bizjournals.com
Tracey Drury
August 30, 2024
Federal telehealth waivers put in place during the pandemic are set to expire at year-end and providers and patients are pushing federal legislators for extensions.
The waivers cover an array of services and specialties, ranging from geographic flexibilities to extend care to people in rural settings to mental health follow-up visits and medication approvals for people with substance use disorder. A waiver removes certain federal health care requirements to make a patient visit more convenient.
“This is huge, a very big deal,” said Dr. Joshua Lynch of UBMD Emergency Medicine, an addiction medicine specialist who runs a multi-state program called Matters. “Having these rules expire drives us backwards and reduces care, there’s no way around it. We’ve proven that telemedicine is a good choice for patients, both objectively and through data, and taking that away would be a step in the wrong direction.”
Lynch’s practice would be affected in particular by the expiration of prescribing waivers by the Drug Enforcement Administration, which allows providers to prescribe drugs without an in-person visit. One waiver deals with controlled substances, while another is specific for buprenorphrine, which is prescribed to treat substance use disorder.
“We’ve learned now over the last several years that patients with substance use disorder do very well when they’re assessed on telemedicine and started on buprenorphine,” he said. “Probably about half or more than half of patients that interact with Matters rely on telemedicine to a certain extent and that could be at least 1,000 patients a year. That’s just one program, but there are many people around New York state that don’t really have the option to go somewhere to get access to medication.”
Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, said the waivers enable access to medications for hundreds of thousands of patients nationwide, not only those with substance use disorder but also a variety of mental health diagnoses.
“It’s opened access to care for a while for really uniquely vulnerable patients that the health care system prior to the existence of this waiver had not been treating well,” Zebley said. “It’s head-spinning how restrictive that was up to that point in time.”
He stressed the end of the waivers would essentially end the ability for the vast majority of providers to offer telehealth services, upending a model of care that is reliable and that both beneficiaries and providers think delivers clinically appropriate care.
“And if you look at the tremendous burnout of our health care workforce, the tremendous strain on the health care system and the fact we have far too few providers for an ever-aging population, why would we rip out from under that weakened system a tool to make the most of our limited resources, to make sure our workforce can work more efficiently?” Zebley said. “It would be frankly a disaster.”
Among a dozen waivers detailed on the American Telemedicine Association’s website set to expire:
Geographic and originating sites: Waivers allow patients to be seen in any geographic area and in any setting, including their own home. Pre-pandemic, patients had to be in a rural area or a health provider shortage area and have the telemedicine visit take place in a physician’s office.
Eligible providers: Limitations on the types of providers who can perform telehealth services were waived, allowing other providers such as physical therapists, occupational therapists, speech language pathologists and audiologists to perform telehealth.
Eligible distant/provider sites: Federally qualified health centers and rural health centers can serve as distant sites for telehealth.
Tele-behavioral health visits: Pre-pandemic, patients must have received an in-person evaluation six months before initiating telehealth, followed by an in-person visit annually. The waiver no longer requires an in-person evaluation.
https://www.bizjournals.com/buffalo/news/2024/08/30/federal-telehealth-waivers-expire-access.html