Legislation Legislation New Mexico Legislation S.B. 93 - Broadband Access and Expansion Act H.B. 141 - ED Infrastructure Technology Definition S.B. 24 - Parity of Regulation of Telecommunication Federal Telehealth Legislatio n H.R. 7992 - Telehealth Act (2019-2020) H.R.3228 - VA Mission Telehealth Clarification Act (2019-2020) H.R.4900 - Telehealth Across State Lines Act (2019) H.R.5473 - EASE Behavioral Health Services Act (2019-2020) H.R.7233 - Knowing the Efficiency and Efficacy of Permanent Telehealth Options Act (2020) H.R.7338 - Advancing Telehealth Beyond COVID–19 Act (2020) S.2408 - Telehealth Across State Lines Act (2019) S.3988 - Enhancing Preparedness through Telehealth Act (2019-2020) S.4039 - TELEHEALTH HSA Act (2020) S.4216 - KEEP Telehealth Options Act (2020) Federal Broadband Legislation H .R.205 - To accelerate rural broadband deployment. H.R.4229 - Broadband Deployment Accuracy and Technological Availability Act S.4021 - Accelerating Broadband Connectivity Act of 2020

NM Telehealth Workgroup Hosted by the New Mexico Telehealth Alliance 7/29/2021 New Community Forum for NM Healthcare Peers on Telehealth Topics This is a monthly community forum to discuss telehealth issues with your healthcare peers. The intent is to help New Mexican systems advance remote care. Topics will change monthly and be directed by what the group members ask for. Hosted by the New Mexico Telehealth Alliance, our first session on July 29 is a collaboration with Presbyterian Healthcare Services and the University of New Mexico. We will explore audio only post-pandemic billing using HCPCS code G2252. Register here: https://www.eventbrite.com/e/nm-telehealth-community-forum-registration-163947169397 < Previous News Next News >

A New Model For Healthcare: Adding Telehealth To Unclog Patient Flow ‘Hot Spots’ Dr. Corey Scurlock MD, MBA June 8, 2022 It may not match the scale of the exodus of nurses from the healthcare workforce, but a growing shortage of physicians is no less of a threat to patient care. A recent survey found that one in five doctors plan on leaving the profession in the next two years, hastening a projected shortfall of as many as 124,000 doctors by 2034. This has reached such a concerning level that the U.S. Department of Health and Human Services and U.S. Surgeon General Dr. Vivek Murthy have launched a strategic advisory to mitigate clinical burnout. More Information: https://www.forbes.com/sites/forbesbusinesscouncil/2022/06/08/a-new-model-for-healthcare-adding-telehealth-to-unclog-patient-flow-hot-spots/?sh=248c6d415725 Covid-19 and longstanding concerns about changes in the business of healthcare have left many physicians burned out. Older doctors are seeking early retirement, and younger doctors seek a more balanced work/life ratio. Many aren’t interested in some of the all-consuming specialties such as critical care, neurology, oncology and psychiatry. As with everything else in our world right now, supply is not meeting demand. Action is required, but it can’t just rely on yesterday’s solutions. Opening up more slots in medical schools won’t fill the immediate need for experienced, board-certified physicians. Buying up physician practices is largely played out, as most doctors are already employed. I would argue that we can’t wait for a new MD pipeline to open up. Instead, we need to fix the broken practice of medicine. Doctors are burned out because they are locked into 15-minute appointment cycles wrapped around the exigencies of electronic health records systems that demand complete documentation of each step, leaving little time for the “How are you, Ms. Jones?” moments. Patients are unhappy with eight-month waits for new patient appointments to confirm diagnoses of serious diseases. Within the hospital, a lack of staff and available expertise meets up with broken processes to choke off patient flow from the emergency department to laboratories to medical floors. Staff personnel stand around waiting for paperwork. Patients wait on gurneys for everything. By the time things are straightened out, the original order might no longer be appropriate for a patient. Discharge alone has become a major headache. One antidote to this is to create a hybrid model of care as I have done with my company and as my business helps other companies do. It relies on points in the care process being actively managed remotely by specialist physicians who also have a background in telehealth. These veterans should understand where timely intervention can unblock patient flow at “hot spots” in a patient’s journey caused by delays in care, inappropriate care transitions or potential patient harm. Telehealth-enabled monitoring can reduce transfers by accurately assessing patient acuity and overseeing the work of less-experienced hospital staff. Through these interactions, the goal is to see reduced patient readmissions and ED visits, shorter hospital stays and better utilization of resources. Of course, all of this begs the question: If the hospital can’t find enough specialists, how can virtual care physicians fill these roles? The answer is pretty simple, in my opinion. You bring back the joy of being a doctor. These telehealth doctors work from home, linked to pods of multi-specialists who work with the same hospitals, getting to know the staff. They can work when they like and as much as they like. They access the medical record but are called upon to solve problems, full stop. You can also make sure their work is always varied. Doctors want to heal, not master the intricacies of Epic’s latest software. With the tailwind of favorable policy and reimbursement the telehealth industry is experiencing right now, it might be an opportune time to consider this type of strategy. But as one explores telehealth as a business venture, it's important to recognize that all such business is still highly regulated, as it is in the field of care delivery. The core components of an end-to-end telehealth solution include people, process and technology. Here are some thoughts on each. • Technology: Audio-video providers have matured significantly, and increasing interoperability has enabled new entrants. Health systems have sought to standardize enterprise platforms versus best-of-breed applications. Clinical analytics tools can be overlaid on the EMR leading to simpler clinical insight gathering. While not mandatory, such systems target quality or performance metrics to support ROI. • Process: Efforts to virtualize care can be disruptive to care delivery. Consider what technology platforms to purchase, KPIs to measure and clinical workflow to create. • People: Delivering telehealth-enabled care will place the highest regulatory burden on an organization. Malpractice, state licensing and credentialing, and HIPAA, to name a few, are considerations that need to be tackled first. Secondly, your attention to provider experience is paramount to ensure a healthy and sustainable workforce to attract talent. As Covid-19 wanes, we are facing unprecedented change in the provisioning of care. New care models will emerge. Telehealth is not the only solution, but it is clear that it will be a primary one. A recent survey (registration required) of health system CEOs by the University of Colorado’s Health Administration Research Consortium put virtual care as the No. 1 strategy for future growth. For those looking for solutions to today’s healthcare challenges, here are three points to remember: • Telehealth is here to stay: It could be the great equalizer for care access and equity. • Patient flow is key: By focusing on the patient journey across the continuum, hot spots can be identified and targeted. • Clinical and operational alignment are needed: People, processes and technology can combine as a force multiplier to return greater value, but only if everyone has agreed on a care road map. As telehealth goes, we are not battling efficacy anymore; we are battling inaction and the cost such inaction creates. I believe unlocking the potential of all our nation's providers can deliver better care everywhere. It's time to imagine what the design of the next-generation, digitally-enabled clinical workforce looks like, and it's all about access and equity in care delivery. < Previous News Next News >

