A Blog by Jonathan Low

 

Nov 26, 2021

How Telehealth Rollbacks Are Stranding Patients

States are concerned that relaxation of licensing and other rules to enable more out of state doctors and other specialists to attend to patients may lead to abuses and a lower level of care. 

But patients who have benefited from telehealth fear they will suffer if forced to see healthcare professionals in person, especially if they are poor or live in rural areas. JL 

Stephanie Armour and Robbie Whelan report in the Wall Street Journal:

Most states over the past two years allowed residents to conduct some medical appointments virtually, by setting rules that required insurers to pay the same for virtual visits and in-person appointments and by eliminating requirements for in-person check-ins. Insurers also expanded coverage of telehealth appointments during the pandemic. The provisions helped patients avoid exposure to Covid-19 and alleviated some of the pressure on healthcare workers. (But) states are now curbing access to telehealth services that were expanded during the pandemic.

States are curbing access to telehealth services that were expanded during the pandemic, prompting some doctors and businesses to lobby for a permanent expansion of remote care that they say some patients need.

Most states over the past two years allowed residents to conduct some medical appointments virtually or by phone, by setting rules that required insurers to pay the same for virtual visits and in-person appointments and by eliminating requirements for in-person check-ins. Insurers also expanded coverage of telehealth appointments during the pandemic. The provisions helped patients avoid exposure to Covid-19 and alleviated some of the pressure on overtaxed healthcare workers.

Telehealth visits were 154% higher in the last week of March 2020 versus a year earlier, according to data from the Centers for Disease Control and Prevention. A McKinsey & Co. report this past July showed that demand for telehealth continued to grow through 2021.

“It was like someone switched on a light,” said Geoffrey Boyce, chief executive officer of Array Behavioral Care, a telehealth provider that specializes in mental-health counseling.

Health insurers began scaling back coverage allowances made during the pandemic in fall 2020, and some state provisions have expired or are set to do so next year.

Some hospitals, doctors and telehealth providers say making pandemic allowances for telehealth services permanent would expand access to care and treatment.

Some licensing boards oppose extending telehealth services permanently. The Justice Department in September charged 138 providers in connection with a combined $1.4 billion fraud largely involving telemedicine. A wider embrace of telehealth could open the door to further fraud, said Lisa Robin, chief advocacy officer at the Federation of State Medical Boards.

Jennifer Roman, a 27-year-old former firefighter and emergency medical technician from Franklinville, N.J., has a rare neurological condition called idiopathic intracranial hypertension that has required 10 brain surgeries in six years. She also suffers from Behcet’s disease, an inflammatory disorder.

She sees specialists at Johns Hopkins University and New York University, and takes medication for tremors, which her doctors had monitored by videoconference during the pandemic.

Her insurer told her in June that it would no longer cover out-of-state telehealth visits, meaning she would have to drive about two hours to visit each of her doctors instead. She said that the trip is too difficult for her to make regularly and that because of the rarity of her conditions, there aren’t appropriate specialists in her state. She has been forgoing appointments that were conducted virtually last year.

“For people in the rare-disease community, what’s happened as a result of telehealth coverage being cut back is, we have been left behind to get worse,” Ms. Roman said.

During the pandemic, all 50 states and the District of Columbia used emergency declarations to waive some parts of licensing requirements for out-of-state doctors conducting telehealth appointments, according to Alliance for Connected Care, a nonprofit focused on healthcare technology and regulation. Twenty-five states have ended the emergency declarations, the organization said.

Kara Ditto, a psychiatrist in Virginia, sees more than 200 patients in Georgia via a telepsychiatry startup called MindStrong using a temporary license granted after demand for mental-health services exploded during the pandemic.

MindStrong’s Georgia practice closed for two weeks in July after the state’s emergency declaration expired. She said disruption was hardest for patients on medication who need to monitor their progress with the help of a physician. “These are people who for medical and economic reasons just can’t drive or be driven two hours to see a mental-health specialist,” Dr. Ditto said.

The practice reopened after regulators assured therapists that they wouldn’t be penalized for offering telehealth sessions while waiting for their Georgia licenses to be processed.

Mental-health patients are at particular risk if their care regimens are disrupted, said Nicole Christian-Brathwaite, a psychiatrist in Massachusetts. “You really shouldn’t change clinicians midstream,” she said.

The Biden administration in August committed more than $19 million to strengthen telemedicine services in rural and underserved areas. Advocates are pressing for more. They want all states to maintain and expand licensure flexibilities for the duration of the Covid-19 pandemic and to reinstate any licensing allowances that have expired.


Elizabeth Stout, who moved to Washington, D.C., from Jacksonville, Fla., during the pandemic for an internship, was able to see her previous therapist, who is licensed in Florida, because D.C. waived licensure requirements due to Covid-19.

The flexibility expired in July. Providers who weren’t licensed in the district were given another 60 days to continue remote services. Ms. Stout, 21, who survived the 2018 shooting at a high school in Parkland, Fla., said her therapist told her this past fall that she couldn’t continue to provide the telehealth appointments. She had been seeing her since shortly after the shooting and valued the bond.

“Not being able to talk to her is taking a toll,” Ms. Stout said.

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