Top of Page Agenda Kick-off, Welcome, Intros Opening Remarks Equity Gaps AI + Digital Innovation Medicare Telehealth HCA/Turquoise Care Closing Remarks Innovating Remote Access 2 Innovating Remote Access to Care A New Mexico Telehealth Alliance, Southwest Telehealth Resource Center, & HealthInno NM Collaboration 2024 Q4 Education & Networking Special Event: Date: Thursday, October 17th, 2024 Time: 2:00 - 7:30pm MST Place: Indian Pueblo Cultural Center & Zoom Cost: Complimentary! Agenda INNOVATING REMOTE ACCESS TO CARE A special extended event starting with educational presentations from national and regional experts, followed by Table Talks for networking and small-group discussions, and ending with an open mic session for in-person attendees to introduce themselves and their work, and to announce upcoming events, accomplishments, and collaborative opportunities. The recorded educational presentations linked below focus on trends and updates in remote care delivery, telehealth adoption, regulation, and local efforts to expand innovative approaches to remote access to health care. AGENDA Kick-off, Welcome, Event Partner Introductions Opening Remarks Bridging Health Equity Gaps / Disparities AI + Digital Innovation Medicare Telehealth HCA/Turquoise Care Vision & Strategies Closing, State Legislature Remarks PRESENTATION RECORDINGS, SLIDE DECKS, & SUMMARIES: Kick-off with Event Welcome + Introducing Partner Stefany Goradia, MEIE ( LinkedIn ) Head of Impact + Community, HealthTech Rx Stetson Berg, MPH ( LinkedIn ) Board Chair, New Mexico Telehealth Alliance Alex Carter, PA-C ( LinkedIn ) Board Vice Chair, New Mexico Telehealth Alliance Video Key Points & Highlights Stefany Goradia: Overview of HealthTech RX's mission and event goals Networking and Participation: In person attendees encouraged to network and rotate through 4 Table Talks on diverse healthcare topics. No scheduled breaks; food served and cash bar served opens at 5 PM. Focus Areas: Enhancing care delivery for rural and underserved communities. Exploring partnerships and innovation in digital health solutions. Event Structure: First Half: Educational presentations by local/national experts on trends and regulations (2–5 PM). Second Half: Interactive Table Talks focusing on specific topics (5–7:30 PM). HealthTech RX Role: Functions as innovation hub and convenes stakeholders for collaborative problem-solving. Organizes quarterly events, innovation challenges, hackathons, and pilot programs to address unique healthcare challenges. Event Overview: Q4 HealthInno NM event by HealthTech RX, focusing on healthcare innovation in New Mexico. Aims to bring together healthcare leaders, technologists, policymakers, and stakeholders to improve health equity and economic development. Theme: "Rethinking Remote Care," emphasizing telehealth and tech-enabled care models for underserved communities. Stetson Berg: Telemedicine advancements and local/national scale innovation Alex Carter: Personal and professional insights on telehealth Opening Remarks Elizabeth Krupinski, PhD ( LinkedIn ) Professor & Vice-Chair for Research, Dept. of Radiology & Imaging Sciences, Emory University Associate Director of Evaluation, Arizona Telemedicine Program Director, Southwest Telehealth Resource Center Video Key Points & Highlights Southwest Telehealth Resource Center: Focuses on promoting and supporting telehealth in Four Corners region and Nevada. Aims to expand, start, or improve telehealth programs through training, grant support, and resource sharing. Mission and Goals: Enhance patient care and accessibility using telehealth. Overcome challenges and advocate for telehealth adoption as a standard care tool. Historical Collaboration: Participated in Four Corners Telehealth Consortium, connecting states in the region. Involved in telehealth and digital health initiatives since the mid-1990s, including partnerships in New Mexico. Future of Telehealth: Envisions telehealth as a standard tool for quality care rather than a distinct service. Strives for seamless integration of telemedicine and digital health in healthcare practices. Event Contribution: Supporting educational talks and roundtables to share knowledge and resources. Encourages attendees to adopt telemedicine and digital health practices to improve care delivery. Telehealth: Bridging Health Equity Gaps or Widening Disparities? Michael Holcomb, BS-MIS ( LinkedIn ) Associate Director for Information Technology, Arizona Telemedicine Program Interim Director, Southwest Telehealth Resource Center Carrie Foote, BS, BA ( LinkedIn ) Program Administrator, Southwest Telehealth Resource Center Video Key Points & Highlights Modalities: Synchronous care Asynchronous care Mobile health Remote patient monitoring Requirements: Service availability Broadband internet connection Patient/caregiver Literacy Telehealth compatible technology Patient assistance/accommodations Funding Sources Patient consent Privacy and HIPAA Benefits: Promotes equity by addressing barriers to healthcare access Dismantles geographic constraints Eliminates transportation obstacles Promotes ongoing care for chronic conditions/improves chronic disease management Provides access to specialists Increases access for underserved populations Addresses healthcare professional shortages and healthcare deserts Challenges: Digital divide