Kara Tao: Telehealth Beyond the COVID Pandemic
We all remember those endless days spent at home in front of the computer, looking into a mosaic of squares. Quarantine was a monotonous, difficult time for many, but platforms such as Zoom and FaceTime allowed us to maintain those critical connections with friends and family. And although Zoom interactions didn’t have the same emotional connection as in-person conversations, they provided us with remnants of normalcy.
Simultaneously, hospitals were hit hard with a tremendous amount of changes. Hospitals became emptier and emptier, and many sectors of clinics that didn’t address emergency issues closed down. Furthermore, as the COVID pandemic surged throughout the nation, patients didn’t want to risk infection to access in-person care.
While these consequences severely impacted the patient-provider environment, some of these pandemic challenges brought positive changes in care delivery as well. In particular, the use of telemedicine allowed doctors to meet with their patients in their own homes, reducing the financial burden of transportation and expanding access to physicians needed for their particular circumstances. Telemedicine takes advantage of online platforms, replacing in-person visits with a simple video call to the patient. Dr. Emil Baccash, a New York City geriatrician, told the New York Times, “there are some patients, especially elderly patients, who can’t get out of the house. I can talk to them and look at their problem on my computer, take a snapshot, say, of a leg infection and enter it directly into their medical record. If a blood test is needed, I can have a lab technician come to their house.” Dr. Yi Hua Chen, a hematopathologist at Northwestern University, said, “patients whose medical conditions are fairly stable, and saves their commute back and forth from home to the hospital. It has become particularly important to people with disabilities that have difficulty traveling in a car.” In short, telemedicine can avoid the unnecessary expenses of paying a deductible at the doctor’s office; for follow-ups/check-ins, an in-person visit is not needed in the first place.
During the COVID pandemic, the effects of telehealth were astonishing when observed in numbers. A report from the U.S. Department of Health and Human Services (HHS) found that Medicare telehealth visits in 2020 increased from 840,000 in 2019. In a cost-minimization analysis, results from multiple different studies demonstrated lower overall costs for telehealth. For example, in a study of patients with chronic obstructive pulmonary disorder, telehealth reduced each visit by $361 on average per patient. The report also highlighted the specific sectors of health that benefitted from telehealth, particularly behavioral health. In 2020, a third of behavioral health visits were conducted via telehealth. Thus, we can already see telehealth as having long-term benefits in areas related to mental health.In fact, over half of U.S. counties do not have psychiatrists. Mental health professionals within a county might not have the capacity to handle growing numbers of patients. A 2017 study from the Substance Abuse and Mental Health Services Administration also found that out of an astonishing 46.6 million Americans struggling with mental health, only 42.6 percent received treatment. An anonymous patient reported to the New York Times that receiving telehealth treatment is “far less cumbersome,” thereby decreasing the levels of stress and anxiety while commuting to an in-person clinic.
However, as COVID restrictions are slowly being lifted, states have re-established restrictions against providing telehealth. Specifically, there are significantly more restrictions on where patients can receive Medicare telehealth services, medicare reimbursements for telehealth visits, and mental health telehealth services. In Connecticut during the onset of the pandemic, Governor Ned Lamont issued Executive Order 7G that suspended licensure, certification, and registration requirements for telehealth providers. Lamont provided multiple extensions to this order, but eventually declared its expiration on April 15, 2022. In contrast, Idaho’s Telehealth Access Act remains in place until January 1, 2023. While many physicians advocate the benefits of telehealth, other physicians are more likely to support these restrictions and encourage the limitation of telehealth. For example, therapy visits over Zoom require careful consideration. Dr. Peter Pronovost tells the New York Times, “There is still a real value in being in the same room, in touch in the laying on of hands.” Dr. Elizabeth Rosenthal provides additional support on this claim by citing a study that found in-person interactions increase the likelihood of treatment compliance.
However, patients who rely on telehealth are now suddenly cut off from their physicians, and are once again subject to costly transportation and clinical expenses. When describing how the restrictions worked, Dr. Chen said, “for telehealth, if you want to see a patient out-of-state, you would usually need a license from the state. Some states have provided temporary permission, but these permissions will expire very soon; from January 1st, I will no longer have permission to see my patients in nearby states such as Indiana.” Although certain healthcare practitioners argue that telehealth visits cannot replicate in-person visits, it’s worth considering how telehealth visits can be a crucial solution for those who have rare conditions that cannot be addressed locally. Dr. Shannon M. MacDonald and Dr. Julia Berv recount the experience of J., a young 7-year-old with a rare cancer that couldn’t be addressed by local specialists. Thus, Dr. MacDonald and Dr. Berv, both of whom were located in Massachusetts, provided care both in-person and remotely.
Considering the many benefits of telehealth, ranging from convenience to relieving financial burdens, why should states return to licensing restrictions when telehealth has brought concrete, positive change to the future of healthcare? Although telehealth should not be considered a replacement for in-person visits, it’s certainly a better option for those who need specialized care or have difficulty commuting from home. Dr. MacDonald and Dr. Berv argue that there exists current precedents of interstate medical practice. Specifically, they mention an amendment passed for the Department of Veteran Affairs (VA), allowing military health care providers to offer care irrespective of state boundaries. While certain physicians have received permission to provide care in multiple states (through the Interstate Medical Licensure Compact Commission that exists in only 24 states), they are still subject to state regulations and annual renewal fees. Especially for physicians treating rare conditions, there needs to be a push for national licensure, particularly considering that there already exists a precedent for military physicians.
Kara Tao is a first year at Yale University in Morse College
