ONCOLOGY® co-Editor-in-Cheif Julie M. Vose, MD, MBA, chief of the Division of Hematology/Oncology at the University of Nebraska Medical Center in Omaha, Nebraska, discusses the emergence of telehealth during the COVID-19 pandemic and the needs of patients going forward.
Telehealth as a method of health care delivery has taken on greater significance due to the COVID-19 pandemic, as well as for its ability to increase access to care for those who live greater
distances from their doctor’s office and those unable to leave their homes. Under its section 1335 waiver authority, the Centers for Medicare & Medicaid Services (CMS) approved temporary expansion of telehealth services during the public health emergency (PHE) to a patient’s place of residence. Prior to the waiver, CMS would only pay for telehealth services on a limited basis when the patient was receiving this service in a designated rural area at a medical facility. CMS also expanded telehealth services by allowing telephonic evaluation and management services. This aspect is essential as many older or disadvantaged patients are unable to follow the instructions or lack internet access to allow telehealth video visits.
However, many of the telehealth flexibilities and policy changes made by Congress and Health and Human Services (HHS) are due to expire at the conclusion of the PHE, wherein patients and physician practices would be expected to revert to primarily face-to-face services without any type of risk-based assessment for gradually reopening medical practices and health systems to care for nonacute patients without COVID-19 infections. Patients with cancer have reported high satisfaction with telemedicine, allowing better continuity of care, enhanced communications, and greater treatment adherence, which would be a good incentive to continue the use of telehealth for this population, where appropriate.
Prior to the PHE, there were several disincentives to the wide development of telehealth. These included difficulty securing payment from CMS for telehealth and difficulty providing telehealth services across state lines. Prior to the pandemic, many states required individual state licensure for physicians while some states participate in the Interstate Medical Licensure Compact (IMLC), which launched in 2017 and established a voluntary, expedited pathway to licensure of physicians wishing to practice in multiple states. The IMLC currently includes 29 states and the District of Columbia, and reduces the burden placed on medical providers to independently become licensed in multiple states. If all states participated in the IMLC that would break some of these barriers for the wider use of telehealth.
With hematology/oncology care facilities located in cities close to state lines or rural areas, telehealth video and telephone visits have been a great improvement for patient care. Telehealth allows patients who would otherwise need to travel long distances for a short visit to receive convenient and personalized care virtually. However, some patients who need a full physical examination; lack an established relationship with the hematology/oncology physician; or are receiving antineoplastic therapy and need a more thorough evaluation are more suited for in-person visits. Several bills are being considered to enhance telehealth on a more permanent basis, including the Telehealth Modernization Act (HR 1332/S 368) and the Audio-Only Telehealth Act (HR 3447/S 150). With proper safeguards, continuation of popular telehealth video and telephonic services for hematology/oncology treatment will enhance the care for our patients with cancer or blood disorders.