Changes to telemedicine are coming with the end of the federal pandemic public health emergency May 11.
Dr. Pamela Hoffman, a pediatric psychiatrist at Yale New Haven Health System and Yale Medicine, is worried that starting May 12, some patients who began prescription treatments virtually during the pandemic will have to be seen in person by their psychiatrist. The requirement applies to patients who need a prescription for a controlled substance, such as ADHD medication.
Dr. Melissa Santos, a psychiatrist and division head of pediatric psychology at Connecticut Children's, worries that this change could result in some people losing access to their prescription medications.
“If they don’t get seen in person, that stimulant cannot be prescribed,” Santos said. “What it does is it forces the provider to make time to see a patient in person who might not need it. I do worry that patients' issues will come to a head maybe faster; they won’t be seen as quickly.”
The issue is exacerbated by a shortage of pediatric and adolescent psychiatrists.
During the public health emergency, one of the provisions of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was put on hold, allowing providers to see patients remotely and then prescribe controlled substances. The act requires an in-person exam prior to prescribing a controlled substance.
The other issue? Physician burnout.
“I worry if we go back to offering just in-person, what that’s going to mean for the workforce, because some of our mental health workforce, we know for their own self-care and their own well-being, are working from home a little bit more,” Santos said.
Last year, the state legislature introduced PsyPact, allowing psychologists to practice virtually across state lines.
Other changes with the Appropriations Act of 2023 will not take effect until after Dec. 31, 2024. The act extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency. And yet others might not go into effect until 2025 or not at all, if new legislation is passed before then.
Dr. Hoffman said psychiatrists are continuing to see an increase in patient load. “The acuity of the patients that we're seeing in the emergency room [has] definitely gone up, [and] I can tell you that at the Yale Child Study Center, the volume of children being seen for mental health issues has been rising over the past several years, even prior to the pandemic.”
