As we approach the end of 2024, a crucial healthcare policy decision looms that could significantly impact some of our most vulnerable patients. The telehealth flexibilities that have revolutionized healthcare delivery, particularly for hospice patients, are set to expire on December 31, 2024, unless action is taken.

The Current Landscape

During the COVID pandemic, emergency measures allowed healthcare providers to prescribe controlled substances without requiring in-person evaluations. This change proved transformative, especially for hospice care, mental health treatment, and substance use disorder management. However, these essential flexibilities now hang in the balance.

The DEA's Proposed Changes

The Drug Enforcement Administration (DEA) has submitted a final rule that could extend virtual prescribing capabilities beyond the current deadline. However, the proposal comes with potential restrictions that have raised concerns among healthcare providers and advocates:

• More stringent requirements for in-person visits, particularly for Schedule II drugs
• Implementation of a new special registration process for telehealth prescribers
• Additional regulatory oversight of virtual prescribing practices

Impact on Hospice Patients

Dr. Holly Yang from the American Academy of Hospice and Palliative Medicine (AAHPM) highlights the critical nature of these services for hospice patients. Many face significant challenges:

• Severe mobility limitations that make in-person visits difficult or impossible
• Limited access to healthcare facilities, especially in rural areas
• Need for immediate pain management and symptom relief
• Requirement for urgent care response without the burden of travel

The Push for a "Clean" Extension

A bipartisan coalition of lawmakers, alongside organizations like the American Telemedicine Association, advocates for a straightforward extension of current flexibilities. Their arguments include:

1. The DEA needs more time to develop balanced regulations
2. Current telehealth practices have proven effective and safe
3. New restrictions could create unnecessary barriers to care
4. The proposed registration process could disrupt existing care patterns

The Rural Healthcare Gap

Perhaps nowhere is the impact of these decisions more profound than in rural and underserved communities. For these areas, telehealth has bridged a critical access gap, providing:

• Timely access to specialist care
• Reduced travel burden for seriously ill patients
• Continuous monitoring and adjustment of treatment plans
• Better management of chronic conditions

Looking Forward

As the deadline approaches, healthcare providers, patients, and advocacy groups anxiously await the final decision. The outcome will significantly influence the future of healthcare delivery, particularly for those most in need of flexible care options.

The question isn't just about maintaining current standards—it's about protecting a vital lifeline that has demonstrated its worth in improving patient care and access. As we move forward, finding the right balance between regulatory oversight and healthcare accessibility will be crucial for ensuring that our most vulnerable patients continue to receive the care they deserve.

For hospice patients and their families, this isn't just a policy decision—it's about maintaining their dignity and quality of life during their most challenging moments. The coming months will be critical in determining whether we continue to progress in healthcare accessibility or risk taking a step backward.

Preparing for Change

As healthcare organizations navigate these uncertain regulatory waters, having the right tools becomes increasingly important. Ottehr's eRx module offers a comprehensive solution designed specifically for hospice providers, helping them maintain efficient prescription workflows while staying compliant with evolving regulations. The system's flexible architecture adapts to both in-person and telehealth scenarios, ensuring that whatever policy changes may come, providers can continue focusing on what matters most: delivering quality care to their patients. To learn more about how Ottehr's eRx module can help your organization prepare for these changes, visit our website or contact our team today.

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To learn more about Ottehr’s modular and production-ready open-source telehealth platform, schedule a call or visit the Github repository to fork for free today.

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FAQs

Q1: What happens if the telehealth flexibilities expire on December 31, 2024? Who will lose access to virtual care?

If the current telehealth flexibilities expire without an extension or new regulations in place, the immediate impact would primarily affect the virtual prescribing of controlled substances. Your loved one would still have access to general telehealth services, but there would be changes to how medications are prescribed:

• Initial prescriptions for controlled substances would require an in-person medical evaluation
• Existing prescriptions might need to be reviewed during in-person visits
• Your healthcare provider may need to adjust care plans to include periodic in-person evaluations

However, many healthcare organizations and advocacy groups are actively working to prevent any gaps in care. Your hospice provider should communicate any necessary changes to your care plan well in advance of the deadline.

Q2: How does the proposed DEA registration process for telehealth prescribers work, and will it affect my current care team?

The DEA's proposed special registration process, while still being finalized, would likely include:

• Additional credentialing requirements for healthcare providers
• Specific technology and security standards for virtual prescribing
• Regular auditing and reporting requirements
• Potential limitations on the types and quantities of medications that can be prescribed virtually

For patients, this might mean:

• Your care team may need time to complete the registration process
• Some providers might need to update their technology systems
• There could be temporary adjustments to prescription workflows

Healthcare providers are encouraged to begin preparing for these changes now to minimize any disruption to patient care.

Q3: I live in a rural area and can't easily travel to in-person appointments. What options will I have if new restrictions are implemented?

Rural patients will have several options to maintain access to care under potential new restrictions:

1. Hybrid Care Models:
   • Combining periodic in-person visits with regular telehealth check-ins
   • Coordinating with local healthcare facilities for required in-person evaluations
   • Using mobile health units that travel to remote areas
2. Care Coordination Programs:
   • Working with local pharmacies for medication management
   • Partnering with community health workers for in-person support
   • Utilizing home health services when available
3. Technology Solutions:
   • Electronic prescribing systems that streamline medication management
   • Remote monitoring devices that can share health data with your care team
   • Secure messaging platforms for ongoing communication with providers

Healthcare providers and advocacy groups are particularly focused on ensuring rural patients maintain access to care. Your hospice provider can help develop a personalized plan that works for your specific situation and location.

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Additional Sources:
https://paproviders.org/dea-expected-to-extend-telehealth-flexibilities-for-controlled-substances-a-third-time/

https://hospicenews.com/2024/10/17/aahpm-board-president-telehealth-access-critical-for-hospice-patients/

https://thehill.com/policy/healthcare/4950196-telemedicine-flexibilities-extension-anxiety/