Oregon Moves Towards Opening Telemedicine to People’s Homes

The Senate Health Committee sent a bill to the floor Wednesday to move telemedicine services beyond the clinic or hospital setting to a client or patient’s home with unanimous, bipartisan support.

Senate Bill 144 requires that health insurance companies cover and pay for a service if a doctor or nurse practitioner offers their care remotely through a secure video conference technology similar to Skype or Facetime.

If passed into law, SB 144 will take effect next January -- overriding a push by Regence BlueCross BlueShield and Health Net Health Plan to delay it another year.

“These are very big movements forward,” said Len Bergstein, the lobbyist for the Pacific Northwest clinic chain ZoomCare, which has been at the forefront of providing services remotely for patients willing to pay cash, but will be able to charge insurers if SB 144 becomes law. “It puts Oregon on the frontier of care. … Telemedicine for ZoomCare will be one for the most essential components of care.”

Bergstein said Oregon was leaping ahead of its neighbor Washington, where ZoomCare also has clinics. Washington state is considering facility-to-facility telemedicine, something Oregon established in 2009.

SB 144 would allow patients living in remote areas or simply without the time or means to easily visit a doctor’s office to see a primary care provider for simple visits or a mental health provider for therapy sessions -- all without leaving the comfort of their home. It also provides opportunities for people to connect with a provider at work or school and be ensured that their health insurance will cover the cost.

Insurance companies will not be forced to pay for services they wouldn’t cover otherwise, nor will they be required to pay for the remote service the same as an office visit; rates will be set through private contract negotiations. The Oregon Health Authority will be tasked with setting coding rules enabling a telemedicine visit to be noted in a patient’s record for research purposes.

ZoomCare promoted a similar bill in 2014, but it died in the face of opposition from health insurance groups and the Oregon Association of Hospitals and Health Systems.

This time around, Bergstein said Kathy Britain of the Telehealth Alliance of Oregon organized stakeholders, including Health Net and Providence Health & Services, involving them in the process to craft SB 144 during the months between legislative sessions, and Britain’s efforts paid off.

“This is how I like to see government work -- getting everyone at the table,” Sen. Laurie Monnes Anderson, D-Gresham, told The Lund Report. “It didn’t please everyone but they talked it through,” she said, noting that concerns raised by Regence lobbyist Tom Holt had been discussed at length during the meetings, and the overwhelming majority of stakeholders, including Providence, agreed the telemedicine law should take effect next year.

“Everything in the bill that passed was through a collaborative process,” said Providence lobbyist Dale Penn.

The collaborative effort did not produce a starkly different bill -- Bergstein said it primarily clarified concerns raised by opponents. He said hospitals also may have realized that the Affordable Care Act has changed their incentives, penalizing them for readmissions and making them more open to the idea of providing care outside their buildings.

Providence, additionally, like ZoomCare, has been a leader in providing telemedicine services. Providence offers worksite telemedicine with nurse practitioners for state employees enrolled in the Public Employees Benefit Board in Salem and at a handful of prisons in Eastern Oregon, saving costs for PEBB and providing care without requiring an employee to miss work.