Language/cultural barriers Digital and health literacy Differential adoption rates Technology comfort level Lack of private space Lack of accommodation for disabilities Telehealth as sole access point Economic barriers Policy barriers Lack of continuity of care Rates of use: High: 73% - young adults 18-24 69% - earn $100k/year 66% - private insurance 62% - white Low: 38% - no high school diploma 44% - older adults >65 51% - Latino and Asian 54% - black Disproportionally impacted by digital divide: Elderly Racial/ethnic minorities Disabled Low-income Rural Limited English proficiency Inherent biases in some technologies Solutions for equitable access: Provider education Assessing patient readiness Infrastructure expansion (broadband) Digital health literacy Telehealth access points Telehealth in libraries Partnerships and leadership Evidence-based solutions AI + Digital Innovation in Healthcare Elizabeth Krupinski, PhD (LinkedIn ) Professor & Vice-Chair, Research Dept. of Radiology & Imaging Sciences, Emory University Associate Director of Evaluation, Arizona Telemedicine Program Director, Southwest Telehealth Resource Center Video Key Points & Highlights Background: Expert in medical imaging, AI, and human-computer interaction Leadership roles in telemedicine and imaging societies AI in Healthcare: AI is transforming healthcare through predictive analytics, ambient clinical intelligence, and wearable technology. 64% of U.S. hospital systems already use AI, primarily for sepsis prediction, reducing hospital readmissions, and improving efficiency. Key AI Applications: Predictive Models: Identifying risks like sepsis and patient decompensation. Ambient Clinical Intelligence: Automatically documenting clinical interactions to save time and improve patient-provider communication. Wearables: Devices like sensors in clothing and rings to monitor health metrics and predict adverse events. Embodied AI: Robotics for tasks like patient transport, medication delivery, and remote communication. Challenges in AI Adoption: Bias: AI often reflects biases in training datasets, leading to inaccuracies in diverse populations. Transparency: Many AI tools lack the ability to explain their decisions, hindering clinical trust and utility. Regulation: Limited FDA oversight of AI tools creates potential risks in their clinical use. Data Quality: Poor data and limited external validation can reduce AI effectiveness. Deskilling: Over-reliance on AI could hinder skill development in healthcare professionals. Ethical and Practical Considerations: Addressing privacy concerns in ambient listening technologies. Balancing the use of AI with human judgment to prevent cognitive biases and over-reliance. Developing explainable AI to enhance clinical decision-making. Future Potential: AI-enabled tools for automating repetitive tasks, improving workflows, and enhancing diagnostics. Integration of advanced biometrics to detect conditions like depression, anxiety, or autism using subtle cues like voice or eye movement. Opportunities to improve healthcare equity by addressing systemic biases in healthcare algorithms. Medicare Telehealth: How to Plan Patient Care During Uncertainty Carol Yarbrough, MBA-TM (LinkedIn ) Business Operations Manager, Telehealth Resource Center, UCSF Medical Center Video Key Points & Highlights Background: Specialization in healthcare compliance, reimbursement, and telehealth policy. Offers guidance on billing, coding, and regulatory compliance for telehealth services. Medicare Telehealth Evolution: Telehealth policy began with Social Security Act (2001), limiting originating sites and eligible providers. During the COVID-19 public health emergency, telehealth services were expanded significantly. Policy Changes and Uncertainty: Public health emergency waivers allowing broad telehealth access are set to expire. Congress and CMS are deliberating future policies, with potential extensions being debated. DEA policies on telehealth prescriptions, especially controlled substances, remain unresolved. Current Telehealth Codes: Medicare supports 268 telehealth CPT codes; some are provisional and may be removed. Behavioral health services retain strong telehealth support, including Audio-Only services (with limitations). Indigenous Health Telehealth Initiative: New federal funding supports telehealth access for indigenous communities in pilot states (e.g., California, Oregon, New Mexico). Practice Management Insights: Clinics should prepare for potential policy changes by documenting telehealth utilization and exploring asynchronous care options. Consider workflow optimizations to balance telehealth and in-person care. Legislative Advocacy: Stakeholders are encouraged to engage with legislators to support permanent telehealth policies. Advocacy is particularly crucial for urban areas where telehealth services might be curtailed. Future Outlook: CMS might provide short-term extensions while working on long-term solutions. New opportunities include caregiver training via telehealth and innovative uses for asynchronous care. HCA/Turquoise Care Vision + Strategies for Expanding Remote/Access to Care Alexandria Castillo Smith, MPH, MSW ( LinkedIn ) Deputy Cabinet Secretary, NM Healthcare Authority Video Key Points & Highlights Overview of Turquoise Care (TC) Goals Goal 1 – Build a NM healthcare delivery system