Telemedicine and Controversy

I have had the privilege to be involved in telemedicine for forty years.    Then, and now I view this as mostly a very good thing.  The doctor with expertise does not have to be in the same geographic location to help a patient.  While Telemedicine has evolved in so many positive directions, it has been fascinating to observe how telemedicine has become embroiled into some of the most controversial issues of our days, and has managed to create some major issues of its own.

Telemedicine and Abortion

Medication abortion now makes up the majority of abortions in the United States, according to data released by the Guttmacher Institute, a reproductive rights organization.

https://abcnews.go.com/GMA/Wellness/majority-abortions-us-now-pills-data-shows/story?id=83075210

According to the New York Times, women in states with abortion bans are turning to Telemedicine.  The misoprostol pill is used to terminate early pregnancies.

https://www.nytimes.com/2022/11/02/briefing/abortion-pills.html?searchResultPosition=1

Telemedicine abortions just got more complicated for health providers. In the U.S., more than a dozen states severely restrict access to abortion, and almost as many have such laws in the works. Across the country, since Roe v. Wade was overturned, clinics that do provide abortions have seen an increase in demand. Many clinics rely on help from physicians out of state, who can alleviate some of the pressure and keep wait times down by providing services via telemedicine.

https://www.npr.org/sections/health-shots/2022/09/26/1124360971/telemedicine-abortion-medication-ban

 

Telemedicine and Gun Control

Telemedicine became part of the dialog regarding Gun Control this past June when U.S. Senators reached a bipartisan compromise on gun violence and school safety that includes new federal investments for mental health services and telehealth.

https://www.fiercehealthcare.com/providers/bipartisan-gun-violence-deal-supports-major-investments-behavioral-health-telehealth

While the agreement does not include the outright bans on semiautomatic assault rifle purchases or age restrictions backed by most Democrats, it does introduce new scrutiny for buyers under 21 years of age, stiffer penalties for illegal straw purchases of firearms and grants for states to implement red flag laws.

Also core to the proposed deal are “major investments” in mental health and supportive services delivered through community behavioral health centers and schools.  Further supporting these investments would be additional funds aimed at increasing mental and behavioral telehealth accessibility “for youth and families in crisis,” the senators said.

Telemedicine and Opioid Abuse

There has been increased use of Telehealth for OUD Services During COVID-19 pandemic associated with a reduced risk of overdose.

https://nida.nih.gov/news-events/news-releases/2022/08/increased-use-of-telehealth-for-opioid-use-disorder-services-during-covid-19-pandemic-associated-with-reduced-risk-of-overdose

 

But prescribing controlled medications online is controversial. There’s a concern that fewer safeguards will lead to more abuse. Should it be OK to prescribe controlled substances via telemedicine? Limits on virtual addiction treatment may soon return, making care harder to access.

https://www.npr.org/sections/health-shots/2021/12/30/1064818982/telehealth-addiction-treatment-prescribing#:~:text=This%20is%20why%20virtual%20prescribing%20of%20controlled%20medications,the%20R%20Street%20Institute%2C%20a%20free-market%20think%20tank.

 

How Are Telehealth Laws Intersecting with Laws Addressing the Opioid Overdose Epidemic?

Opioid-involved drug overdose deaths have been a growing concern in the US for several decades. The Centers for Disease Control and Prevention identified several strategies to address the opioid overdose epidemic, including increased availability of and access to medication-assisted treatment and guidance on safer opioid prescribing practices. Telehealth offers the potential for increasing access and availability to these strategies, and laws governing telehealth have implications for their utilization.

https://www.cdc.gov/phlp/publications/topic/telehealth.html

Telehealth fraud

Recent federal crackdowns on Medicare fraud linked to telehealth have raised concerns in Washington that virtual care introduces new opportunities for criminals to defraud vulnerable patients. But lobbyists and researchers say risks aren’t necessarily greater than in-person, and warn that fear could drive lawmakers to make virtual care harder to access

 

https://www.statnews.com/2022/08/08/telehealth-fraud-doj-risk-hhs/

 

Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options

If you live in one state, does it matter that the doctor treating you online is in another? Surprisingly, the answer is yes, and the ability to conduct certain virtual appointments may be nearing an end.

Telehealth visits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Most states and the Centers for Medicare & Medicaid Services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Those restrictions don’t keep patients from visiting doctors’ offices in other states, but problems could arise if those same patients used telemedicine.

Now states are rolling back many of those pandemic workarounds.

https://khn.org/news/article/state-medical-licensing-rules-threatens-telehealth-patient-options/

I have hope that the benefits of telemedicine will prevail and that unscrupulous operators do not take advantage of the telemedicine’s capabilities for their own well being.  HHS reported that there were 52.7 million Medicare telehealth visits during the pandemic.  Patient satisfaction was extremely high.   Delivering better patient care shouldn’t n be controversial.

I welcome your thoughts and comments.

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