COVID-19 has killed over 875,000 U.S. citizens but how many more people have died or suffered due to lack of adequate access to doctors for other medical conditions during the pandemic?
The rapid implementation of telemedicine at the beginning of lockdown has helped offset additional fatalities resulting from unattended diseases. Overall use of telehealth since the pandemic started has doubled, according to a Harris Poll, with 82% preferring in-person doctor visits. The flexibility and convenience of telehealth is viewed by the majority as a supplement to, not a replacement for, office visits.
As we move out of the COVID-19 crisis, we must ensure that state and federal legislation on telehealth is comprehensive, covers adequate insurance reimbursement, includes provider training, allows for a balance between in-person and virtual care, and maintains protections for patients living with serious mental illnesses or serious brain disorders. Federal and state policymakers must coordinate their efforts to guarantee laws will enhance access to this health care platform, while also balancing the need for in-person care.
Mental health providers were one of the first specialties to adopt online treatment during the pandemic. Thirty-three percent of all appointments between November 2020 and February 2021 were conducted virtually. With the dramatic rise in people experiencing poor mental health during this stressful time and the shortage of mental health professionals, this increase is not surprising. In our family’s experience, having access to licensed therapists and primary care doctors via the internet has been a game changer during lockdown. Instead of driving an hour or more to an appointment with the added anxiety of exposure to a deadly virus, we could instantly connect with a doctor from the safety of our home on a computer or smartphone. Of course, not everyone has access to the internet, and that must factor into future considerations regarding how services are dispensed to ensure equity.
Will this quick shift to the flexibility of telehealth continue when the pandemic abates? What regulations will be adopted to safeguard the effective usage of technology to protect patient health?
While telemedicine has been a godsend to many during this public health emergency, it will never take the place of in-person office visits with physicians; it is a tool that should be used to complement, but not replace, in-person care. Many symptoms can be missed without this vital contact, such as the early signs of tardive dyskinesia tremors. Health care professionals must be trained to effectively use the telehealth platform, and Congress should work to maintain patient protections for those living with mental illness.
The Consolidated Appropriations Act of 2021, Section 123, would expand access to tele-mental health services and includes an essential safeguard for providing the best medical care for a population that needs extra support to access health care, and for everyone else. This expansion includes an important guardrail to protect access to medically necessary care after the federally declared public health emergency ends: Providers must see a patient at least once in person in the prior six months and at a future interval determined by the secretary of health and human services to bill Medicare for a tele-mental health visit. This provision is critical to ensuring patients with serious mental illness, and other patients needing periodic in-person visits, receive the screening, diagnosis and care they require. We need to push to codify this provision for all fields of medicine, all patients and all types of insurance.
Some in Congress are attempting to repeal these important patient protections — even before they go into effect. Patchwork laws won’t work. Congress should consider all aspects of telehealth and the times in which it is a viable option. Technology in and of itself is not the goal here; fostering the relationships between care providers and patients is the objective to achieve optimal treatment and save lives.
Linda L. Mimms is a patient advocate and board member of the Schizophrenia & Psychosis Action Alliance.
