ABSTRACT
Increasing exclusive breastfeeding rates is an established public health strategy to reduce chronic disease and protect infants from illness. The role of breastfeeding in addressing health disparities takes on new significance as the COVID-19 pandemic has disproportionately impacted some communities in Hawai'i, and those with chronic conditions face increased risk of hospitalization and death. However, there are myriad policy, systemic, and environmental barriers that make it difficult for parents to breastfeed, some of which have been exacerbated by the COVID-19 pandemic. This editorial discusses the importance of breastfeeding in reducing chronic disease, reviews the status of breastfeeding in Hawai'i, explores the challenges parents face in breastfeeding their infants, especially in the time of COVID-19, and presents opportunities for improved access to lactation care to reduce health disparities. ©Copyright 2021 by University Health Partners of Hawai‘i (UHP Hawai‘i).
ABSTRACT
Introduction: In response to the need for social distancing and infection prevention during the COVID-19 pandemic, there has been increased use of telehealth services to manage cancer and hematology patients. Throughout Marchand April of 2020, the Medicare and Medicaid programs expanded coverage of telehealth services, allowing cancerand hematology patients to receive certain telehealth services from their home during the public health emergency.We analyzed data from ASCO's PracticeNET learning network to examine the reported level-of-service fortelehealth services compared to standard in-office visits. Methods: 20 practices submitted their billing data for analysis;practices were located in 14 states and ranged insize from 2 to 29 hematologists/oncologists. We analyzed a total of 33,435 established patient evaluation andmanagement visits performed by hematologists/oncologists from March 15 to April 18, 2020. 3,062 (9.1%) visits were performed via telehealth and 30,373 were performed in a physician office or outpatient hospital department.The level-of-service of each visit was identified through the reported Current Procedure Terminology (CPT) code, where levels 1-5 correspond to CPT codes 99211-99215, respectively, and level 5 represents the highest complexityvisit. Telehealth visits were identified through use of the modifiers 95, GQ, and GT, as appended to the applicableCPT code. Results: The level-of-service distribution for telehealth-based visits was level 1 (1%), level 2 (4%), level 3 (35%), level 4 (50%), and level 5 (11%). This contrasted with in-office visits: level 1 (3%), level 2 (2%), level 3 (27%), level 4(51%), and level 5 (18%). Differences were greatest in level 3 visits (35% vs. 27%) and level 5 visits (11% vs. 18%).Differences in level-of-service persisted when exploring various disease cohorts, including patients with solidneoplasms, blood neoplasms, benign hematology disorders, and circulatory disorders. Conclusions: Analysis of established patient visits showed that telehealth visits were reported at lower level-of-service as compared to in-office visits. This finding may be related to directing straightforward visits to be performedvia telehealth or due to limitations in using telehealth by patients with complex medical problems.