Is Telemedicine Here to Stay?

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So much has changed so fast with the arrival of the Sars-CoV-2 (COVID-19) pandemic.  With the early shutdowns and uncertainty how the virus was spreading from person to person, a lot of non-urgent health care for routine vaccinations, diabetes, blood pressure, heart disease and more came to a full stop. 

Fast forward to today, and doctor’s offices are among the safest places to visit. If you need to go in person. But do you need to go in person? Kaiser Permanente has stated publicly that as many as 50% of patient visits, including specialty followup appointments will be performed via telemedicine going forward. They have put construction projects on hold because of this eye opening.  

Telemedicine increases health care access for everyone with smartphone, notebook and computer service living close or far. A telemedicine visit can determine the need for an in person visit, or result in orders for a lab or imaging workup. Time is saved for everyone, fewer vehicles on the road, less petroleum used, less CO2 adding to the emerging climate crisis. 

Everyone benefits from telemedicine except perhaps insurers. Before Governor Brown issued COVID-19 emergency orders mandating insurers pay video/telemedicine visits at the same rate as in-person visits — the insurers had placed a significant financial penalty in front of all health care visits using this communication method. Something they appear eager to return to doing.

Naturopathic doctors who invest in 4 years of medical school with blood, sweat, tears and huge debt to become eligible to be licensed to practice medicine in Oregon, also continue to suffer outrageous pay discrimination from health insurers. On average NDs are paid 50% for the same medical services paid to every other healthcare provider type licensed in Oregon. 

The value added at a visit comes from the doctor’s training, experience, competence and ability to issue orders, diagnose and formulate treatment plans. None of which absolutely requires a visit be in person. Already our healthcare reimbursement system short sheets primary care in favor of high end hospitalization and specialty care. It makes no sense to those on the outside. Health insurance however, is a cost plus business. Your interests and your insurer’s interests are only nominally aligned.

What to do about it? Rachel Prusak, NP, is Oregon district 37 representative and vice-chair of the Oregon House Healthcare Committee. She has spent her summer and fall conducting a stakeholder workgroup on the topic of patient access to care, including video/telemedicine. The issue of pay equity in health care is a central theme. Expect the Healthcare Committee to be introducing major legislation to address these equity and access issues in the 2021 legislative session. Prusak’s efforts need our support to make this new way of doing things sustainable and permanent. 

Going forward we should all be demanding the ability to see our doctor, including our naturopathic doctor, via telemedicine. Our insurance premiums should reimburse all licensed healthcare providers with equitable pay for their work.