A joint study by Yale and Harvard Schools of Medicine has found that telehealth is just as effective as in-person care. According to Yale, the study is one of the largest randomised clinical trials to directly compare telehealth and in-person care.

The use of telehealth surged at the height of the COVID-19 pandemic through waivers that expanded Medicare coverage for a wide range of medical services. These flexibilities are set to expire by the end of 2024 unless Congress takes action to extend them. Many private insurers follow Medicare’s lead, so a change by Congress will likely affect private insurers’ funding for their telemedicine programmes as well.

While advocates argue that telehealth improves accessibility, US lawmakers have expressed concerns about quality of care, costs, and the potential for fraud.

A multi-site study involving 1,250 patients with advanced lung cancer across 22 US sites has found that those who received early palliative care via telehealth reported quality-of-life scores that were equivalent to those who received in-person care.

The study’s authors argue that the study’s findings highlight the importance of keeping telehealth accessible to patients.

They published their study in JAMA on September 11. The study adds to growing evidence that telehealth provides comparable quality of care to in-person visits across specialties.

“Medicare has to make some big decisions about whether or not to continue the waivers that allow telehealth visits to be reimbursed,” said Lee Schwamm, MD, associate dean for digital strategy and transformation at Yale School of Medicine and a co-author on the research. “This study is really important for providing Congress with the evidence that they need to support the concept of extending waivers.” The outcome will impact nearly all individuals who seek medical care, but especially those with chronic and/or disabling conditions.

Before the COVID-19 pandemic, Medicare offered very little reimbursement for telehealth. Many commercial insurers follow Medicare’s lead, and patients typically only received coverage for virtual visits if they lived in rural areas. The patients also had to attend these visits from a Medicare-approved facility, such as a rural health clinic, rather than from their home.

But with the pandemic, Medicare relaxed these restrictions, granting millions of Americans access to virtual services. Telehealth visits skyrocketed—from 5 million among Medicare recipients between April and December 2019 to over 53 million in the same period in 2020. Furthermore, a national study following 36 million individuals with private insurance found that telehealth visits increased by 766% during the first three months of the pandemic.

The Subcommittee on Health of the US House of Representatives Committee on Energy and Commerce is reviewing fifteen bills related to Medicare telehealth access. The American Telemedicine Association has referred to these deliberations as the 2024 telehealth “Super Bowl.” Lawmakers are debating whether to extend the waivers temporarily or make permanent changes to telehealth reimbursement policies for ambulatory care.

Many providers are worried about the implications if Congress decides against extending telehealth flexibilities. “If the renewal of the waivers is not passed, it will have a huge impact on medicine,” said Eric Winer, MD, director of Yale Cancer Center, who also is not affiliated with the study. “At a time when we’re trying to make health care more convenient, providing a number of different approaches for clinician-patient interactions is very important.”

In their recent study, Schwamm and colleagues affiliated with Harvard Medical School, where he formerly was on the faculty, investigated whether conducting palliative care through telehealth was as effective as in-person care in improving patient quality of life. They enrolled 1,250 patients diagnosed with non-small cell lung cancer — the most common form of lung cancer. The average age of participants was 65.

The researchers ran the trial at 22 cancer centres across the United States and trained the providers at each centre on the technology needed to conduct a virtual visit. They assigned half of the participants to receive telehealth after an initial in-person palliative care visit. The other half received care entirely in the doctor’s office.

To assess quality-of-life outcomes, the team used a questionnaire called the Functional Assessment of Cancer Therapy-Lung (FACT-L). They found that there was no significant difference in quality of life between the two groups.

The study also reveals that caregivers are less likely to participate in virtual visits than in-person, perhaps pointing to the greater independence telehealth allows patients. Many patients depend on their caregivers to drive them to and from appointments, but with telehealth, they can speak to their providers from their own homes without needing to arrange for transportation. “There’s more flexibility and freedom for patients who may typically rely so much on their caregivers to receive care,” said Dmitry Kozhevnikov DO, director of ambulatory palliative care at Yale New Haven Hospital-Smilow Cancer Center.

Other factors including caregiver quality of life, patient and caregiver satisfaction with care, and mood symptoms were equivalent across groups. “That’s really reassuring,” Schwamm said. “For patients with advanced lung cancer, this was an effective way to deliver palliative care.”

Palliative care doctors are in short supply. “They tend to be concentrated at academic health systems,” Schwamm explains, “So, there’s a tremendous geographic disparity in who can access a palliative care doctor.”

Telehealth has the potential to dramatically expand the number of patients who can obtain care while still providing quality treatment. “When it comes to palliative care, in-person visits are quite difficult because it’s forcing some of our sickest and compromised patients to make trips into a hospital setting,” said Winer. “Telemedicine allows patients to have the same benefit of in-person care without having to travel.”