Telemedicine exploded in popularity after COVID-19 hit, but limits are returning for care delivered across state lines.
That complicates follow-up treatments for some cancer patients. It also can affect other types of care, including mental health therapy and routine doctor check-ins.
Over the past year, nearly 40 states and Washington, D.C., have ended emergency declarations that made it easier for doctors to use video visits to see patients in another state, according to the Alliance for Connected Care, which advocates for telemedicine use.
Some, like Virginia, have created exceptions for people who have an existing relationship with a physician. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine.
Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-of-state telemedicine entirely. That leaves follow-up visits, consultations or other care only to patients who have the means to travel for in-person meetings.
Susie Rinehart is planning two upcoming trips to her cancer doctor in Boston. She needs regular scans and doctor visits to monitor a rare bone cancer that has spread from her skull to her spine.
Rinehart doesn’t have a specialist near her home outside Denver who can treat her. These visits were done virtually during the pandemic.
She will travel without her husband to save money, but that presents another problem: If she gets bad news, she’ll handle it alone.
“It’s stressful enough to have a rare cancer, and this just adds to the stress,” the 51-year-old said.
Rinehart’s oncologist, Dr. Shannon MacDonald, said telemedicine regulation enforcement seems to be more aggressive now than it was before the pandemic, when video visits were still emerging.
“It just seems so dated,” said MacDonald, who recently co-wrote a piece about the issue in The New England Journal of Medicine.
To state medical boards, the patient’s location during a telemedicine visit is where the appointment takes place. One of MacDonald’s hospitals, Massachusetts General, requires doctors to be licensed in the patient’s state for virtual visits.
It also wants those visits restricted to New England and Florida, where many patients spend the winter, said Dr. Lee Schwamm, a vice president for the Mass General Brigham health system.
That doesn’t help doctors like MacDonald who see patients from around the country.
Cleveland Clinic also draws a lot of patients from out of state. Neurosurgeon Dr. Peter Rasmussen worries about how some will handle upcoming travel, especially because winter can bring icy weather.
A fall “literally could be life ending” for someone with a condition like Parkinson’s disease who has trouble walking, he said.
Psychiatrists have a different concern: Finding doctors for patients who move out of state. This is especially difficult for college students who temporarily leave home.
Most U.S. counties have no child and adolescent psychiatrists, noted Dr. Shabana Khan, chair of the American Psychiatric Association’s telepsychiatry committee.
“If we do try to transition patients, often there is no one there,” Khan said.
Helen Khuri’s mother found a specialist to help her when the 19-year-old’s post-traumatic stress disorder flared up last spring. But the Emory University student had to temporarily move from Atlanta to Boston for treatment, even though she never set foot inside the hospital offering it.
She rented an apartment with her father so she could be in the same state for telemedicine visits, a situation she deemed “ridiculous.”
“It didn’t necessarily make sense to … kind of uproot my life, just to receive this three-week treatment program,” Khuri said.
Even people seeing doctors close to home can be affected.
Dr. Ed Sepe’s Washington, D.C., pediatric practice has patients in Maryland who have started driving a few miles across the border into the city to connect by video. That saves them a 45-minute trip downtown for an in-person visit.
“It’s silly,” he said. “If you are under a doctor’s care, and you are in the U.S., it doesn’t make any sense to have geographic restrictions for telemedicine.”
Sepe noted that low-income families tend to be in jobs that don’t allow time off for in-person visits. Some also have a hard time getting transportation. Video visits were helping with these obstacles.
“It’s bigger than just telemedicine,” he said. “There’s a missed opportunity there to level the playing field.”
States can play an important role in telemedicine’s growth by guarding against fraud and protecting patient safety, according to Lisa Robin, an executive with the Federation of State Medical Boards.
But the federation also recommends that states loosen some telemedicine restrictions.
That includes permitting virtual follow-ups for someone who has traveled out of state to seek care or for people who temporarily move but want to stay with a doctor.
States could also form regional compacts with their neighbors to ease cross-border care, noted Dr. Ateev Mehrotra, a Harvard health policy professor who studies telemedicine.
“There’s so many ways that these issues can be addressed,” he said
In the meantime, patients who need care now are trying to figure out how to manage it.
Lucas Rounds isn’t sure how many visits he will make to see MacDonald in Boston to monitor his rare bone cancer. The 35-year-old Logan, Utah, resident already spent months away from home earlier this year, undergoing radiation and surgery.
Plus he has a wife and three young girls and expenses like a mortgage to consider.
Rounds says he has to think about taking care of his family “if the worst happens.”
“If I die from cancer, then all these expenses we’ve accrued … those are dollars that my family wouldn’t have,” he said.
