October 24, 2016
Telemedicine: High-Quality, Affordable Care for Mississippi Families
Hearing on Telemedicine
Testimony before the Miss. State Senate, Public Health & Welfare Committee
October 18, 2016
I am Dr. Jameson Taylor, vice president for policy with the Mississippi Center for Public Policy.
This is what we believe about telemedicine: Telemed needs to be allowed to flourish and grow and respond to consumer needs. Burdensome regulations will hinder this growth and reduce access to high-quality care. To repeat: We believe telemedicine needs to be allowed to flourish and grow and respond to consumer needs. Burdensome regulations will hinder this growth and reduce access to high-quality care.
You might say we believe in a free market for healthcare. What this really means is that we believe that a light regulatory touch will promote the supply side of healthcare and solve the problem of access by increasing quality and lowering cost. In other words, if government stays out of the way, healthcare innovation will massively increase the supply of affordable, high-quality care. This strategy has worked for computers and cell phones. Why not healthcare?
But I am here today, not as a healthcare policy analyst, but to share my own telemed story with you.
I am married and have two children. Over the past few years, our family has paired telemed with a High Deductible Health Plan. Our family deductible is typically $5,000 a year. What this means is that my insurance company does not cover a dime of my healthcare until I spend $5,000 out of pocket. In this respect, my family is not different from many others in Mississippi. For instance, if we look at the health insurance policies on the ACA exchange, we see deductibles ranging from $4,000 to $13,000.
Just yesterday, I pulled up a plan for a family of four in Hinds County. One option was a bronze plan from Magnolia Health at a cost of $800 a month and a deductible of $13,600 a year.
I guarantee that if you have a deductible of $13,000 a year, you are going to act like an informed consumer for healthcare because you are going to be paying cash, almost exclusively, for your care. That, at least is how my family and I shop for healthcare. We approach healthcare as consumers and believe that a free market for healthcare is the best way to attain high-quality care at a fair price.
When we consider taking our kids to the doctor for the usual problems: sniffles, an ear infection, a stomach ache, we have a choice between using telemed at $40 a visit or going to our pediatric specialist for $165 or going to MEA for around $120. Depending on the situation, we choose the option we think is best for our family. Sometimes it is telemed, sometimes it is an in-office visit, sometimes it is MEA.
Let me walk you through a typical telemed visit for us. Our usual provider, by the way, is connected with Blue Cross Blue Shield and is called Doctor on Demand.
Last year, our daughter had the typical crud that turned into a fever. We had a family event coming up, and my wife wanted to make sure we did all we could to get our daughter feeling better. That said, it wasn't a very serious illness. At $40 a visit, we chose to use telemed. The alternative would have been an in-office visit at $165. Under those circumstances, we would not have gone to the doctor.
I want to make this point very clear: This is not an apples to apples scenario. If you hinder access to telemed, you are not necessarily generating new business for brick-and-mortar doctors. You are, for some people - the single mom with no cash to spare, a family on vacation down in Biloxi, a truck driver on the road -eliminating that doctor's visit altogether.
Money and time are not infinite resources - at least not in my world and not for the hardworking people of Mississippi. If we did not have the option of using telemed in this case, we would not have gone to the doctor at all. We would have waited things out and hoped our daughter recovered.
Again, our situation is not unusual. We all know access to healthcare is a problem in Mississippi. One-third of our population is underserved because we do not have enough primary care physicians and rural doctors.
This problem will not be resolved by giving everyone an insurance card - whether it be private insurance or government-sponsored insurance, like Medicaid.
According to a recent study by researchers at the Social Science Research Center at Miss. State:
- "32% of adults covered by private insurance (ages 50-64) reported difficulties in obtaining an appointment when seeking an initial appointment with a primary care physician";
- "35% of Medicare-insured adults (ages 65 and older) reported problems when seeking a new appointment"; and
- "Up to half of primary care physicians' offices in Mississippi are not accepting new Medicaid patients."
All of these people have insurance, but they are having trouble obtaining primary care.
I believe we are making a fatal mistake in approaching healthcare in Mississippi from an attitude of scarcity and protectionism. We have an abundance of healthcare needs. We have so much need we can't handle it all. Why regulate a telemed market that is clearly working to address some of these needs?
The study from Mississippi State also notes the following:
"Even with health insurance, access to care may be limited by several factors, including whether one can contact doctors' offices by telephone during office hours, whether one can receive a scheduled appointment within a reasonable amount of time, lengthy waits in doctors' waiting rooms, restrictive clinic hours, and patient access to transportation."
