OIG Audit Analyzes Telehealth Use in Substance Abuse Treatment

A federal audit of substance abuse treatment programs has found that many encountered technical problems with using telehealth during the coronavirus pandemic – but they see the benefits and want to continue using it.

Conducted by the Health and Human Services Department’s Office of the Inspector General (OIG), the audit of 143 randomly selected opioid treatment programs (OTPs) found that 87 had problems using connected health platforms – but 128 of them found success using the technology to improve access to treatment.

The audit is important for two primary reasons. First, it shows that substance abuse programs are using telehealth at a time when behavioral health issues and abuse rates are skyrocketing – issues that were seen prior to the COVID-19 crisis but which the pandemic is exacerbating. Second, with the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxing some restrictions on telehealth during the crisis, the report should help the federal government decided on a long-term strategy for continuing telehealth after the pandemic.

According to the audit, almost all the OTPs surveyed used telehealth to improve access to individual and group counseling sessions and psychiatric services, and to facilitate new patient admissions. One program found that patients were more willing to take part in hour-long conversations by phone than to come to a clinic for in-person treatment.

“Our no-show rate is nonexistent because of telehealth,” one officials told OIG investigators, according to the report. “We have bus and transportation issues when weather is bad, but with telehealth it is not an issue. The verbal feedback from patients is 100-percent satisfaction.”

To facilitate connected care, the clinics used a variety of channels, including Zoom, Google Voice and BlueJeans, sometimes offering tablets to patients so they could connect with counselors, and they allowed counselors to work remotely or from home and to use their own mHealth devices. They also offered training for both patients and staff on how to use telehealth technology, and allowed staff to use telephones to check on patients and conduct diversion checks.

Almost have of the OTPs surveyed said they have had problems with federal guidelines that restrict how they use telehealth, and some said the relaxed guidelines put in place to deal with the pandemic helped to improve access to care.

Some have asked that federal regulators allow OTPs to use telehealth to replace the requirement for an in-person exam prior to prescribing buprenorphine for medication-assisted treatment (MAT) therapy – an issue for which substance abuse treatment programs and telehealth advocates have long lobbied.

“SAMHSA’s ongoing refusal to make this accommodation made new methadone patient inductions more difficult and time consuming than they needed to be, in addition to needlessly exposing our team members to a greater risk of COVID-19 infection,” one OTP told the agency.

The clinics also asked that federal regulators continue to relax requirements for using telehealth after the COVID-19 emergency, including allowing them to use the phone more often when an audio-visual telemedicine platform isn’t available or necessary.

“I have a concern that the gains that are being made in telehealth delivery are going to be taken away when things return to normal,” one clinic administrator said.

That said, many OTPs reported problems using telehealth during the pandemic, with issues ranging from unfamiliarity with the technology to a lack of resources, including broadband connectivity. And they noted that their patients often don’t know how to use telehealth themselves or don’t have access to the technology or the Internet.

Some also reported that patients aren’t always comfortable with online treatment, particularly with such sensitive topics as addiction and behavioral health.

“OTPs reported that both counselors and patients had difficulty transitioning from in-person counseling to counseling using telehealth,” the OIG audit stated. “OTPs stated that patients preferred in-person counseling over telehealth, and some refused to use telehealth. As a result, OTPs suspended some counseling sessions or were not able to be provide them. Some OTPs found that group counseling was difficult to coordinate and that it was difficult to get patients to use telehealth for group sessions. Some OTPs also reported that some patients did not respond well to receiving counseling over the phone.”

Those issues suggest the need for a flexible federal policy on telehealth that allows providers to use the technology when it’s appropriate and beneficial and to stay with in-person treatment when that course of action is more suitable.