19 Fall/Winter 2020 continues limited which facilities could pro- vide telehealth services; some practi- tioners, such as physical and occupational therapists, speech language pathologists and others, were not allowed to offer telehealth either. Payment for telehealth had also been an issue. According to Harris, the federal office that scores medical bills always treated Medicare telehealth visits as duplicative visits, not replacement ones, as patients would regularly have a telehealth consultation followed by an in-per- son visit. That led to those bills being scored as much more expen- sive. In addition, hospital clinical staff had simply not been able to bill for telehealth in a very widespread or efficient way. “All of that has sort of hamstrung telehealth for a while,” Harris said. She also noted that insurance providers have also been reluctant to pay for telehealth services at the same rate as in-person visits. “They say a telehealth visit is not as expensive, so insurance wants to pay less,” Harris said. “A lot of times they’re paying $15 or $20 for a telehealth visit. You can barely make up your expenses at that rate.” Throw in the lack of reliable broad- band internet connections in rural and underserved parts of the country, and the result has been that telehealth has never been able to take off. According to the Depart- ment of Human and Health Services, before the pandemic only an average of 14,000 Medicare beneficiaries in the entire country received a tele- health service each week. This February in Oregon, of the 210,183 primary care visits just .1 percent were telehealth. The Pandemic Play But then came the pandemic and the orders to stay at home and avoid clinics and hospitals unless absolutely necessary. And with it came a tempo- rary loosening of the restrictions that had been hobbling telehealth. Telemedicine, Wallowa Memorial Hospital, Enterprise Then came the pandemic and the orders to stay at home and avoid clinics and hospitals unless absolutely necessary. And with it came a temporary loosening of the restrictions that had been hobbling telehealth.