October 21, 2021

Experts: Teleheath needs broadband, reimbursement

man with internet devices


Greater Cortland area healthcare providers are happy to see Gov. Andrew Cuomo’s plan to expand telehealth across the state, but they say it will take more flexibility from insurance companies and the expansion of broadband to really work.

“With an audio-only or video-only visit we can take care of a lot,’’ said Phillip Snider, the chief medical information officer for Guthrie Systems, which operates Guthrie Cortland Medical Center. “Let’s say somebody has diabetes and they normally come in to see their doctor provider three to four times a year. Well there’s really no reason they can’t do that by video visit or even audio a couple times a year, especially if their numbers are running well, they don’t have any diabetic wounds or ulcers or skin issues that they’re having to have somebody lay eyes on.”

Cuomo announced earlier this month his budget proposals for 2021-22, which included expanding telehealth, which has been used increasingly since the COVID-19 pandemic began.

Cuomo proposes:

• Permitting telephone visits. Permitting interstate licensure.

• Allowing unlicensed staff, such as credentialed alcoholism and substance abuse counselor trainees, to deliver care via telehealth.

• Expanding reimbursement for patient monitoring.

• Requiring telehealth in commercial insurance and expanding access to mental health and addiction services.

• Increasing training and education opportunities.

But for it to work, Snider said there needs to be a strong advocate for reimbursement. Broadband access also must be expanded, especially in rural communities where someone can live an hour’s drive or farther from a doctor.

“The thing I really like about his proposal that he’s pushing is that he’s a big proponent of the audio-only visits,” Snider said, noting it’s great for people who don’t have access to broadband or a phone with a camera.

But even with limited broadband in some areas, Snider said Guthrie has had good success with video visits.

“There are some places, though, where people have to drive to the parking lot of their favorite restaurant and they can get the wi-fi that way,” he said.

Lisa Hoeschele, the executive director and CEO of Family Counseling Services of Cortland County, said broadband and access to technology or phone minutes are huge issues.

“What we’re looking for is flexibility — flexibility to make clinical decisions in a regulatory environment,” she said.

However, she’s not looking too deeply into Cuomo’s proposal, because she said they don’t always end up happening or even the same thing they were originally intended to be.

Some proposals die or get changed at the legislative level. Even if they are eventually adopted, they must be enacted by state agencies.

“His first-blush proposals are not always what becomes reality when it gets to the Office of Mental Health or Office of Addiction Services and Supports,” Hoeschele said.

“We’re dealing with multiple regulatory bodies,” she said.

Michelle Adelewitz, the practice manager for primary care provider IthacaMed, said that the agency has been using telemedicine so much that it bought two tablets and a wifi booster so people could do the visit from the parking lot using their technology and signal.

“The Venn diagram of access problems and high-risk vulnerable populations is pretty close to a circle,” she said.