Telemedicine was made easy during COVID. not any more

Telemedicine exploded in popularity after COVID-19 hit, but limits are returning for care delivered across state lines.

That complicates followup 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-ofstate doctors to practice telemedicine.

Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-ofstate 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.