Telemedicine exploded in popularity after COVID-19 hit, but limits are returning for care delivered across state lines.
That complicates further treatments for some cancer patients. It can also affect other forms of care, including mental health therapy and routine doctor visits.
Over the past year, nearly 40 states and Washington, DC, have ended emergency declarations that make it easier for doctors to use video to examine patients in another state, according to Alliance for Connected Care, which advocates for the use of video. telemedicine use.
Some, like Virginia, have made exceptions for people with pre-existing relationships with doctors. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine.
Doctors say the result is a patchwork of regulations that creates confusion and has prompted some practices to completely shut down out-of-state telemedicine services. That is only for patients who have transportation to meet in person.
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Susie Rinehart is planning two upcoming trips to her oncologist in Boston. She needs regular CT scans and doctor visits to monitor a rare bone cancer that has spread from her skull to her spine.
Rinehart didn’t have a specialist near her home other than Denver that could treat her. These visits were made virtually during the pandemic.
She’ll be traveling without her husband to save money, but that presents another problem: If she gets bad news, she’ll handle it alone.
The 51-year-old said: “It was stressful enough to have a rare cancer, and this added to the stress.
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Dr Shannon MacDonald, Rinehart’s oncologist, said enforcement of telemedicine regulations now appears to be more aggressive than before the pandemic, when video hits were still popping up. .
“It just seems so outdated,” says MacDonald, who recently co-wrote an article on the issue in the New England Journal of Medicine.
For medical boards, the patient’s location during telemedicine is where the appointment takes place. One of MacDonald’s hospitals, Massachusetts General, requires doctors to be licensed on a patient’s behalf for virtual visits.
Dr. Lee Schwamm, vice president of Mass General Brigham health system, said these visits were limited to New England and Florida, where many patients are on winter break.
That doesn’t help doctors like MacDonald, who see patients from all over the country.
The Cleveland Clinic also attracts a lot of out-of-state patients. Neurosurgeon Dr Peter Rasmussen is worried about how some will handle the upcoming travel, especially since winter can bring icy weather.
A fall “can literally be the end of life” for someone with a condition such as Parkinson’s disease, he said, who has difficulty walking.
Psychiatrists have another concern: Finding doctors for patients who move out of state. This is especially difficult for college students who temporarily leave home.
Most US counties do not have child and adolescent psychiatrists, noted Dr. Shabana Khan, chair of the extrasensory neurology committee of the American Psychiatric Association.
“If we try to transfer patients, there’s usually no one there,” says Khan.
Helen Khuri’s mother turned to a specialist to help her when the 19-year-old’s post-traumatic stress disorder flared up last spring. But the Emory University student had to temporarily move from Atlanta to Boston for treatment, even though she had never set foot in a hospital that provided the service.
She rented an apartment with her father so she could be in a similar situation when she went to see a doctor remotely, a situation she called “ridiculous”.
“It doesn’t necessarily make sense to … get rid of my life, just to receive this three-week treatment program,” Khuri said.
Even people who see a doctor close to home can be affected.
Ed Sepe’s Washington, DC, pediatric clinic in Maryland has begun driving several miles across the border into the city to connect by video. That saves them a 45-minute ride downtown for an in-person visit.
“It’s silly,” he said. “If you’re under the care of a doctor, and you’re in the United States, it doesn’t make sense to have geographic restrictions on telemedicine.”
Sepe notes that low-income families tend to work in jobs that don’t allow time off for in-person visits. Some also have difficulty in transportation. Video hits have helped solve these obstacles.
“It’s bigger than just telemedicine,” he said. “There’s a missed opportunity there to level the playing field.”
According to Lisa Robin, an executive director of the Federation of State Boards of Health, states can play an important role in the growth of telemedicine by protecting against fraud and protecting safe for the patient.
But the federation also recommended that states relax some restrictions on telemedicine.
That includes enabling virtual tracking for people who have traveled out of state to seek care or who have moved temporarily but want to stay with the doctor.
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Ateev Mehrotra, a Harvard health policy professor who studies telemedicine, notes that countries can also form regional organizations with neighboring countries to ease cross-border care. gender.
“There are many ways to solve these problems,” he said.
Meanwhile, patients in need of care are currently trying to find a way to manage.
Lucas Rounds wasn’t sure how many times he would visit MacDonald in Boston to monitor his rare bone cancer. Logan, 35, of Utah, spent months away from home earlier this year, undergoing radiation and surgery.
Plus, he has a wife and three young girls and mortgage-like expenses to consider.
Rounds says he has to think about taking care of his family “if the worst happens.”
“If I died of cancer, all the costs we would have accrued… those are dollars my family wouldn’t have,” he said.
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