,” Hunt says through his Internet video hook-up. “Are you guys ready to do that?”
A robot in the room with the patient allows Hunt to hear the sounds from the stethoscope as clearly as if he were right there. It also has a camera that he can control and a video screen that lets the patient see him.
“I want to kind of look at you a little bit closer here,” he says, as he begins his examination. “Can you close your eyes real tight for me? Open ’em up real bright for me. OK, look to your left. There you go. Now look to your right with your eyes only, please. Look to your right with your eyes only. Good! Alright, now relax – and can you show me your teeth? Excellent!”
After about two minutes of these tests, Hunt gives the woman his diagnosis.
“You tried to have a stroke,” he says. “In fact, you probably had a small stroke. I’m just gonna cut to the chase here, OK? Fortunately, it’s a very slight remaining, but our concern is, are there going to be any further problems here, OK?”
Hunt starts the patient on an aspirin regimen, and orders a battery of tests aimed at making sure she doesn’t have any ongoing issues. He then reassures her as he signs off
“I’ll be up all night, OK? If something happens, I’ll be back just like that,” he says. “I’m going to put some orders in the system right now, get things going. And anything else I can do before I sign off? Alright, thank you for your time, and I wish you the best, ma’am.”
Insurers opposed
A bill considered this year by the Kansas House Health and Human Services Committee was aimed at encouraging more of this kind of care. It would require insurance companies that offer coverage for telehealth care to pay the same rate for telehealth services as they do for in-person services.
The bill was opposed by insurers, including Blue Cross and Blue Shield of Kansas, who insist a mandate is the wrong approach.
“It takes away the ability of the insurance companies to be able to price accordingly for the services provided, while also keeping an eye on how to keep premiums as low as possible for our employer groups and our members who purchase insurance,” says Mary Beth Chambers, a spokeswoman for Blue Cross and Blue Shield of Kansas.
Chambers says there are some cases — abdominal exams, for instance — where only a hands-on inspection will do. She worries that those cases might result in insurance companies having to pay for both an initial telehealth consultation and an in-person follow-up.
State Rep. Jim Kelly, who proposed the bill, says that concern is misplaced.
“The standard of care is going to be required to be the same, so that you could not do by telehealth a visit that would require hands-on,” Kelly says.
He rejects the notion that parity in payments amounts to a mandate.
“The issue that we wanted to do was to not force any company that wasn’t offering telehealth coverage to have to provide it, and that would be the mandate,” he says. “The other is more of a way to make it a playing field where providers would be willing to do it.”
Kelly sees equal pay for equivalent services as essential to the spread of telehealth care — and he sees telehealth as one way to make health care more accessible in rural and urban areas facing provider shortages. He argues that increasing access to follow-up and preventive care could reduce the need for more expensive hospitalization and emergency room services.
As things stand, the telehealth parity bill did not make it out of committee and was referred for possible interim study. Kelly, though, says the bill is based on best practices from states that have adopted telehealth parity.
Thirty-three states, including all four states bordering Kansas, already have such laws on the books. Kelly is hopeful Kansas will soon follow their example.
Bryan Thompson is a reporter for KCUR 89.3 and the Kansas News Service, specializing in rural health and agriculture.