Should Telehealth for Traumatic Brain Injury Continue After the Pandemic?

With the onset of the COVID-19 pandemic, remote care spiked as much as 154%. In response, the Centers for Medicare and Medicaid Services expanded coverage for telehealth services and providers, which ultimately affected coverage and reimbursement costs.

Some of the changes included: no restrictions based on geographic location, allowing all healthcare providers who are eligible to bill Medicare for telehealth, and reducing or waiving patient cost-sharing for telehealth visits.

Traumatic Brain Injury (TBI) patients, who often require months and years of services and rehabilitative therapies, had to turn to telehealth to stay on top of treatment while staying safe from COVID-19 transmission.

Yet the telehealth modality might continue to be used with TBI patients even after the pandemic. In the post-pandemic future, telehealth can be utilized for a variety of treatment scenarios, including for cognitive rehabilitation, education therapy and counseling, as well as a compliment to in-clinic therapies and for situations when travel is not possible.

In a survey recently conducted by the Brain Injury Association of America (BIAA), 98% of over 400 healthcare providers said they would continue to use telehealth for TBI patients in the future. That is, however, if it will continue to be reimbursable.

The Case for Continued Telehealth for TBI

The BIAA survey found that 76% of participants indicated that TBI patient progress while using telehealth services was equal or greater than their progress in the clinic setting. TBI treatment services that were effectively delivered via telehealth, according to the surveyed healthcare professionals, included:

• • Counseling/psychotherapy – including stress management and relaxation training
  • Speech/language therapy – including cognitive rehabilitation, aphasia therapy, articulation training and problem solving
  • Occupational therapy – upper extremity gross and fine motor exercises and self-care skills training
  • Physical therapy – balance, endurance and strength/flexibility
  • Education therapy – SRA reading, mathematics, exercises and goal setting
  • Nursing – managing comorbidities, nutritional counseling and medication management
  • Vocational services – some providers offered services such as training in resume development and job leads as well as vocational evaluations

Pending Legislation

There has been recent support for bipartisan bills that call for telehealth regulatory reform. The Protecting Access to Post-COVID-19 Telehealth Act, introduced in the House in January 2021, would eliminate certain site restrictions on the use of telehealth in Medicare and would continue reimbursement for 90 days after the end of the pandemic, as well as permanently allow the U.S. Department of Health and Human Services (HHS) to utilize telehealth in a disaster situation.

Meanwhile the Telehealth Modernization Act, introduced in the senate on July 2020, would permanently remove any restrictions with Medicare and encourage more types of providers to deliver telehealth such as physical therapists.

The Case Against Telehealth for TBI

Not everyone believes it should be a continued care option, however. The authors of “Telemedicine: What Should the Post-Pandemic Regulatory and Payment Landscape Look Like?” argue that telemedicine is too convenient in some circumstances and that it could encourage excessive use of care.  One of the authors, Ateev Mehrotra, a healthcare policy researcher at Harvard Medical School, testified against prolonged use of telehealth before the House Committee on Energy and Commerce Health Subcommittee at a meeting in March 2021.

Likewise, some members of the House argue that if telehealth becomes too easy to access and be reimbursed for, patients could take advantage of that and overuse the services, leading to an increase in expenses for the government.

There is also the potential for fraud, some say, given that telehealth removes the need for a physical space when interacting with patients. Others believe it creates some limitations, given that many telehealth visits are conducted via video, and some populations in the U.S. lack the technology that would make that service truly accessible.