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How Has The COVID-19 Pandemic Changed Telemedicine in Iowa?

National Cancer Institute
The use of telemedicine increased greatly during the COVID-19 pandemic, but as Gov. Reynolds rolls back pandemic-era restrictions, some health care workers are concerned about its future.

A requirement that Iowa health care providers receive the same reimbursement rates for medically necessary telemedicine visits as they would receive for in person visits has ended under Gov. Kim Reynolds’ latest public health disaster proclamation.

This means Iowa-regulated insurers can now pay Iowa health care providers different rates for medical visits depending on if they were conducted virtually or in-person.

The change, which went into effect Thursday, doesn’t affect mental health services, which are guaranteed payment parity under a new state law, or visits covered by Medicare, whose reimbursement rates are set by the federal government.

Virtual visits have increased significantly during the COVID-19 pandemic as Iowa hospitals and clinics moved to limit the spread of COVID-19.

At the University of Iowa Hospitals and Clinics, the number of telemedicine visits increased from just 726 from January to early March of last year to 63,066 from mid-March to the end of May.

“There were a lot of unknowns in the beginning,” said Doug Van Daele, an otolaryngologist with UIHC, who worked to expand the hospital’s telemedicine program before the pandemic.

“And so consequently, everybody kind of really felt right away that we needed to come together and that in-person visits were really going to have to change.”

UIHC Infographic.png
An infographic from the University of Iowa Hospitals and Clinics shows how dramatically the use of telemedicine services increased when the pandemic hit in spring 2020.

Van Daele said just “a handful of services” were doing telemedicine prior to the pandemic, which quickly changed in March of last year.

“In about a two week period, we rolled out the capability of every service in the organization to be able to do telemedicine,” he said.

Van Daele said virtual visits have dropped now that patients are able to resume in-person visits, but numbers still remain at much higher than they were pre-pandemic.

“It didn't, like, go up to 60 percent of our visits and now down to back to 1 percent,” he said. “On any given day, it fluctuates a little bit, but you're somewhere around the 10 percent mark, for instance.”

With the end of the state’s temporary requirement for payment parity, Van Daele said it means doctors are having a “friendly arm wrestle” with UIHC’s financial department about how to continue telemedicine services at their current level.

“We're committed to continue to evolve and provide telemedicine services where it makes sense and to the patients that it makes sense,” he said. “But it's a little bit of a question mark, at what scale we'll be able to do it as it stands now.”

Barriers Remain

Last month, Gov. Kim Reynolds signed a law that requires payment parity for mental health services as part of a larger tax bill.

The bill that originally passed the House would have required payment parity for all telemedicine appointments, but it stalled in the Senate. Republicans in both chambers agreed on a compromise to include just mental health services, according to the Des Moines Register.

But Van Daele said one of the biggest hurdles to telemedicine his patients still face is access to broadband internet.

“I still have a fair number of patients in my practice who still have flip phones,” he said. “And they just simply don't have broadband at home that they can use with their computer to be able to access it.”

Reynolds set expanding the state’s broadband access as a top priority during the last legislative session. In April, she signed legislation into law to spend $100 million on matching grants for companies to boost broadband access in the state’s rural areas.

Denice Hodgson-Zingman, a cardiac electrophysiologist at UIHC, said she has many patients who don’t have the internet or who struggle with technology, and need to see her face-to-face.

But she said she works in a small subspeciality and has known patients who couldn’t make the special trip to see her in Iowa City for an appointment that could have been conducted virtually.

“It would be fairly common for a cardiologist to refer a patient to us and the patient to have an appointment scheduled, and then they miss it,” Hodgson-Zingman said.

“And then, when we call them and ask them, they just said, ‘You know, I couldn't get a driver. You know, it was too far away. I couldn't get a babysitter,’” she said.

Hodgson-Zingman said about 10 to 15 percent of her new patients now meet with her over telemedicine.

Prior to the pandemic, she struggled to get any patients to meet with her virtually, pointing to challenges to setting up the technology and patient hesitancy.

“I think the pandemic forced a lot of us to try things that we hadn't tried before. That's probably true from the patient standpoint. And so I think those things all, you know, propelled it forward, certainly in our field,” she said.

Natalie Krebs is IPR's Health Reporter