February 3, 2023

Back to the doctor’s office? What’s in store for telehealth after the pandemic

8 min read


It all started with a toothache.

That’s what brought Gary Putt to the doctor’s office. But after several appointments and a biopsy, Putit discovered that he had malignant kidney cells in his jaw, the result of stage IV kidney cancer – which only 14% of people live. In the first five years of diagnosis.

Fifteen years after that diagnosis, which felt like a death sentence, Putit continued to overcome these difficulties. However, this means that he is a complex patient who needs special care that may require him to travel thousands of miles from his home in central Ohio.

When Putt’s cancer recurred, he realized that an epidemic change had made a significant difference in his care: telehealth.

Putit was cancer-free for two years until January 2021, when his cancer spread to his liver, pancreas and lungs. He found a doctor who could perform the type of special surgery he needed in Cleveland – but he was also four hours away.

Between the CoVID-19 epidemic and the Ohio winter, the idea of ​​traveling so far for numerous meetings Was annoying.

“It is difficult for us to travel, and of course, most cancer patients are elderly. And the journey is not easy; especially if you are a long-term cancer patient, you may have some medical issues.” Putit, 69, said.

But then he got the option to make appointments remotely and from the comfort of his own home through telehealth.

He came back and said, ‘We can do this. [through] Telemedicine: Spend the night instead of the eight-hour cycle – three times, “said Putit.

Over the course of a week and a half, Potit saw three specialists through telehealth.

“It’s hard to describe how much the small worries of life, such as traveling in the snow, fighting the cold weather and staying in hotels, put so much pressure on a person who is already under so much stress from the fact that my We have new tumors and we don’t. We know what we’re going to do, “said Putit. At such a critical juncture in her cancer journey, telehealth felt like a “blessing.”

For millions like Potit, the epidemiological telehealth flexibility has made healthcare more accessible.

However, this flexibility expires 151 days after the end of the CoVID-19 public health emergency, which is outlined as part of the 1.5 trillion. Omni Bus Expenses Bill President Biden signed in March. The emergency was last renewed on April 13 for another 90 days.

During epidemics, the use of telehealth has grown exponentially, mainly in an effort to minimize individual-to-person contact.

According to one US Department of Health and Human Services reportMore than 2 out of 5 Medicare beneficiaries used telehealth services in the first year of the epidemic, numbering at least 28 million. The number of telehealth visits also increased. 63 times in 2020. And the trend continues; During the first two weeks of March, 20% of American adults used telemedicine., According to the US Centers for Disease Control and Prevention.

In March 2020, several new pieces of federal legislation, including the Corona Virus Aid, Relief, and Economic Security (CARES) Act, temporarily waived Medicare restrictions on telehealth. Medicare and Medicaid service centers eased restrictions that allowed beneficiaries access More health services practically

Prior to March 2020, people had to be in a rural area or in a shortage of medical staff to be eligible for telehealth services under Medicare, and services could only be accessed through specialized medical facilities.

However, during the CoVID-19 public health emergency, coverage was expanded to allow people to access telehealth services for the first time in urban areas and from their own homes. On state lines. Another major change was the introduction of audio services only, in which healthcare could be provided by phone call.

Similarly, most people who are covered by private health insurance companies should expect similar coverage. I 42 states and the District of ColumbiaPrivate insurers are required to pay for telemedicine costs.

“I can actually see more people in the suburbs or in rural areas who would not have been able to reach this level before,” said Dr. Stephen Parody, an infectious disease physician and executive vice president of the Caesar Permanente Federation. Said “We want to keep it safe.”

The expansion of telehealth has become a lifeline, especially for patients seeking addictive services.

When home stay orders were enforced and drug rehabilitation centers Closed nationwideTelehealth acted as a bridge to continuity of care.

Dr. Sean Ryan, regional director of the American Society of Addiction Medicine, said: “The flexibility of telehealth during coding allowed gears to change dramatically.” “We were primarily able to further our mission of reducing barriers and meeting the patient where they are.”

Transportation is one of the most common barriers to accessing drug treatment and will not go away once the public health emergency is over, Ryan said.

During an epidemic, the US Drug Enforcement Administration Temporary relaxation rules Around the prescription of controlled substances such as buprenorphine, the treatment of opioid use disorder. Doctors can now prescribe medication after watching a video with a patient, not in the office.

