Hawaii did what so many other states did to keep healthcare services going during the height of the COVID pandemic: they loosened restrictions on tele health. Now, with the pandemic waning, there is a bill pending in the state legislature that would seek to make some of the tele health changes implemented during the pandemic permanent. Unfortunately, the bill reveals competing interests in the tele health arena. It may fail as a result.
The bill in question is known as House Bill 1980. In its original form, the legislation was designed to increase access to mental health services by allowing patients to interact with clinicians via video chat platforms like Zoom. Insurance companies would be expected to pay for the visits just as if they occurred in the office.
Language has been added to the bill for the purposes of limiting who can and cannot utilize a tele health visit and still expect insurance coverage. The bill specifically restricts traditional telephone calls unless certain extenuating circumstances exist, like a patient not having access to a computer or mobile phone for video chat.
Just More Barriers
Critics of the legislation say it doesn’t do what its sponsors promised it would do. Rather than opening doors to more tele health opportunities, they say it just creates more barriers. What if a patient doesn’t like using a computer or mobile phone? Can they talk with a therapist over a landline phone? Maybe. But maybe not.
Putting restrictions on how and when tele health can be utilized takes the power away from patients and gives it to bureaucrats and insurance companies. That is where the competing interests lie. Politicians need the support of powerful lobbyists who are against tele health expansion. Likewise, insurance companies need the help politicians offer to prevent having to pay for yet more coverage.
It is not as though modern tele health solutions are incapable of facilitating a positive experience. To the contrary, modern tele health is more sophisticated than ever before. Knowing what it is capable of only adds fuel to the speculation that throwing up barriers has nothing to do with insuring quality healthcare outcomes.
In-Office Visits Remotely
Step back from the politics and a careful examination of the state of modern tele health clearly reveals just how far the technology has come. Take the tele medicine kiosks from San Antonio-based CSI Health, for example. Most of their models go way beyond video chat. They offer full diagnostic capabilities and the ability to send diagnostic data directly to a clinician in real time.
CSI Health kiosks can facilitate an in-office visit remotely. Everything the clinician could do with a patient sitting directly across from them can be done virtually. Why would bureaucrats and insurance companies not want to encourage this sort of thing? They will not say, so we are left to speculate.
Patients Should Decide
In fairness, there are some clinicians who are still reticent about tele health. They still believe it is in a patient’s best interest to see the doctor face-to-face. Their concerns are understandable. However, healthcare delivery is not about them. It is about their patients.
Patients should always be the ones who decide what is best for them. They should always have the final say regardless of what any doctor, administrator, or judge might think. When we take medical freedom away from patients and give it to someone else, we have taken away the one thing that makes people truly free: autonomy.
Hawaii lawmakers will now have to decide the fate of House Bill 1980. In the meantime, their debate reveals so many conflicting interests in the tele health arena. At least now we know.