The onset of the COVID-19 pandemic has broadly affected how well being care is supplied in the USA. One notable change is the expanded use of telehealth companies, which have been shortly adopted by many well being care suppliers and payers, together with Medicare, to make sure sufferers’ entry to care whereas decreasing their threat of publicity to the coronavirus.
In an article revealed in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology on the College of North Carolina Lineberger Complete Most cancers Middle and UNC College of Medication, mentioned the routine use of telehealth for sufferers with most cancers may have long-lasting and unexpected results on the availability and high quality of care.
“The COVID-19 pandemic has resulted within the speedy deregulation of telehealth companies. This was performed partially by lifting geographical restrictions, broadening affected person, well being care skilled, and companies eligibility,” mentioned Royce, the article’s corresponding writer. “It’s doubtless features of telehealth proceed to be a part of the well being care supply system, past the pandemic.”
The article’s different authors are UNC Lineberger’s Hanna Ok. Sanoff, MD, MPH, medical medical director of the North Carolina Most cancers Hospital and affiliate professor within the UNC College of Medication Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medication, Adventist HealthCare Radiation Oncology Middle in Rockville, Maryland.
Royce mentioned the widespread shift to telehealth was made doable, partially, by three federal financial stimulus packages and the Facilities for Medicare and Medicaid Companies making a number of coverage modifications in March that expanded Medicare recipients’ entry to telehealth companies.
The coverage modifications included permitting telehealth companies to be supplied in a affected person’s house. Medicare beforehand solely paid for telehealth companies in a facility in nonurban areas or areas with a well being skilled scarcity. Medicare additionally accepted cost for brand spanking new affected person appointments, expanded telehealth protection to incorporate 80 extra companies, allowed for companies to be carried out on a wider assortment of telecommunication methods — together with distant video communications platforms, corresponding to Zoom — and modified the restrictions of who can present and supervise care.
Whereas the potential advantages of telehealth have been demonstrated in the course of the pandemic, Royce mentioned they should be balanced with considerations about care high quality and security.
“There’s a lot we do not find out about telehealth, and the way its speedy adoption will affect our sufferers,” Royce mentioned. “How will the security and high quality of care be impacted? How will we combine important parts of the standard physician go to, together with bodily examination, lab work, scans and imaging? Will sufferers and docs be roughly happy with their care? These are all potential downsides if we’re not considerate with our adoption.”
He mentioned acceptable oversight of care is essential. There might be a continued want for goal affected person assessments, corresponding to patient-reported outcomes, bodily examinations and laboratory exams, and to measure care high quality and monitor for fraud. There are additionally numerous normal measures of care high quality that may be applied in the course of the transition to telehealth, together with monitoring emergency room visits, hospitalizations and hostile occasions.
Telehealth presents different challenges, as properly. Although expertise and web entry at the moment are extra extensively obtainable, they aren’t universally accessible. The place one lives, their socioeconomic standing and luxury degree with expertise will be obstacles to utilizing telehealth companies. A reliance on telehealth may decrease participation in medical trials, which may require common in-person appointments.
“Telehealth can be utilized to enhance entry to care in historically hard-to-reach populations. Nevertheless, you will need to acknowledge that if we’re not considerate in its adoption, the other might be true,” Royce mentioned. “For instance, will decrease socioeconomic teams have the identical degree of entry to an enough web connection or mobile companies that make a digital video go to doable? Telehealth must be adopted with fairness in thoughts.”