that is accessible for both preventive and emergency care that supports the whole person (PH, BH, SDOH). Goal 2 – Strengthen the NM healthcare delivery system through expansions and implementation of innovative payment reforms and VBC initiatives. Goal 3 – Identify groups that have been historically and intentionally disenfranchised and address health disparities through strategic program changes to enable an equitable chance at living healthy lives. TC Health Plans Blue Cross Blue Shield of NM Molina Healthcare Presbyterian Turquoise Care United Healthcare Community Plan New TC Benefits New Home Visiting Program for New Mothers Reimbursement for Community Health Workers Chiropractic Services Continuous coverage for children up to age 6 Changes to Telemedicine During Covid-19 Promoted access to video and phone telehealth services Expanded proportion of members in rural and urban areas that were able to access care HCA Approach to Telemedicine: TC Contract Requirements Quarterly Telemedicine Report to HCA from MCOs Audiovisual asynchronous, remote monitoring Training for providers of appropriate services for telemedicine Targets set to increase telemedicine usage by 20% or be penalized. NM Medicaid Telemedicine Services Telemedicine Must include audio and visual Be delivered real-time a the originating and distant site No restrictions on services that can be offered via telehealth If provider resides outside of NM they must be licensed in NM Telephone Able to reimburse for all telephonic visits covered during the Public Health Emergency After 12/31/2024 will follow the codes that are permitted by Medicare, primarily BH codes. Project ECHO Have hubs of virtual learning opportunities on a wide variety of topics for providers MCOs support Project ECHO and encourage utilization Collaborates with Indian Health Services Have a unique relationship with Medicaid Program MCOs identify members who would benefit from Project ECHO MCO Support for Advancing Telemedicine Providing access to high-speed internet for rural communities Bring in new providers that focus on telehealth services and specialties Scholarships to health professionals Grants to physician practices to keep providers in NM Tribal Communities’ Health Care Priorities Native American Technical Advisory Committee – 13 Tribes represented Goals include: Increase BH services for Native Americans Increase Medicaid reimbursable provider types and services for HIS and Tribal clinics Increase the number of long-term care options Increase NA enrollment in Medicaid Rebuilding Behavioral Health in NM Received CMS federal approval to begin to provide Medicaid coverage to those exiting incarceration up to 90-before release Raising BH Medicaid reimbursement rates up to 150% of Medicare rates 6 Certified Community BH Clinics (CCBHCs) slated to launch in 2025 Support for pregnant members with Substance Use Disorder Added 5 new BH Practices for enhanced rates, encouraging more providers to expand their services Rural Health Care Delivery Fund $80 Million in funding available to rural health care providers Expansion and delivery of new services in rural communities, including telehealth services NM Telehealth Alliance, NM State Telehealth Law, and Closing Remarks Stetson Berg, MHA ( LinkedIn ) Board Chair, New Mexico Telehealth Alliance Video Key Points & Highlights New Mexico Telehealth Alliance (NMTA): Established in late 1990s to advocate for and advance telehealth in New Mexico. Focuses on policy, legislation, and connecting stakeholders to solve telehealth challenges. Telehealth Law in New Mexico: Among the most progressive in the U.S., enabling telehealth billing parity for audio, video, asynchronous, and remote patient monitoring services. State law allows billing for phone visits, as clarified in 2022 "audio only" update. Applies to fully insured health plans under NM Office of Insurance and specific public health plans, but not Medicaid, Medicare, or self-insured plans. Legislation and Advocacy: NMTHA worked with legislators to craft state-friendly telemedicine policies before the pandemic. Advocating for expanded reimbursement models to ensure telemedicine services are financially sustainable for providers and facilities. Resources and Collaboration: Offers webinars, online resources, and direct problem-solving for billing, policy issues, and other telehealth barriers. Collaborates with federally funded organizations like Southwest Telehealth Resource Center for expertise and solutions. Reimbursement Challenges: Payment parity exists but often doesn't cover operational costs for telehealth services, especially in rural settings (e.g., f inancial strain on providers/facilities delivering telemedicine with insufficient reimbursement). Interstate Practice Issues: Licensure laws vary by state, complicating cross-border care for established patients. Efforts to create interstate compacts for streamlined licensure are ongoing but involve significant paperwork and limitations. Call for Feedback and Participation: NMTHA encourages stakeholders to share telehealth challenges and ideas to inform future legislative and operational improvements. Slides: Equity Slides: AI Slides: Medicare Kick-off, Welcome, Intros Equity Gaps Opening Remarks AI + Digital Innovation Medicare Telehealth HCA/Turquoise Care Slides: HCA Closing Remarks Slides: NMTHA

