Back to the doctor’s office? Here’s what’s next for telehealth after the pandemic 2022-04-29 05:42:04

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Fifteen years after a diagnosis that seemed like a death sentence, Petit continues to beat those odds. However, this means that he is a complex patient who needs specialized care that can require him to travel thousands of miles from his home in central Ohio.

When Buteat’s cancer recurred, he found that one pandemic-era change made a crucial difference to his care: telehealth.

Potet was cancer-free for two years until January 2021, when the cancer had spread to his liver, pancreas, and lung. He found a doctor who could perform the kind of specialty surgery he needed—but it was also a four-hour drive away, in Cleveland.

Amid the Covid-19 pandemic and Ohio winter, the idea of ​​traveling so far has been on multiple dates It was daunting.

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“It’s hard for us to travel, and of course most cancer patients are elderly people. Traveling is not easy…especially if you’re a cancer patient in the long-term, you may have some medical problems,” Potet said. , 69.

But then came the option of doing his appointments remotely and from the comfort of his home, through telehealth.

“They came back and said ‘We can do all this.’ [through] “Telemedicine instead of having to drive an eight-hour round trip, and spend the night—three times,” Putyat said.

Over the course of a week and a half, Petit met three professionals through telehealth.

“It’s hard to describe how life gets a little complicated, like traveling in the snow, battling cold weather, staying in hotels, and how much stress it puts on someone who is already under extreme stress from the fact that I have new tumors and we don’t know what we’re going to do,” Buteat said. At such a critical point in his cancer journey, telehealth felt like a “blessing.”

For millions of people like Potet, the resilience of telehealth in the pandemic era has made healthcare more accessible.

However, this flexibility is set to expire 151 days after the Covid-19 public health emergency, outlined as part of the $1.5 trillion, ends. omnibus spending bill It was signed by President Biden in March. The state of emergency was last renewed on April 13 for another 90 days.

Expanding telehealth in times of crisis

Over the course of the pandemic, the use of telehealth has grown exponentially, which has essentially called for efforts to reduce in-person contact.

according to A report from the US Department of Health and Human ServicesIn the first year of the pandemic, more than 2 out of 5 Medicare beneficiaries used telehealth, at least 28 million people. The number of visits to telehealth services has also grown 63 times as much in 2020. The trend continues. 20% of adults in the US used telemedicine during the first two weeks of MarchAnd According to the US Centers for Disease Control and Prevention.
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In March 2020, several new federal legislation, including the Coronavirus Assistance, Relief, and Economic Security (CARES) Act, temporarily waived Medicare restrictions on telehealth. The Centers for Medicare and Medicaid Services eased restrictions that allowed beneficiaries to access More health services default.

Prior to March 2020, people had to be in a rural area or a place with a shortage of medical personnel to qualify for telehealth under Medicare, and services could only be accessed through specific medical facilities.

However, during the Covid-19 public health emergency, coverage expanded to allow people to receive healthcare services remotely in urban areas and from their homes for the first time – sometimes even across state lines. Another big change was the introduction of voice-only services, where health care could be delivered through a phone call.
Likewise, most people covered by private health insurers should expect similar coverage. at 42 states and the District of ColumbiaPrivate insurance companies have to pay for telemedicine.

“I can actually see more people in the suburbs or rural areas who might not have had the same level of access before,” said Dr. Stephen Parodi, an infectious disease physician and executive vice president of the Kaiser Permanente Consortium. “We want to keep that.”

Shift gears quickly

Telehealth expansions have become a private lifeline for patients seeking addiction services.

When orders were issued to stay at home and addiction recovery centers Closed across the countryTelehealth has served as a bridge to the continuity of care.

“What the flexibility of telehealth allows during Covid is an extraordinary change of pace,” said Dr. Shaun Ryan, regional director of the American Society of Addiction Medicine. “Essentially we were able to further our mission of lowering the barrier and meeting the patient where they are.”

Ryan said transportation is one of the most common barriers to receiving addiction treatment and it won’t go away once the public health emergency is over.

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During the pandemic, the US Drug Enforcement Administration Temporarily relaxed rules About prescribing controlled substances such as buprenorphine, a treatment for opioid use disorder. Doctors can now prescribe medication after a video patient visit rather than a clinic visit.

“As far as we can know what data is being collected, [that] led to better patient care and retention.”

