Over the last two years, most states have allowed residents to conduct some medical appointments virtually or by phone, by establishing rules requiring insurers to pay the same for virtual visits and in-person appointments, and by eliminating requirements for in-person check-ins. During the pandemic, insurers also expanded coverage for telehealth appointments. The provisions assisted patients in avoiding Covid-19 exposure and relieved some of the strain on overburdened healthcare workers.
According to data from the Centers for Disease Control and Prevention, telehealth visits were 154 percent higher in the last week of March 2020 compared to the previous year. According to a McKinsey & Co. report released in July, demand for telehealth will continue to rise through 2021.
“It was like someone switched on a light,” said Geoffrey Boyce, chief executive officer of Array Behavioral Care, a telehealth provider that specializes in mental-health counseling.
In the fall of 2020, health insurers began reducing coverage allowances made during the pandemic, and some state provisions have expired or are set to expire next year.
Making pandemic allowances for telehealth services permanent, according to some hospitals, doctors, and telehealth providers, would increase access to care and treatment.
Some licensing boards are opposed to permanently extending telehealth services. The Justice Department charged 138 providers in September in connection with a $1.4 billion fraud involving telemedicine. According to Lisa Robin, chief advocacy officer at the Federation of State Medical Boards, a wider acceptance of telehealth could lead to more fraud.
Jennifer Roman, a 27-year-old former firefighter and emergency medical technician from Franklinville, New Jersey, suffers from idiopathic intracranial hypertension, a rare neurological condition that has necessitated 10 brain surgeries in the last six years. She also has Behcet's disease, which is an inflammatory disorder.
She sees specialists at Johns Hopkins University and New York University and takes tremor medication, which her doctors had been monitoring via videoconference during the pandemic.
Her insurer informed her in June that it would no longer cover out-of-state telehealth visits, requiring her to drive approximately two hours to each of her doctors. She stated that the trip is too difficult for her to make on a regular basis, and that due to the rarity of her conditions, there are no suitable specialists in her state. She has been skipping appointments that were scheduled almost a year ago.
“For people in the rare-disease community, what’s happened as a result of telehealth coverage being cut back is, we have been left behind to get worse,” Ms. Roman said.
According to the Alliance for Connected Care, a nonprofit focused on healthcare technology and regulation, during the pandemic, all 50 states and the District of Columbia used emergency declarations to waive some licensing requirements for out-of-state doctors conducting telehealth appointments. According to the organization, twenty-five states have lifted their state of emergency declarations.
Kara Ditto, a Virginia psychiatrist, sees more than 200 patients in Georgia through MindStrong, a telepsychiatry startup, using a temporary license granted after demand for mental-health services skyrocketed during the pandemic.
After the state's emergency declaration expired in July, MindStrong's Georgia practice closed for two weeks. She stated that disruption was the most difficult for patients on medication who needed to monitor their progress with the assistance of a physician. "These are people who can't drive or be driven two hours to see a mental-health specialist for medical and financial reasons," Dr. Ditto explained.
After regulators assured therapists that they would not be penalized for providing telehealth sessions while their Georgia licenses were being processed, the practice reopened.
Mental-health patients are especially vulnerable if their treatment plans are disrupted, according to Nicole Christian-Brathwaite, a psychiatrist in Massachusetts. "You should never change clinicians in the middle of a project," she advised.
In August, the Biden administration pledged more than $19 million to improve telemedicine services in rural and underserved areas. More is being sought by advocates. They want all states to maintain and expand licensure flexibilities for the duration of the Covid-19 pandemic, as well as to reinstate any expired licensing allowances.
Elizabeth Stout, who moved to Washington, D.C., from Jacksonville, Fla., for an internship during the pandemic, was able to see her previous therapist, who is licensed in Florida, because D.C. waived licensure requirements as a result of Covid-19.
The grace period expired in July. Providers who did not have a license in the district were given an additional 60 days to continue providing remote services. Ms. Stout, 21, who survived the Parkland, Fla., high school shooting in 2018, said her therapist told her last fall that she couldn't continue to provide the telehealth appointments. She had been seeing her since shortly after the shooting and cherished their relationship.
"Not being able to communicate with her is draining," Ms. Stout said.