Home Health & Hospice Week

Nix visual requirement, industry experts urge Medicare.

Hospices hoping to see flexibility for their patients regarding telehealth and prescribing controlled substances are so far disappointed.

The Drug Enforcement Agency said on March 16 that “DEA-registered practitioners ... may issue prescriptions for all schedule II-V controlled substances to patients for whom they have not conducted an in-person medical evaluation” with certain conditions, including that “the telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.”

A few weeks later, the DEA said in a March 31 letter that “practitioners have further flexibility during the nationwide public health emergency to prescribe buprenorphine to new and existing patients with [opioid use disorder] via telephone … without requiring such practitioners to first conduct an examination of the patient in person or via telemedicine,” but just based on “a telephone evaluation.” But the DEA did not extend that flexibility to any other patients.

The result: “Palliative care providers often are unable to prescribe controlled substances for patients who have remote visits via telephone without video,” note authors Patrice Villars, Eric Widera, and Chad D. Kollas in a recent Health Affairs blog post. “Many palliative care patients may be unable to receive timely and adequate pain and symptom relief and are at risk for potentially avoidable clinical, emergency department, and hospital visits,” the blog post says.

Villars, Widera, and Kollas call on the DEA to lift the visual restriction to ease suffering for “many sick and vulnerable people — particularly the elderly” and prevent ER visits.

Note: The DEA statement and letter are at www.deadiversion.usdoj.gov/coronavirus.html#TELE. The Health Affairs post is at www.healthaffairs.org/do/10.1377/hblog20200422.989316/full/.