After the outbreak of COVID-19, telemedicine’s popularity skyrocketed, but restrictions on care supplied across state boundaries are returning.
This complicates some cancer patients’ follow-up therapy. It can also impact other types of care, such as mental health counseling and normal doctor visits.
According to the Alliance for Connected Care, which promotes the use of telemedicine, roughly 40 states and the District of Columbia have stopped emergency declarations that made it easier for doctors to use video visitation to see patients in another state over the previous year.
Some, such as Virginia, have made exceptions for individuals with an established relationship with a physician. A few states, such as Arizona and Florida, have made it simpler for out-of-state physicians to perform telemedicine.
According to doctors, the resulting patchwork of legislation generates uncertainty and has forced some practices to cease all interstate telemedicine operations. Only patients who are able to travel will be able to receive follow-up care, consultations, or other forms of treatment.
“So archaic”
Susie Rinehart is scheduled two forthcoming visits to her Boston-based oncologist. Her unusual bone cancer has moved from her head to her spine, necessitating frequent scans and doctor’s appointments.
Rinehart cannot be treated by a specialist near her home outside Denver. These visits occurred nearly throughout the outbreak.
She will travel without her spouse to save money, but this creates an additional problem: if she receives terrible news, she will have to deal with it by herself.
The 51-year-old stated, “Having a rare form of cancer is hard enough; this only adds to the strain.”
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Dr. Shannon MacDonald, Rinehart’s oncologist, stated that telemedicine regulation enforcement appears to be more stringent now than it was before the pandemic, when video visits were still in their infancy.
MacDonald, who recently co-wrote an article about the topic for The New England Journal of Medicine, stated, “It simply feels so obsolete.”
To state medical boards, the location of the patient during a telemedicine visit is the location of the appointment. Massachusetts General, one of MacDonald’s hospitals, requires doctors to be licensed in the patient’s state for virtual visits.
Dr. Lee Schwamm, vice president of the Mass General Brigham health system, stated that the organization wants these trips limited to New England and Florida, where many patients spend the winter.
This is not helpful for physicians like MacDonald, who see patients from across the nation.
Cleveland Clinic also attracts many out-of-state patients. Dr. Peter Rasmussen, a neurosurgeon, is concerned about how certain individuals may handle impending travel, especially considering winter might bring treacherous conditions.
A fall “may literally be fatal” for a person with a condition such as Parkinson’s disease who has difficulty walking, he said.
Stony Brook, New York: On October 8, 2021, Kristie Golden, associate director of operations at Stony Brook Medicine, is pictured with Teladoc, a moving telemedicine cart that enables clinicians to interact with their patients remotely. John Paraskevas/Newsday RM, sourced from Getty Images
Psychiatrists have a separate concern: locating doctors for out-of-state patients. This is especially challenging for college students who are temporarily living away from home.
Dr. Shabana Khan, chair of the telepsychiatry committee of the American Psychiatric Association, remarked that most counties in the United States lack child and adolescent psychiatrists.
“If we attempt to transition patients, there is often no one available,” Khan said.
Helen Khuri poses for a portrait on the Emory University campus in Atlanta, Georgia, on Thursday, October 6, 2022. When her daughter’s post-traumatic stress disorder flared up last spring, Khuri’s mother contacted a professional to assist her. Khuri had to temporarily relocate from Atlanta to Boston for treatment, despite never entering the hospital providing it. John Bazemore / AP
When the 19-year-post-traumatic old’s stress disorder flared up last spring, Helen Khuri’s mother hired a professional to assist her. But in order to receive therapy, the Emory University student had to temporarily relocate from Atlanta to Boston, despite never having set foot in the hospital providing it.
She rented an apartment with her father in order to be in the same state for telemedicine visits, a circumstance she thought absurd.
“It didn’t make sense to uproot my life merely to do this three-week treatment program,” Khuri explained.
To cross the boundary
Even patients seeing local physicians may be affected.
Dr. Ed Sepe’s pediatric practice in Washington, D.C., has Maryland patients who have begun commuting a few miles across the border to connect by video. This eliminates their 45-minute travel downtown for an in-person meeting.
He stated, “It’s ridiculous.” If you are under a doctor’s care in the United States, it makes no sense to impose regional restrictions on telemedicine.
Sepe observed that low-income families typically have jobs that prohibit personal visits. Some also have difficulty obtaining transportation. Videoconferencing helped to overcome these obstacles.
“It goes beyond telemedicine,” he stated. The situation presents a squandered chance to level the playing field.
According to Lisa Robin, an official with the Federation of State Medical Boards, states may play an essential role in the development of telemedicine by preventing fraud and ensuring patient safety.
However, the federation also suggests that states relax certain telemedicine limitations. This includes allowing patients who have flown out of state to receive care to perform virtual follow-ups, as well as providing virtual visits for persons who have temporarily relocated but wish to continue seeing their doctor.
States might also develop regional compacts with their neighbors to facilitate cross-border treatment, according to Dr. Ateev Mehrotra, a Harvard health policy and telemedicine expert.
“There are so many methods to handle these challenges,” he remarked.
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In the interim, people who require immediate care are attempting to determine how to manage it.
The number of times that Lucas Rounds will visit MacDonald in Boston to monitor his uncommon bone cancer is uncertain. The 35-year-old resident of Logan, Utah, has already spent months away from home this year for radiation and surgery. In addition, he has a wife, three small daughters, and costs such as a mortgage to consider.
Rounds says he must consider how to provide for his family “should the worst occur.”
“If I die of cancer, then all these expenses we’ve incurred would be monies my family would not have,” he stated.