Nebraska lawmakers are once again looking for ways to expand so-called telehealth services throughout the state to address a shortage of specialized health care providers and an aging rural population.
Telehealth services are flourishing nationwide, allowing doctors and patients to connect through webcams and smartphones. But advocates say the technology still faces substantial obstacles that have kept it from spreading faster in Nebraska.
One senator has launched a legislative study of the technology that will begin in earnest later this month. Sen. Merv Riepe of Ralston said he wants to learn how other states are adopting the technology and what Nebraska can do to make it easier, safer and more effective.
The unanswered questions include how doctors are reimbursed when using telehealth, the cost of using the technology and liability when something goes wrong.
"We need to approach this with a very open mind," said Riepe, a former hospital administrator. "I don't want us to overregulate, but you need to protect the public. And I want to know if we're providing enough incentives for the appropriate use of telehealth services across the state."
Riepe said he views telehealth as part of a larger movement toward alternative forms of healthcare. One new law he sponsored this year will allow patients to pay doctors directly for consultations and physicals, rather than going through insurance.
The agreements allow doctors to offer a range of services for a monthly or quarterly fee, while insurance covers those that aren't included in the package. Riepe said telehealth services could be included in those packages, creating a greater incentive for doctors and nurses to use them.
Telemedicine will become increasingly important in Nebraska as the state's health care provider shortage worsens, said Dr. Brian Bossard, a Bryan Health physician in Lincoln.
The technology allows rural patients to meet with specialists in Omaha or Lincoln without having to
travel and eases the workload for doctors at smaller community hospitals. Some small hospitals use telemedicine carts loaded with equipment and high-resolution cameras, which allow doctors to diagnose patients from Lincoln.
Bossard said Bryan Health uses telehealth for acute care, emergency room services and admitting patients at rural facilities even though it sometimes costs the hospital money.
"We know there's a need, and we feel it's an important to continue to provide access to these services," he said.
Andrew Whitney, Bryan Health's telemedicine services director, said Nebraska's laws haven't kept pace with other states that embraced the technology. The cautious approach isn't always bad because officials want to ensure patient safety, he said, but the technology will become more important in the future.
"We are definitely not at the forefront, but we're not at the rear either," Whitney said. "Nebraska hasn't been hostile to it. It's just been slow to change."
Telehealth services in Nebraska face three major barriers, advocates say.
First, the state has not joined the Interstate Medical Licensure Compact, an agreement that offers expedited licensing for doctors who want to practice medicine in other states. Seventeen states have passed laws to adopt the compact, including neighboring Iowa, South Dakota, Wyoming, Colorado and Kansas. If Nebraska joined the compact, telehealth supporters said out-of-state doctors could treat Nebraska patients remotely and Nebraska doctors could examine residents from nearby states.
Former state Sen. Jeremy Nordquist of Omaha introduced a bill last year that would have added Nebraska, but the measure stalled in committee because of technical problems with the proposal.
Second, the state doesn't require parity between telehealth services and in-person consultations. Because insurance companies don't have to reimburse as much for a telehealth exam, doctors don't have as much incentive to use the technology. The lack of parity also creates uncertainty over how much doctors will get paid, said Elizabeth Hurst, a lobbyist for the Nebraska Hospital Association.
Many physicians "provide telehealth not knowing if they're going to get reimbursed," Hurst said. "The payer may decide they don't think telemedicine is worth reimbursing at the same rate."
Third, telehealth equipment is expensive to buy and maintain at a time when hospitals are trying to cut costs. Hospitals have to train staff how to use it, and Nebraska doesn't have many vendors, Hurst said.