2022 Proposed Physician Fee Schedule Center for Connected Health Policy July 2021 ...I want my MTV (Mental Telehealth Visits)! On July 13, 2021, the Center for Medicare and Medicaid Services (CMS) released their proposed CY 2022 Physician Fee Schedule (PFS). The PFS is historically where CMS will make administrative changes to telehealth policy in the Medicare program. As the pandemic begins to stabilize and restrictions begin to lift, there has been great concern as to what will happen with the temporary telehealth changes on the federal level. The CY 2022 proposed PFS is one step towards addressing those questions. Telehealth Services & Communications Technology Based Services (CTBS) The PFS is traditionally where CMS will add additional telehealth services to the eligible telehealth services list for Medicare. No new services were added in the CY 2022 proposal. Instead, CMS made permanent adoption of G2252, virtual check-in service of 11-20 minutes, which was introduced in last year’s PFS and noted that the temporary services they had placed in Category 3, also in last year’s PFS, will remain active until the end of CY 2023 and not the end of the year that the public health emergency (PHE) is declared over. Mental Health & Audio-Only The most significant proposals involve the provision of mental health services via telehealth and utilization of audio-only to deliver those services. In December 2020, Congress passed the Consolidated Appropriations Act (CAA) which included a change to federal telehealth policy. That change allowed for the provision of mental health services in the home and without the geographic limitation, if the patient had an in-person visit with the telehealth provider within six months prior to the telehealth service taking place. CMS is implementing that policy and outlined details in the PFS noting that the in-person visit would need to have taken place before each telehealth encounter. Therefore, if you had an in-person visit with your telehealth provider a month before you received services via telehealth, that visit would qualify. But if you wanted a follow-up visit eight months later via telehealth, you would need to have another in-person visit with that provider. Additionally, CMS stated that because of the likelihood that mental health services provided via technology will continue post-pandemic, the concern about cutting off people who receive such services, and the efficacy of utilizing audio-only to provide mental health services, the agency is revisiting its stance on how it defines “interactive telecommunications system.” In federal statute, telehealth is provided through a “telecommunications system.” There is no federal definition for “telecommunications system.” In regulations, CMS added the word “interactive” before “telecommunications system.” CCHP has always maintained and provided comments to CMS over the years that given the lack of a federal statutory definition for “telecommunication system,” it is within CMS’ power to change the definition to be more expansive. In comments to last year’s PFS and at the end of the year when the public was solicited for comments regarding the temporary waivers, CCHP reiterated this position. In their response to comments in last year’s PFS, CMS noted that they “continue to believe that our longstanding regulatory definition of “telecommunications system” reflected the intent of statute and that the term should continue to be defined as including two way, real-time, audio/video communications technology.” In the proposed CY 2022 PFS, CMS has reassessed their position. Based on data from COVID-19 and other factors, CMS is proposing to allow the use of audio-only to provide mental health services in the Medicare program if: It is for an established patient; The originating site is the patient’s home; The provider has the technical capability to use live video but, The patient cannot or does not want to use live video and There must be an in-person visit within six months of the telehealth service. Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs) CCHP has maintained that additional flexibilities may be given to FQHCs and RHCs without Congressional action by redefining what constitutes as a “visit” for these entities. CMS is proposing to expand the definition of a “mental health visit” for FQHCs and RHCs by including that definition mental health services provided through “interactive, real-time telecommunications technology” including audio-only. For the latter, the patient must not be capable or not consent to the use of live video. Additionally, the rate paid to FQHCs and RHCs will be their prospective payment system (PPS) rate or all-inclusive rate (AIR). It should be noted that FQHCs and RHCs will still be not be considered distant providers providing telehealth services. This is a definition change to what constitutes a “mental health visit” for these entities. Therefore, that would also mean that the statutory limitations on the use of telehealth, such as geographic limits, would presumably not apply if CMS is not viewing this as “telehealth” but simply as a visit for these entities. Other items were proposed in the CY 2022 PFS. To read about those proposals and a more in-depth look at the aforementioned ones, download CCHP’s fact sheet (below). Public comments on the PFS are due September 13, 2021. CCHP’s fact sheet - https://www.cchpca.org/2021/07/Proposed-CY-2022-Physician-Fee-Schedulefinal.pdf < Previous News Next News >

New HHS-OIG Reports on Telehealth Challenges and Oversight in State Medicaid Programs Center for Connected Health Policy September 2021 Last week the Department of Health and Human Services Office of Inspector General (HHS-OIG) released two new telehealth reports, both related to the use of telehealth to deliver behavioral health services to Medicaid beneficiaries. HHS-OIG breaks up their study into two reports. Last week the Department of Health and Human Services Office of Inspector General (HHS-OIG) released two new telehealth reports, both related to the use of telehealth to deliver behavioral health services to Medicaid beneficiaries. HHS-OIG breaks up their study into two reports: *States Reported Multiple Challenges with Using Telehealth to Provide Behavioral Health Services to Medicaid Enrollees (Challenges Report) which focuses on state care delivery issues, and *Opportunities Exist to Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid (Evaluation Report), which looks closer at state data collection and evaluation efforts. The reports are both based on surveys HHS-OIG conducted with Medicaid directors from 37 states as well as various stakeholders in early 2020. The surveys were particularly focused around telemental health delivery through managed care organizations, however most stakeholders focused on general telehealth issues in their responses. While the information was gathered pre-pandemic, HHS-OIG applies the findings to support understanding and recommendations to the Centers for Medicare and Medicaid Services (CMS) around post-pandemic telehealth policy. Key Challenges: Lack of Telehealth Training and Limited Broadband In terms of challenges related to care delivery via telehealth, the number one issue reported by 32 out of 37 surveyed states, was a lack of provider and enrollee training. In HHS-OIG’s interviews, stakeholders described not only provider issues related to use of telehealth technology, but also lack of education around telehealth coverage and reimbursement policies. Lack of internet access came in as the second highest challenge, reported by 31 out of 37 states. Broadband issues raised included not only enrollees having insufficient broadband speeds, but some clinics in rural areas having no broadband access at all. Other challenges provided by state Medicaid programs included: -Concerns around how providers protect patient privacy and personal information. -Lack of interoperability between provider electronic health record systems and how to increase provider sharing of patient information. -The high costs of telehealth infrastructure, such as initial equipment costs as well as maintenance and repair costs. -A lack of licensure reciprocity across states. -A lack of understanding around telehealth consent policies. Citing how CMS has given states