COVID-19 may have held a defining role in the “rebirth” of telehealth and remote care models in the USA, but their utility in improving patient access to neuromodulation therapies looks set to extend far beyond the global pandemic. This was a key message delivered by Vwaire Orhurhu, an interventional pain physician at University of Pittsburgh Medical Center (UPMC) in Williamsport, USA, at the 25th North American Neuromodulation Society (NANS) annual meeting (13–15 January 2022; Orlando, USA).
Orhurhu began his presentation by noting that “healthcare is changing”—adding that this change was accelerated by the outbreak of COVID-19 and will most likely lead to greater variation in the delivery of care. However, he continued—while their usage was more limited prior to the global health crisis—telehealth and telemedicine have been around for decades, with prior research demonstrating that they can enable effective diagnoses and treatments to be performed remotely.
Orhurhu referred to existing medical literature in this space, reporting a 94% reduction in wait times, from 72 to four days, on average, when comparing telehealth to more established approaches involving visits to the clinic. He also pointed to another benefit—a reduction in the number of steps needed to successfully deliver care to the patient—and the fact neuromodulation therapy outcomes for both pain and function have been shown to be comparable to those achieved with in-person models.
As well as noting that the outbreak of COVID-19 “precipitated the rebirth” of telehealth, Orhurhu pinpointed the expansion of telehealth under the US Centers for Medicare & Medicaid Services (CMS) 1135 waiver in March 2020 as the moment when physicians began rethinking patient access, due to increased reimbursement and redefined complexity in the use of telehealth being offered under the waiver.
Orhurhu then outlined a number of leading models for implementing telehealth into medical practice: the largely clinical data-focused ‘store and forward’ approach; the more stripped-down ‘direct contact consultation’ model that attempts to drill down and determine which patients truly require in-person consultations; and the ‘direct contact hub and spoke’ model in which clinicians can create networks of patients or fellow care providers, and directly engage with and impact them by deploying telehealth.
The fourth and final model he focused on is known as the ‘direct contact home base’ model—which is currently the most well-known and commonly used telehealth framework, and involves the clinician directly engaging with and advising their patients while they are at home. “The reason I bring this up is because the other models are not as well-utilised, as people do not talk about them as much,” Orhurhu added. “But, when we talk about neuromodulation and how we can deliver care to our patients, I do think these models play a key role.”
In addition, he highlighted guidance from the American Academy of Pain Medicine (AAPM) that was released in 2020 and supplied information on which patients may be considered “red flags” that should not be considered as telehealth candidates. This guidance also indicated the most appropriate contexts in which telehealth could be appropriate, including coordination of referrals, discussions of imaging results, non-controlled medication management, and post-procedure care, in established follow-up patients.
Orhurhu then provided a handful of tips for physicians wanting to implement any of the four major telehealth models into their neuromodulation practice. Crucially, he said, they should ensure their platform is Health Insurance Portability and Accountability Act (HIPPA)-compliant. “Initially, when telehealth first got off the ground, there was a lot more leniency towards it because it was an emergency and patients had to be seen—but there are much stricter guidelines now,” he added.
Other pointers he relayed to the NANS audience included the need to establish a process for using telehealth and ensuring medical teams understand that remote consultations are still clinical visits, and should be treated as such. Orhurhu further highlighted the importance of maintaining good patient communication, as well as staying on top of the latest regulatory and reimbursement policies, which are everchanging.
“Every company out there with a neuromodulation platform is beginning to talk more and more about this,” Orhurhu concluded. “So, I always encourage my colleagues to reach out and see what else is out there that can be applied to their patient population at this time.”
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