AAN statement calls telehealth 'essential and effective method' for delivering health care

The American Academy of Neurology released an update to their 2014 position statement on telehealth in which they reiterate their call for expanding its use.

“Telehealth won’t replace all in-person neurologic care, but for people with neurologic conditions, it has been shown to complement it,” Jaime Hatcher-Martin, MD, PhD, of SOC Telemed in Reston, Virginia, said in a press release. “It is also important that people have options. In addition to video visits, telehealth visits by phone are essential to ensure access to care for people who either cannot afford or who do not have access to highspeed broadband internet.”

The update to the 2014 statement, which was published in Neurology, “reflects recent advances in telehealth practice and research and changes in related regulations, policies, and legislation,” Hatcher-Martin and colleagues wrote. They called for policies that limit “unnecessary restrictions” to virtual health care and outlined factors that impact the delivery of telehealth, including access, standards, reimbursement, practicing across state borders, professional liability and care coordination with local providers.

The researchers outlined multiple benefits of telehealth, including improved access to neurological care; greater comfort, convenience and safety; decreased travel time and related costs; and earlier intervention, among others. Hatcher-Martin and colleagues also noted that “video visits have proven to be cost-effective,” though they acknowledged that these visits do not decrease practice-related expenses compared with in-person visits because of needs related to technical infrastructure and support.

Barriers to access, research gaps

In acknowledging barriers to telehealth, the researchers also proposed solutions and extended the potential patient populations who could benefit from those solutions. For example, when they described barriers to accessing telehealth, they included patients in rural settings as well as those in nursing homes and rehabilitation facilities and those who are unable to drive, among others.

“The AAN encourages actions to minimize the digital divide by supporting affordable nationwide high-speed internet access to limit disenfranchisement of those with inadequate or unaffordable network connectivity and efforts to promote digital literacy and alleviate other technology or device limitations,” Hatcher-Martin and colleagues wrote. “Because some patients have barriers related to language and visual or hearing impairments, resources to assist with translator services and appropriate, easily-accessed adaptive technology must be available and reimbursed at equitable rates.”

The statement addressed issues related to the use of telehealth across state borders, noting that each state has its own definitions of a physician-patient relationship and other factors related to that relationship, which can impact the use of telehealth.

“These variations pose significant barriers to the practice of telehealth across state borders. Licensing, prescribing, and related policies should be simplified,” the researchers wrote. “A desirable solution could include blanket reciprocity and an expedited licensing process that would require one unrestricted state license, a new background check for each state in which telemedicine is practiced and reduced annual fees for limited practices.”

Such practices would ensure patients’ rights are protected to receive telehealth services “as they require,” according to Hatcher-Martin and colleagues.

The researchers acknowledged the limitations of telehealth services, including the ability of telehealth services to evaluate new patients and costs related to starting a telehealth practice. Hatcher-Martin and colleagues also reviewed fraud and cybersecurity in their discussion of telehealth’s limitations.

The statement also addressed ongoing research gaps that, if addressed, could help increase the evidence base for telehealth, including “the known marked racial, ethnic and socioeconomic disparities in access to neurological care and outcomes.” Hatcher-Martin and colleagues noted that the neurology community “must better understand and address technological literacy and the digital divide as well as patient perspectives on quality, trust [and] privacy concerns if living in crowded living conditions or in regions with inadequate internet bandwidth.”

Taking action

The statement ended with specific points of policy guidance for telehealth, which the AAN “recommends that all stakeholders support.” These recommendations focus on patient advocacy, the promotion of telehealth services to improve care, access to telehealth for all patients in U.S. states or territories and issues related to payment.

“Prior to the pandemic, telehealth programs were restricted, mostly available only to people in rural areas or a limited number of specified locations who did not otherwise have access to specialized care, or in small pockets of contracted services, often outside of Medicare or other insurance coverage,” Bruce H. Cohen, MD, FAAN, chair of the AAN’s advocacy committee, said in the press release. “Neurologists have been asking for an expansion of telehealth for many years. Now it is clear, telehealth is an essential and effective method of delivering care. It is important to neurologists and their patients that after the pandemic telehealth continues to play an essential role in medical care.”

On Wednesday, May 19, 2021, neurologists from 47 states will meet with federal lawmakers for the 19th Annual AAN “Neurology on the Hill,” according to the press release. These virtual meetings will discuss the AAN’s new telehealth statement and will ask lawmakers to cosponsor the Telehealth Modernization Act or the CONNECT for Health Act to maintain access to telehealth for people with neurologic conditions.

“People with neurologic conditions like Alzheimer’s disease, migraine, MS, Parkinson’s disease, ALS or epilepsy often must visit their neurologist many times a year to monitor the progression of disease and to have medications adjusted. However, this can be challenging due to mobility issues, lack of reliable transportation and cost,” Orly Avitzur, MD, MBA, FAAN, president of the AAN, said in the press release. “The COVID-19 pandemic has led to neurology practices dramatically reshaping the delivery of care for their patients. The AAN is asking members of Congress for a permanent expansion of telehealth services to improve safety and access to care and to reduce health care costs for people with neurologic disease.”

Reference:

American Academy of Neurology. Neurologists call for permanent telehealth expansion following COVID-19 pandemic. Available at: https://www.aan.com/PressRoom/Home/PressRelease/4894. Accessed May 14, 2021.