Telehealth offerings continue at DHMC, elsewhere after COVID-era expansion

By NORA DOYLE-BURR

Valley News Staff Writer

Published: 05-16-2023 5:37 PM

LEBANON — Even as the COVID-19 emergency has ended, Dartmouth Health continues to see as many as 700 outpatients a day via telehealth, which became vital for maintaining access to care during the pandemic, according to the medical director of Dartmouth Health Connected Care.

That’s equivalent to about 12% of daily outpatient visits across the DH system and about 17% at Dartmouth Hitchcock Medical Center in Lebanon, Dr. Kevin Curtis, the Connected Care medical director, said in a recent interview.

While that’s below the peak of 2,600 visits a day the health system was providing early in the pandemic, it’s well above the 10 telehealth visits a day it was providing pre-pandemic, and the numbers are “holding strong,” Curtis said.

Most pandemic protocols have expired, but federal and state officials have acted to extend regulatory provisions that allowed telehealth, which enable patients to interact with their clinicians via phone or video chat.

Last Friday, New Hampshire Gov. Chris Sununu signed into law HB 500, which allows clinicians to continue prescribing controlled drugs via telehealth. A last week, the Drug Enforcement Administration announced that it would extend pandemic-era rules allowing clinicians to prescribe medications via telehealth for at least the next six months.

“I would like to applaud the New Hampshire Legislature,” Curtis said of HB 500.

Had the Legislature failed to pass the legislation, people such as oncology patients, palliative medicine patients, those with chronic pain and people with attention deficit hyperactivity disorder who receive prescriptions via telehealth would have a more difficult time accessing those medications, Curtis said. In some cases, they might not get the medications they need or they might be delayed.

Passage of HB 500, which was sponsored by Hanover Democrats Rep. Mary Hakken-Phillips and Rep. James Murphy, was also greeted with enthusiasm by those in the behavioral health community.

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“Without the passage of this bill, psychiatrists and nurse practitioners would be severely limited in the scope of clients that can utilize telehealth, whether related to pandemic concerns, limited transportation or inclement weather,” Roger Osmun, CEO of Lebanon-based West Central Behavioral Health, said in news release.

The DEA last week announced that it would allow clinicians prescribing via telehealth to continue doing so for the next six months, when the agency is expected to issue longer-term rules. Both the federal and state changes were necessary because the more restrictive of the two would supersede the other, Curtis said.

Vermont also passed laws ensuring that the state laws on telehealth wouldn’t be more restrictive than federal ones, said Jessa Barnard, executive director of the Vermont Medical Society.

Act 4, the COVID flexibility bill, contained a temporary extension and H.222 will make permanent a change eliminating the requirement that patients have an in-person visit in order to allow buprenorphine prescriptions for people with opioid use disorders. That was the only remaining restriction on prescribing controlled substances via telehealth in Vermont, according to Barnard.

Overall, Barnard said, telehealth is an “important piece of providing access for health care services.”

For patients, telehealth can help address barriers to care such as transportation, child care and work conflicts. It also can mean that they get seen more quickly than they otherwise would.

For providers, telehealth can offer them the chance to work from home. Also telehealth can help save on clinic space and, amid a workforce shortage, it can reduce the demand for other staff, such as those who check in the patients.

“A lot of times no telehealth means no care,” Curtis said.

A separate extension included under the federal Consolidated Appropriations Act of 2023 allows clinicians to continue providing audio-only telehealth visits, which Katelyn Darling, operations director for DH Connected Care, said are important for patients who may not have the Wi-Fi connection necessary for video appointments.

Also extended federally through 2024 is a billing mechanism under Medicare to include “home” as a location where patients can participate in a telehealth visit. Prior to the pandemic, patients had to travel to a site that could bill Medicare, either the practice of the provider they were seeing in-person or another clinic closer to home where they could connect with the provider virtually.

But when a patient covered by Medicare attends a telehealth appointment from home, it will now be reimbursed at a lower rate than if that person went in to the hospital, Darling said. DH will still allow patients to participate in visits from home, however.

“We’re not going to let that affect our patients,” she said of the Medicare change.

Some additional challenges remain for telehealth, including requirements that clinicians be licensed in the states where patients are during the telehealth visit. For DH clinicians, who care for patients who live across Northern New England, the licensing process can be “expensive” and “time-consuming,” Darling said.

In the future, a centralized board may be formed for licensing clinicians nationwide.

It’s not yet clear “to what degree states feel the need to own the licenses of people who practice in their state,” Curtis said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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