The forthcoming expiration of telehealth flexibilities implemented during the pandemic could have a devastating impact on vulnerable populations, including those receiving hospice or palliative care.

This is according to Dr. Holly Yang, immediate past president of the American Academy of Hospice and Palliative Medicine (AAHPM). Currently, temporary federal rules allowing for greater access to telehealth are set to expire on Dec. 31. While legislation is in play to extend them, the outcome is uncertain, and the end of the year is approaching. 

Hospice News sat down with Yang to discuss the importance of these flexibilities and how their impending departure could impact patients and families, particularly those in rural areas or with limited mobility, poor health equity or social determinants of health needs.

What are some of the flexibilities that are set to expire at the end of this year?

There’s a number of them, actually, which are quite concerning and require action to have good patient care continue.

Some of them are the prescribing flexibilities with the [U.S. Drug Enforcement Administration (DEA)]. One is the face-to-face recertification for hospice patients, and also just the current telehealth flexibilities that have been in place since the pandemic are set to expire at the end of this year.

I would hope that there would be action, because I think so many people, both in hospice and palliative care and beyond that, have adapted and depend on telehealth to extend access to care for patients across our country. It affects all of telehealth, and it’s a major issue — but especially for our patient population, because they tend to have less mobility.

Regarding the prescribing issue, is that pertaining specifically to controlled substances or opioids, or is that kind of any kind of prescribing over telehealth?

The DEA is looking specifically at prescribing. For hospice, the important thing is wanting to make sure that it’s really clear that it’s going to be hard for a lot of our patients to have an in-person visit prior to getting a prescription. So it’s really critical, actually, that it be continued, because it would deeply impact our ability to control pain and other symptoms when people enroll.

What would the sunset of those flexibilities mean for the hospice and palliative care providers?

We would really go backwards in our ability to take care of patients. We have expanded the ability to provide access in unique ways. I think most of the time we try to see people in person as much as possible, and the telehealth changes have made it so that we can get to people who can’t come to us.

Especially if they’re in rural areas, it cuts down on travel times and when it’s appropriate to see people virtually and that really matters, especially because being able to commute and do all those things takes quite a bit of time away from actual patient care. Sometimes the best way to get people care the fastest is via telehealth.

We would actually regress in our ability to have access to care for our hospice and palliative medicine population. Our population has significant issues with, again, mobility, because of pain, because of functional status, and whether they are in a city or they’re in a rural area, this applies.

From a palliative care standpoint, it’s important to have telehealth flexibilities for these patients. From a hospice standpoint, it allows us to get to patients faster. If there’s something urgent, we can be there virtually immediately, as opposed to commuting through really difficult traffic or those through long distances to be able to see them.

Does this pose greater risk for some patients more than others?

Rural populations for sure, there are massive health care deserts. Even a doctor in some counties in our country is hard to come by for primary care. We know hospitals are closing in rural areas.

I would also emphasize people who have less health equity, people who have a lower socioeconomic status. Because, again, if you don’t have a car, are you going to get to the doctor? So if you need to go to a palliative care clinic visit, you’re not going to get there, especially if you have an oncology visit, a radiation oncology visit. You’re going through multiple treatments. Being able to do that is a cost burden that is actually quite phenomenal for people.

It’s also people in urban areas, people with lots of traffic, people who don’t have access to transportation. Telehealth has allowed us to provide high-quality care to people that have a much harder time coming to see us.

Can you tell me about AAHPM’s advocacy efforts on this issue?

AAHPM works by commenting on proposed rules like Medicare Physician Fee Schedules and thinking about how we pay for telehealth. We respond with letters to the DEA. Our CMO actually went and testified during a DEA listening session in person.

We work in coalition with other groups around telehealth. For instance, we have been working with the Alliance for Connected Care. So we’ve been part of different coalitions of multiple organizations trying to advocate to Congress, to DEA, to all the groups that matter, to make sure that they extend these flexibilities.

In your view, what would appropriate reimbursement for telehealth look like?

Ideally, telehealth services should be valued as the same as other services because we are providing the care. We want to make sure that people are reimbursed for their time and expertise in providing the care, and that people have access to all levels of care, telehealth and in person.

The telehealth flexibilities, the prescribing flexibility, all of that has been really a game changer for us, and would be a really sad thing if it went away.