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New Data, Old Glitches Renew Telehealth Debate In Tallahassee

Ryan Benk
Dr. Daniel Mcdyer demonstrates his Epic MD software with one of his office managers.

As another Florida legislative session boots up in Tallahassee this week, lawmakers are set to take another whack at regulating telehealth.

Telehealth, telemedicine and distance-medicine are all names for consulting and diagnosing patients from afar with the help of technology like a video conferencing service that Jacksonville OBGYN Daniel Mcdyer uses.

Mcdyer’s software also allows him to take notes, snap pictures and write prescriptions for his mostly pregnant patients, who don’t have to leave home.

He said most doctors aren’t waiting on Tallahassee to implement telehealth technology. But they want to know: Who should be footing the bill? No insurance plans cover visits through his system.

“I give the patients the option of coming to the office to be seen for the problem or being seen virtually, where they’re charged for the visit through their credit card. It’s essentially the cost of a copay,” he said.

As it stands, telehealth costs are mostly passed on to patients. Florida law doesn’t force insurers to cover telemedicine, as 34 states do. Nor does it require them to reimburse doctors the same amount for virtual and in-person visits, something just three states require, according to the nationalCenter for Connected Health Policy.

“My frank concern, as you say, is that we don’t have regulation. We don’t have any sort of regular form of reimbursement for the service,” said St. Vincent’s HealthCare CEO Tom VanOsdol.

Like Dr. Mcdyer, VanOsdol’s hospital chain charges patients out of pocket for a slew of telehealth services.

Proponents like him say telehealth has the potential to save doctors and insurers money in the long-run by increasing patients’ access to preventative care, though most insurers argue mandating reimbursement parity could lead doctors to increase what they charge for the long-distance visits.

VanOsdol said insurance companies are being short sighted by refusing to cover the service.

“Because it’s quite possible that patient that can’t get access, can’t get in to see a doctor and can’t get access to telehealth is going to present to an emergency department with an exacerbated illness that could’ve been treated at a lower level, earlier in the process,” he said.

Fierce legislative disagreement over telemedicine spawned the creation of the Florida Telehealth Advisory Council two years ago. Inits report to the legislature, the body recommended lawmakers mandate both coverage and equal reimbursement from insurers after drawing on hundreds of stakeholder surveys of health care facilities, practitioners, health insurers and health maintenance organizations (HMOs).

Senator Aaron Bean, R-Fernandina Beach, ispushing a telehealth measure that doesn’t do either of those things. Instead, it makes a vague promise to encourage the state employees’ insurance plan, and its commercial counterparts, to include telehealth.

“Telemedicine is an idea whose time has come,” he said. “It’s embracing technology that’s out there already and using technology to better treat Floridians, to get better outcomes, to do it more effectively, to do it more efficiently, to do it at less cost and still get better outcomes. It’s a triple win.”

Bean saidhis telemedicine measure is likely to evolve as it makes its way through four committee stops this year. As it’s written, it would require telehealth doctors treating Floridians to be licensed in the state, unless their state enters into a special agreement with Florida — another telehealth council recommendation.

That could affect St. Vincent’s, as most of its telehealth visits are conducted using a national service that connects patients to out-of-state doctors.

Meanwhile, a spokesman for the state’s largest health insurer — Florida Blue — said his company won’t comment until the Legislature sets new guidelines. 

Ryan Benk is a former WJCT News reporter who joined the station in 2015 after working as a news researcher and reporter for NPR affiliate WFSU in Tallahassee.