After a campaign season of competing gubernatorial candidates talking up telehealth, a doctor and Wyoming’s top health official asked lawmakers to follow up on that promise and better fund and promote efforts to bring specialized care to the rural reaches of the Equality State.
“Candidates have been talking about telehealth, but at the end of the day, if they’re looking at the (state) Department of Health and (asking), ‘What are you doing to promote it,’ we have $40,000 a year in general funds that’s attached to it,” Tom Forslund, the director of the health department, told the Labor, Health and Social Services Committee on Tuesday.
In other words: Talk is cheap, and current funding is even cheaper.
The discussion was led by Jackson-based urologist Dr. Lisa Finkelstein, who said she’s embraced telehealth after stopping regular trips to Pinedale and Rock Springs clinics. She said the old days of telehealth, of dropped calls and dodgy connectivity, are past.
“It’s a new day in Wyoming for telehealth,” she told the committee, which was meeting in Cheyenne, via Skype.
She had two asks of the committee. First, make telehealth a priority. Finkelstein said a task force to better study and educate providers on telehealth would be one example. Funding — to address the pitiful telehealth-tied budget that Forslund described — would also help.
Second, she asked for help promoting it.
“We need buy-in from doctors,” Finkelstein explained. “Most physicians are at least curious and really start listening when I explain barriers are being removed. Of course, they first ask, ‘Am I going to be paid and am I going to get sued?’ The answer I would like to say is yes and no,” but insurers make it more complicated.
Forslund and Finkelstein said that “barriers” to telehealth expanding have been taken apart in recent years and that Medicaid had led the way in Wyoming. Providers are fully reimbursed for tele-visits, Forslund said. He said last year, there were 71 providers in the state that had submitted Medicaid telehealth claims for just under 1,300 patients, and the department paid out roughly $500,000. Nearly all of that — just under 90 percent — was for mental health and substance abuse aid.
A letter from Wendy Curran, a vice president at Blue Cross Blue Shield Wyoming, to Finkelstein showed there were roughly 800 telehealth services billed in 2017 via the insurer. Of those, Blue Cross Blue Shield paid 99 percent, according to the letter.
But, Curran goes on to write, two providers accounted for more than 50 percent of those services. Only 28 providers took part at all.
“We don’t have any full-time staff assigned to it, we have very little budget assigned to it,” Forslund testified. “From a budget sense, it’s not a high priority for state government if you look at money spent. From the payment side, we are doing a lot from the promotion side. If we wished to promote it then we need to have a significantly more amount of general funds infused into system.”
Both Democrat Mary Throne and her eventually victorious opponent, Gov.-elect Mark Gordon, said they supported telehealth during the gubernatorial campaign. Hospital officials, including Wyoming Medical Center’s Michele Chulick, have talked about the abilities of bringing specialized care from medical hubs like Casper and WMC to rural areas that lacked the number of specialists.
A recent partnership between WMC and the Memorial Hospital of Converse County brings Casper neurologists to the Douglas emergency room via a telehealth robot to help treat stroke victims. Hospital officials have said they want to expand the program further. Other hospitals, like Cheyenne Regional Medical Center, have also explored telehealth opportunities.
In the case of the WMC partnership, the hospital provided the necessary equipment free of charge to partnering facilities and is not charging for the services, a hospital spokeswoman told the Star-Tribune.
Still, the message from Finkelstein and Forslund on Tuesday was there was a ways to go.
“Medicaid is on the forefront of all of these items you guys are asking about,” Finkelstein said after lawmakers peppered her and Forslund with questions about telehealth. “The other insurers, however, are not. It varies across the board. Part of the problem with telehealth, not just in Wyoming but around the country, is that each insurer has different rules.”
“What we need is help,” she concluded. “Whether it’s in the form of marketing or advertising. Again, getting the buy-in from the providers is really what we need ... This is the last mile. To answer your questions, a lot of these barriers have been taken down. Not enough providers know this. That’s where we’re falling short. That’s what we’re here to present.”