Bicycle Health, a virtual provider for opioid use disorder, flew clinical staff to Alabama last week to assess approximately 300 patients in-person.
The move came as the state implemented new legislation prohibiting clinicians from prescribing controlled substances like buprenorphine via telemedicine without an in-person encounter with a patient in the prior 12 months. This was allowed in many states, including Alabama, during the COVID-19 pandemic, when Bicycle Health moved to an entirely virtual model.
“Telehealth is both a safe and effective way to deliver care for opioid use disorder,” Bicycle Health chief medical officer Brian Clear, M.D., told Fierce Healthcare. Without an in-person alternative, “that patient is out of luck. They end up in a situation of a medical emergency."
The provider was notified of the pending legislation about three months before it would go into effect July 11. Right away, it notified its patients in the state to start looking for in-person providers and leaned on its pool of social workers nationwide to focus on finding alternatives and resources. Less than a month before the deadline, only about one-fifth of Bicycle Health’s Alabama patients had transferred to in-person providers.
“80% is completely unacceptable,” Clear said of the volume of patients left without care.
Major barriers to in-person care for patients include distance, expense or long wait times. Some programs were also unwilling to accept patients who had previously been in a telemedicine program for opioid use disorder, Clear said.
The state had among the highest rates of increase in opioid overdoses in 2020, according to official figures. It also suffers from a major access gap to care, more so than other states, according to Clear. There was little opportunity to offer input on the new rule during the state’s legislative process, he added.
In a last-ditch effort to help its patients, Bicycle Health flew clinical staff, including two physicians licensed in the state but working remotely, to Birmingham last week in an operation coined Alabama Airdrop. The physicians conducted in-person sessions at a hotel conference room with nearly 300 patients over the course of six days.
Since those patients have now been seen in person, they qualify for one more year of telemedicine treatment for opioid use disorder with the provider under the law. But, the company cautions, this is a short-term solution. If their providers get sick or go on vacation, that leaves dozens of patients in a potentially unpredictable situation.
“Even our workaround has limitations that are very concerning,” Clear said.
The company intends to work with nonprofit Aletheia House, which supported the Alabama Airdrop operation, to work out a longer-term patient transition plan for those in the state.
“As a longtime provider of substance abuse treatment in Alabama, we see the firsthand impacts of opioid addiction and the challenges that access to treatment creates for patients in recovery,” Gloria Howard, COO of Aletheia House, said in a press release. “Bicycle Health’s Alabama Airdrop will prevent the discontinuation of care for hundreds of patients and continue to support their journey toward recovery.”
Bicycle Health argues its telemedicine model enables greater face-time with patients and higher retention rates compared to in-person care. Low overhead costs also enable it to offer affordable rates, it claims, with a subscription rate of $199 a month for uninsured patients.
Regarding supporting telehealth, “if certain states choose to ignore the evidence and move in the wrong direction,” Clear said, “tragically it forces us out.”
Bicycle Health is no longer accepting new patients in Alabama.