broad flexibility in how they structure their telehealth policies, the recommendations from the report to CMS focus on increasing creation and dissemination of additional informational and educational resources, such as best practices amongst states, funding options related to broadband and interoperability, and creating a state plan amendment template that could additionally assist states in covering some ancillary infrastructure costs. Evaluation: Telehealth Data and Oversight Within the Evaluation Report which focused more on data collection and analysis, HHS-OIG found that only 3 out of 37 states are unable to track which services are provided via telehealth, however only 2 out of 37 states have evaluated that data specific to impacts on access to behavioral health services and only one state has evaluated telehealth impacts on cost. The report notes that though other states didn’t directly evaluate telehealth data however, they did provide information on observational telehealth impacts based on their experiences with telehealth. For instance, 17 out of 37 states reported that telehealth increases access to providers and a few states also noted potential cost savings, while 6 out of 37 said the impact of telehealth on cost is largely uncertain. The final focus of the Evaluation report was related to telehealth quality assessments and oversight by Medicaid agencies. While 10 out of 37 states noted concerns around quality, one state mentioned quality as more of a clinical practice issue, and two states believed provider training could address such concerns. In regard to oversight, only 11 states were said to conduct monitoring specific to telehealth, while other states noted they oversee all services the same. HHS-OIG made much stronger and more specific recommendations when it comes to state oversight and evaluation, suggesting the need for additional telehealth specific measures by CMS, states, and managed care organizations. Looking Ahead The HHS-OIG reports highlight many of the broad issues and questions related to telehealth that have become forefront in policymakers’ minds over the past year and half, such as challenges around addressing the digital divide and how to best evaluate telehealth impacts. The recommendations point toward a few different potential post-pandemic pathways for CMS mainly around increasing education and oversight. As we’ve seen confusion grow around what state Medicaid agencies believe CMS allows them to do as permanent telehealth policy, such as around federally qualified health centers (FQHCs), perhaps the most essential recommendation made by HHS-OIG comes back to increasing coordination amongst state Medicaid agencies with CMS. The reports’ limited scope to behavioral health services through managed care organizations is also notable in terms of policy application even though state and stakeholder responses may have been more general. For instance, many states and policymakers seem to be focused around Medicaid fee-for-service policies more so than managed care, as well as reimbursement challenges, such as payment parity and similar fee schedule considerations. In addition, the HHS-OIG study did not break down any differences or feedback by telehealth modality, while many states and stakeholders have been focused on the future of audio-only availability – especially as a way to address the challenge of limited broadband access. In terms of evaluating data, while many states may have not had a data evaluation plan in place at the time of HHS-OIG survey, many now do as a result of recently enacted legislation predicated on the surge of use and attention to telehealth during the pandemic. Therefore, it may be interesting for HHS-OIG to consider conducting a similar more broad survey in a year or two after states have had more time to collect and wrap their heads around the data. Challenges Report: https://oig.hhs.gov/oei/reports/OEI-02-19-00400.pdf Evaluation Report: https://oig.hhs.gov/oei/reports/OEI-02-19-00401.pdf < Previous News Next News >

Most Americans Support Expansion of Asynchronous Telehealth Options Mark Melchionna July 21, 2022 A new survey shows that a majority of Americans support legislation that would expand asynchronous telehealth, thereby increasing access to care, particularly mental healthcare. Two-thirds (69 percent) of Americans are in favor of legislation to expand access to asynchronous telehealth, according to a new survey. Telehealth company Hims & Hers Health worked with polling firm Public Opinion Strategies to conduct a survey of 1,301 US adults between Feb. 13 and 17. The results indicate that optimizing telehealth and changing policies are critical. The COVID-19 pandemic significantly affected healthcare overall, resulting in an increased need for care, especially for behavioral healthcare. Dig Deeper Why Asynchronous Telehealth Has Been a Boon for Patients, Providers New Bill Seeks Nationwide Medicare Coverage for Asynchronous Telehealth Services Asynchronous Telehealth Can Extend Primary Care at Community Health Networks The survey found that only 38 percent of respondents reported having good mental health, which was lower than the 52 percent who said the same in February 2021. But about 60 percent of respondents said that accessing care is a problem. Researchers then collected data regarding virtual care methods that could help widen mental and physical healthcare access. About 55 percent of survey respondents said they have participated in a telehealth visit, higher than the 10 percent who reported the same in June 2019, 29 percent in April 2020, 43 percent in August 2020, and 51 percent in February 2021, according to the survey. In addition, asynchronous telehealth use is of high interest among survey respondents. About 69 percent of respondents favor legislation that could increase access to asynchronous telehealth. These types of legislation are most popular among Democrats (77 percent) and Black adults (76 percent), though high proportions of Republicans (60 percent) and Hispanic adults (70 percent) are also in support. In addition, a vast majority of healthcare workers (82 percent) indicated high levels of support for expanding asynchronous telehealth. “Patients want to receive care in the way that works best for them, and this is increasingly a combination of telehealth support via synchronous real-time video consultation and asynchronous interactions, as well as in-person care between providers and patients," said Galen Alexander, director of public affairs at Hims & Hers, in an email. "Telehealth, both synchronous and asynchronous, can help address some of the mental health crises our country is facing. Based on this representative survey, Americans want to be in control of their care and would like to see legislators allow for different modes of receiving care.” Previous research has also indicated an increasing need for telemental healthcare. A study published in January showed that despite a slight decline in overall telehealth use, virtual mental healthcare remained popular. It also revealed that mental health conditions were the most common telehealth diagnosis in September and October 2021. Lawmakers do appear to be taking steps to expand telemental healthcare. In May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives that focus on increasing access and directing insurers to support virtual care. For original article: https://mhealthintelligence.com/news/most-americans-support-expansion-of-asynchronous-telehealth-options < Previous News Next News >

