A report released in December from the US Department of Health and Human Services (HHS) confirmed massive increases in the use of telehealth in 2020 compared to 2019, with behavioral health providers seeing the highest telehealth utilization relative to other providers. Telehealth comprised a third of all visits to behavioral health specialists, a much larger share than for primary care physicians or other medical specialists. The report, produced by researchers in HHS’s Office of the Assistant Secretary for Planning and Evaluation, analyzed data from 34.9 million Medicare beneficiaries, making it the largest telemedicine dataset so far. Medicare’s relaxed rules around reimbursing healthcare providers for digitally delivered care were crucial to the 63-fold increase in telehealth visits during this period. It is perhaps unsurprising that behavioral health was the top user of the modality, as these clinicians were early adopters of telemedicine well before Covid made it a necessity. Individual mental health care in the form of counseling or talk therapy is particularly amenable to this format. Psychological care providers across the country have come up with innovative ways of using technology to stay in touch with their patients, many of whom are struggling with pandemic-fueled stressors and increased anxiety or depression. Like many others, Tufts child psychiatrist John Sargent pivoted to telemedicine when Covid hit. His patients, who generally have to travel an hour or more for care and deal with traffic and parking in downtown Boston, cancelled fewer appointments. “It was incredibly freeing to all of us and turned out to be amazingly do-able—as long as we weren’t thinking about the people who don’t have internet access.” Paradigm Shift In Neurologic Care? Neurology, for its part, has incorporated forms of telemedicine for 25 years or more, typically to facilitate subspeciality care. Barbara Giesser , a multiple sclerosis (MS) specialist now with Pacific Neuroscience Institute in Santa Monica, California, was part of the MS telehealth program established at the University of Arizona in the 1990s to increase access to specialized care in the rural Southwest. “Neurological therapeutics can be very complicated, especially in areas like MS, Parkinson’s disease, epilepsy, and headache,” Giesser says. “People with these disorders may be better served by subspecialists, and there may not be any in their area.” Stroke is the classic application of telehealth in
THIS IS TELEMEDICINE T ELEMEDICINE HAS EMERGED as an important tool for tracking progressive neurologic diseases such as Parkinson’s. In one initiative, a collaboration of researchers is using smartphones to collect real-world data on symptom progression and treatment response in people with Parkinson’s disease (PD). Within the first six months of the study, 960 participants had performed at least five self- administered active PD symptom assessments. The authors concluded: “Although remote assessment requires careful consideration for accurate interpretation of real-world data, our results support the use of smartphones and wearables in objective and personalized disease assessments.”
36 DANA FOUNDATION CEREBRUM | Winter 2022
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