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New Policy Perspective Offers Guidance for Optimal Telehealth Visits

October 18, 2022

By Rob Goldsmith, Director of Advocacy and Policy

Part of our mission at the Society is to help clinician members stay on the leading edge of a rapidly evolving healthcare environment. That’s why we’re proud to release a timely policy perspective on the appropriate use of telehealth visits in endocrinology.

The paper was published this month ahead of print in The Journal of Clinical Endocrinology & Metabolism.

The COVID-19 pandemic has drastically changed the delivery of healthcare. Telehealth visits are increasingly more popular and have become the preferred mode of care for many patients, especially within the endocrinology specialty.

According to Medicare Part B claims data, endocrinology utilized telehealth services the most of any specialty not related to mental health in 2021.

Product of the CACC

The increase of telehealth utilization has been a frequent topic of discussion at meetings of the Society’s Clinical Affairs Core Committee (CACC). What became clear was the need for us to provide guidance on when telehealth delivery is appropriate.

Kudos to CACC member Dr. Varsha Vimalananda for her proposal to form a CACC workgroup that developed the paper on this topic.

The paper was written by a nine-member panel of US endocrinologists with expertise in telehealth clinical care, telehealth operations, patient-centered care, healthcare delivery research, and/or evidence-based medicine. The panel identified and vetted research studies published since 2000 on telehealth in endocrinology. Dr. Vimalananda served as the lead author of the paper.

The resulting policy perspective focuses on five aspects of care that are used for determining appropriateness of telehealth care:

  • Clinical factors, including whether an in-person physical exam or assessment is needed;
  • Patient factors, such as geographic distance to the clinic, access to transportation, work and family obligations, and comfort level with technology;
  • Patient-clinician relationship;
  • Clinician’s physical surroundings and personal circumstances; and
  • Availability of infrastructure needed to provide quality telehealth services.

The paper also lays out a series of considerations for deciding whether telehealth is appropriate, and how such a decision might affect the quality of care (see graphic).

Endocrinology, in general, is well suited to telehealth, since often the physical exam is neither diagnostic nor prognostic and can be completed virtually. Even conditions that require frequent visits—such as newly initiated insulin therapy or diabetes mellitus treatment in pregnancy —can be appropriately managed via telehealth with remote access to patient-generated health data, the paper notes.

Furthermore, telehealth offers certain advantages to patients, especially those who face geographical or personal barriers to accessing in-person care. In such circumstances, fully in-person care is not likely to be feasible, effective, or patient-centered, and telehealth is an appealing option.

Our panel concluded that endocrine care moving forward is likely to involve a hybrid of in-person and telehealth visits, and thus the decision to use telehealth for any given patient will not be made at a single time point but rather considered in a longitudinal context.

The paper also acknowledges that more research is necessary to develop a robust evidence base for future guideline development.

Carrying Out Society’s Mission to Improve Patient Health and Wellbeing

On another important front, telehealth has proven to be an effective tool for addressing health disparities, which is a key part of our Society’s mission. Studies show that expanded access to telehealth services ensures that patients from underserved populations also receive the care they need.

A recent Government Accountability Office (GAO) report, for example, found that the proportion of Medicare beneficiaries utilizing telehealth services was similar across racial and ethnic groups.

Audio-only telehealth — which allows endocrinologists to provide care to patients who do not have the necessary technology needed to access virtual care — provides greater access for patients in rural and underserved populations.

Not only will this paper be an important resource for our members, it also will serve as a guide for care delivery that benefits underserved populations.

Congressional Action Needed to Continue Telehealth Access

For all the reasons above, ensuring and expanding access to telehealth has become an important advocacy priority for the Society.

The COVID-19 Public Health Emergency (PHE) put in place waivers that expanded access to telehealth services. The PHE is expected to continue through the end of the year. But Congress will need to pass legislation extending these telehealth exemptions after PHE ends.

The Society has been a leading voice on the issue and have worked hard to educate lawmakers and congressional staff on the need to expand telehealth access.

We urge Congress to pass legislation extending telehealth exemptions for two years. We also call for lawmakers to make the coverage and payment of audio-only services permanent and to relax the originating site requirements, which would ensure that patients can receive telehealth from home.

This will continue to be a major priority for us in the months ahead.

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