There is a lot of fuss about how health care will be paid for these days. Here in Maine, however, there is a problem that goes beyond paying for health care — it’s how to access services in the first place. A potential solution to a growing need for health care is the use of telehealth or telemedicine. If we want a healthy, safe Maine, we need to take steps to ensure that this solution is available statewide.
Maine is one of the most rural states in the nation; 11 of our 16 counties are identified as “rural.” Long distances and a lack of transportation limit access to health care services for a large percentage of Mainers. Directly related to our ruralness, we have a shortage of health care providers and health care services; 277 of our towns are designated as Medically Underserved Areas, and every county in the state has at least one town that is underserved. Additionally, there are 68 Health Professional Shortage Areas (HPSAs) in the state.
To put these numbers in perspective, approximately 133,000 Mainers are unable to get the medical care they need; this is more than the entire population of Kennebec County. Because of a shortage of providers, many Mainers have no source of primary care. Emergency rooms, therefore, serve as a catch-all for the management and treatment of preventable illness. As a result, Maine has the second highest ER utilization rate in the nation, with our rural residents having higher rates of hospitalization than those living in urban areas. This is expensive, and no way to meet health care needs.
Telehealth is the use of telecommunication technologies such as audio-video conferencing and remote monitoring to deliver medical, health, and educational services to patients who have difficulty accessing routine and/or specialty health care. Health care practitioners, including primary care providers, specialists, and mental health providers, can use telehealth services to remotely evaluate, assess, diagnose, and treat a variety of serious health conditions and even save lives.
Despite recent progress in the state to expand availability of telehealth services, several barriers remain that deter providers from maximizing telehealth technology as an alternative model for health care delivery. Despite the clear benefit to patients, there is little incentive for Maine providers to “buy in” to telehealth care as a business investment. Disparate reimbursement practices and variations in liability coverage for providing care remotely do nothing to help providers give up face-to-face visits, despite the burden on the patient. This leaves those who cannot travel to receive health care services at a significant disadvantage.
Sen. Geoff Gratwick, D-Bangor, has proposed a bill to eliminate these barriers, L.D. 949, An Act Regarding Telehealth. It would eliminate incongruent reimbursement practices and ensure that reimbursement rates for services provided via telehealth and services provided via in-person visits are comparable. It would also ensure that liability coverage for providers using telehealth is equal to coverage provided for face-to-face care. By reducing barriers to the utilization of telehealth by health care providers, the bill directly supports increased use of telehealth services, and subsequently, increased access to necessary health care for thousands of Mainers.
Whether used to bridge gaps in care by eliminating geographical barriers, or to facilitate 24/7 access to specialists, I have seen telehealth improve access to care. One of my patients, “Judy,” comes to mind. Judy’s husband awoke one morning to find her slurring words. He knew she must be having a stroke and sprang into action. Because there was no local health care facility, Judy was transported via ambulance to a hospital nearly an hour away.
Time is of the essence in stroke treatment, requiring a specific protocol to determine the right course of action. With no specialists on site, telehealth was used to facilitate an urgent consultation via videoconference with a neurologist. In this case, the hospital had a telestroke program that minimized further delays in treatment.
Using the program, providers were able to implement a life-saving treatment in a timely manner. Happily, Judy has no residual effects from her stroke. Shouldn’t all Mainers have that kind of good fortune?
Sen. Gratwick is on the right track — his proposed legislation will save Maine lives.
Jennifer Morris, RN, BSN, of Waterville, is enrolled in the Husson University Family Nurse Practitioner Program. She is following legislation as an assignment in her Health Policy Course.