Telemedicine and Patient Care Access: Challenges in the Post-Roe Landscape
Telemedicine offers the potential both to bridge geographic gaps and to increase access to in-clinic appointments for pregnant patients. However, varying state laws and patient disparities continue to provide challenges for physicians.
As healthcare professionals traverse an unfamiliar legal and clinical landscape following the Supreme Court ruling in Dobbs v. Jackson, which overturned Roe v. Wade, The Doctors Company has gathered experts to present frontline clinician perspectives.
Three prominent OB/GYNs recently gathered to discuss the potential benefits and limits of telemedicine for their specialty: Sheila Dejbakhsh, MD, MPH, of Orange Coast Women’s Medical Group; Daniel Grossman, MD, Professor at the University of California, San Francisco, and Director of Advancing New Standards in Reproductive Health (ANSIRH); and Ghazaleh Moayedi, DO, MPH, of Pegasus Health Justice Center.
These experts highlighted how telehealth is currently impacting reproductive healthcare and what barriers stand in the way of its growth.
Implications of Telehealth for Access to Care
Telemedicine plays an important role in states where medication abortion has become a standard of care.
“We have a great deal of evidence about the safety and effectiveness of this model,” Dr. Grossman says. “And telemedicine can be used in those states to potentially move some patients out of the clinic, out of facilities where abortions are being performed, so that there’s more capacity to serve patients who are traveling.”
Dr. Moayedi practices in Texas—a state both large and underserved enough that even patients moving within the state often must drive hours to access OB/GYN care. In states like Texas, she explains, “telehealth certainly has the potential to help free up space in clinics.”
Beyond medication abortions, Dr. Dejbakhsh describes how telehealth offers efficient access for pre-op and post-op services for patients undergoing later-term procedures, which reduces patients’ total time away from work and family.
Despite this increased access, Dr. Moayedi says, “we have yet to see telehealth really address disparities in healthcare across the board. So we don’t have good evidence that telehealth expands care specifically for black and indigenous communities, people who are immigrants, undocumented. And so those are the most structurally oppressed groups of people that we care for, and it is not clear that these tools are actually the sources that those folks need.”
Barriers to Providing Telehealth Across State Lines
Because some states ban the use of telemedicine to prescribe medication abortions, telemedicine may not have the capacity to cross state lines as thoroughly as some had hoped.
“In Texas,” Dr. Moayedi says, “telehealth has always been banned specifically for medication abortion, even when telehealth provisions were being expanded for other aspects of COVID healthcare.”
Dr. Grossman, speaking from California, says, “A lot of people are asking whether there is a way to use telehealth to maintain access for people who are in states with bans, or to expand access. So far, it would be legally very difficult to provide telemedicine across state lines to patients in states with bans. It would be hard to maintain a license in those states.”
Implications of State Laws that Expand Abortion Access
States with abortion access are passing various kinds of shield laws to protect patients and providers against criminal liability, including Massachusetts, California, New York, Maryland, and Vermont. It is yet unknown how many total states will succeed in passing some form of shield law, or how broad those shields will be—the specific protections offered by such shield laws can vary widely. It is also unknown whether such laws will hold up to challenges in the courts.
Still, Dr. Grossman points to these shield laws as crucial for hospital systems to know about and incorporate into their plans: “It doesn’t reduce the risk to zero, but it does provide quite a few protections against civil penalties, against criminal penalties. It protects our licenses, depending on the state’s law. So it’s important that hospital systems become informed and well educated about these legal protections, and don’t just immediately say, ‘This is too risky. We’re not doing this.’”
Further, Dr. Grossman calls on healthcare systems to play a leadership role in expanding access to care: “I think there’s a role for health systems to be involved in the advocacy process to get those protections in states where they are not yet in place, but there’s a potential to get them in place, and strengthen them in states where they have been put into effect. Because we certainly know the healthcare systems can be strong advocates when it comes to issues around reimbursement and things like that. But they should also be strong advocates around this, too.”
Dr. Moayedi also called on medical professionals and healthcare systems to become patient advocates at the level of legal change: “This moment is one that calls on us to not only serve our patients in the exam room, but to serve them outside the exam room, too. It’s all of our responsibility to step up and expand care.”
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.