Past AMA president: Telehealth is ‘essential,’ but remote allergy care has limitations

The COVID-19 pandemic has been a “catalyst” for innovations in allergy care, leading to advancements in telehealth and home patient monitoring, according to Susan R. Bailey, MD, FACAAI, immediate past president of the AMA.

Pulse oximeters are now widely used among patients and can be a “valuable” objective measurement for helping them determine whether they need to go to the hospital, Bailey said during a plenary session at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting. However, she questioned their efficacy and validity in clinical practice.

“Of course, rapid full-scale implementation and payment for telemedicine has been essential,” Bailey said. “But there are no questions that there are major limitations in our specialty when it comes to delivering allergy care remotely.”

These limitations include thorough physical examinations, allergy skin testing and allergen challenges, all of which need to be performed in the physician’s office, Bailey said.

“Home subcutaneous immunotherapy is still not the best choice, and although there is a trend by payers to force therapy such as biologics to be given at home, organized allergy has been very active on our behalf to keep patient safety at the forefront and allow us to continue to give these biologics in our offices,” she added.

Still, many patients “really like” telehealth, and it has allowed physicians to continue to provide care throughout the pandemic, Bailey said.

“My own practice went from zero to 100% telemedicine in a matter of days,” she said. “The industry itself saw 10 years of growth in about 10 weeks.”

Restrictions on telehealth use have been temporarily lifted until the end of the public health emergency, which was recently extended until the end of 2023, according to Bailey.

“It is vital that we continue to have payment parity between telemedicine and in-person visits, regardless of who the payer is,” she said. “There has been a proliferation of telemedicine platforms, but there are still concerns about privacy and data integrity, as there will be in any delivery system.”

During the most recent conversation she had with HHS Secretary Xavier Becerra, Bailey acknowledged there was, what she thought, “a surprising amount of reluctance to make telemedicine provisions and payment permanent because of a concern about the potential for fraud and abuse.”

“It’s imperative that we continue to study the usage patterns and cost effectiveness of telemedicine as the pandemic progresses so that we have hard data to demonstrate the value of continuing this important modality beyond the formal public health emergency,” she added.

While there has been an impressive number of innovations and technological advancements in medicine since the start of the pandemic, a simpler advancement has been the increased use of face masks, which Bailey said have “reduced inhalation of pollen grains and dust mite allergens, as well as mold spores and irritants.”

“It has also been my general impression that food allergies have been easier to control because of greater control over diets since people weren’t eating out,” she said.

Bailey added that she has been able to convince more of her patients with allergies to wear masks while doing yardwork, which she has been recommending for years “but most of them didn’t want to.”

“Personally, I hope that mask wearing will continue to be, if not commonplace, then just not so weird and abnormal after the pandemic is over, especially during cold and flu season,” she said.