Telemed can help with all of these access problems.
In our case, we usually use telemed early in the morning or late at night, when we are trying to figure out just how sick we are and whether we need to take a sick day from school or work.
Likewise, the wait for a telemed appointment is usually 10 minutes or less. In our case, we are able to pull up a screen full of doctors - all of them licensed in Mississippi - and choose the doctor we want. Usually, we choose the same doctor. Her primary practice is in California.
As far as waiting rooms go, I also want to add that, frankly, as a parent, the last thing you want to do is expose your child and yourself to other sick patients in the waiting room. The last time my wife took our kids in for a routine checkup, our doctor informed her that she was seeing a lot of children with hand-foot-and-mouth disease. That is not a comforting thought when you are in a crowded waiting room trying to keep your toddler from chewing on and handling everything he can reach.
Indeed, in my research on this issue, I found several medical sources that suggested simply avoiding the waiting room altogether. Advises Dr. Hansa Bhargava, medical editor for WebMD:
"As a doctor, here are some guidelines I use for myself:
"Stay home if you can. Ask yourself: are you sick enough to need to go in? Granted, this can be a hard decision. ...
"If you are not sure whether you need to come in, try calling your doctor's office. This way, you may be able to save yourself a visit."
Telemed delivers the best of both worlds. It allows you to stay home and see your doctor. My family and I value the convenience and, if you will, additional safety, telemedicine provides. For me, a quick telemed visit may mean the difference between missing a morning of work or not. For my kids, it means the same when it comes to school. For my wife, it means access to high-quality care at the touch of a button. Imagine that, at the touch of a button. ... But isn't that the kind of service we expect today?
You can order all manner of life-saving products online - for instance, that last-minute wedding anniversary gift ... at the touch of a button.
You can book a dream vacation - instead of going to a travel agent - at the touch of a button.
You can sit in on courses at MIT and radically change the direction of your entire life - at the touch of a button.
Why is healthcare so radically different that we are going to deny consumers this same choice?
To get back to our routine telemed visit, during the last three visits, we have been offered a prescription twice. In my limited research, this is on par with the national average for in-office visits.
And, let me be honest, if you are going to pay $165 for a doctor's visit, you kind of expect to walk out of the office with some kind of vindication that you were right to go to the doctor - a prescription. Many patients want that antibiotic, even if it's just for a bad cold. When you pay $40 for a visit and you hear that all you really need is some sleep and orange juice, you feel a lot better about the hit to your pocketbook.
Before I end, one thing I want to mention is that we prefer to connect with our telemed doctor over the phone, as opposed to video feed. I live in Jackson. I have a decent internet connection. Many Mississippians do not. Just like any technology, you want multiple options: both phone only and video.
I suspect, too, that my wife prefers the phone consult because, then, she doesn't feel like she has to do her hair and make the kids picture perfect before seeing our doctor.
In any event, the phone consult has worked well for us. Indeed, I imagine nearly every person here has been on one end or another of a phone-only consult with their brick-and-mortar doctor.
Of course, most doctors doing telemed ARE brick-and-mortar doctors. As I mentioned, they are also licensed by the state of Mississippi.
And that is, really, what all this comes down to. If the state is going to license doctors, it needs to trust these doctors to serve their patients in whatever setting they choose.
Whether it's in a telemed setting or an office setting, we have to trust the doctors to make the best decisions for their patients. Otherwise, the state shouldn't license doctors to begin with. We also have to trust families like mine to make the best healthcare decisions we can for our children. ... Because I guarantee that I care a lot more about my kid's safety and health and my own health than any other person in this room.
Finally, I want to end with a quick story about Billy Durant. Durant co-founded General Motors. But before he founded GM, he worked for a carriage maker. As a carriage maker, he vehemently spoke out about how dangerous automobiles were. He called the new technology "smelly, noisy, and dangerous." He even refused to let his daughter ride in a car. Less than four years later, Durant co-founded GM.
Like the automobile revolution during Durant's day, the healthcare revolution has already begun. We can use our smartphones to monitor blood sugar levels and measure heart rates. Patients increasingly want to text and web chat their doctors. Soon, we are going to see nanotechnologies that can be implanted in patients, perhaps making routine doctor visits a thing of the past. Government cannot regulate all of these innovations. And Mississippi shouldn't let bureaucracy be the reason we don't share in this progress. Take a cue from Billy Durant and join the winning side - the side that promises to expand the supply of high-quality, low-cost care for the people of Mississippi.