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President's Column

Read monthly updates from AAN President Carlayne E. Jackson, MD, FAAN, to learn about Academy news and action on issues important to the neurology profession and patients.

JULY 2023

The End of the PHE: Persevering and Thriving in Neurology

It’s now been three and a half years since we first heard about the mysterious virus that was rapidly causing severe respiratory illnesses in people and an alarming number of deaths. It soon became clear this was not just a common influenza but a horrifyingly deadly pandemic that gripped the world and changed how we lived and how we worked. Every country, state, province, and municipality wrestled with how to react to the COVID-19 pandemic and how to best help its citizens.

In the United States, the Health and Human Services Secretary announced a Public Health Emergency (PHE). Congress swiftly passed legislation to assist businesses and individuals. Regulatory agencies reviewed policies to reduce obstacles, including those affecting health care. “Pivot” became the new buzzword in business planning.

Early in the PHE, your AAN created the COVID-19 Neurology Resource Center and developed a wealth of resources to help members deal with urgent situations like quickly implementing telehealth visits and safely reopening their practices to in-person visits. We provided guidance about the federal funding and loans available to help keep their practices running and pay employees. In 2020, we offered free webinars to prepare members for Telemedicine and COVID-19, Financial Support for Practices, and Key Considerations for Reopening a Neurology Practice. To date, the AAN’s “Telemedicine and COVID-19” webinar is one of the most-viewed webinars, with over 15,000 views. In all, our COVID-19 Neurology Resource Center logged more than 200,000 page views.

On Capitol Hill, the AAN was a strong proponent of legislation that would expand the telehealth flexibilities allowed under the PHE. As Congress has looked for ways to continue these flexibilities, the AAN has endorsed several proposed bills, including:

  • Advancing Telehealth Beyond COVID-19 Act (H.R. 4040)
  • Telehealth Extension and Evaluation Act (S. 3593/H.R. 7573)
  • CONNECT for Health Act (S. 1512/H.R. 2903)
  • Telehealth Modernization Act (S. 368/H.R. 1332)
  • Telehealth Extension Act (H.R. 6202)
  • Protecting Access to Post-COVID-19 Telehealth Act (H.R. 366)
  • Protecting Rural Telehealth Access Act (S. 1988/H.R. 5425)
  • Permanency for Audio-Only Telehealth Act (H.R. 3447)

Most recently in 2023, the AAN has:

  • Signed on to a stakeholder request that the Centers for Medicare & Medicaid Services harmonizes deadlines impacting Medicare telehealth
  • Delivered comments to CMS about additional services that should be included on Medicare’s permanent list of telehealth services
  • Submitted comments in response to the Drug Enforcement Agency’s proposed rule regarding prescribing of controlled substances via telehealth
  • Provided input for an updated CONNECT for Health Act

We’ve successfully engaged our membership in pushing for expansion as well. Telehealth was one of the AAN’s asks during 2022’s Neurology on the Hill and members enthusiastically responded to our five grassroots campaigns with nearly 10,000 letters sent to their representatives in Washington, DC.

Congress passed the Consolidated Appropriations Act, 2023, which expanded Medicare telehealth flexibilities, including audio only, for two years through December 31, 2024. While this helped eliminate the threat of a sudden end to telehealth flexibilities at the end of the PHE, the AAN will continue to advocate for a permanent expansion before the end of the 118th Congress.

Further, many of the pandemic-era telehealth flexibilities—notably expanded services reimbursement—will be determined by CMS for 2024. The AAN will continue to gather member feedback to use in advocating for adequate coverage and reimbursement from the regulatory agency. To help members navigate the post-PHE federal policy landscape, the AAN has produced a summary outlining key telehealth deadlines.

In the early days of the PHE, the AAN worked to rapidly formulate recommendations for regulators across the Department of Health and Human Services and decision-makers in the White House concerning the need for relief from regulatory burdens so that providers could focus on patient care. We stressed the importance of loosening of regulatory restrictions on telehealth, the paramount significance of ensuring adequate personal protection equipment and other resources to allow for continuity of care, and the urgency surrounding expedited financial relief for practices. As the PHE continued, the AAN worked to communicate key learnings that stemmed from practice changes during the PHE to policymakers. The AAN also provided formal comment on the need for permanent changes impacting telehealth and the need for a sustainable payment system to promote workforce sustainability.

Many members likely know that neurologists were early adopters of telehealth, principally with the expansion of telestroke prior to the pandemic. Today, neurology experiences higher telemedicine use among medical specialties, bringing care to patients for whom access is limited by geography, transportation, and/or health status. In April 2021, the AAN’s Telehealth Subcommittee was launched under the Medical Economics and Practice Committee. In the two years since its inception, the subcommittee has produced numerous resources for members, including disease-specific exam guides, case studies, and policy summaries as the telehealth policy landscape continually evolves. A series of educational teleneurology videos targeted at neurology residents is forthcoming.

I am a firm believer in silver linings, and while not minimizing the horrors and disruptions of the pandemic, there were some significant upsides that emerged over time. I asked a couple of my colleagues who were deeply involved in our PHE work what positives they drew from the last three years.

Dr. Bruce H. Cohen, who chairs the Advocacy Committee and is a member of our Board of Directors, shared with me, “We got to spend more time with our families allowing us to appreciate the art of life, focusing on the things that mattered, and putting aside what did not matter. In our professional life, we were able to foster new friendships via Zoom meetings, despite the drawbacks of the technology. In terms of patient advocacy, we cut through 10 years of administrative, regulatory, and legislative hurdles to get us ahead on telehealth, almost overnight. Within weeks, neurologists became adept at performing physical exams using telehealth services. It made it much easier for patients with neurologic conditions (physical or cognitive) to access medical care. That new access allowed me to conduct office visits with patients in our respective homes, bringing a new aspect to the physician-patient relationship.”

Dr. Brad Klein, also a Board member and chair of our Medical Economics and Practice Committee, noted, “While COVID-19 was devastating to so many patients and their families, a few potential silver linings did emerge. The pandemic catalyzed the adoption and acceptance of telehealth. It improved access to neurology services, particularly for patients in remote areas, reduced travel time and costs, and provided a convenient option for patients who may have difficulty physically visiting a clinic. Even though we knew socioeconomic status, race, and other factors impacted health, the pandemic made these inequities even more blatant, requiring us to think more aggressively about health inequity at the bedside, from a population health perspective, and logistically for services like telehealth. The pandemic highlighted the importance of patient engagement and digital education in health care. Digital platforms, social media, and online resources helped patients become more empowered, with increased awareness and interest in their health. Neurologists showed remarkable resilience in their response to the crisis. They swiftly adjusted their practices, embraced telemedicine to ensure continuity of care, and became adept at rapidly acquiring and assimilating new information, staying up to date with ever-evolving scientific guidelines and research, as well as rapid legislative and regulatory changes. We developed stronger support networks, leaning on our colleagues and communities for guidance, collaboration, and emotional support. Emerging from the pandemic, we found new strength and resolve to provide the best possible care for our patients, no matter the circumstances.”

I think what Dr. Klein said bears repeating: “we found new strength and resolve to provide the best possible care for our patients, no matter the circumstances.”

We came to neurology because we embraced the unique challenges of brain disease and the desire to treat and cure them. We have continued in neurology despite the frustrating challenges inherent in our health care environment. If we indeed resolve to provide the best possible care for our patients, no matter the circumstances, we shall persevere and thrive in neurology.

 

Carlayne E. Jackson, MD, FAAN
President, AAN
cjackson@aan.com
@CarlayneJackson on Twitter