Testimony before the Virginia Senate Committee on Finance and Appropriations on Senate Bill 663 Regarding Telehealth
The Heartland Institute
February 8th, 2022
Dear Chair Howell and members,
Thank you for the opportunity to testify today on Senate Bill 663. I would like to thank Senator Stanley for bringing this legislation forward. My name is Matt Dean, and I am a senior policy fellow with the Heartland Institute. The Heartland Institute is a 37-year-old independent, national, nonprofit organization whose mission is to discover, develop and promote free-market solutions to social and economic problems. Heartland is headquartered in Illinois and focuses on providing national, state and local elected officials with reliable and timely research and analysis on important policy issues.
By expanding the definition of “originating site” the Department of Medical Assistance Services (DMAS) has determined that hospitals would be able to bill for telemedicine services in a similar way as other licensed facilities (such as psychiatric residential facilities, rural health clinics and FQHCs) now can. This will provide better rural access to care and improve outreach.
In 2020, as nonessential medical procedures were postponed in hopes of slowing the spread of the coronavirus, telehealth (which is also sometimes referred to as telemedicine) was forced to immediately scale up to provide connections between patients and providers who were separated by lockdown orders. After nonemergency visits resumed, many patients justifiably feared coming to hospitals and clinics as the virus raged across America. Protecting frontline emergency workers became the highest priority of policymakers who were given models showing a pandemic rivaling or eclipsing the worst pandemics in US history. Telehealth visits became the alternative to bringing millions of sick and healthy people together. Now, state laws are being considered to replace temporary emergency use of expanded telehealth with state-specific laws tailoring their future use.
TELEHEALTH BEFORE AND AFTER COVID-19
Telehealth is most commonly defined as the use telephones, tablets and computers to remotely connect medical providers with each other or to patients. Telehealth is most commonly defined as video and audio telecommunication, but some legislation expands that to telephonic communications as well. Telehealth began in surgical suites and emergency rooms to bring the expertise of specialty physicians to complex surgeries and procedures. Over time, telehealth was expanded to replace some face-to-face primary care visits for the convenience of the patient. Patients in remote areas, or those who lacked the ability to travel could see their doctor or mid-level provider from their home. Through 2019, telehealth grew slowly beyond early adopters.
Then came COVID-19, and telehealth was given a trial by fire. In just a few short months, telehealth services skyrocketed from just 2.8% of all healthcare services, to over 70% of services in the first 90 days of 2020. Federal and state emergency executive orders immediately sidelined restrictions on telehealth. Turf wars between providers, that for over a decade to restrict the growth of telemedicine, were declared over. Suddenly, providers were forced to make it work.
The success of telehealth has been recognized as one of the positive outcomes of the tragedy of the pandemic. Patients enjoyed the convenience of being able to see their doctor from home. Physicians could prioritize face-to-face visits for only those visits that could not be done remotely. It was clearly more convenient for both in many instances. Patient satisfaction *****
In 2019, the Trump administration made permanent the emergency rules allowing the expansion of telehealth. This gave doctors and patients the flexibility to choose which visits could be remote, greatly expanding the access of patients to care.
Heartland supports the efforts by the Trump administration to make permanent the emergency telehealth measures put in place during the early days of the pandemic. Heartland also recognize the work of the DeSantis administration for working with stakeholders to mitigate concerns and improve the bill in the process in the 2019 reforms.
Telehealth was designed to expand access, and the numbers certainly speak for themselves. Patients report satisfaction with the services and they are voting with their thumbs. After peaking in April 2020, patients are returning to in-person visits, but also about 25% are choosing telehealth over an option for an in-person visit. That access should include all those who need care. Allowing hospitals to bill for care will increase the access and equity in the system.
Nothing in this testimony is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, The Heartland Institute’s website provides a great link to many policy resources.
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