The recent past federal funding Infrastructure improvements are an advantage for healthcare providers and will expand access to care through telehealth. Once an auxiliary feature, telehealth is now a critical component in providing patient care, and funding for the bill will expand the reach of high-speed Internet, improving patient access at a time when they are more dependent. of Internet connectivity for your healthcare than ever before.
However, as a board-certified physician in addiction medicine and medical director of a nationwide addiction medicine practice, waiting for government funding was not an option, as we treated patients suffering from addiction. an opioid use disorder (OUD) during the COVID pandemic. Medications for OUD are vital, meaning that if the continuity of medication is interrupted, patients face a high risk of death, usually from relapse and unintentional overdose. Thus, launching a telehealth platform to preserve access to care was the difference between life and death for hundreds of thousands of patients in my specialty, who have traditionally relied heavily on face-to-face treatment.
But the shift to telehealth did more than just keep access, extended it. After treating virtually every one of our more than 8,000 patients, we discovered that we could get there month patients than ever because telehealth removed geographical barriers. As a result, about a third of the patients we see today live outside of a county where we have a physical office; before the pandemic, that number was virtually zero. We have also studied the impact of telehealth on the quality of our attention and we found that our telemedicine results have been equivalent to ours of brick and mortar (the results are in peer review).
Clearly, telehealth has been a great victory, and while government funding to improve access to broadband and telehealth is a step in the right direction, we need much more to help us end the crisis. opioid epidemic. We recently learned that 100,000 people they lost their lives to a drug overdose only last year. To put it in perspective, opioid deaths have increased by 200% since 2000. We need to do more.
Here are some lessons we learned from the pandemic and how we can use these lessons to save more lives:
Create permanent regulatory and reimbursement pathways for evidence-based quality treatment
Patients with OUD face huge geographical barriers to receiving life-saving care: approx. half of all U.S. counties There is no single qualified medical provider to prescribe buprenorphine, a common and highly effective drug to reduce opioid deaths and enable recovery. Telemedicine is ready to address these access gaps Yes it remains legal as public health emergency orders expire.
Congress has a disproportionate role to play in creating access to drugs for opioid use disorder through telehealth. The Ryan Haight Act of 2008 it usually requires prescribers to perform in-person evaluations before prescribing buprenorphine, but adjusting the rule to allow providers to electronically prescribe life-saving medication more broadly would speed up the start of therapy for thousands of patients. There is a path to permanence for the electronic prescription of opioid use medications under the Comprehensive Law of Addictions and Recovery 3.0, which was presented in March 2021.
To consolidate telehealth into the treatment paradigm, Medicare and Medicaid Service Centers (CMSs) must also describe a clear policy that requires public and private insurers to fully reimburse telehealth services, otherwise non-health care providers they will have no choice but to stop using them. Finally, the Department of Health and Human Services (HHS) needs to find the alignment between its policies and the recent actions of the Drug Enforcement Agency (DEA), which has been attacking pharmacies that are filling legal prescriptions under the false pretense of fueling the opioid epidemic. Barriers for patients seeking drug-assisted therapy are numerous without the DEA limiting buprenorphine prescriptions that significantly reduce the risk overdose. These actions by the DEA illuminate the real problem: Dangerous and often abused pain pills are less regulated than life-saving drugs such as buprenorphine or methadone.
Continue to integrate telehealth as a key to treatment
New infrastructure funding will improve broadband Internet access, but provider organizations have found ways to adapt to patient behaviors and reach out to remote patients from the start of the pandemic. After the transition to telehealth in March 2020, we found that 89 percent of the people we treated started therapy with a smartphone, meaning that access to broadband and the ownership of the smartphone may not be the barriers to attention that we initially thought they were.
By staying aware of patients’ behaviors and adapting to their needs, we can develop telehealth applications more effectively and continue to integrate them into our treatment modalities. Improvised solutions that providers implemented at a time of great need during the pandemic will be replaced by permanent, specialized solutions that optimize the patient experience. These adaptations will be key to the survival and growth of telehealth.
Create options for patients
Access to care is a long-standing problem in addiction therapy with a multitude of barriers for patients, which only results in 20 percent of people with OUD who receive the necessary treatment. In order to reach as many patients as possible, providers must consider all possible barriers to care, including lack of transportation or inflexibility of schedules. In addiction therapy, we must also recognize the stigma associated with seeking help, an important factor in keeping patients out of the funnel of treatment, regardless of the options available to them.
Telehealth is a powerful tool for expanding the reach of health care providers, but the pandemic exposed the fact that too many patients live there. sanitary deserts. More than a third of the country lives in a region that does not have adequate access to pharmacies, primary care providers, hospitals, and so on. Telehealth can work very effectively as a diagnostic tool and can replicate face-to-face therapy sessions, but it cannot solve a problem. wide range of health services that require face-to-face consultation or treatment from a physician. By creating options for patients that include both virtual care i In strategically located clinical offices, providers can mitigate the most common barriers to initiating treatment and creating a higher level of access for patients.
Regulators and providers will keep up to date with patient preferences
By listening to patients and creating a balance between virtual and face-to-face care, providers and legislators can close the gaps that limit access to care and reach more patients in neglected areas. In an internal survey of our patients, 87% said they felt more or less supported in a virtual care setting. It is time for government policy and reimbursement to align with consumer preferences and the growing evidence base.
The appearance of telesalut this evolution began in 2020 and the recently approved infrastructure funding will help, but we have opportunities to address numerous barriers to care through a holistic approach to the opioid epidemic. This bill is a starting point, not the “end of it all.”
About Jacob “Gus” Crothers
Jacob “Gus” Crothers, MD is an addiction medicine specialist and chief physician. The groups recover together, the national leader in values-based care for opioid use disorder.