In the early months of the COVID-19 pandemic, Gov. Laura Kelly issued an executive order that significantly expanded access to telehealth.
Along those changes was expanded reimbursement and payment parity for certain services through Medicaid, while private health insurers also temporarily enacted more pay parity for telehealth.
Health experts on Wednesday presented to state lawmakers overseeing KanCare some research on how that pay parity — or equal reimbursement rates — has affected providers.
"If we want to maintain access to telehealth services in Kansas and make sure patients have access to telehealth, we need to make sure that payment is fair," said David Jordan, CEO of the United Methodist Health Ministry Fund, in an interview.
The report, conducted by the Health Ministry Fund and the University of Kansas Health System, showcase the expanded use of telehealth during the pandemic. Furthermore, it showed how pay parity gave telehealth a boost.
Reimbursement prior to COVID-19 didn’t cover costs, according to 60% of providers surveyed, and 85% of knowledgeable respondents said telehealth reimbursement was worse than that of in-person visits. But after Kansas allowed for equal reimbursement rates during the pandemic, only 38% of knowledgeable respondents said the same.
Now, 85% of providers said pay parity is the top issue in ensuring telehealth continues, according to the report.
The increased, continued use of telehealth services even beyond the pandemic might provoke state legislators to revisit the issue of whether to make that pay parity permanent. Kansas could consider requiring KanCare and maybe even private health insurance companies to reimburse telehealth medical care the same rates as in-person.
"Telehealth is not intended to replace in-person care," said Jordan, who emphasized he wasn’t advocating for anything but simply providing information. "However, when appropriate, telehealth is a very valuable tool for patients to manage their care and to access care in a way that makes the most sense for them."
State lawmakers in the KanCare Oversight committee, who were considering what to recommend for 2021’s legislative session, thought the idea of pay parity, however, will be a tough subject to tackle.
"It’s a can of worms. When you open it, it explodes in this building," said Rep. Brenda Landwehr, R-Wichita, who chairs the KanCare Oversight committee.
"It’s not going to be a slam dunk, just because a survey said," she said, adding all parties, including insurers, will need to be involved to hash out details. But Landwehr acknowledged how the virus has really pushed the conversation on telemedicine.
"COVID has advanced a lot of positives, and telehealth happens to be one of them," she said. "It was moving there, but it’s accelerated that."
Such legislation on pay parity, if proposed, will likely face significant opposition.
About three years ago, there was the same debate over enforcing pay parity between remote and in-person medical visits. Insurance companies weren’t fans.
"Telemedicine services are not equivalent to in-person services and, therefore, should not receive parity to in-person services in reimbursements," Coni Fries, of Blue Cross Blue Shield of Kansas City, testified in a committee meeting at that time. "Primary care physicians are paid at a higher rate because we expect them to manage our members’ care throughout the year. On the contrary, telemedicine appointments might be one-time engagements."
BCBS Kansas also said at that time that parity would strip insurers of the ability to manage one’s own services. The company actually allowed for such pay parity during the pandemic but only temporarily, until the end of this year, according to a spokesperson.
In the end, Kansas lawmakers did pass a telehealth law that went into effect in 2018, but it only mandated coverage parity, not payment parity. Insurers have to cover a telehealth service if it could also be provided in person, but they could set their own rates for telehealth reimbursement.
For now, Dorothy Hughes, a University of Kansas professor who played a part in creating the report, said there will be more studies looking into how telehealth has played out in the state during COVID-19.
"Providers value their autonomy, right, and they want to be able to use their clinical judgment, as opposed as to having to make decisions between in-person or telehealth based on finances," she said.
Correction: This story incorrectly stated that Blue Cross Blue Shield Kansas implemented pay parity until the end of June. Pay parity for telehealth will actually be until the end of this year.