States and insurers resurrect barriers to telehealth, putting strain on patients

States and insurers resurrect barriers to telehealth, straining patients As emergency provisions end, patients are scrambling — in some cases, driving across state lines — to keep their telehealth appointments. Katie Palmer STAT

Telemedicine is here to stay. But its free-for-all era may be coming to an end.

State-issued emergency declarations and insurer policies that were issued at the start of the Covid-19 pandemic and that were meant to encourage the use of telemedicine are being phased out across U.S. states, one by one. And as they fade away, rules that make telemedicine more complicated — and costly — are setting back in.

Experts say the moves, which come as vaccinations have ramped up and case counts have dwindled, are causing headaches among patients and providers alike. Doctors are scrambling to stay on top of rapidly-changing rules. Patients are contorting themselves to keep their virtual appointments — even driving into different states and taking calls from the side of the road so they can legally receive care.

“The party is winding down in subtle ways that are really going to impact patients,” said Ateev Mehrotra, a hospitalist and health care policy researcher at Harvard Medical School who focuses on telemedicine. “And I shouldn’t use the future tense, I should say are currently impacting patients in really, really important ways.” ...

One of the most visible impacts is playing out on state borders, where the lifting of pandemic restrictions is creating a new phenomenon: the rest stop televisit.

Such visits are becoming more common, especially for patients who see doctors in city centers near state lines, or those who live in New England’s tightly-clustered states. It’s something Stephanie Titus, a primary care physician in Massachusetts, is watching unfold firsthand.

In the last year, Titus has treated patients located in Rhode Island, Vermont, New Hampshire, and even Maine virtually. That would normally require her to obtain a license in each of those states — a process that can take months and cost hundreds of dollars. But thanks to emergency orders from state governors and licensing boards, some of which expedited the application process or extended telehealth licenses to providers in neighboring states, that was no longer necessary.

Many of Titus’ far-flung patients now want to continue televisits whenever they’re practical. “For something as simple as blood pressure checks when they have a reliable blood pressure monitor at home,” said Titus, “it doesn’t make sense to have them travel.” But on July 1, Titus’ network, Mass General Brigham, decided to end telemedicine appointments for patients in states where their providers are not licensed, in anticipation of the lifting of temporary license allowances. ...