For ages, parents, caregivers and those not feeling so great themselves have had a choice in pursuing medical advice: either visit the doctor (or hospital, or now, the walk-in clinic) or call and talk to a nurse.
The former — an increasingly expensive proposition — garners an in-person interaction, allowing the medical expert to see and/or feel the problem area, observe the patient’s eyes, tongue, etc., take a temperature, blood pressure and all that. But for routine visits or minor complaints, it’s a bit much, both in time and expense. A phone call can net some good advice, and is free or inexpensive, but is limited to what information can be transmitted verbally.
Fortunately, technology has provided an intermediate option: telemedicine — basically Skyping with a doctor or other provider, but also including sending additional information electronically during the “visit” that helps flesh out the case. It keeps patients out of physicians’ waiting rooms, notorious as great places to catch a cold, or worse, while perusing old magazines. It’s also inexpensive, to the point where insurers are actively pushing it as an alternative to actual office visits to cut costs all around.
It’s a worthwhile addition to the medical toolkit, especially for those who don’t need intense treatment, but have trouble traveling. It can even be used to teleconference, bringing in multiple providers or advocates to better assess the needs of the patient.
But in New Hampshire, while telemedicine (or telehealth, as it’s often called) has been available to those on Medicaid, state law has allowed them to access it only for medical specialists. That means the many Granite Staters who have coverage through the program — Medicaid served approximately 133,200 people in 2017, according to the N.H. Department of Health and Human Services — can’t use it for primary-care doctor’s visits, pediatricians, mental health professionals or substance-abuse counselors, for example. That’s most of the medical needs that population has.
That changes next month, however. Gov. Chris Sununu recently signed Senate Bill 258 into law. Sponsored by State Sen. Jay Kahn, D-Keene, it expands access to telehealth by allowing providers to bill for those services.
Kahn noted an example, given during testimony on the bill, of a student who goes to the school nurse complaining of an earache or other issue. Through telehealth, the nurse can connect with a physician and the student’s parent at once, relaying test results in real time. The doctor can then make a diagnosis and call in a prescription to a local pharmacy, saving the parent time off from work and getting treatment to the child sooner.
Kahn said before the passage of SB 258, billing for telehealth through Medicaid totaled less than 1 percent of that program’s medical billing. “That’s appalling that a viable means of delivery isn’t being used,” he said. “We need to get rid of these structural barriers.”
Telehealth isn’t just a matter of convenience, or cost. In some settings, such as long-term care, it’s of particular value. Cathy Gray, CEO of Cedarcrest Center for Children with Disabilities in Keene, noted telehealth “visits” are a boon to her organization, saving time and other resources for staff, while reducing stress and the physical toll of travel for the children.
It’s easy to envision the same being true of elderly residents in smaller nursing facilities or who live at home and can’t easily arrange travel for a routine doctor’s visit. In a rural county, that’s of particular value.
Infuriatingly, telehealth requires a strong and steady Internet link. In other words, it needs solid broadband service, something rural regions of New Hampshire are known for not having. Lawmakers in Washington seem to finally have improving rural broadband on their radar, although the proposed solutions are varied and remain somewhat hamstrung by the lobbying clout of telecommunications giants, who aren’t interested in competition or in being told they have to extend service to less-profitable areas.
Fortuitously, the picture in New Hampshire is improving, again largely thanks to Kahn. A year ago, he ushered through Concord a bill changing the state’s prohibition on municipal bonding for broadband improvements. Already, Chesterfield has struck a deal to expand service town-wide, and other communities including Dublin are looking to do the same.
Someday soon, perhaps, doctors’ waiting rooms will be empty, and they can stop paying for all those magazine subscriptions.