Report: Telehealth Programs Increase Workload for Nurses and Support Staff Katie Adams December 20, 2022 Many providers think their telehealth program increases the workload for nurses and support staff, according to a recent report. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators. Telehealth isn’t as widely utilized as it was at the dawn of the pandemic, but the care modality is definitely here to stay. However, many providers believe their telehealth program increases the workload for nurses and support staff, according to a recent report from research firm Sage Growth Partners. Providers also said they don’t think physicians enjoy using telehealth visits to treat patients. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators, the report said. In September, Sage Growth Partners surveyed 95 health system executives and 75 leaders of physician practices. Practices with fewer than five physicians were excluded from the survey. Most respondents said that their organizations will focus on optimizing and sustaining their current telehealth programs in 2023 rather than expanding them. In fact, only about 10% of participants — 11% of hospitals and 8% of practices — said they are looking to grow their telehealth offerings next year. Health system executives were more likely than practice leaders to say that telehealth visits should make up a higher percentage of their ideal in-person-to-telehealth visit mix. Health system leaders said the mix should be 30% telehealth and 70% office. Among practice leaders, the ideal mix looks more like 20% and 80%. Their difference of opinion also extended to another question on how they think telehealth utilization will grow by visit type over the next two years. Health system leaders said that utilization will fall slightly for most visit types — even behavioral health. They said that 36% of behavioral health visits were delivered via telehealth in September, but they expect this to fall to 33% in September 2024. Urgent care and telepathology were the two visit types for which health systems leaders predicted telehealth growth — they expect telehealth utilization to increase from 3% to 7% for urgent care and from 2% to 4% for telepathology. Practice leaders expected telehealth utilization to increase slightly or remain the same for most visit types. Specialty care was the only exception — for this visit type, practice leaders predicted utilization to fall from 23% to 20% over the next two years. Both groups agreed that telehealth actually increases burden on staff though practice leaders seem to feel it more acutely. More than half of practice leaders said telehealth has increased support staff’s workload, and 28% said it generates more work for nurses. Among health system executives, 35% said telehealth increased support staff’s workload, and 30% said it creates more work for nurses. Additionally, less than half of total respondents (46% of hospitals and 47% of practices) agreed that telehealth increases physician satisfaction and physicians like using telehealth visits to treat patients. A key reason for this is that many providers are operating their telehealth programs using inefficient workflows, according to the report. Nearly 60% of survey respondents said they have not yet created new workflows for telehealth visits. Instead, hospitals and physician practices are still relying on workflows that mirror in-person visits. In 2023, providers will need to improve these workflows, and many will consider bringing on the help of third-party telehealth administrators, such as Amwell or Caregility, the report said. Hospitals are more than twice as likely to use third-party partners to administer telehealth services — with 20% of hospitals doing this compared to 9% of practices. Hospitals were also more likely to say they would change their telehealth administering party over the next two years — with 44% of hospitals saying this compared to 25% of practices. Photo: Anastasia Usenko, Getty Images See original article: https://medcitynews.com/2022/12/report-telehealth-programs-increase-workload-for-nurses-and-support-staff/ < Previous News Next News >

Making Telemedicine Feasible for Everyone – Especially Those With Physical Challenges Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 In the context of healthcare, nondiscrimination on the basis of disability means equal access to available health care services, whether those services are provided in-person or via telehealth. Telemedicine has for years been touted as providing access to healthcare for everyone, anywhere, anytime and it has been quite successful in doing so in many respects but disparities still exist among a number of patient populations. In particular, those who traditionally have challenges accessing healthcare due to physical challenges often experience similar or even greater challenges with telemedicine. Think about for a minute. Telemedicine is predominantly provided using audio and/or video-based telecommunications technologies. This fundamental fact of how telemedicine visits occur can actually exacerbate digital disparities. According to the Americans with Disabilities Act (ADA), an individual with a disability is defined as: 1. a person who has a physical or mental impairment that substantially limits one or more major activities; or 2. a person who has a