‘Diamond’ of pro-Trump commentary duo dies of heart disease
RALEIGH, N.C. (AP) — Lynette Hardaway, a zealous supporter of former President Donald Trump whose death had prompted widespread speculation over its cause, died earlier this month of a heart condition, according to a death certificate obtained Monday by The Associated Press.
Known by the moniker “Diamond” of the conservative political commentary duo Diamond and Silk, Hardaway, 51, died Jan. 8 of heart disease due to chronic high blood pressure.
Hardaway and her sister, Rochelle “Silk” Richardson, found internet stardom as Black women who ardently backed Trump during his 2016 presidential campaign. After making several campaign appearances with the former president, the two leveraged their notoriety to land regular commentator roles at Fox News. Their promotion of coronavirus falsities eventually got them dropped, but they landed at the far-right cable and digital media platform Newsmax.
The cause of Hardaway’s death, which was not released by the family, had become a topic of widespread speculation. A torrent of social media users suggested COVID-19 was to blame.
Many of the posts were based on an unsourced, and since-deleted, online report from November that claimed Hardaway had been hospitalized with COVID-19. Both Diamond and Silk vehemently denied that the virus had put Hardaway in the hospital.
COVID-19 was not listed as a cause or contributing factor on her death certificate, which was provided to the AP by the Hoke County Register of Deeds and was signed by a local doctor. No autopsy was performed.
A memorial ceremony held in Fayetteville, North Carolina, and streamed online Saturday renewed speculation when Richardson suggested her sister’s death was somehow linked to the COVID-19 vaccine. She insinuated Hardaway may have been “poisoned” by another person who had been vaccinated, amplifying the false notion that recipients can affect those around them.
At the memorial, Richardson mentioned people “dying suddenly,” a reference that has become shorthand among some anti-vaccine activists for deaths they say were caused by COVID-19 shots, despite studies showing the vaccines are safe and effective.
Joined on stage at the memorial by Trump, Richardson said her sister died after returning to her North Carolina home from a relative’s birthday celebration. Richardson noticed her sister looking strange and Hardaway suddenly said: “I can’t breathe,” Richardson recalled. She and her husband performed CPR on the kitchen floor as they waited for emergency services.
Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
US proposes once-a-year COVID shots for most Americans
WASHINGTON (AP) — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.
The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.
This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.
The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.
The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.
In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.
For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.
FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.
The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.
Under FDA’s proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.
Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.
The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.
White House reveals winter COVID-19 plans, more free tests
WASHINGTON (AP) — The Biden administration is once more making some free COVID-19 tests available to all U.S. households as it releases its contingency plans with coronavirus cases ticking upward this winter.
After a three-month hiatus, the administration is making four rapid virus tests available per household through covidtests.gov starting Thursday. COVID-19 cases have shown a marked increase after the Thanksgiving holiday, and further increases are projected from indoor gathering and travel around Christmas and New Year’s.
Cases are up across 90% of the country, White House COVID-19 coordinator Dr. Ashish Jha said Thursday during a briefing. Deaths and hospitalizations are also on the rise, with nearly 3,000 deaths reported last week. Most of those have been concentrated in people age 65 and older, Jha said.
“We don’t want this winter to look like last winter or the winter before,” Jha said.
As cases begin to rise again, much of the United States is also dealing with other respiratory viruses heading into this winter with an influx of flu and RSV, or respiratory syncytial virus. Jha told reporters he is confident that the worst of RSV — which hit young children particularly hard — is over, but that flu cases are only just spiking.
The administration is putting personnel and equipment on standby should they be needed to help overwhelmed hospitals and nursing homes, as was necessary in earlier waves of the coronavirus. So far, there have been no requests for assistance, but surge teams, ventilators and personal protective equipment are ready, the White House said.
The administration is also urging states and local governments to do more to encourage people to get the updated bivalent COVID-19 vaccines, which scientists say are more effective at protecting against serious illness and death from the currently circulating variants. The administration is reiterating best practices to nursing homes and long-term care facilities for virus prevention and treatment and is urging administrators as well as governments to encourage vulnerable populations to get the new shots. Less than half of all nursing home residents have received the latest booster shot, Jha said.
The planning comes as the administration has struggled to persuade most Americans to get the updated boosters as cases and deaths have declined from pandemic highs and most people have embraced a return to most of their pre-pandemic activities. Less than 14% of people in the U.S. older than have gotten the most recent booster.
The White House said the new tests would come from the national stockpile, which still has reserves even after the administration shut off the at-home testing program in September, citing a lack of money from Congress. The administration is still asking Congress for billions more dollars for the virus response.
The pause on free at-home testing program this summer allowed the administration to save some free at-home tests for the surge in cases this winter, Jha said.
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