However, this is another flexibility that patients risk losing once the federal public health emergency is over.

There are some challenges that come with making addiction care virtual. First, it is difficult for addiction professionals to monitor whether their patients will start using them again or are taking their medication as directed.

“So my encouragement is for people to be smart and objective in evaluating, what should it look like to move forward? And not just push the connection somehow,” Ryan said.

Ryan said the future of addiction care will likely benefit from a combination of telehealth and in-person care, but that won’t be possible if stringent restrictions on telehealth before the pandemic continue.

permanent changes

Some changes are here to stay. According to the Federal Medicare Payments Advisory Committee, mental, behavioral, and neurodevelopmental health accounted for 25% of telehealth fees in the first year of the pandemic. Now, behavioral health services, Like individual and group therapy, it will always be available through telehealth, even after the public health emergency has ended.

The White House says so I realized the impact that telehealth has had on improving access to mental health care, and it’s even one of Biden’s Key Strategies To address the mental health crisis in the country.
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Dr. Andrew Botti, a psychiatrist and volunteer clinical faculty at the University of California, San Francisco School of Medicine, said telehealth expansions have helped remove some of the barriers to access for his patients. Gone are the long wait times, transfers, and transportation costs.

“When we don’t have to rely on the results of certain physical examinations…a video can be just as efficient as seeing someone in person, and somehow better, given the access issues,” Botti said.

Booty indicated that some It’s hard to notice things on screen, like nuances in body language or how someone carries themselves into a room.

However, he said he would prefer to be able to see patients “with increased frequency via video rather than not seeing them or seeing them often because of [limited] being able to.”

Covid makes telehealth possible

Given the benefits offered by the expansion of telehealth, some lawmakers are pushing Congress to consider making more flexibility in telehealth permanent.

Telehealth response to electronic addiction treatment prescriptions, or TreatmentsThe Act will permanently allow certain controlled substances, such as buprenorphine, to be prescribed online after a video consultation with the provider.
The CONNECT FOR HEALTH LAW He also received bipartisan support in Congress. The bill was introduced in 2016 by Hawaii Senator Brian Schatz, and a revamped version was reintroduced last year in response to the massive use of telehealth over the pandemic.
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According to Schatz’s office, the previous version of the bill received little attention, but that has changed over the course of the pandemic, as lawmakers recognize the significant role telehealth has played in expanding access to care.

The bill’s actions include the permanent removal of geographic restrictions on the use of telehealth – a provision temporarily put in place for a public health emergency – and the removal of restrictions on emergency services.

“The past year has shown us that telehealth works, is popular, and is here to stay,” Schatz said. in the current situation In April 2021.

But because bills often take time to travel to Congress, providers and patients alike have relied on Covid-19 public health emergency renewals to keep telehealth expansions going.

Meanwhile, according to a CMS spokesperson, individual states can choose to make telehealth expansions permanent. Illinois became one of the first to do so last year, when Governor JB Pritzker signed a bill allowing telehealth expansions made during the pandemic to be covered through 2027.

For Petite, the expansion of telemedicine has been a silver lining to the COVID-19 pandemic. But now, faced with the possibility that not all of these expansions will be permanent, he worries that he won’t be able to get the same quality of care he’s had over the past two years.

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

Technical difficulties

In line with the goals of increasing access to health care, there is still work to be done to make telehealth equitable.

HHS found that Medicare beneficiaries in rural areas and blacks got fewer telehealth visits than other groups during the first year of the pandemic.

So, while telehealth may seem like an answer to cross-access issues, providers should also consider: Who can access telehealth in the first place?

“Problems with hardware, software, data connection, Wi-Fi – all of these things came up at the right time [patients] We were at home. “Where would they go if they didn’t have them at home?” Ryan said.

Thus, the future of telehealth depends on assessing the needs of each person.

“If we think of a one-size-fits-all model, you very likely end up increasing inequality,” said Sensi Hernandez-Cancio, vice president for health justice at the National Partnership for Women and Families. During a Kaiser Family Foundation discussion on the future of telehealth in March.

Ensuring people have access to broadband and that medical centers have programs that can protect patient privacy will be expensive. Hernandez Cancio said that while the initial cost of improving the technology may be prohibitive, it is an investment that could save money in the long run as more people get the care they need.

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