Elo and 19Labs Partner To Offer Next Generation Telehealth Kiosks PR Newswire and 19 Labs July 2021 The partnership allows pharmacies, schools, and rural communities to go beyond just video calls and deploy eClinics with smart diagnostic devices and remote monitoring. The hospital-at-home trend is rapidly changing the healthcare industry. COVID-19 has accelerated telehealth technology's rate of innovation, and the industry has advanced by more than five years in just five months. Healthcare companies are now moving quickly to provide care in new locations and serve new use cases, bringing healthcare access not just to the home but also to other places like rural communities, schools, and pharmacies. 19Labs and Elo are working together to bring eClinics to these new locations globally. 19Labs' GALE eClinics are next generation point-of-care platforms that seamlessly integrate leading mobile and healthcare technologies into cost-effective and smart solutions such as telehealth carts, healthcare kiosks, or portable telehealth kits. They are highly secure, easily deployable, and can be operated by anyone with minimal training. "19Labs' eClinics enable our customers to easily deploy enhanced telehealth using the world's most advanced diagnostic devices: from ultrasound, ECGs, and even blood pressure," said Dan Ludwick, Chief Product Officer, Elo. "The eClinics do more than just video calls. They bring together Zoom, Amwell, custom wellness applications, and remote patient monitoring into a solution that can be easily used by anyone, which can drastically reduce operating and deployment costs." "Elo has been a great partner," says Ram Fish, 19Labs CEO & Founder. "They are a dynamic, innovative company with global reach, and we are happy to work with them in making healthcare more accessible worldwide. Their Android-based touchscreen systems are beautiful, well-engineered, and provide a unique, affordable solution to deploying kiosks in different form factors within the healthcare industry. Elo's tablets are built-to-last and highly reliable. Their commercial-grade hardware is complemented by great Android implementation. These make Elo's solutions perfect for enhanced telehealth." In Oaxaca, Mexico, the state's health ministry has been rapidly deploying 19Labs' eClinics. Dr. Lorena Ocampo, Chief Coordinator of Telemedicine at Oaxaca's Ministry of Health, says the next generation healthcare kiosks will significantly increase healthcare accessibility and quality in the region. "It's been a pleasure working with 19Labs and Elo. The impact these units have on the healthcare conditions within the community, and the ability to easily access advanced medical care, radically improves the quality of service that we are able to provide." About Elo As a leading global supplier of interactive solutions, #EloIsEverywhere. To date, we have deployed more than 25 million installations in over 80 countries. A new Elo touchscreen is installed every 21 seconds, on average, somewhere in the world. Built on a unified architecture, Elo's broad portfolio allows our customers to easily Choose, Configure and Connect & Control to create a unique experience. Choose from all-in-one systems, open-frame monitors and touchscreen monitors ranging from 10 to 70 inches. Configure with our unique Elo Edge Connect peripherals that allow use-specific solutions. Connect & Control with EloView®, a secure cloud-based platform for Android-powered devices. EloView enables secure deployment and management of a large network of interactive systems designed to reduce operating costs while increasing up-time and security. Consumers can find Elo touchscreen solutions in self-service kiosks, point-of-sale terminals, interactive signage, gaming machines, hospitality systems, point-of-care displays and transportation applications—to name a few. Learn more at EloTouch.com. About 19Labs 19Labs is the creator of GALE, Next Generation Point-of-Care platform for pharmacies, schools, and rural communities. GALE brings together "best of breed" diagnostic technologies from industry leaders like Zoom, Elo, Amwell, Eko, Samsung Mobile, MIR, Omron, Viasat, and many others in one smart, efficient, and cost-effective platform. It was designed from the ground up to be operated by non-healthcare professionals, in locations with limited infrastructure and optimized for low bandwidth and intermittent connectivity. To learn more about GALE, please visit www.19labs.com/platform. < Previous News Next News >

Trends in Telehealth: CCHP's 50 State Telehealth Policy Summary Report, Fall 2022 Center for Connected Health Policy October 18, 2022 Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2022. Additionally, we are also making available a summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting our key findings. The most current information in CCHP’s online policy finder tool may be exported for each state into a PDF document. The Fall 2022 summary report adds in two new jurisdictions, Puerto Rico and Virgin Islands, and covers updates in state telehealth policy made between July and early September 2022. Note that in some cases, after a state was reviewed by CCHP, it is possible that the state may have passed a significant piece of legislation or implemented an administrative policy change that CCHP may not have captured. In those instances, the changes will be reviewed and catalogued in the upcoming Spring 2023 edition of CCHP’s Summary Report. As in previous editions, information in the policy finder remains organized into three categories: Medicaid reimbursement, private payer laws and professional requirements. Additionally, for this edition, CCHP received support from the National Association of Community Health Centers (NACHC) through funding from the Health Resources and Services Administration (HRSA) to create a specific category on federally qualified health center (FQHC) Medicaid fee-for-service policies. FQHCs have many unique rules that apply to them that sometimes effect their ability to utilize telehealth, such as the definition of a visit/encounter in the Medicaid program. The new FQHC category takes these considerations into account and will help FQHCs be able to more easily navigate to the policies that specifically affect them. See full article: https://mailchi.mp/cchpca/just-released-cchps-50-state-telehealth-policy-summary-report-fall-2022trends-in-telehealth-policy < Previous News Next News >

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Contact SBRL Community Contacts Get answers to your Federal and State broadband questions: New Mexico broadband contacts Federal broadband contacts Contacts for New Mexico broadband questions: Rand Tilton, NM Department of Informatio n Technology (NM DoIT)/Broadband Rand.Tilton@state.nm.us Gar Clarke, NM DoIT Geospatial Program Manager Presented October 2021 webinar: "NM Broadband and What’s Next." Recording: HERE Sli des: HERE NM Broadband Program (NMBBP ): Online Interactive Broadband Map Statewide Broadband Strategic Plan (June 2020) NM Speed Tester New Mexico Contacts for Federal broadband questions: U.S. Senator Ben Ray Lujan: Sen. Lujan wants to know about telehealth or broadband barriers and successes you have experienced. Telehealth barriers and successes: M e lanie_Goodman@lujan.senate.gov Health polic y matters: Calli_Shapiro@lujan.senate.gov Broadband and telecommunications matters: Jeffrey_Lopez@lujan.senate.gov. Senator Ben Ray Lujan's recording about New Mexico telehealth: HERE Federal

Telehealth Mini-Grants NM BHSD March 16, 2021 BHSD would like to announce the release of funding in the form of telehealth mini-grants. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us To CYFD and BHSD Non-Medicaid Providers: Dear New Mexico Providers: BHSD would like to announce the release of funding in the form of telehealth mini-grants. When the COVID-19 public health emergency ends, BHSD will no longer be able to support behavioral health providers who are delivering behavioral health services through telehealth systems that are not HIPAA compliant. We are now offering funding to help providers come into compliance so that critical behavioral health services will not be disrupted. If your agency is currently delivering services using the telephone and/or another non-HIPAA compliant system, this grant could help you make the transition. BHSD is seeking letters of interest that respond to this question: what is your current telehealth system, and what do you need to become HIPAA compliant? Funding is available in amounts of up to $50,000 per agency, and all work must be completed by the end of 2021, which is when the PHE is currently set to expire. Letters of interest should include: • Specific hardware and/or software and costs • Training for staff and administrators and costs • Anticipated changes to practice model • How many practitioners/staff members do you expect to train • How many clients do you anticipate serving with your new system • Timeframe for making changes BHSD will expect any agency that receives funding to report back on progress made on each of these points. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us < Previous News Next News >

