Laura Kilcline is a registered dietitian/nutritionist, private practice owner and president of the Rhode Island Academy of Nutrition & Dietetics.
If telemedicine in RI is here to stay, medical nutrition therapy should be included. The COVID-19 pandemic wreaked havoc on many aspects of our health-care system, but it also started some positive changes.
One of the most striking was former Governor Raimondo’s emergency executive order expanding access to telemedicine services for all Rhode Islanders and ensuring “pay parity” for providers. This means that a doctor, dietitian or other licensed professional providing telemedicine visits must be paid the same amount as if the appointment happened in person. This was not the case before the pandemic. Permanent parity for telemedicine is currently under consideration by the Rhode Island General Assembly, but in varying forms.
Telemedicine has made sure that the pandemic would not stop Rhode Islanders from getting the medical care they needed. One important part of that care is medical nutrition therapy services provided by registered dietitian nutritionists (RDNs). When the public health emergency ends, these rules will expire. When they do, it will be harder for some of our state’s most vulnerable residents to get the care they need.
Many people benefit from telemedicine: parents with young children, people with mobility issues (including many older adults), people without transportation and those with inflexible work schedules. It is time to stop letting those barriers get in the way of quality health care. With the technology available today, you should be able to schedule medical appointments during your toddler’s naptime without worrying about wheelchair access, bus routes or finding a ride and without having to sacrifice your limited vacation time for medical appointments.
Registered dietitian nutritionists provide nutrition counseling and education to help people eat better, feel better and prevent and treat diseases like diabetes, heart disease, eating disorders and kidney disease. Since outpatient dietitians don’t typically perform physical exams, most nutrition visits are equally effective over the phone or through video chat. In some cases, telemedicine enhances the patient experience by giving the RDN a glimpse into the home food environment (such as reviewing food items in a patient’s pantry), and by using technology to teach patients about important nutrition topics related to their health. If more Rhode Islanders are able to access RDNs via telehealth, we can continue to improve public health in a cost-effective way through preventative care.
Consider the case of Gladys, who has struggled to consistently keep appointments with her health care providers for months, since she was so sick it was hard for her to leave her apartment. However, through telemedicine, Gladys was able to meet with her dietitian most weeks to get help finding ways to increase her nutrition. During the time meeting with her dietitian, she was able to eat more and gain strength and now is able to take more frequent walks and visit with her daughter and granddaughters because of her telemedicine appointments.
Change in the law is needed and we are encouraging our state legislature to include medical nutrition therapy in the telemedicine bills being considered. The Senate version of this bill would ensure coverage and equal payment for only primary care physicians and behavioral health care providers, which while an important step forward, leaves out the important work dietitians perform. The House version of this legislation (which RIAND supports), however, is much more inclusive and impactful.
Telemedicine is not just technology; it’s about making sure everyone gets the health care they need. We urge the Rhode Island General Assembly to include medical nutrition therapy as an eligible telemedicine treatment in the final version of the telemedicine bill.