Jean Elwing, MD phaware® interview 554

Telehealth Is Ending: What That Means for PH Patients

Telehealth use surged during COVID, but what happens next? Dr. Jean Elwing discusses the rapid expansion of telemedicine in pulmonary hypertension, the upcoming expiration of COVID-era telehealth funding in 2026, and why licensure and reimbursement policies could dramatically affect patient care. This episode highlights what's at stake for rare disease patients and why advocacy and awareness are essential to sustaining virtual care options.

My name is Dr. Jean Elwing, and I’m a Professor of Medicine and the Director of the Pulmonary Hypertension Program at the University of Cincinnati. Today, we’re going to talk about telehealth. So, what is telehealth? It’s a broad term, and it includes telemedicine. It’s the application of patient care remotely. Telemedicine is a delivery of clinical care. It can include assessments, medication management, and reevaluations. I think most people think of that virtual visit when they think of telemedicine, but telemedicine really encompasses many, many things, and things that we use every day in the modern era of medicine. 
 
There’s synchronous telehealth. That’s telemedicine where we’re talking to a patient real time, by telephone or by video. Then, there’s asynchronous That’s the stuff that people don’t realize is part of this telemedicine care. That’s like your MyChart messages, or a patient sending an image, or their rhythm on their monitor. That’s something that we use all the time, but don’t really appreciate that we’re doing electronic care.
 
In addition to this conversation, either synchronous or asynchronous that we’re having with the patient, we can also use a lot of different devices that aid in this. We can use monitors that tell us about heart rhythm, we can use scales that tell us about weight, blood pressure cuffs, even implantable things, like loop recorders or CardioMEMS that will tell us about pressures and things that are a little bit more complicated, and need somebody specialized to monitor. 
 
So, how many people are using it? It’s pretty universal. If you look at a survey from 2022 from CDC, 30% of all US adults had some encounter using telemedicine in that past 12 months. The AMA did a survey, and about 50% of physicians used telemedicine visits during that time. 
 
When they look really closely at pulmonary and pulmonary arterial hypertension, we learned a little bit more. For pulmonary clinics, about a quarter of their visits were telemedicine in 2024. That’s a lot. In terms of primary care, if you go back a few years, 2019, about 20%, and then fast-forward to 2023, about a third. So, this is something we are using all the time. Those are the visits. 
 
We use the asynchronous MyChart messages and communication every day, multiple times, with many patients. In pulmonary hypertension specifically, we have learned how to use this to take care of our patients to expand our reach. Recently in 2024, we did a Delphi, with 11 physicians and six APPs to understand what the consensus was about telehealth in pulmonary arterial hypertension. Our definition of telehealth through the Delphi was very similar to what I mentioned earlier. Telehealth is the use of virtual or remote methodologies to interact with, monitor, assess, and deliver healthcare. So, really encompassing so many aspects of our day-to-day interactions with patients.
 
As a group, we felt that telehealth could effectively be used for return visits, diagnostic test follow-up, and medication management. It offers convenience, enables additional visits, and increases patients’ access to specialized care that they need. In the Delphi, you try to find ideas and concepts that everyone has consensus on, and we felt as a group, we had consensus that there was benefits of telehealth in pulmonary arterial hypertension patients to enable additional visits, to improve access to care, increase convenience, to improve health equity and time efficiency. 
 
But we did recognize this is not easy. We need reimbursement so patients’ visits can be covered. We need connectivity, broadband, devices to make it happen. One thing we’ve thought about that really hadn’t been discussed before is we want to be able to include all of our patients, even our patients that need translators. That’s one thing that’s missing for most of us in our remote visits is a remote person, or device to help us with translation.
 
The other thing we know is a challenge is reimbursement. Telehealth really took off at the beginning of COVID, but the funding for this is set to end soon. This is something that’s very concerning, because I just told you how much we’re using it and how much it’s helping us access more patients and help us care for those patients we’re already seeing in our clinic face-to-face. But as of January 30th, 2026, the funding for COVID era telehealth is set to end. Now, this could be reconsidered, so we really have to be on the watch for this, to understand if we’re going to be able to continue to deliver those virtual visits. That’s something that’s very concerning that we may have to modify how we’re using our remote interactions with patients, but I’m hopeful that this will be reconsidered. 
 
The other thing we faced after COVID was that we needed to have licensure in all the states we were seeing patients in. If I was in one state and I needed to follow up with a patient in the next state over, I could only do that now if I have a license in that state. In order to address those needs after COVID, they implemented several things for us to be able to access more states, more patients, and provide more care. Some states have interstate compacts, so I could apply for a license and that would cover several states in my region, but you do have to do an application, and you have to pay the fees that are necessary, and then keep that up over time so you could continue to see those patients. Some states have reciprocity, and some states endorse other states in terms of their ability to get licensure in those locations, so that’s something you need to look up and find out where your state has any relationships with another state.
 
Some states allow you to have licenses just to do telehealth, but that does not allow you to do any in person visits. Then in some states, they allow you exceptions for travel or emergencies, so you really have to say, my patient is going to visit someone in state X, I want to see if I can see them virtually because they’re having an emergency with their pulmonary hypertension medications. 
 
So, how do we really make this happen? I told you all the complexities. Well, you have a patient who needs extra care, and they’re in a location where it might be difficult for them to come and see you in person. So, you want to see them virtually. You want to know where they’re at. If you have licensure and if you have the ability to see them because they have adequate resources, broadband, some kind of device that they can see you virtually.
 
Then, once you start that visit, you need to check, where are you at? What’s your location? To verify that that is a location that you can see somebody, based on your license, and then of course your insurance coverage. Once that’s in play, then of course you can talk to them and see them very similarly that you can in a face-to-face visit. Over the last several years, we’ve done several different surveys and publications on how we can use telemedicine in pulmonary hypertension. There’s two that I want to bring your attention to. One that was published by Dr. Christine Zhou, and she was working with us in the CHEST Pulmonary Vascular Network. We sent a survey out to pulmonary hypertension providers and we found out how we are using telemedicine. We found out that during COVID, it expanded to just a little bit of use of telemedicine to more than 80% of us using telehealth.
 
After COVID came to an end, there was question, are we going to use this anymore? How are we going to implement it? Based on that survey, we learned most people had planned to continue to use it for low risk patients that need follow-up for medications, or patients that need that added check-in to keep them healthy. We also did that Delphi I mentioned earlier, and that taught us, we had consensus that this was an option for our lower risk patients and those that need extra check-ins and follow-ups on test results, and that we did see benefit, but we saw those challenges we discussed, coverage, broadband, all of those things. 
 
Just to bring it to a close, I think we can say telehealth is used every day in pulmonary hypertension. Telemedicine is used by a lot of us at this point to reach more patients, and it can enhance our care in a hybrid model. We see patients face-to-face and we compliment that with telehealth. But there’s gaps. I can’t tell you for sure we’re changing outcomes, we think we are, we think by that extra interaction, we’re improving our patient care, but we need to study that actually. This really has a role in helping advance what we started face-to-face, and make sure it happens for our patients in an efficient, timely manner. I think we can bring it all together and say, this is a resource we would love to continue using as long as our patients have access to the tools they need to compliment what we do in that face-to-face visit in clinic. 
 
Thank you for joining, this is Jean Elwing, and I’m aware that my patients are rare.

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