Controversy about Eliminating Telephone Telehealth Coverage By Dr. Maheu April 7, 2021 Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. A study published in the Journal of the American Medical Association focused on telehealth use among the low-income population in California. The study included data from outpatient primary care and behavioral health visits from February 2019 to August 2020 at forty-one federally qualified health centers representing 534 locations in California. The study showed that, with regards to primary care visits, 48.5% of visits occurred via telephone, 48.3% occurred in person, and 3.4% occurred via video. For behavioral health visits, 63.3% via telephone, 22.8% in person, and 13.9% via video. The study’s key finding was that most telehealth appointments during the pandemic period were conducted over the phone. “Eliminating telehealth coverage for audio-only telemedicine visits would disproportionately impact underserved communities,” according to Lori Uscher-Pines, the study’s lead author. “Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth,” she said. “These are important considerations for policymakers if telehealth continues to be widely embraced in the future.” Since the use of telehealth expanded due to COVID, few studies have examined differences in the use of telehealth modalities. However, one federal agency estimated that 30% of telehealth visits had involved phone therapy sessions alone during the pandemic. According to the study, telehealth visits delivered via over-the-phone therapy peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits. Before the pandemic, many definitions of telehealth excluded phone therapy visits, and private insurers or the government rarely reimbursed them, the study authors noted. Some payers, including the Centers for Medicare and Medicaid Services, have indicated they may stop telehealth coverage reimbursement for phone therapy sessions when the pandemic ends. Read more about previous rulings for COVID-19 Telephone Telehealth Reimbursement. “There are some concerns that telephone visits could result in fraud, abuse, and unnecessary and lower-quality care. Although these concerns are important to assess, eliminating telehealth coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of the clinics to meet patient needs” stated Dr. Uscher-Pines. The Reality of Professionalism and Telephone Therapy It seems a bit dramatic to point out that telephone therapy can be more subject to fraud and abuse when it actually is often the only lifeline for many people in distress during the pandemic, and beyond. Fraud and abuse can potentially exist everywhere. The real question is whether the professional has bothered to learn how to properly use the telephone for clinical interventions – or if they are making it up on the fly. Unfortunately, although a clear evidence base exists for telephone-based interventions, very few professionals have received adequate training, and more likely, no professional training to use only the telephone to deliver services to a patient or client. They may not have yet realized that a good in-person clinician is not the same as a good telephone therapist, regardless of intention or need. This point can be clarified quite readily by looking at the case of the alcoholic therapist-in-recovery who now decides to offer therapy for alcohol use. Assuming of course that the therapist has excellent therapy skills to start, the therapist’s history with alcohol can actually interfere with their functioning as an addictions therapist, narrowing perspective with unchallenged assumptions related to etiology, treatment options, and/or prognosis. This is why the professional standard for qualifying alcohol therapists is not one’s prior experience with alcohol, but rather, a course completion certificate or certification in alcohol interventions. Even a good (or great) in-person therapist approaching telephone telehealth without training is likely to overestimate the quality and/or effectiveness of their communications. If one does read the literature about telehealth in general and telephone therapy in particular, it is very clear that professional training in order. In fact, most published studies directly call for clinicians to get such training for telehealth and telephone therapy as well. The Telephone Telehealth Evidence-Base The research in telehealth, in general, has also been quite clear that therapists who have received training are more likely to use the medium correctly to deliver outcomes that are not only comparable to in-person care but also to minimize frustration in both themselves and their clients/patients and feel more confident about how to protect the privacy of the exchange. In 2018, after conducting a systematic search for articles published over a 25-year period (January 1991–May 2016), Coughtrey & Pistrang published a study of 14 studies that concluded that “telephone-delivered interventions show promise in reducing symptoms of depression and anxiety.” This conclusion is warranted, given that much of the Similarly, in 2020, Castro and colleagues published a meta-analysis looking at 10 studies looking at treatment adherence to telephone therapy for depression. In general, they showed beneficial effects on depression severity when compared to control conditions. However, in these and other published reports showing the effectiveness or adherence rates related to telephone telehealth, treatment models are typically highly manualized. That is, they do not consist of free-form, open discussion common to many psychotherapeutic approaches. Therapists in such studies tend to follow very strict procedural dictates, and often, the recipient of care is given written materials and assignments that coincide with specified topics for each meeting. Conducting a mid-pandemic online qualitative survey of mental health care professionals in Netherlands, Feijt and colleagues (2020) reported, “Regarding the mediated nature of communication, the most frequently reported challenge concerns the lack of nonverbal signals that practitioners normally use in face-to-face communication, such as posture and hand movements, but also general demeanor, including smell. Practitioners find it more difficult to connect with their client or clearly communicate their intended message. This is even stronger when sessions are conducted by telephone when there is only audio to rely on.” Such a conclusion seems warranted, given that in-person training often teaches practitioners to rely on visual stimuli to render a diagnosis, develop and deliver a treatment plan. In evidence-based telehealth professional training, and especially in competency-based certificate programs of professional training, many of these issues can be addressed using protocols that are tailored to the clinician’s specific client for one’s patient population, setting, state, and professional requirements. On the other hand, clinicians who use communication technology without professional training are likely to be as confused by the online delivery of healthcare as someone accustomed to using a handset telephone who now is handed a smartphone to make a simple call. Therapist Vulnerability in Telephone Telehealth? Assessing a client or patient’s emotional state from voice alone can be problematic, particularly if the professional’s prior telephone habits involve multitasking. As discuss by Hilty, Randhawa, Maheu, McKean, Pantera & Mishkin (2020), distractions are the #1 problem with digital interventions. Don’t we all multitask when on the phone? Where then does distractibility leave the busy professional who typically multi-tasks during telephone therapy? Professionals who allow their workspace to be impinged by devices that regularly emit incoming messages, beeps, flashing lights, and other forms of alerts will likely find it difficult to stay focused on the voice input they now are attempting to use to deliver the same standard of care as in-person. Some therapists even so boldly encourage their clients and patients to “take a walk” while they themselves stroll about their neighborhoods or other local