A slew of health care bills is wending its way through the Maine Legislature. If passed, these bills would go a considerable distance toward increasing Mainers’ access to care. By dropping multiple barriers to care, these bills would position Maine to take advantage of new technologies and delivery system models – 21st-century care in place of 20th-century care.

The COVID-19 pandemic has been a horror, but dealing with it has unleashed a wave of innovation like nothing we’ve ever seen before. Existing companies like Amazon, InstaCart, Netflix and Zoom made life in quarantine bearable and afforded many of us the chance to maintain our incomes and avoid losing touch with the rest of the world. In health care, there was more innovation in the first months of the pandemic than in my previous 27 years as a health economist.

A patient sits in her Brooklyn, N.Y., apartment during a 2019 telemedicine videoconference with Dr. Deborah Mulligan. A federal order allowing physicians to conduct telehealth visits across state lines was a factor in a spike in the number of telemedicine visits between December 2019 and the first few months of the pandemic. Mark Lennihan/Associated Press, File

It has been possible for some years to visit doctors and other providers remotely – through laptops, tablets and smartphones (and old-fashioned landlines). But in December 2019, virtual care was still a tiny niche market. Within months, however, telehealth had ballooned (according to a McKinsey report) to between 50 and 175 times the number of visits the technology was delivering just months earlier.

A key factor in the rise of telehealth was a federal government order enabling physicians to conduct telehealth visits across state lines. In the early, desperate months, numerous other barriers to care also fell. Nurse practitioners and other non-physician providers were granted greater autonomy. Certificate of need laws were suspended.

In Maine, an executive order by Gov. Mills welcomed in care from providers in other states. Physicians, physician assistants and nurses were granted rapid pathways to emergency licenses. Out-of-state telehealth providers could see Maine patients without obtaining Maine licenses. Maine providers could renew or reactivate their licenses more easily. Physician assistants and advanced practice registered nurses (like nurse practitioners) could practice without physician oversight.

Now, the Maine Legislature is considering a range of bills to render some of these changes permanent and build upon them. Collectively, they would boost the spread of telehealth, expand the ranks of providers qualified to treat Maine’s residents and grant existing providers broader authority to assist their patients.

One bill or another would make the provisions of Gov. Mills’ executive order permanent, add audio-only calls to the definition of reimbursable telehealth and allow nurses to practice telehealth. At least one bill would ensure that asynchronous communications (such as a back-and-forth exchange of texts) would fall within the bounds of telehealth. With remote monitoring devices and a society profoundly accustomed to emails and text, asynchronous care will be increasingly vital.

These capabilities are profoundly important to a state like Maine, with its islands, mountains, remote villages and Native American reservation lands. Providing access to such communities is always a challenge. Access to new technologies and to an expanded health care workforce can go a long way toward filling gaps. New ways of providing virtual care are emerging every day. New devices will allow greater and more precise remote diagnoses, monitoring and treatment. The telehealth of 25 years from now will likely be as different from today’s telehealth as an iPhone X is from a mid-’90s flip phone. It’s important to prepare the regulatory landscape for such innovations.

Long ago, the political chestnut “as Maine goes, so goes the nation” was well known across the country to the point of cliché. A year or two from now, we may find that in the area of health care, Maine has revived that role as harbinger of change.


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