Your typical health care visit used to consist of driving to a clinic or office, filing out some paperwork, and waiting for someone to call your name when your provider was ready for you. Suddenly many people were attending appointments on the computer or over the phone, and telehealth became a household word. While telehealth appointments have been around for decades, they were on the periphery of the health care system. After the pandemic made it impossible to deliver health care in the same ways as before, telehealth became necessary, and barriers to reimbursement, technology, and licensure began to fall. Some health systems had to move from small-scale telehealth implementation to 100 percent virtual encounters overnight. Patients soon began seeing their doctors from within their own homes.
When Johnnett Kent learned she had lung cancer, the COVID-19 pandemic was already descending on California. Her doctor didn't want the 49-year-old to risk her health by heading into a crowded clinic between surgery, radiation and chemotherapy. So she started checking in with Kent through her smartphone. Kent was skeptical of the arrangement at first, thinking, "Can this really work?" Her Wi-Fi was glitchy and video calls froze as she tried to talk from her bed.
Nearly two years into the COVID-19 pandemic the landscape of virtual health care has changed dramatically. Services offered via telehealth exploded as the virus swept through the country and patients were unable to seek care in person from their clinics and doctors. Telehealth, telemedicine, and teletherapy commonly filled the gap but the expanded use was largely fueled by a number of pandemic-related flexibility initiatives including waivers, mandates, and orders at the state and federal level. As the pandemic recedes, and states declare an end to their public health emergencies, these flexibilities are expiring and/or changing. New proposals regulating telehealth are introduced on a near daily basis at the state and federal level.
A bipartisan pair of US senators have proposed legislation that would allow certain controlled substances to be prescribed via an initial telehealth encounter and--under certain conditions--expand Medicare reimbursement of audio-only substance use disorder treatment services. The proposed TREATS Act has been referred to the Senate Committee on Health, Education, Labor, and Pensions, and could significantly reduce the regulatory burdens associated with the remote prescribing of controlled substances. For more than a decade, healthcare providers in the United States have been largely prohibited from prescribing controlled substances via telehealth without having previously performed an in-person medical evaluation of the patient. Although Congress created the framework for a "special registration" pathway that has the potential to more broadly permit the practice, the Drug Enforcement Administration (DEA) has not issued regulations to implement it. This has been a significant roadblock for the treatment of substance use disorder, which is often treated with controlled substances. Recently, Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) proposed the Telehealth Response for E-prescribing Addiction Therapy Services Act (the TREATS Act), which would allow certain controlled substances to be prescribed via telehealth.
Ansel Armstrong had just found a psychologist when COVID-19 turned the world upside down, forcing in-person care to go remote. So video sessions replaced a 40-minute drive between Lawrence and Topeka. "I love how much it frees up my schedule," Armstrong said. It eased the process in other ways, too. I have my cat on my lap.