public areas while offering telephone therapy. All the while, these professionals profess to be delivering the same standard of care as when the client is seated in front of them, in a closed room. Could these realities be used to discredit an earnest professional who is attempting to deliver quality care via telephone therapy to people in need? Telehealth Service Delivery is Not Intuitive Telehealth service delivery is not intuitive, regardless of one’s experience in person or the need of the client. Faulty assumptions, lack of knowledge, undeveloped skillsets, and naive attitudes can lead to preventable error and potential harm. Pierce, Perrin, & McDonald (2020) stated, “Organizations interested in encouraging telepsychology use should adopt policies supporting the use of telepsychology and provide adequate training to do so.” Such calls for training are common to published reports and mimic those of telehealth in general for more than two decades. In 2000, Maheu and Gordon reported the results of an extensive survey assessing psychologist’s assumptions regarding the legal and ethical requirements for telehealth. Fourteen years later, a similar article was published by Maheu and a larger team of researchers who assessed roughly the same variables. In the 2020 study, two-thirds of clinicians endorsed items suggesting that standard legal and ethical mandates don’t apply to telehealth delivery of psychotherapy (Maheu & Gordon, 2000). In a more extensive survey, Glueckauf, Maheu, Drude, Wells, Wang, Gustafson & Nelson (2018) showed that the number had decreased to one-third. The disturbing fact is, however, that while two-thirds of clinicians endorsed items suggesting an awareness of legal and ethical mandates, it cannot be assumed that those clinicians understood how those mandates apply to their everyday telehealth practices. Where does this leave the average clinician who has no or minimal telehealth training, yet is confident that they are delivering quality care because they “feel good about it” and because it is “needed?” Therapists too are vulnerable to emotional reasoning… Courtroom Realities of Telephone Therapy Knowing how litigating attorneys work, it is quite conceivable that opposing counsel in a lawsuit against a therapist would wield several such recently published telehealth articles in the direction of an unwitting therapist who blithely offers telephone therapy without the proper documentation to prove that they indeed were actually trained in evidence-based telephone telehealth. Perhaps the CIVID emergency would tempter such accusations, depending on the circumstance. Hopefully so. However, the worrisome issue at hand is that most clinicians have never been taught the reality of what actually happens in courtrooms. Such training can be a difficult awakening. To help our readers better understand the issues involved with delivering clinical care in an area where there is a lack of professional training, we will make you privy to a training video that we regularly show in our 2-day certificate training programs. It features Attorney Joe McMenamin demonstrating his litigation skills as a prosecuting attorney for the defense in a “mock deposition.” In this video, he demonstrates exactly how a prosecuting attorney would “prepare” their case against a witness’s testimony for a trial wherein the therapist is being sued by an angry client. The video is painful to watch. Our only solace at TBHI is that Mr. McMenamin has not only worked for decades as a prosecuting attorney for the defense, but he is also a physician. he understands and shares the ethos of many healthcare professionals, and has worked these many years to defend us in court. That’s his motivation for working with TBHI for decades to develop training materials and peer-reviewed books and articles – to help professionals who are poorly informed of what can happen when one is led by the unbridled desire to help rather than a firm grounding in telehealth theory and practice. Caveat While this type of cross-examination wouldn’t happen to professionals who deliver telephone therapy during the pandemic because we are currently in a state of national emergency, but if telephone therapy were to be approved long-term, this is precisely the type of rigor that would be expected of professionals delivering professional services to people in need. As all licensed professionals know, there is a high bar for the delivery of professional services. Practicing licensed healthcare professional in the United States or Canada as well as in many other countries isn’t something one does in the same manner as they would if they were talking to a family member on the phone, multitasking, opening email, glancing at texts, perhaps outside strolling about the park — while the other party probably is also multi-tasking and/or strolling about as well. When we share the video below, please use this information to extrapolate how a skilled professional needs to be able to defend the amount of training they have obtained in any new area of practice including phone therapy sessions alone when a litigating attorney has them on the witness stand. Please note, we at TBHI are not saying this process is fair or right. It simply is reality. Courtroom Realities of Telehealth Malpractice Before watching, please let us explain what is happening in the video. First, this is one of the many training videos that we typically share with our training audiences. You will see how the attorney discredits the psychologist who is named “Dr. Joanne Johnson,” acted by Dr. Marlene Maheu for purposes of this role-play. The cross-examining attorney is Mr. Joe McMenamin, who is indeed a litigating attorney and physician in real life. He, however, defends practitioners in court rather than a prosecuting attorney, which he depicts in this audio lesson. However, having litigated against attorneys who prosecute, he is in a unique position to show you exactly what happens in court, should you ever have the misfortune of experiencing it firsthand. The interactions portrayed in the audio recording are abbreviated because Dr. Johnson provided additional information rather than doing as witnesses are instructed, and that is to give yes/no answers when possible, and offer as little as possible unless directly asked. You will see that Dr. Johnson actually offers a fair amount of information to get to the point of the demonstration. Upon experiencing the agony of witnessing such an exhaustive exchange, but in real life, it would behoove you to obtain the advice of a defense attorney about offering as much information as is depicted. The purpose of the demonstration, in this case, was to show you what a skilled litigator can do to disarm a well-intentioned professional during a deposition. The attorney goes on to explain his rationales, strategies, and how opposing counsel (which he is role-playing) would generally use the information gathered to discredit the plaintiff in court. This first training video is 37 minutes in length. TBHI Position on Telephone Therapy Just to be clear, TBHI is in complete support of phone therapy sessions alone for all clients and patients who need or are interested in such healthcare. However, having been the Chair of the CTiBS Committee on Telebehavioral Health Competencies, the Founder of TBHI is acutely aware of the lack of competence in psychotherapists who deliver such care. Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. All untrained professionals then are encouraged to consider serious telehealth training if they wish to be competence and legally and ethically compliant with the evidence base. References Castro, A., Gili, M., Ricci-Cabello, I., Roca, M., Gilbody, S., Perez-Ara, M.A., Seguí, A. & McMillan, D. (2020) Effectiveness and adherence of telephone-administered psychotherapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 514-526, ISSN 0165-0327,https://doi.org/10.1016/j.jad.2019.09.023. Coughtrey, A. E., & Pistrang, N. (2018). The effectiveness of telephone-delivered psychological therapies for depression and anxiety: a systematic review. Journal of telemedicine and telecare, 24(2), 65-74. Feijt, M., de Kort, Y., Bongers, I., Bierbooms, J., Westerink, J., & IJsselsteijn, W. (2020). Mental health care goes online: Practitioners’ experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychology, Behavior, and Social Networking, 23(12), 860-864. Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205. Hilty, D. M., Randhawa, K., Maheu, M. M., McKean, A. J., Pantera, R., & Mishkind, M. C. (2020). A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care. Journal of Technology in Behavioral Science, 1-28. https://doi.org/10.1007/s41347-020-00126-x Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484. Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Demographic, organizational, and clinical practice predictors of US psychologists’ use of telepsychology. Professional Psychology: Research and Practice, 51(2), 184. Link: https://telehealth.org/telephone-telehealth/?utm_source=ActiveCampaign&utm_medium=email&utm_content=New+COVID-19+FCC+Telehealth+Grant+%7C+TBHI+Telehealth+News+4%2F14%2F21&utm_campaign=April+13th+Newsletter&vgo_ee=L60XUD6gIFzXzaAzbkkf6r35hO7C%2FF3J%2FgQB9Uu3XAY%3D Previous rulings for COVID-19 Telephone Telehealth Reimbursement: https://telehealth.org/reimbursement-covid-19-telephone/ < Previous News Next News >

