SC lawmakers turn to technology to solve SC health problems [The State (Columbia, S.C.)]

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March 21--COLUMBIA, S.C. -- The children of rural Williamsburg County don't have many pediatricians in town, but they do have one on TV because of a telemedicine program operated by MUSC.

Now, state lawmakers want to expand telemedicine -- where doctors treat patients via video conference -- because they see it as a potential fix for some of South Carolina's health problems. Telemedicine, they say, offers the chance to give specialized medical care to poor residents in rural areas -- people who need it the most but don't have access to it.

Last week, the S.C. House of Representatives approved a $22.7 billion budget, for the state's fiscal year that starts July 1, that includes $8 million to expand MUSC's telemedicine program. That expansion is part of a proposal that many Republicans tout as an alternative to providing more poor people health insurance under Medicaid, as proposed by the Affordable Health Care Act.

In the state Senate, lawmakers are considering a bill that would require private insurers companies to cover telemedicine visits.

But an alliance of health-care providers has delayed the Senate bill for at least two weeks. They worry telemedicine would make health care so accessible that private health insurance plans would become unprofitable.

"When you can't reasonably control the volume on it, then you can't control the pricing," said Jim Ritchie, a lobbyist who represents the S.C. Alliance for Health Plans, an insurance industry group. "Employers who provide health insurance for employees are going to see (the cost of) those plans go through the roof, and they are going to have to drop coverage, or at least reduce coverage. That, in the end, defeats the whole purpose."

Dr. James McElligott disagrees.

McElligott runs the MUSC telemedicine program that serves Williamsburg, where he treats school children for sore throats and ear infections via video conference. The MUSC program is paid for through the state Medicaid program, so the Senate bill would not affect it. But he says it is important to expand telemedicine by requiring health insurers to cover it.

"Do you want to give care or not? That is the question," McElligott said. "Their response, without saying it directly, is: 'But we don't want everyone to get the care.' "

State Sen. Ray Cleary, R-Georgetown, chairman of the Senate subcommittee handling the bill, wants a compromise. He proposes amending the bill to require private health insurers to cover telemedicine visits only for certain specialists, like cardiologists. That way, it would limit the number of people who would use the system and ensure the program did not grow too quickly.

Another idea, Cleary said, is to use the state health plan and its 500,000 members as a pilot program for telemedicine.

"The alliance for health care wants to get it right," he said. "Instead of just opening it up and trying to solve the mistakes, we're trying to have fewer mistakes."

South Carolina'sMedicaid program -- the joint federal-state taxpayer-funded health insurance for the poor and disabled -- has been using telemedicine since 2011. But it has seen limited success, spending just $28,750 to "see" 328 patients. That's only a tiny portion of Medicaid's S.C. budget next year of more than $6 billion.

"We've got sort of competing goals here," said state Medicaid director Tony Keck. "One is to save money, but one is to make sure we are buying access, and access means more physician visits for some populations. If it (telemedicine) lowers the barrier for people seeing a physicians, we might spend more money."

MUSC president Ray Greenberg said he would like to use the extra $8 million in taxpayer money to expand his medical school's maternal fetal-medicine program for high-risk pregnancies. He noted the three S.C. counties with the highest infant mortality rate -- Allendale, Barnwell and Hampton -- are rural and have limited or, in some cases, no access to obstetrics practices.

But, Greenberg added, most rural hospitals can't afford to pay for the telemedicine program. Of the state's 19 rural hospitals, as defined by the state Department of Mental Health, only three are on MUSC's telemedicine network, he said.

"One way it could save money is not everybody having to come to the most expensive place to get care," he said. "That's clearly a savings."

Reach Beam at (803) 386-7038.

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