From Dr. Steven Hansen’s Arizona Humane Society office, you may have heard a sigh of relief when Arizona Gov. Katie Hobbs signed Senate Bill 1053 into law on May 9. Beginning in August, veterinarians licensed in the state will legally be able to provide veterinary care through telemedicine, a care alternative many have become accustomed to on the human side of healthcare.
The Arizona Telemedicine Program Blog, Category: Policy
In last week’s blog, I discussed Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances. To summarize the restrictions, the DEA requires that any prescription of a controlled substance must be issued by a practitioner who has conducted at least one in-person medical evaluation of the patient, with a few, very complicated exceptions.
During the COVID-19 Public Health Emergency, the DEA has relaxed these restrictions and is allowing telehealth evaluations to substitute for in-person evaluations. Sara Gibson, MD, a Flagstaff-based telepsychiatrist, last week discussed the impacts of the restrictions and waivers on patients in underserved areas with opioid use disorder. Today, she points out another at-risk population affected by the DEA prescribing restrictions outside of the PHE.
Since the COVID-19 Public Health Emergency (PHE) was declared in January, the use of telehealth has skyrocketed. This is in part because many restrictions on it have been lifted for the duration of the PHE in order to make healthcare services more accessible to patients while maintaining physical safe distance. Some of the temporarily waived restrictions include Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances.
Normally, the DEA requires that any prescription of a controlled substance be issued by a DEA-registered practitioner who has conducted at least one in-person medical evaluation of the patient, with a few exceptions. These include the patient being located in and treated by a DEA-registered hospital or clinic or the patient being in the physical presence of another DEA-registered practitioner during the evaluation.
By now, I think we have all heard about the surge of temporary waivers, relaxations of Medicare coverage restrictions, regulatory changes and flexibilities, and governors’ orders allowing for the expansion of telehealth during the COVID-19 Public Health Emergency (PHE).
This is all great news for telehealth – for now. Medicare telehealth services increased by 11,718 percent between March and April, and other payers are reporting similar increases. But what happens when the PHE is over? And when will the PHE be over?
So far, the Health & Human Services (HHS) Secretary has renewed the PHE once, in April, for 90 days. HHS has announced its intent to renew it again this month, meaning the PHE would then expire October 21, unless renewed again or declared over before that date.
The long-awaited promise of telemedicine may finally be realized as a response to Covid-19.
For decades, advocates hailed telemedicine as the way forward to improve access and reduce cost, while maintaining high-quality care. There have been steady gains in investment and growth across the country, and an increasing number of studies suggest that for certain services, namely chronic care management and mental health services, telemedicine may be superior to in-person care. Specifically, studies showed better health outcomes through improved medication adherence, integration of medical tests, and reduced hospital readmissions. However, even with these positive steps, it would be a stretch to claim that telemedicine had transformed the US healthcare system and, in large part, that is because of legal barriers that were in place prior to Covid-19.