Column: Expand access to audio telemedicine

House Bill 1980 HD2 SD2, a bill making its way through the state legislature with broad support from both patients and providers, will greatly expand access to health care for Hawaii‘s kupuna of low-income, limited English-skilled and rural residents. The bill recognizes the use of telemedicine modalities, including audio-only (phone), as reimbursable patient visits to their healthcare providers.

In the interest of all Hawaiians, the House of Representatives should follow the Senate’s lead in passing this important measure.

The pandemic has fueled revolutionary advances in telemedicine. Vulnerable patients met safely with doctors using smartphones, tablets and computers. Over the past two years, we have learned that the use of telehealth technologies — particularly those that involve family members in virtual visits to providers — has the potential to lead to greater access to care, lower barriers to transportation, and improved outcomes for those in need of care.

Not all telemedicine visits included video. Some patients — particularly those in rural, underserved communities with limited internet access and those struggling with the use of technology — benefited greatly from audio-only access to telehealth services.

Audio-only transmission played a crucial role during the pandemic, ensuring open lines of communication and improving access for marginalized groups.

While Hawaii’s original emergency declaration included coverage of audio-only telehealth interactions, that flexibility has now expired. And as Hawaii’s limited broadband access continues to pose a barrier to accessing two-way audiovisual communications, the most vulnerable among us – including those in rural and underserved communities – may not be able to access the benefits that telemedicine can offer.

Audio-only interactions have a wealth of support. The Centers for Medicare and Medicaid Services (CMS) found that a third of their telemedicine encounters during the pandemic were conducted over the phone. The RAND Corp. found that telephone interactions were a literal “lifeline” for hospitals and medical facilities that lacked the infrastructure to deliver audio and video services. Many states have changed their policies to allow audio-only telemedicine, and the Department of Health and Human Services and CMS recently made phone/audio-only treatment a permanent part of certain Medicare-eligible telehealth services come.

We know only audio works to provide much-needed assistance to Hawaii’s vulnerable communities. It is both critical and common sense to make audio-only a consistently acceptable option for the delivery of care in Hawaii.

We call on the Hawaii House of Representatives to pass HB 1980 HD2 SD2 immediately.