Tucked away in the government spending bill Congress passed over the weekend to avert a government shutdown are a few provisions that could have a significant impact on Wyoming health care.
The spending bill allows acute hospital care at home and telehealth temporary waivers to continue through March 31, 2025.
Wyoming residents often have to travel long distances to attend medical appointments because of a lack of health care options throughout the state.
COVID Boosts Telehealth
Prior to the COVID-19 pandemic, Wyoming patients still had to travel to a medical facility to attend a telehealth appointment, even if the appointment was as short as five minutes long.
That changed as a result of the pandemic, helping telehealth appointments surge throughout the state due to patients being able to make doctors’ visits from their homes.
Wyoming’s State Employee Group Insurance Plan through Cigna covers 35,600 people, of which 19,551 received telehealth exams in 2022.
Medicaid reported 24,656 billed visits for telehealth in 2023, which is down from the 72,654 visits it saw in 2021 and 43,409 visits in 2022.
The original spending bill extended telehealth for two years and acute hospital care at home by five years.
After House Speaker Mike Johnson, R-Louisiana, and Democrats came to an agreement on a 1,500-page package, President-elect Donald Trump and billionaire Elon Musk, who Trump has tapped to make government more efficient, exerted their political influence, leading to a highly reduced spending package.
According to HealthCare Finance, Congress is expected to do more comprehensive health care measures next year under Trump.
Among Wyoming's fee-for-service Medicare beneficiaries receiving behavioral health services, more than 1,100 (37%) sought care from providers outside the state in 2023, up from 29% in 2021.
U.S. Sen. John Barrasso expressed concern during a 2023 hearing about the health care industry relying too heavily on telehealth and out-of-state reliance.
“It’s important, it helps us, but I worry about these issues,” he said.
In November, Barrasso introduced legislation that secures increased federal support for hospitals that care for a large number of Medicaid and uninsured patients in Wyoming and other rural states.
Mental Health And Substance Abuse
Telehealth services are particularly used by people with mental health or substance abuse issues.
Mental health issues are a problem in Wyoming, with the state typically posting some of the highest suicide numbers per capita in the country.
“This is a really big deal for older adults when they’re needing outstanding opportunities to meet with a physician,” said Tom Lacock, Wyoming AARP associate state director.
United Healthcare reported that nearly 58% of their virtual care visits were dedicated to mental health and substance abuse in 2022, while that same year Mountain Health Co-op’s numbers reported that 43% of its telehealth visits were dedicated to mental health and substance abuse, with 82% of those visits facilitated by licensed clinical social workers.
Of Medicare’s 2023 telehealth claims, the largest category of claims was for behavioral health services, which accounted for 26% of all Medicare telehealth claims in Wyoming.
Lacock also explained that for issues like PTSD, getting telehealth services at home is particularly beneficial. He worries about cutting the in-person flexibility of these services when considering the biggest age group for suicide is men over 70 years old.
As these services have become more well-known, he said their use has grown within the behavioral health industry.
Medicare Pay Cut Not Avoided
Also stripped from the bill was a provision to prevent a Medicare pay cut to physicians. This means physicians get a 2.8% Medicare payment cut on Jan. 1.
Sheila Bush, executive director of the Wyoming Medical Society, said although this won’t directly affect patients, it could lead to physicians scheduling fewer Medicare patients on a daily basis, which would lead to delayed care.
“At some point, no matter how invested the physicians are in these patients, you can’t keep the doors open and them without reducing the number of appointments available,” she said. “They’ll have to reset to offsetting with more commercial patients.”
Leo Wolfson can be reached at leo@cowboystatedaily.com.
