Telehealth on the rise in New Jersey, where it has become the norm

Credit: (AP Photo / LM Otero)
File photo: A doctor prepares for an online visit with a patient from their home workstation.

For Pamela Dyer, a 48-year-old Farmingdale resident, telehealth has provided an essential lifeline to well-being during the pandemic lockdown last year, according to representatives from Easterseas NJ, which provides services to people. with disabilities. Dyer, who suffers from schizophrenia, depended on his phone to connect with a case manager and attend weekly therapy sessions, while staying at home safe from the coronavirus.

Dyer is far from alone. Easterseals, which traditionally runs in-person programs, said it organized more than 7,000 telehealth visits last year. Tens of thousands of New Jerseyans have experienced the switch to telemedicine since the onset of the pandemic, as physical and behavioral health caregivers have been forced to embrace virtual options that had received minimal attention in the past. Billing for telehealth services in the northeastern United States climbed nearly 8,500% between November 2019 and the following November, according to FAIR Health, which tracks national insurance claims data.

For some, telehealth was preferable to a doctor’s visit in person, while others saw it as a beneficial safety net. A survey by the Mental Health Association of New Jersey found that eight in ten people who received virtual mental health services saw them as a “great alternative” when in-person services were not available. Almost everyone has found it safe and convenient, but almost 60% still prefer in-person care.

To ensure telehealth options continue to expand, New Jersey lawmakers approved a measure requiring insurance companies to cover the cost of virtual tours at the same rate they would pay for in-person services, including for policies covering public workers and the state’s Medicaid program. , NJ FamilyCare. Biparty legislation, one of dozens of bills passed on the last day of June with the state’s budget of $ 46.4 billion, has been strongly supported by doctors and other healthcare providers, some of whom had been skeptical about the effectiveness of telemedicine in the past.

“An essential tool”

“While telemedicine has been evolving since the 1970s, in the last few months during the COVID-19 pandemic, telemedicine has become an essential tool that many people in New Jersey have used to obtain needed health care. . The value of telemedicine during this pandemic should not be underestimated, ”the Medical Society of New Jersey said in a statement supporting the bill. MSNJ and the New Jersey Academy of Family Physicians testified that telehealth improves patients’ access to care, especially as the need for mental health services increases, helps reduce exposure to COVID-19, and improves health patient engagement, among other benefits.

But while the popularity of telehealth skyrocketed, support for the legislation was not universal. Representatives of the insurance industry have raised questions about the cost, which remains largely unknown. The bill allocates $ 5 million to help NJ FamilyCare members get the devices or technology they need to access telemedicine programs, but a non-partisan Office of Legislative Services analysis suggested it could require up to $ 50 million more per year to cover the additional costs of telehealth. benefits for state employees under the bill.

The legislation is now awaiting Gov. Phil Murphy’s signature to become law. Its staff declined to comment on its plans on Monday.

The legislation would update a long-debated law passed in 2017 that defined telemedicine in New Jersey, established strict requirements on how and when it could be used, and determined that providers would be paid up to the rate they received. for in-person treatment. , But not more. This led insurance companies to negotiate reimbursement rates with providers, which would be eliminated under the new proposal, which imposes “parity” for in-person and virtual visits and is likely to increase costs. costs.

Advantages – and limitations

Linda Schwimmer, president and CEO of the Health Care Quality Institute in New Jersey and a long-time advocate for expanding telehealth services, urged state officials to consider the benefits and limitations of these services before codifying a payment model in law. A report released in April by the Quality Institute and BioNJ, the state’s professional life science association, called for a commission to study issues of value and fair access, as well as test models and regulatory projects.

“Now that the use of telehealth has grown so rapidly (during the pandemic), we have a good opportunity to assess its value and implement models of care that include telehealth while recognizing its benefits and its limits, ”Schwimmer said in an email. The regulations will need to be addressed at the federal and state levels, she said, and urged officials to expand pandemic rules that have allowed more freedom temporarily. “These changes should be considered in light of what is best for patients and what is needed to improve the quality of care and access to services,” she said.

The 20-page bill, which lawmakers have repeatedly amended, specifies that state-regulated health insurance companies must reimburse providers at an equal rate for all forms of physical or behavioral care, whether they are provided in person or virtually, as long as the service is a benefit covered by the patient’s plan. It also gives providers and patients greater flexibility in the type of technology they use to communicate, even if it should allow virtually the same standard of care that would be available in person.

Accessing the right technology is a challenge for some patients, the Mental Health Association of New Jersey found in its survey of 75 mental health clients in July and August 2020. Almost all depended on phone calls for their patients. services, as opposed to video. -conferences or other formats preferred by current New Jersey law. Some 83% of respondents said these remote sessions allowed them to stay connected to others despite pandemic containment, and 78% considered virtual treatment to be effective.

Credit: (New Jersey Mental Health Association)
How respondents answered one of the questions in a survey from the Mental Health Association of New Jersey, conducted in the summer of 2020

Easterseals NJ, which has seen its no-show rate for a program cut in half with telehealth, is keen for access to these services to continue long after the pandemic. But some clients clearly prefer in-person care, MHANJ noted. Just over 15% of respondents said they “strongly agree” that virtual services were the best option, while one in five “strongly disagree” and a third ” at variance “.

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