Telehealth in the US for patients with end-stage kidney disease: its utilization and impact on social, economic and health outcomes.

Abstract

The use of telehealth in the United States accelerated in 2020 when a coronavirus disease of 2019 (COVID-19) related public health emergency (PHE) was declared. Centers for Medicare and Medicaid Services issued emergency waivers that relaxed restrictions imposed by regulations on geographic locations, originating and distant sites, audio-video-conferencing technology and re-imbursement. This review focuses on the history of telehealth usage for patients with end-stage kidney disease. Patients who receive home dialysis gained widespread access to telehealth in 2019, following passage of the Bipartisan Budget Act of 2018, Sec 50302 by the US Congress. For the first time in telehealth application, the patient's home could be an originating site without geographic restrictions for telemedicine. These earlier regulations will continue even after the PHE expires. While they made telemedicine possible for many patients receiving home dialysis, in practice, the uptake of telemedicine in the home setting may have been sluggish following the 2018 law. Rules governing the frequency of telemedicine visits and other stipulations for home dialysis that were specified in the 2018 law were relaxed in the setting of the COVID-19 waivers, further facilitating the use of telemedicine for home dialysis care. Meanwhile, the in-center dialysis unit became an originating site for the first time during the COVID-19 PHE, with a corresponding sharp increase in the use of telemedicine for in-center hemodialysis care. The waivers enabling the use of telemedicine for patients who receive in-center hemodialysis and further facilitating the use of telemedicine in home dialysis, expire with the end of the COVID-19 PHE unless Congress passes new legislation. Comparisons among the periods before, during and after the PHE can illustrate telehealth's impact and some of its challenges. Most of the literature on telehealth represents observational data. Future studies on telehealth, including clinical trials, could provide information on outcomes and cost savings.