Health Care

Virtual Access to Doctors During the Pandemic Changed the Lives of Patients With Disabilities. Now That Care Is in Jeopardy.

Telemedicine opened up new possibilities for patients with disabilities and chronic conditions.

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Three years ago, at age 14, my sister was diagnosed with a rare chronic connective tissue disorder. Her illness makes it extremely difficult—and sometimes dangerous—for her to sit up, walk, ride in a car, and do many other everyday activities. It also means that in order to receive treatment, she has to see specialists who live in other states two or more hours away from our small Vermont town. Even going to see her primary care doctors, ironically, means potentially jeopardizing her health in the process. "It feels like a risk/reward calculation every time we go," she says.

The pandemic, despite all of its difficulties, did bring some blessings for her: All of her medical appointments shifted online and she was suddenly able to get the care she needed without the risk that going to the doctor would make her condition even worse.

While this shift to telehealth made health care easier and more accessible to everyone, it has had even bigger benefits for many people who suffer from chronic illnesses or have disabilities.

Kiki Christensen, who has suffered from a multi-system illness called Ehlers-Danlos syndrome for 45 years since the age of 10, was able to virtually access 13 new care providers—including two specialists who practice far away from her home in California—who helped her with the many multi-system side effects of her illness. She was also able to save energy during the pandemic by continuing to meet with her regular doctors virtually. 

"Telehealth enabled me to assemble the care team that I've always needed," she says over email. "Instead of the energy deficit required to cross town in a car, I was able to see doctors at home. This enabled me to save enough energy and strength to continue daily at home physical therapy, and to access an online Qigong class that helps me very much. I was also able to knock out my migraines due to the experts at USC Keck. I never would have seen them if it was only in-person because I could not drive to Keck in the past." 

This change has made a world of difference for Christensen. "I went to Disneyland with my cousin last month," she says. "I totally shocked myself with how much strength I had gained."

The broad access to telehealth across state lines was made possible by states waiving medical licensure requirements as a part of emergency orders during the pandemic. These made it possible for health care providers to have appointments with patients in other states.

Now that emergency orders are being lifted, the future of telehealth is unclear.

"One of the big benefits of what happened during the pandemic was an expansion, but it was also a sense of clarity," said Ateev Mehrotra, a healthcare policy researcher at Harvard, in a late June symposium on telehealth. "We're about to enter a time where it's very, very confusing because everyone's going to potentially have a different set of rules. And for a telehealth provider, that makes things 10 times worse because you have 10 sets of rules for every state you're in." 

Now, providers may have to give up their newer virtual patients or jump through a lot of hoops to keep them. And patients who were able to see doctors from the comfort and safety of their homes may have to again make those risk/reward calculations about whether it's worth traveling to receive care.

The good news is that a number of organizations and states are taking measures to preserve the freedom of care that telehealth has enabled. 

The Interstate Medical Licensure Compact is an agreement among 30 U.S. states that streamlines the complex licensure requirements for medical providers who want to offer telehealth care across state lines. Eligible physicians can use one application to qualify for licenses from all participating states. A similar compact, Psypact, exists for mental health providers. 

Legislators in Connecticut, Arizona, and Delaware have recently passed bills that will allow out-of-state providers to continue to provide telehealth services to those in their states.

There are also two federal bills in progress in the House and Senate that aim to reduce barriers to telehealth. The Senate bill would remove all federal geographic requirements for digital health appointments. 

"Remote access to healthcare was suddenly available for all of us during the pandemic," says Christensen. "It should have always been available, as soon as the technology permitted. Certainly, we can't take it away now for the most vulnerable among us." 

NEXT: Only Biden or Congress Can Prevent 4,000 Inmates From Being Forced Back Into Federal Prison Post-COVID

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  1. See? SEE!? This is why bureaucrats don’t want to relax their totally justified restrictions in an emergency – once the emergency is up you people insist they don’t need to put the restrictions back in place!

    1. lol… “don’t need to put the restrictions” — Yep; that about pegs it right on.

  2. Sounds like you have a good case to declare telemedicine a reasonable accommodation to a disability, and required by the ADA.

    1. Get rid of occupational licenses, including medical licensing, while you’re at it.

      The thriving industry of “board certified physician” associations is proof that better doctors are perfectly willing to prove their worth by joining professional guilds that can provide the public with assurances of quality. Government is not needed for that purpose.

  3. Sounds like you have a good case

  4. Fox News host Sean Hannity urges viewers to ‘take COVID seriously’ and says he ‘believes in the science of vaccination’

    https://www.dailymail.co.uk/news/article-9805145/Fox-News-Sean-Hannity-tells-viewers-Covid-seriously-people-died-not-Dr.html

    Does this mean he’s turned his back on Trump?

    1. Well, in fairness Trump did advocate for people to get vaccinated. Like twice, and not at a rally or some big public appearance of course. Because THAT wouldn’t be an appropriate venue to ask people to get vaccinated or anything, oh no.

      1. What are you talking about? Trump invented the vaccine, which made it awesome. Well, until Biden got elected. Then Biden invented it. Which makes it bad now. I think. Judging everything based upon who not what gets so confusing.

