The Oregon State Capitol. (Saphara Harrell/Salem Reporter)
Annaliese Ellsworth, a Salem-based therapist, recalled how it used to be like “rolling the dice” whenever a patient requested a video appointment.
She followed up these requests with phone calls to insurance companies to see if they’d cover the cost of the visit. Sometimes insurance companies would agree, she said. But a lot of the time the answer was “no.”
Ellsworth recalled how that all changed overnight last year when Gov. Kate Brown issued her first stay-home order last year in response to the Covid pandemic. With therapists and medical providers having to close their doors to most routine in-person care, state public health authorities required insurance companies to pay for “telehealth” or “telemedicine” visits.
Ellsworth was initially worried that her clients (particularly older ones) wouldn’t agree to virtual therapy sessions or their internet connection wouldn’t work. One client refused.
A year later, Ellsworth sees her 25 to 30 clients each week remotely (including the client who opted out).
“Once it’s in place it’s not very hard,” said Ellsworth of setting up the software system to manage online appointments.
Ellsworth submitted a letter to a state legislative panel in support of a bill moving through the Oregon Legislature that would make telehealth visits a permanent part of how Oregonians receive health care services.
Proponents of the bill say telehealth could expand significantly expand healthcare options for Oregonians, particularly for behavioral health. But healthcare companies are concerned it could increase costs while not adding value to services.
House Bill 2508 requires the Oregon Health Authority to ensure that health services delivered virtually are reimbursed by insurers at the same rate. Providers also can’t discourage the use of telehealth under the bill.
The bill has bipartisan support and its sponsors include state Reps. Teresa Alonso León, D-Woodburn, and Brian Clem, D-Salem. It passed out of the House Health Care Committee on Thursday and awaits a vote by the full chamber.
The bill has support from a broad range of healthcare providers and advocacy organizations, including the Oregon Medical Association, the Rural Health Association, Planned Parenthood, Oregon Academy of Family Physicians and others.
These organizations and others submitted a letter to the committee describing the benefits of telehealth seen during the pandemic: fewer patients missed appointments and more used video appointments instead of more expensive options.
Telehealth seems to have particular potential for mental health services. Psychiatrists report being able to reach 85% of patients at the height of the pandemic compared to “negligible numbers” seen before, according to the letter. Both the Oregon Psychological Association and the Oregon affiliate of the National Alliance on Mental Illness submitted testimony saying telehealth has improved access to behavioral health services.
Ellsworth, whose practice specializes in working with people recovering from traumatic experiences, said televisits have helped clients overcome obstacles to accessing therapy. She said some clients have chronic illnesses that make traveling to in-person sessions difficult. She mentioned clients with agoraphobia, an anxiety disorder that can make leaving the house a debilitating experience, who’ve come to their first session bawling.
“They’re already a very vulnerable population and they already have obstacles put in front of them,” she said. “All of those barriers will go down with telehealth.”
She also mentioned single mothers who’ve had difficulties finding childcare. There are also people in rural areas who have limited options for therapists and can’t find someone specializing in a specific condition.
To make televisits work, Ellsworth had to set up software and worked with clients, having them sit about three feet away from their camera so she could pick up on their body language. But otherwise, a virtual therapy appointment isn’t much different from in-person, she said. She referenced research showing it’s effective.
However, some of Oregon’s largest healthcare providers including Providence Health, Kaiser Permanente and PacificSource have weighed in with concerns.
William Olson, chief operating officer for Providence, said in a letter to the committee that the bill could end up increasing costs without producing more efficiencies. He called for the bill to sunset after two years and a report to be delivered to the Legislature on how it’s working out.
Richard Blackwell, PacificSource’s director of Oregon government relations, pointed out in a letter to the committee that state health authorities are seeking to shift the healthcare system from the “fee-for-service” model to improving outcomes. That means medical providers are paid for improving patient health, rather than for each appointment or service provided. He said requiring telehealth visits to be covered runs against that goal.
Additionally, he said some visits are better done in-person, such as a doctor who needs to discover the cause of reported abdominal pain or a psychiatrist who wants to gauge a medication’s effects on a patient.
“While telemedicine certainly bridged an access gap in delivering care during the COVID-19 pandemic, audio and visual interactions and text or email communications do not always impart the full picture of a patient’s condition,” he said.
Salem Health did not respond to emailed questions as of Thursday afternoon.
Dr. Erik Vanderlip, chief medical officer of ZoomCare, said in an email that telehealth has been an integral part of the Portland-based company that’s billed itself as an on-demand provider of health care. He said that the company averages 10,000 consultations using its online video and chat platforms.
ZoomCare, which has a clinic in Salem, shut down its VideoCare platform several years ago because people preferred to come in for in-person visits. Since restarting, the company has learned that about 75% of a person’s needs can be handled over VideoCare. While he said that in-person visits will increase after the pandemic subsides, his company will be focused on what option works best for the patient.
Contact reporter Jake Thomas at 503-575-1251 or [email protected] or @jakethomas2009.
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