Tennessee House, Senate quarrel over telemedicine bill heats up

by Andy Sher


Photo by Robin Rudd/ Rep. Robin Smith

NASHVILLE — An influential libertarian group has launched what it says is a "multimillion-dollar" campaign in support of a telemedicine bill sponsored by state Rep. Robin Smith, R-Hixson, blanketing mail boxes across the state with support for the measure.


Americans For Prosperity-Tennessee state director Tori Venable said that "over the past two months, we have seen how Gov. [Bill] Lee's implementation of telemedicine and repealing our state's burdensome certificate-of-need laws saved people's lives during this public health crisis.


"When government gets out of the way, our health care system is better prepared to handle emergencies and help patients get the care whenever they need it," Venable added.


The effort comes as the Tennessee House and Senate are at odds over House Bill 2350/Senate Bill 2312, the telemedicine bill that Smith is carrying. Lee has made use of telemedicine far more available during the coronavirus pandemic, invoking his emergency powers to do so.


But that's only during the pandemic. Thus, Smith said, her bill is still needed. Both the House and Senate passed the legislation earlier but in different versions before lawmakers' abrupt March 19 recess as the extent of the coronavirus pandemic became clearer.


As lawmakers returned May 26, Senate leaders said they would focus solely on revising the state's budget and similar must-do measures, with the telehealth legislation not included. But the House opened the floodgates on most legislation. And on Wednesday, Smith moved on the House floor to stick to the House telemedicine version, refusing to go along with the Senate's version of the bill.


One of the major differences is a dispute over what physicians and other professionals can charge when conducting some patient encounters online or by phone versus with an actual in-person visit. Smith's bill allows medical professionals to be reimbursed at the same rates as those conducted at an office or clinical setting.


Many insurers reimburse physicians and medical professionals here using telemedicine at lower rates than in-facility interactions with patients, Smith said. Proponents call the issue "pay equity" and Smith said it has become central in the dispute between the House and Senate. The House is insisting insurers reimburse providers using telemedicine at the same rates as comparable procedures in an office or hospital setting.


Moreover, Smith said, a number of insurers that do allow telemedicine now rely on national companies that have networks of physicians or other professionals outside the state.


What can be done via telemedicine is limited in a number of ways, Smith said, noting standard procedures like drawing blood or weighing a patient can't be done online or by phone. More complex procedures such as use of diagnostic imaging equipment can only be done in an office or clinical setting as well, she said. Insurers have auditing teams that can determine whether a practice is trying to "upcode" such procedures that telehealth can't do, Smith added.


The "pay equity" issue is a long-standing battle between providers such as physicians over telehealth and insurers resisting making it, in their view, wide open. But as a result of the pandemic, telemedicine came into its own when in-person visits were restricted due to the coronavirus, making it more difficult for people to get medical advice or checkups.


Last month, the state's largest insurer, Chattanooga-based BlueCross BlueShield of Tennessee, announced a major shift, declaring it was permanently retaining its coverage of telemedicine with its in-network doctors and other health care professionals.


BlueCross BlueShield began doing that back in March when federal officials suggested that people keep at least 6 feet apart, wherever possible, to limit the spread of the COVID-19 virus. Then came Lee's executive order.


Smith said Tennessee physicians and professionals should have similar access and praised BlueCross BlueShield of Tennessee as setting an example that it can be done.

But sentiment among senators is that with Lee's executive order in effect, there is no need to rush and lawmakers can return to the issue next year.


Moreover, the senators also note, because of BlueCross BlueShield's huge market share, other insurers will eventually follow.


Smith, however, believes that could be a long time coming and argued action is needed now. Another issue involved, she said, is the move can "help save the bottom line" for embattled rural hospitals.


"I understand the differences in the chambers, but I am very proud to stand with all my House colleagues," she said, noting her bill has widespread bipartisan support. "This is a Tennessee patient, Tennessee provider, Tennessee hospital" benefit.


Smith, a registered nurse, said that following the House's refusal on Wednesday to go along with the Senate version, the measure is headed to a conference committee. There the chambers would hammer out their respective differences.


In its direct mail and online support efforts, AFP-Tennessee's Venable said the group is also including another issue it supports, overhauling the state's certificate of need process involving how the state approves certification of hospitals, facilities and practices that would-be new providers say unfairly discriminates against them. That battle has gone on for years. Incumbent providers, especially many hospitals, charge the newcomers are "cherry picking" the highest-paying services.

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