      2. Well the article is about tele type practices so if it was over the airwaves it’s good right and meets the idea of this article?

    2. Trumps base strikes me as very anti vaccine but I imagine he was playing it up to appeal to swing voters.

  5. How about a libertarian article saying the government has no business interfering in anybody’s interaction with their doctor

    1. Nah – start with that crap and next thing people will say the govt should be spending a gazillion dollars employing their buddies to slow down doctors.

    2. Because we already think that, and what’s the use of just reaffirming out opinion? Articles like this could sway people who don’t agree with us in general, but are on the fence. Very sick and needy people carry a lot of suasion.

  6. Try getting a medical diagnostic test via telemedicine and let us know how it works out.

    Sure, you can get an X-Ray from the back of a van but not everything is that easy and compact.

    Not saying telemedicine doesn’t have it’s place, but unless it’s just a check in visit or something like that you’re still going to need to head to a facility quite often. Especially for chronic conditions that need monitoring via diagnostic tests.

    1. That depends on the condition and the test. Most tests require a blood draw – but pretty much nobody does the actual tests on-site anymore. So why can’t the doctor (in whatever state) order a test that sends a local phlebotomist to your house to draw the blood and send that sample to the testing facility directly? What medical reason is there for you to be compelled to go to the doctor’s office to have your blood drawn?

      X-rays and MRIs require bigger equipment. Very hard to bring them to the patient. But few doctors have that dedicated equipment, either. They are available in many communities as stand-alone services. The doctor is sending you to that local facility regardless. What difference does it make if the doctor is three states away?

      I’m sure there might be some tests which can only be performed by the doctor in immediate proximity – but the only one that comes to mind is a prostate exam. That leaves an awful lot of medicine within reasonable scope for telemedicine.

      1. As the article makes clear, the biggest benefit are licensure requirements being waived which is a big deal since the best expert in the field you require might be two states over and isn’t licensed in your state.

        Keep in mind each providers time is actually finite thus ‘access’ cannot be infinitely expanded no matter how much technology one throws at it.

        Some people will benefit, and others will be thrown under the bus with longer wait times. If my practice area is expanded by several states, or to the whole country, one could expect more patients and thus less actual availability.

        In essence, telemedicine is a way to stretch our available health resources. Ultimately, expanding the number of providers is a far more preferable and permanent solution. It’s a good first step, make no mistake, but it won’t ultimately fix the underlying issues.

  7. Of course the best outcome would be that none develops, but…what do you think the partisan divide on this issue would shake out as? Easy answer if Trump says something soon about it: They’ll be for or against whatever Trump says, because he said it. But if Trump doesn’t?

    On one hand, if the waivers are reverted to the status quo pre-pandemic, that means the emergency is over, and whoever’s in now, i.e. Democrats, will claim credit for ending it. So Democrats would be against extending this temporary deregulation, while Republicans would be for it. On the other hand, it could be viewed as simply a business-vs.-the-rest-of-us issue, and being allowed to practice medicine more freely would be pro-business, hence Republican, and being Democrats would mean being anti-biz, hence opposed to deregulation. So both of these hands would have the Republicans as the good guys, Democrats bad.

    Moving on to the feet, on one foot allowing people to see doctors more easily is pro-sick-people, hence pro-Democrat, while they’ve been saying Republicans want to kill either everybody or sick people. So foot #1 has the sides opposed to both hands. For the other foot, we’ll have to see what the insurers think about this. I forgot who’s supposed to be in the insurance companies’ pockets.

    1. The caricature really has become reality. Democrats are against you if you’re making money, unless you’re making money from only a single entity (meaning you’re an employee), in which case they’re for you. Republicans are for whatever the Democrats are against, and vice versa.

  8. So she has enough energy to visit Disneyland but not her doctors?

    There’s no reason not to have Telehealth, but if she was helped so much by an online Qigong class, then I strongly suspect she’s partly suffering psychosomatically.

    1. That would actually be perfect for her. E-D syndrome is a connective tissue disease that affects the joints causing them to be hyper mobile. So a low impact activity like Qigong would be recommended.

  9. Remember the Constitutional Amendment that gave the ‘Feds’ complete authority over everyone’s healthcare??

    Yeah; me neither..

    1. It is not the Feds. It is the States. It is expensive and a royal pain to get state licenses. It can take up to a year. There are companies you can hire who will do most of the work for you and they don’t come cheap.

      1. It’s not the ‘Feds’??? Where did the AMA come from? Where did Obamacare come from? Where did Medicare/Medicaid come from?

        I’d be highly surprised to find even state medical licenses weren’t ‘crony’ purchased and inflicted by the ‘Feds’ as they’ve done millions of times on everything.

        1. The AMA is not a federal agency.
          Obamacare and Medicare et al have nothing to do with licensing.
          The Medical Board of state of Alabama might take issue with the accusation that they were purchased by the federal government.

          You have no idea what you are talking about.

          1. Well since you want to change the subject to liscensing; you should be gripping on your State’s News outlet instead of the National Coverage of Reason.

            To pretend the ‘Feds’ haven’t played a huge “crony socialist” hand in creating the healthcare crisis would be extremely naive.

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