Community clinics say the easing of restrictions on telehealth during the pandemic has made it possible for healthcare workers to connect with hard-to-reach patients through a phone call. – people who are poor, elderly or live in remote areas, and do not have access to computers or mobile phones with video capabilities.
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Community clinics say the easing of restrictions on telehealth during the pandemic has made it possible for healthcare workers to connect with hard-to-reach patients through a phone call. – people who are poor, elderly or live in remote areas, and do not have access to computers or mobile phones with video capabilities.
Silke Enkelmann / EyeEm / Getty Images
Caswell County, where William Crumpton worked, runs along the northern edge of North Carolina and is a rural area with mostly former tobacco farms and occasional fast food restaurants.
“There are large areas where cell phone signal is nonexistent,” says Crumpton. “Things like satellite radio are even more of a challenge.”
Crumpton, who grew up in the field, is the CEO of Compassionate health, a federally funded community health center. The county does not have a hospital or emergency room. And for much of the pandemic, about half of the center’s patients could only be reached the classic way: A basic voice call on a landline.
“We have individuals living in homes that can’t make cell phone calls if they want to,” he said. “They don’t have high-speed Internet; moreover, the only connection they have to the outside world in some cases is a dial-up phone.”
So, as state and federal governments temporarily relaxed privacy and security restrictions on telehealth early in the pandemic, more patients around the country were able to get a doctor’s diagnosis and treatment. Phone treatment has no video or camera function. As a result, healthcare workers can connect with hard-to-reach patients – those who are poor, elderly or living in remote areas.
But today, the regulations that temporarily relax licensing and reimbursement restrictions in ways that expand the use of this type of telehealth service are changing rapidly.
There are approximately 1,000 proposals pending before state and federal legislatures to address the expansion or expansion of telehealth beyond the pandemic’s public health emergency. To date, about half of all U.S. states have passed measures to keep audio-only television systems in place. In the remaining states, absent the law, the old telehealth restrictions have or will return to effect; some will shut down when the federal public health emergency ends sometime later in the year, while others have established their own timelines.
Meanwhile, insurance policies are also changing. For example, Medicare says it will cover audio-only visits for mental and behavioral health treatment through 2023. But some private insurers have stopped paying coverage for sound-only care.
Taken together, the changes mean that patients may face an abrupt discontinuation of the care they are used to having remote and easy access.
Without telehealth, she “could be dead by now.”
That return to normal was not what Gail Grinius wanted to see. Grinius, a patient at Compassion Health, says accessing medical care has always been a challenge in her community.
“There are a lot of people who don’t have a vehicle,” she said. So when they run out of medicine or need a checkup, they usually call 9-1-1. She said being able to visit a doctor over a phone call would be a “lucky thing” for many people, just as she has been through the pandemic.
Grinius is 71 years old, has diabetes, skin and blood vessel diseases that make it difficult for her to walk. She also takes 15 different medications, so being able to see her doctor over the phone is important. “Otherwise, I don’t know,” she joked, “I could be dead by now.”
As lawmakers and insurers debate whether to continue allowing this type of sound-only care to continue, the crux of the debate is whether this low-tech way to continue. Is it safe and effective to reach more people?
The pandemic has changed Krista Drobac’s mind about that trade-off.
“Before the pandemic, I only thought of sound as a quality issue; now I think about equity,” said Drobac, executive director of advocacy group Alliance for Connected Care. “It really expands patients’ access to providers they wouldn’t otherwise be able to see.”
What’s missing when you don’t have a health check?
But the Texas psychiatrist Nidal Moukaddam She sees the problem very differently: “The phone is horrible. It’s horrible,” she said.
Moukaddam said nearly all of the patients in her clinic who had their first appointment by phone didn’t show up for follow-up care. She’s an associate professor of psychiatry and behavioral sciences at Baylor College of Medicine and a member of the Physicians Advocacy Foundation. “Only sound does not provide us [a] connect with the patient, “who is often contacted via cell phone when grocery shopping or driving or in the bathroom, she said, and is therefore not fully engaged.
Moukaddam also couldn’t assess whether they had tremors, skin discoloration or alcoholic breath, she said. “The problem is it kills medicine – you can’t do the job without a physical exam.”
Telehealth has 38 times increase since the pandemic started, according to a study by consulting group McKinsey & Company – not only for therapy and mental health, but also for the treatment of physical conditions.
It’s a mixed bag for people like Dr. Rahul Shah, a chiropractor in South New Jersey, said he likes the ability to conference calls for patients with their family members, but has also heard of patients seeing a surgeon for the first time in the operating room. .
“It was scary,” he said. “That’s scary,” said Shah. Think of the risks a doctor takes by never putting his hand on that patient – I mean, that’s mind-numbing, and that’s never going to happen. It’s now pre-pandemic, Shah said.
There is still no substitute for health care in place, he said. For example, he recently saw a patient at his office who came in with multiple medical tests and CT scans showing his pain radiating from his lower back. But when the man stumbled from his chair, Shah suspected another culprit, and ordered another MRI scan.
Shah said: “Hey, it turns out the gentleman has evidence of serious neck problems. “If I hadn’t seen him step out of his chair, I would have missed this whole line of questioning.” He says the change in diagnosis after a face-to-face visit occurs every other week during his practice.
Towards a combination of telehealth and on-site healthcare
Like many doctors, Shah sees medicine moving toward a combination of both telemedicine – in cases where only treatment is needed – and on-site care. His home state of New Jersey has yet to pass a bill that would expand remote flexibility or specify what type of insurance will pay for these phone or video visits. But with the changing insurance and legal landscape, Shah also says it’s hard to know how much of his practice should be investing in new capabilities to offer remote appointments.
It’s a common complaint, says Courtney Joslin, a resident at the R Street Institute, a free-market consultancy.
“There is so much uncertainty about what will become permanent and what will be the same,” she said. “Nowadays, a lot of service providers and even hospitals are saying, ‘Well, should we continue to invest in the infrastructure for this? Will our state continue to allow this? “
And that leaves many patients – and their doctors – in limbo.
