The Journal Gazette
Sunday, January 24, 2021 1:00 am

Pandemic loosens telehealth rules

Bills in works to make changes in Indiana permanent

NIKI KELLY | The Journal Gazette

INDIANAPOLIS – Dan Spalding is a convert. To telehealth, that is.

After battling a bad sinus infection for months last year during the infancy of COVID-19, the online news editor found a doctor in Warsaw doing virtual visits. One round of prescriptions didn't make a dent but after a second telehealth meeting, the physician prescribed something different, which knocked it out.

“It was just a friendly conversational discussion about my illness,” Spalding said. “I felt at ease and confident. They didn't want me (to come in), and I didn't want to go. I will absolutely do it in the future.”

Spalding is one of thousands of Hoosiers introduced to telemedicine in the last year. And lawmakers want to make sure they have the option in the future – when there isn't a public health crisis.

Several bills have been filed to loosen Indiana's strict telehealth laws that were waived by executive order during the emergency.

“I think many people were afraid of the unknown, but the pandemic forced our hand and now we realize it's a pretty good option,” said Sen. Ed Charbonneau, R-Valparaiso.

If current law isn't changed, only a limited number of health care professionals could provide telemedicine services. And they wouldn't be allowed to use audio-only services, email or texts.

But when COVID-19 hit, the rules changed – opening up the system to protect people from travel and in-person visits.

Roberto Darroca, a Muncie doctor who is president of the Indiana State Medical Association, said Indiana health visits went from less than 2% virtual to more than 70%. The number has settled to around 16% now.

“This is a pretty big deal. Telehealth has become such an important part of our delivery of health care to Indiana,” he said. “The silver lining of the pandemic is it forced us to be innovative.”

Indiana's Medicaid program saw similar numbers. In 2019, there were about 76,000 telehealth claims. During the first six months of 2020, that jumped to more than 349,000.

“Everyone agrees this is part of the future of health care,” said Dr. Jennifer Sullivan, secretary of the Indiana Family and Social Services Administration.

She said every year the conversation was getting a little “closer to what the patients wanted and health care providers realizing they were going to have to come along with us” but the pandemic accelerated that timeline.

Darroca said with telehealth there are fewer appointment cancellations and fewer emergency room visits because people are getting help before it becomes urgent. Lack of transportation was always a big reason for cancellations, and telehealth resolves that issue.

Virtual visits are also helping Hoosiers who live in rural areas with few provider options or who might need to work with a specialist who is hours away.

“Even though many physicians were initially resistant, they are now seeing the value of it and embracing the technology. We need to continue moving forward,” Darroca said.

Charbonneau is carrying the legislation in the Senate – Senate Bill 3 – and the House also has several bills. They are generally similar except for one thing – the House versions essentially apply to all licensed health care professionals while Charbonneau's bill lists specific types of providers.

At a recent hearing on the bill, group after group testified asking to be added to the bill – from chiropractors and dental hygienists to respiratory and physical therapists.

Sullivan said she was initially nervous about some of the uses but decided to be aggressive and flexible during the pandemic. She was pleasantly surprised to see home speech therapists and physical therapists walk parents through exercises over video or work directly with the children through the First Steps program.

One area where usage surged is mental health services, which previously weren't allowed.

Psychotherapy claims were three of the top five telehealth claims for Medicaid and that is only because they are broken down by length of appointment – 30, 45 and 60 minutes.

Hoosiers have struggled the last year with social distancing, job loss, addiction and more at record rates.

There are still details to work out involving the type of communication that will be allowed. Video consultations are the optimum option but some follow-ups can be easily handled via phone or email. Some doctors are also using texting capabilities.

Charbonneau says there are times when all forms of communication are appropriate. But he said the whole system is built on having an existing doctor-patient relationship with at least introductory in-person visits when possible.

Payment is currently the same for telehealth as for in-person, but that could change.

“I do want to be cognizant of the fact that telehealth without support is not a panacea,” Sullivan said. “We need reliable internet access so we don't have winners and losers. We don't want to make inequity worse. We don't want to leave people behind who don't have access to devices, and are going to be thoughtful about how we incentivize and pay for these services.”

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