New FAIR Health White Papers Shows Large Telehealth Utilization Increases Before COVID-19 Center for Connected Health Policy April 2021 Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. In its fourth edition of the Healthcare Indicators and Medical Price Index White Paper, FAIR Health found that the fastest area of healthcare utilization growth from 2018 to 2019 occurred for telehealth services. FAIR Health conducted the annual analysis using its data repository of 32 billion claims for patients in commercial insurance plans. Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. FAIR Health also noted that the most common claim type for telehealth was for mental health services, bolstering other recent evidence that telehealth utilization continues to grow for behavioral and mental health services. The findings are an important contribution to ongoing policy discussions about where telehealth is going after the pandemic. While most telehealth experts have been paying close attention to telehealth utilization during the pandemic, these findings suggest that the story of telehealth’s rapid growth likely begins in 2019, one year prior to the public health emergency. FAIR Health is a national nonprofit organization that maintains a large database of privately insured healthcare claims data. The organization performs healthcare utilization and cost analyses on market trends for use by researchers, consumers, and industry stakeholders. For more information about FAIR Health's data, view their website. FAIR Health Consumer: https://www.fairhealthconsumer.org/#about FH Healthcare Indicators and FH Medical Price Index 2021: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/FH%20Healthcare%20Indicators%20and%20FH%20Medical%20Price%20Index%202021--A%20FAIR%20Health%20White%20Paper--FINAL.pdf < Previous News Next News >

UCHealth slashes code blues up to 70% with telehealth technologies Bill Siwicki December 20, 2022 The academic medical center uses tele-sitter and virtual ICU platforms for a program it calls Virtual Deterioration. UCHealth is a non-profit healthcare organization based in Colorado made up of 12 hospitals across the state. THE PROBLEM The organization had a new use case for virtual care, a program called Virtual Deterioration. Essentially, it was trying to find patients who were deteriorating in the hospital sooner in order to provide rescue and treatment faster to give them the best outcome. "What we were seeing prior to this program was a lot of variability as we tried to detect deterioration, and then once we were detecting it, reaching out to the bedside caregivers as to what happened next," said Dr. Diana Breyer, chief medical officer of the Northern Region at UCHealth. "And so, this was very much a part of our plan to decrease that variability for patients that were staying in place for us to be able to monitor them consistently with more frequent vital signs to make sure we really had rescued them and utilized technology to keep an extra set of eyes on them," she added. PROPOSAL UCHealth already had implemented vendor AvaSure's TeleSitter platform for patient safety and the vendor's Verify for virtual ICU. It expanded use of these technologies to Virtual Deterioration. Prior to implementing the technology, the process for virtual deterioration involved staff in a remote clinical command center working in tandem with frontline staff. "And we did try a process before we employed the technology, where it was a lot of secure chat through our EHR, similar to texting, in addition to a lot of phone calls and not really being able to visualize our patients," said Amy Hassell, RN, senior director for the Virtual Health Center at UCHealth. "This approach created a lot of friction and interruption to the bedside staff who were trying to do hands-on tasks with the patient," she continued. "So we decided to bring in an audio-visual connection. We have mobile carts, and some of our hospitals have cameras in the ceiling so we can just turn on that camera when a deterioration event is occurring." With the camera in the room, physicians and nurses in the command center now can see and interact with the patient as well as the care team. "They're able to see what's occurring so that it's just like we're in the room with that care team member," Hassell explained. "When we do this, it helps us cut down on phone calls and interruptions at the bedside, allowing us to still participate and do our part of the program. "The program provides support and makes sure milestones of care are being met throughout that deterioration event, and help triage if needed," she continued. Because it's a clinical command center that operates a lot of equipment and different platforms, staff have a weekly operational meeting with the IT team that supports the area. "They were part of our planning phases; further, we did our own IT technical dress rehearsals ahead of implementation with the clinical folks each time we went live," Hassell explained. "IT is in lockstep with us and have been very helpful to getting this deployed by helping support us, navigate us through the bumps, as we push the envelope. They're great partners to us and have been since the very beginning." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE Today, the Virtual Deterioration technology is a separate platform. There's going to be context-aware linking soon, and that will help because then staff can go right in from the patient's chart through that portal. Clinicians at the bedside use this technology. Nursing staff and physician staff are the ones pulling the monitoring equipment into the room and using it at the bedside. On the reciprocal end, it's the remote clinical command staff who are accessing that camera to participate with the team and interact with them. UCHealth is in the midst of developing a new role called the "patient technology technician." "The patient technology technician is a staff member who brings the mobile device into the room so that nurses and physicians don't have to be responsible for setting it up, and they can remain focused on the patient," Hassell said. "That's been successful. We're really trying to get all of our folks operating at the top of their license. "This role will be very helpful as we continue to scale it, so the nursing staff aren't the ones having to bring monitoring equipment to that rapid response," she added. RESULTS When UCHealth started looking at this project, it looked for deterioration in particular, such as what are the metrics being sought. One of them that is well-established in the literature is around decreasing code events in the acute care setting, Breyer noted. "Those patients ideally are brought to the ICU and if they're going to code, code there, or if they're rescued," she said. "So we have seen improvement throughout the work that we've been doing around deterioration in this space both in the northern and southern region of UCHealth where we've implemented the solution. "And that's probably our biggest metric that we're able to measure," she continued. "I'll add that in the space of deterioration, it is sometimes difficult to measure what you're