Telemedicine came into its own during the COVID-19 pandemic.
Under the CARES Act, physicians could bill the same amount for a telemedicine visit with Medicare patients as they could for an in-person visit. And many commercial healthcare insurers followed suit, relaxing restrictions for telemedicine for most patients.
This “points to the fact that now that telehealth is mainstream, it is essential that no group be left behind if at all possible,” Jonathan Weiner, a professor of health policy and management and health informatics at the Johns Hopkins Bloomberg School of Public Health, tells Fierce Healthcare. “This would include patients with disabilities that impact their use of telehealth as well as those facing technical or financial access barriers. And while telehealth rates may have decreased since the peak of the pandemic, we aren’t going back to the pre-COVID era. This mode of care is here to stay, and we must view these barriers as an important potential cause of healthcare disparities.”
However, not all demographic groups benefited from the changes. People who are visually impaired or blind face barriers to using telemedicine, as a survey conducted by the American Foundation for the Blind (AFB) discovered.
The AFB surveyed 488 adults in the U.S. who are blind, have low vision or are deafblind and found that 70% of visually impaired patients tried to use telemedicine, but 57% reported problems accessing the platforms. Visual impairment is a growing problem, as Health Affairs reported yesterday.
“Age-related macular degeneration accounts for 54 percent of all blindness among White Americans,” according to Health Affairs. “Among African Americans, cataracts and glaucoma accounted for 60 percent of blindness. Glaucoma was the most common cause among Hispanic Americans, accounting for 28.6 percent of blindness. In adults ages 40 years and older, 3.22 million people had visual impairment, while 1.02 million people were blind. These numbers are projected to double by 2050.”
The problem has not gone unnoticed by the federal government. At the end of July, the Department of Health and Human Services (HHS) issued guidelines for healthcare providers to avoid discriminating against people with disabilities when providing services via telemedicine.
“A person who is blind or has limited vision may find that the web-based platform their doctor uses for telemedicine appointments does not support screen reader software,” the HHS states.
The agency offers examples of how obstacles to providing telemedicine to visually impaired people might work in the real world. For instance, dieticians who use the web to advise patients about their diets need to check to see whether a visually impaired patient can actually see or access those recommendations.
“A sports medicine practice that uses videos to show patients how to do physical therapy exercises may need to make sure that the videos have audio descriptions for patients with visual disabilities,” HHS states. “A urologist who provides remote consultations through a video platform may need to provide a consultation by phone for a patient who requests that option due to a visual disability.”
The types of devices visually impaired people can access make a big difference. For instance, eSight is electronic eyewear that can enhance vision. Healthcare workers can facilitate the use of telemedicine by visually impaired individuals by providing guidance in pre-consultation exchanges.
“Importantly, the pre-appointment consult should address patients’ unique technology needs, troubleshoot common technology issues that could occur during the interview, and specify contact information for technical support,” Health Affairs reports. “Such consultation should incorporate appropriate formats such as braille, audio recordings, and digital formats, as needed. An organized text transcription in real time is beneficial, as it gives persons with VI an option to zoom into said text/images as they would any other document presented on their respective devices. During this process, administrative staff should engage patient companions and educate them on using the telemedicine platform.”