In September of 2022, The New England Journal of Medicine published a timely article entitled “Losing Contact – Covid 19, Telemedicine and the Patient-Provider Relationship.”
The article highlighted the journey of a rare cancer patient, and the challenges of being treated by specialists when there are geographical barriers. Telemedicine, which became more available and helped to lift some of the treatment barriers, was one of the offshoots of the Covid 19 pandemic, when in-person medical visits were often impossible.
The pandemic also helped to lift some of the restrictions physicians face in treating out-of-state patients. It has reduced some of the treatment disparities that existed pre-pandemic. Now, with the restrictions of the early pandemic being lifted, telemedicine and the ability to see out-of-state patients is being challenged.
In response to this challenge, the Life Raft Group Medical Advisory Board has issued the following position letter in hopes that other organizations and physicians will follow suit, advocating for treatment ease and equity:
Telehealth and telemedicine are essential tools in assuring patients can access the healthcare services they need in as safely as possible from the providers who can best serve their needs. This is especially important for rare cancer patients.
For our patients who have Gastrointestinal Stromal Tumor (GIST), a rare cancer of the gastrointestinal tract, telemedicine has been a lifeline during the COVID-19 pandemic, allowing them access to disease-specific specialists regardless of their geographic location. Because of the nature of GIST and of rare diseases in general, it is vital that patients receive care from medical experts familiar with the most effective treatment plans for these patients.
In addition, by allowing this access, it eliminates barriers to seeking optimal care such as transportation issues and the recumbent costs, challenges caused by childcare issues and work absence issues, and inequities for patient in rural areas not able to access services from major academic institutions.
The ability to have insurance coverage for this specialized treatment has also helped to alleviate some of the financial toxicity associated with rare cancer treatment.
The flexibility of waiving strict regulations against physicians treating patients across state lines has resulted in lives saved for those who were unable to access medical centers of excellence prior to the establishment of telemedicine waivers, and for those who would not have sought in-person care during the pandemic for safety reasons.
Those challenging the continuation of these measures cite the possibility of fraud, and of poorly qualified practitioners. Insurance providers indicate that it may be more costly for them, as patients may be more likely to want to do a telehealth visit, which actually may result in less cost for the insurer, as more frequent visits allow for the ability to identify serious conditions in a timelier manner.
Recognizing that strict regulatory standards for physician licensure is a safeguard for patients and their families, many states are nonetheless finding ways to extend the ability for physicians to practice telemedicine across state lines.
The National Cancer Institute (NCI) of the National Institute of Health (NIH) announced it will award $23 million to establish telehealth cancer centers of excellence at NYU Grossman School of Medicine, Northwestern University, University of Pennsylvania, and Memorial Sloan Kettering Cancer Center as part of its Telehealth Research Centers of Excellence (TRACE) Initiative.
These centers will research how telehealth affects the delivery of cancer-related care and explore innovations in service delivery. This is a recognized endorsement that telemedicine and telehealth are the wave of the future.
We, the undersigned members of The Life Raft Group Medical Advisory Board, licensed physicians, recognized specialists in our respective fields, and patient advocates believe that the waivers extended during the COVID-19 pandemic allowing for telehealth visits across state lines and reimbursed by insurance should continue permanently, allowing cancer patients to have access to the highest standard of specialized care. This will result in better outcomes and increase survival rates for rare cancer patients.
We further believe that curtailing specialists’ telemedicine privileges will further burden patients and their families both financially and emotionally and will continue to create barriers to specialized treatment for the underserved.
We encourage all efforts to support telemedicine and telehealth.
Signed this second day of December 2022
Michael C. Heinrich, MD, Knight Cancer Institute
Sameer Rastogi, MD, All India Institute of Medical Sciences
Peter Reichardt, MD, Helios Klinikum Berlin-Buch
Gary Schwartz, MD, Herbert Irving Comprehensive Cancer Center
Jason Sicklick, MD, Moores Cancer Center
Neeta Samaiah, MD, MD Anderson Cancer Center
Jonathan Trent, MD, Sylvester Comprehensive Cancer Center