“As far as we can tell from what data is being collected, [that] As a result of better patient care and retention, “Ryan said.

However, there is another flexibility that patients are at risk of losing once the federal public health emergency is over.

There are some challenges that come with making virtual care virtual. On the one hand, it is difficult for drug specialists to monitor whether their patients are re-using or taking their medication as directed.

“So my motivation is to be agile and purposeful in judging people, what it should look like in moving forward? And not just moving the dial forward in one way or another,” Ryan said.

Ryan said the future of drug care could potentially benefit from a combination of telehealth and personal care, but that would not be possible if strict pre-pandemic telehealth restrictions continue, Ryan said.

Some changes are here to stay. According to the Federal Medicare Payment Advisory Commission, mental, behavioral and neurodevelopmental health accounted for 25% of telehealth charges in the first year of the epidemic. Now, behavioral health services, Like individual and group therapy, public health will be permanently available through telehealth even after an emergency is over.

The White House says. Has recognized the effects of telehealth on improving access to mental health care, and this is one of Biden’s effects. Key Strategies To deal with the country’s mental health crisis.

Dr. Andrew Butty, a psychologist and volunteer clinical faculty at the UCSF School of Medicine, says the expansion of telehealth has helped remove some of the barriers to access to their patients. Long wait times, travel and transportation costs are gone.

“While we don’t have to rely on specific test results; video can be almost as useful as watching someone in person, and in some ways better, given access issues,” Botti said. The plant said.

The booty noted that something It’s hard to see things on the screen, like the nuances of body language or how a person walks into a room.

Still, he said he would be able to see patients with “high frequency on video” either not being able to see them or watching them very rarely. [limited] Access

Given the benefits of expanding telehealth, some lawmakers are urging Congress to consider making telehealth more flexible.

Telehealth Response to E-Prescription Addiction Therapy Services, or Heals.The Act will permanently allow certain controlled substances, such as buprenorphine, to be prescribed online after video consultation with the supplier.

Of Connect for Health Act The Congress has also won bilateral support. The bill was introduced in 2016 by Sen. Brian Sheets of Hawaii, and a new version was reintroduced last year in response to the widespread use of telehealth in epidemics.

According to Schatz’s office, there was little interest in the first version of the bill, but it changed during the epidemic, as lawmakers realized that telehealth had played a dramatic role in increasing access to care.

The bill’s provisions include the permanent removal of geographical restrictions on the use of telehealth – a provision made temporarily for public health emergencies – and the removal of restrictions on emergency services.

“Last year showed us that telehealth works, it’s popular, and it’s here to stay,” Schatz said. In a statement In April 2021.

But given the time it often takes to pass bills through Congress, providers and patients alike have relied on the renewal of the CoVID-19 Public Health Emergency to continue the expansion of telehealth.

Meanwhile, according to a CMS spokesperson, individual states may choose to make telehealth expansion permanent. Illinois became one of the first to do so last year when Gov. JB Pritzker signed into law a bill that would allow the expansion of telehealth coverage during epidemics to continue until 2027.

For Potit, the extension of telemedicine was the silver lining of the CoVID-19 epidemic. But now, given the possibility that not all of those extensions may be permanent, he fears he will not be able to achieve the same level of care he has received over the past two years.

“Code made telemedicine possible,” he said. “It would be a shame if we lost this tool to get the best specialist care for our patients.”

With goals in mind to increase access to healthcare, there is still work to be done to make telehealth equal.

HHS found that rural and Black Medicare beneficiaries had fewer telehealth visits during the first year of epidemic disease than other groups.

So while telehealth access seems to be the answer to a wide range of issues, providers should also consider: Who has access to telehealth in the first place?

“Hardware, software, data connections, Wi-Fi issues – all of which are tolerated. [patients] Were at home. Where would they go if they weren’t home? “Ryan said.

Thus the future of telehealth depends on estimating the needs of each individual.

“If we think of all models of the same size, it is very likely that you are going to eliminate the growing inequality,” said Sensei Hernandez-Concei ،, in the National Partnership for Women and Families Health. The Vice President of Justice said during the Qaiser Family Foundation’s discussion on the future of telehealth in March.

Ensure that people have access to broadband and that medical centers have software that protects patient privacy. Hernández-Cancio said that although the initial cost of improving technology can be very high, it is an investment that can save money in the long run because more and more people get the care they need.

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