history or record of such an impairment; or 3. a person who is perceived by others as having such an impairment Under Section 504 of the 1973 Rehabilitation Act, no qualified individual with a disability shall, by reason of his or her disability, be excluded from the participation in, denied the benefits of, or subjected to discrimination under any services, programs, or activities of the covered entity (e.g., healthcare providers). In the context of healthcare, nondiscrimination on the basis of disability means equal access to available health care services, whether those services are provided in-person or via telehealth. Some basic facts highlight the problem. About 15% of American adults (37.5 million) over 18 report some trouble hearing, 2 to 3 per 1,000 US children are born with detectable hearing loss in one or both ears and overall 1 in 8 people (13%) 12 years or older has hearing loss in both ears. Interestingly, non-Hispanic white adults are more likely than other racial/ethnic groups to have hearing loss and non-Hispanic black adults have the lowest prevalence among adults aged 20-69. Rates increase with age. The statistics for vision impairments are equally high. About 12 million people over 40 years have a vision impairment, with 1 million who are blind and 6.8% of children younger than 18 have a diagnosed eye and vision condition. The annual economic impact of major vision problems for those over 40 is over $145 billion! For blindness, access to healthcare is especially critical as 90% of blindness caused by diabetes is preventable and early detection and treatment of conditions such as diabetic retinopathy is efficacious and cost effective. So what can we do in the telemedicine community to help ameliorate these disparities? The National Consortium of Telehealth Resource Centers has developed a fact sheet to help providers. Some of the key recommendations are actually fairly easy to carry out. Inventory products, services, and factors required to provide effective telehealth services to patients and ensure they meet basic accessibility requirements for people with disabilities. Consider compatibility of assistive technology (e.g., alternative keyboards) and whether they can work effectively with your chosen telehealth modality. Learn about and incorporate accessibility features (e.g., close-captioning) of software programs you use. Be sure to include the patient’s caregiver, family member, or home health aide during telehealth visits. Increase your knowledge and awareness on cultural competency and linguistic sensitivity. The easiest thing to do ask patients with disabilities about their accessibility requirements! Some additional aids to consider may take a little more effort but are worth it. For those with hearing loss consider: qualified sign language interpreter, qualified cued-speech interpreter, qualified tactile interpreter, real-time captioning or communication access real-time translation (CART), video remote interpreting (VRI), use written materials, ensure the patient has access to headphones or a headset, confirm participants are wearing their hearing aids or amplification device, and use video whenever possible to allow lip reading and provide visual clues like gestures. For those with vision loss consider: a qualified reader, information in large print, Braille, or electronically for use with a computer screen-reading program, have an audio recording of printed information, be aware of your background - there needs to be contrast between you and your background and blurring the background may make it challenging for the patient, ensure lighting is bright enough for patients to clearly see your face, use simplified and enlarged text, ensure patients have a computer-screen reading program for transmission of electronic information and try providing an audio recording of printed information provided during the appointment. Additional ideas and tips can be found on the Health & Human Services (HHS) website There is also good news in terms of funding. The Federal Communications Commission (FCC) recently announced that under the National Deaf-Blind Equipment Distribution Program (NDBEDP), also called “iCanConnect,” may provide up to $10 million annually from the interstate telecommunications relay service fund (TRS Fund) to support local programs that distribute equipment to eligible low-income individuals who are deafblind to access telecommunications service, Internet access service, and advanced communications services. This is clearly a boon for telemedicine applications. The announcement includes a state-by-state list of the initial allocations for the 56 covered jurisdictions. Hearing and vision loss are just two common challenges deal with. Other physical, mental and behavioral challenges are very common as well, and many of the tips above can be adapted to these patients as well, especially simply reaching out and asking them what their needs are and how you can help meet them as well as involving the patient’s caregiver, family member, or home health aide during telehealth visits. Basically telemedicine must be available to any patient and programs should make it a priority to develop strategies and tools to empower all patients no matter what their resources and capabilities to access safe, effective and efficient care. < Previous News Next News >