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Doctors, clinics and other providers struggle as Oregonians stay home. 'Telehealth' spreading, but unprofitable.

PMG FILE PHOTO - A nurse practitioner in Hillsboro takes a patient's blood pressure.With independent clinics struggling and some primary care doctors considering closing their doors, the state's recent order to promote remote health care consultations is a help — but providers say it is likely is not enough.

In theory, the move allows providers and clinics a means to see patients and maintain revenue while operating from a safe distance away.

But many patients don't realize they can access some care without leaving their homes.

Worse yet, some insurers still reimburse for remote care at a tiny fraction of what they pay for in-person visits — a tenth or even a twentieth of the normal fee, said Alex Kipp, a Portland primary care doctor.

But while providers may not be earning enough money to keep their doors open, ethically speaking they feel compelled to see patients as the pandemic ramps up.COURTESY PHOTO - Alex Kipp, a Portland primary care physician, says many of his colleagues in the profession are anxious over a plunge in appointments and income.

"Our primary obligation is to the health of our patients," said Kipp, who is active in the Oregon Academy of Family Physicians. "It's nerve-wracking for physicians that are in smaller practices.... What we have noticed is there's a tension between wanting to do what's best for the patients but then also making sure that we are staying viable financially."

On March 24 the state of Oregon issued an order requiring private insurers and Oregon Health Plan networks to support providers who provide care to patients remotely, a practice called telehealth.

The directive ended a practice in which some insurers had refused to reimburse providers for telehealth services.

The directive also included the Medicaid-funded Oregon Health Plan that provides care to about a million low-income Oregonians. OHP networks will be required to pay the same rate for telehealth visits that in-person care would receive.

But on the private side of things, the state's order has some glaring loopholes, doctors say. Chief among the complaints, that the policy does not require insurers to set telehealth reimbursements near in-person rates, let alone requiring the same level of pay.

"It's a good first step" but "there doesn't seem to be enough teeth in it," Kipp said.

Dick Clark, head of the Portland Clinic, wrote to Oregon's congressional delegation recently, saying that "Oregon is facing a health care infrastructure crisis that could collapse our independent health care delivery system for years to come," according to the Portland Business Journal.

Some members of the family physicians' group to which Kipp belongs say they can stay in business only two weeks more if the current trends continue. And some clinics are already have begun mandating furloughs for employees.

Betsy Boyd-Flynn, executive director of the physicians' group, said there's a lot of fear out there right now. Many patients don't realize telehealth is an option, while some clinics are just making the transition now.

"There are a lot of health systems and small clinics that didn't think they could do telemedicine. And all of a sudden you're having to learn really, really fast and make a transition really, really quick," she said.

Nick Budnick
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