Despite increased use during the pandemic, many states either already have or plan to roll back expanded telehealth benefits—leaving many patients feeling "left behind to get worse," Stephanie Armour and Robbie Whelan report for the Wall Street Journal.
Is the telehealth era ending?
During the early months of the Covid-19 pandemic, many doctors and patients transitioned to telemedicine, in part due to state emergency orders that mandated the coverage of telehealth visits and waived requirements for out-of-state medical licenses.
Implications for patients
According to Alliance for Connected Care (ACC), a nonprofit focused on health care technology and regulation, all 50 states and the District of Columbia implemented emergency declarations to waive certain licensing requirements for out-of-state doctors conducting telehealth appointments.
At the same time, many commercial insurers and government payers expanded telehealth coverage, with many for the first time offering to pay or reimburse for virtual visits at the same rate they did in-person visits.
As a result, telemedicine use surged, especially among populations vulnerable to the coronavirus, including older adults and those with ongoing medical conditions. For instance, telehealth visits were 154% higher during the last week of March 2020 than the same time period a year earlier, according to CDC data.
"It was like someone switched on a light," said Geoffrey Boyce, CEO of Array Behavioral Care, a telehealth provider that specializes in mental-health counseling.
But despite this increased use of telehealth, many state emergency orders have already expired—and several insurers have also rolled back expanded telehealth provisions. According to AAC, 25 states have already ended the emergency declarations that were in place earlier in the pandemic.
Some licensing boards oppose a permanent extension of pandemic-era telehealth allowances, citing potential for increased fraudulent activity. But many hospitals, doctors, patient advocates, and telehealth providers say they believe this permanent extension would increase access to care, Armour and Whelan report.
With access to telehealth services at risk, many have expressed concern for patients who depend on the flexibility and expanded care options associated with telemedicine.
For example, Jennifer Roman, a 27-year-old with multiple conditions who has had 10 brain surgeries over the past six years, lives in New Jersey and sees specialists at both Johns Hopkins University and New York University. She takes medications that her doctors have monitored via videoconference throughout the pandemic.
But in June, Roman's insurer informed her that her out-of-state telehealth visits would no longer be covered. As a result, she would need to make a two-hour drive to see each of her doctors in person—a trip that would be too difficult for her to make regularly because of her health conditions. Additionally, because of the rarity of her conditions, there weren't closer specialists in her home state.
Since then, Roman has been skipping the appointments that she was able to conduct virtually last year, the Journal reports. "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," Roman said.
These treatment disruptions have also occurred among mental health patients. A telepsychiatry startup called MindStrong was forced to close for two weeks in July after Georgia's emergency declaration expired, the Journal reports.
According to Kara Ditto, a psychiatrist in Virginia who sees over 200 MindStrong patients, this disruption was the hardest for patients on medication who were being monitored by physicians.
"These are people who for medical and economic reasons just can't drive or be driven two hours to see a mental-health specialist," Ditto said. The practice later reopened. (Armour/Whelan, Wall Street Journal, 11/22)