Washington state lawmakers recently extended a law that loosens restrictions on audio-only healthcare delivery, while they wait for the results of a study evaluating its effects.
Early in the pandemic, Washington state passed legislation requiring insurers to reimburse for telemedicine services. The legislation also waived the requirement for a prior in-person visit — but the waiver applying to audio-only care was temporary.
The new law extends that temporary waiver, enabling physicians to treat patients over the phone without a prior in-person visit until July 1, 2024.
How the rules shake out in the long-term will have implications for how healthcare groups and companies offer remote care, said University of Washington Medicine digital health officer John Scott, who is involved in the study.
Scott and his colleagues are surveying insurance companies and crunching numbers from a state healthcare database to assess cost, quality, and the effects of audio-only care on equity and access.
The study is also geared to assess fraud, one of the major concerns of audio health. Fraud typically occurs when people respond to ads for devices like wheelchairs and get a prescription without a physical exam or independent verification that they need the device, said Scott.
Telemedicine can also enable individual physicians to have an outsized influence on care. For instance, telemedicine enabled a pandemic surge of prescriptions for ivermectin, an ineffective COVID-19 treatment dispensed by a small minority of doctors.
“Doctors need to report other doctors about concerns, but it’s hard with telehealth because it’s not seen,” said Scott. “It takes the whole medical community to police that and patients reporting when they have a bad interaction.”
At the same time, telehealth and audio-only options have broadened options for people who might otherwise have trouble making it to a doctor’s office, said Scott. “The most consistent thing I hear is that patients really like it. They like the convenience, they like the access,” said Scott.
Meanwhile, patients and digital health companies are preparing for changes in federal telehealth regulations, set to coincide with the lifting of the national COVID-19 public health emergency on May 11. The federal requirement for an in-person visit, waived during the pandemic, will again be established for prescriptions for controlled substances like opioids, testosterone and ADHD medication.
Scott said that physicians at UW Medicine ideally see patients over video, not just audio, for remote care. “There’s quite a bit of information that you get in seeing a patient, and you can do a limited physical exam,” said Scott.
But some people don’t have access to broadband internet and, even more commonly, others can’t figure out how to use a video interface and resort to a phone call, said Scott.
Results from the study are due in November.
