Source: Center of Connected Health Policy
A focus around accessing substance use disorder (SUD) treatment via telehealth has strengthened during the course of the pandemic both in terms of policy and research. Some of the latest long-term federal policy developments around telehealth have centered around mental health and SUD services. In December 2020, Congress passed the Consolidated Appropriations Act (CAA) which included a change that allowed for the provision of mental health and substance use disorder services in the home without geographic limitations, if the patient had an in-person visit with the telehealth provider within six months prior to the telehealth service taking place. The Centers for Medicare and Medicaid Services (CMS) implemented that policy in their CY 2022 Telehealth Update to the Medicare Physician Fee Schedule, however these new policies and in-person visit requirements will not kick in until 151 days post-public health emergency (PHE), according to the latest federal legislation regarding remaining telehealth flexibilities. CMS also implemented some permanent audio-only allowances, stating the likelihood that mental health and SUD treatment provided via technology will continue post-pandemic and concern about cutting off people who receive those services. More information on the 2022 PFS can be found in CCHP’s Fact Sheet on the final rule. In addition, research has continued to increase specific to SUD and recently, a few new studies were released looking at the use and efficacy of telehealth for SUD, modalities most often used and related patient demographics, as well as telehealth impacts on SUD outcomes. Overall, the research shows an increasing importance in access to SUD treatment and an increasing importance of telehealth in ensuring such access.
A study published in the Journal of Rural Mental Health in March looked at services provided by a Pennsylvania federally qualified health center (FQHC) and how ensuring patients maintained consistent access to Medications for Opioid Use Disorder (MOUD), formerly referred to as Medication-Assisted Treatment (MAT), despite losing in-person options during the pandemic was found to be critical. Using chart review and data from both 2019 and 2020, the study sought to compare certain patient populations and calculate retention rates, ultimately finding that telemedicine is efficacious in retaining patients in MOUD with buprenorphine and that the general transition to treatment via telehealth only went well. Based upon the research, the authors suggest telehealth emergency expansions should be maintained post-pandemic.
Another SUD review recently published in the Annals of Internal Medicine looked at the efficacy of telehealth for SUDs within the context of 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for SUD management. The study found that adding telehealth options to SUD treatment can be beneficial, yet evidence was limited regarding any differences between whether in-person care or telehealth improved abstinence from alcohol or cannabis. Low-strength evidence was found that supports the ability of therapy via telehealth to have similar effects as in-person care in improving abstinences in multiple SUDs however, and that adding text messaging as a part of follow-up care can improve abstinence from alcohol.
As far as demographics, a study in the Journal of Addiction Medicine looked at patient characteristics related to OUD treatment via phone and live video from a SUD treatment site in a nonurban area of New York, finding that nearly 80% of visits were through live video and older patients and those with less education were found to have had more telephone visits. In addition, a KFF study showed that the amount of substance use outpatient visits delivered over telehealth varied by substance use condition. Using patient information from March-August 2021, the study found that nearly 30% of alcohol and opioid-related treatment was provided via telehealth, while 16% of stimulant related visits occurred via telehealth. The study also showed that mental health and substance use visits are growing overall, but especially via telehealth, highlighting that increasing demand and need for such services and the role telehealth can play in increasing that access. The findings showed that rural residents are more likely to use telehealth for mental and substance use disorder visits – 55% in comparison to 35% in urban areas – which the authors suggest shows the impact of provider shortages in rural areas.
Research around telehealth is becoming more prevalent and desirable, especially among policymakers looking at long-term telehealth laws. As more studies continue to be released, it is clear that comparisons between pre-COVID and during-COVID use of telehealth is valuable, as is comparing telehealth impacts across populations and types of treatment. Nevertheless, policymakers looking to utilize such research to justify long-term telehealth policy changes should keep in mind that the ability to generalize and apply specific findings across the healthcare system still likely remains limited until researchers are also able to assess the same expansion impacts in a post-COVID environment.