A 'moving target': PCPs call out inconsistent regulations in the rollout of telehealth
Three years after the height of the COVID pandemic, new interviews with a large group of primary care physicians in the U.S. are providing valuable insight into how the implementation of telemedicine changed their scope of practice and how its use can be improved for the future.
The interviews were conducted with 25 leaders at primary care practices from the Patient-Centered Outcomes Research Institute’s PCORnet project. The providers' responses highlighted four themes pertaining to telemedicine in primary care, each of them consistently portraying inconsistency as a glaring fault in almost every aspect of telehealth.
Details from the interviews were shared on May 21 in The Annals of Family Medicine, where experts involved in the work explained that many practices were not prepared for the forced rollout of telemedicine in spring of 2020.
“The limited capacity to evaluate telemedicine programs at the onset of the pandemic precluded the thoughtful development of such programs, with limited ability to share best practices with peer practices in real time,” corresponding author of the new paper Jashvant Poeran, MD, PhD, with the Division of General Internal Medicine at the Icahn School of Medicine at Mount Sinai in New York, and co-authors noted.
The first theme the team touched on was that the effectiveness of telemedicine largely depended on its users’ (providers and patients) prior experiences with virtual care. Practices that offered virtual visits prior to the pandemic fared better than those who had to implement telehealth on a whim. And practices utilizing patient portals prior to COVID also adjusted more quickly than those that did not, but even in clinics with patients who are familiar with some aspects of telehealth struggled to get all of their patients on board without some sort of assistance (a demonstration of the process, for example). Although the sole purpose of virtual visits is the ease of access and continuation of care, telemedicine does risk leaving behind some populations less keen on the use of technology, the authors suggested.
Inconsistent regulations also hindered the rollout of telemedicine. These policies varied between states and insurance plans, and they affected reimbursement as well. Prescribing controlled substances was cited as especially difficult to navigate, and it continues to be a topic of debate today.
“Enforcing state boundaries in a virtual landscape led to issues that not only negatively affected patient care but also were differentially enacted, leading to respondents’ perception of ‘a moving target,’” the group wrote.
That same sentiment carried over into visit triage rules, with the providers unanimously agreeing that what did and did not warrant an in-person visit varied between practices and states. Some noted that some telemedicine visits felt like a waste of time and resources because their patients needed to be seen in person for a physical examination, labs or imaging. In some instances, these visits created an increased “risk of unsafe situations,” one respondent noted.
The final theme revealed in the interviews is that the providers did not unanimously praise or condemn the continuation of telemedicine. They each cited positives and negatives in the rollout, but noted that some tweaks to the system would further enhance the known benefits of virtual care, such as increasing access to underserved populations.
They suggested that standardized regulations relative to triage rules would be a good first step toward improving telemedicine and that specific training dedicated to triage alone would be beneficial. Implementing scheduling protocols also could improve providers’ overall well-being, as many felt that virtual care blurred the lines between their professional and personal lives.
The full paper can be viewed here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.