doing because you're trying to show that you're now doing something that you were previously not doing. And measuring that omission can be a challenge." The other thing staff are measuring as a process metric is for those patients who stay in place and are not being moved to a higher level of care at the time of their rapid response event. "We are measuring a consistent post-RRT intervention that we previously did not have," Breyer said. "That's another area that we're monitoring. Ultimately, we would like to see this improve mortality, but that's more of a lagging indicator, and that one is a little more variable in the literature as to how much they affect these deterioration events." Hassell stresses the organization is going to have to continue to trend this and the lagging indicator of mortality within the patient population being touched. "But we have early data where we've seen our rapid response rates increase anywhere from 26% up to about an 86% increase, depending on what location you're looking at as we've done this across our system," she reported. "And then, in early data again, we've seen our code blue events in our acute care areas go down by 25% to 70%. "We've seen our code blue events drop, which helps us know we're going in the right direction, we're detecting deterioration earlier, thus reducing a bad outcome from a code blue," she continued. To Breyer's point, UCHealth has seen the post-monitoring period, because it's leaving that camera in place for six hours and virtual staff are helping oversee and watch that patient in conjunction with the frontline staff who are very busy. "And so we've seen an increase in post-rapid response vitals anywhere from a 39% increase up to 152% increase of vitals being ordered, and then working on getting them completed," Hassell explained. "It's been a large range that we've seen, but a lot of intentionality because resources are tied up in that rapid response call. "Once the patient is stabilized, and they're staying on the floor, the nurses then go see other patients that they've not seen for a while," she continued. "And so we've got to make sure that we're taking time to watch over the patient in that kind of fragile window when they still could continue to deteriorate and need a higher level of care. That's where we put a lot of focus and energy, and those are some of our early metrics." ADVICE FOR OTHERS The piece Hassell likes about the technology currently in use is that staff have been able to flex it for a different use case that's been highly valuable. "We're still working on making it an improved platform with the company, but I also think that it's been instrumental and opened up pathways for us that we wouldn't have previously had," she noted. "We weren't seeing the success that we're seeing now until we introduced the camera piece because it solved those issues we mentioned. "And so if you are considering any sort of hybrid approach from, for example, a clinical command center or nursing workflows, you want to have a great platform that you feel your staff can use and interact with seamlessly and with ease," she advised. From a technology standpoint, having it be easy and seamless for the bedside team is key, Breyer said. "While there are now great technology solutions to some of these problems, the heavy lift is the change management with your bedside team, the non-technology piece," she concluded. "And so that's where a lot of the energy for a successful project must be." Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/uchealth-slashes-code-blues-70-telehealth-technologies?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

Telehealth Requires Efforts to Improve Access to Reach Full Potential Mark Melchionna November 29, 2022 New research found that telehealth expansion lacks benefits when efforts to improve access are not present, which may often lead to health disparities. Regions with limited healthcare resources may not benefit from telehealth expansion, prompting the need for efforts to improve access, a new JAMA Network Open study finds. Throughout the recent expansion of telehealth, researchers continuously gained insight into new methods for reaching areas with limited amounts of healthcare resources, highlighting many areas and populations facing limited healthcare resources. The fact and theories about the relationship between telehealth and health disparities led researchers to conduct a cross-sectional study containing 2015 to 2019 American Community Survey data which was linked to national, state, and county-level metrics of healthcare access. Prior to the study, the authors hypothesized that internet access was poor in areas that lacked sufficient access to traditional healthcare resources. Known as healthcare deserts, communities with limited healthcare services such as pharmacies, hospitals, PCPs, and low-cost health centers were reviewed for the study. The data sources included dataQ and GoodRx databases for 60,249 pharmacies, federal information on primary care health professional shortage areas, and geospatial information. Researchers calculated the proportion of populations with internet access and the expected number of healthcare deserts, which represented the population-weighted mean number of deserts in a given region. They also noted statistics for metropolitan status for each state. Among 3,140 counties reviewed in the study, researchers determined that healthcare access and internet service availability corresponded with one another. They found that the states with the largest percentage of households without internet service were Mississippi, Arkansas, Louisiana, New Mexico, West Virginia, and Alabama. The states with the lowest number of households without internet service and the lowest fitted number of healthcare deserts were Washington, New Hampshire, Colorado, Utah, California, and Maryland. Rural areas were more likely to have more health deserts and less internet service availability —78 percent compared to 26 percent of urban counties. Based on these findings, researchers concluded that telehealth expansion may not produce benefits within counties where telehealth is highly needed. Key factors that contribute to rural-urban health disparities in the US may include telehealth expansion without improving internet access as well as clinician shortages. Despite this conclusion, researchers noted limitations, which mainly related to the lack of digital literacy data that may have increased urban-rural disparities, along with the co-occurrence of poor internet and healthcare access across six domains. Previously, however, efforts have been made to support rural communities in obtaining telehealth resources. In September, Equum Medical worked with the National Rural Health Association to provide underserved rural communities with virtual resources. The goal of the collaboration was to assist rural hospitals as they aim to fill gaps in specialty care through tools such as of patient transfer assistance, remote patient monitoring, and help with telehealth implementation. See original article: https://mhealthintelligence.com/news/telehealth-requires-efforts-to-improve-access-to-reach-full-potential < Previous News Next News >

Amazon's telehealth arm quietly expands to 21 more states By Katherine Khashimova Long March 8, 2021 An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector. An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector.The service, Amazon Care, launched a year ago as an app providing on-demand chat and video consultations with medical professionals for Amazon's then-54,000 Puget Sound employees. Users can also book in-person visits at their home or office with clinicians. Payment for the service routes through Amazon.com. In recent weeks Amazon Care has incorporated in Alaska, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Maine, Maryland, Montana, New Hampshire, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont and Wyoming, according to records filed with state agencies. The online health magazine Stat was first to report Amazon Care's expansion. Amazon did not respond to questions about whether access to the newly expanded service will continue to be limited to Amazon employees. But there are indications that Amazon may begin offering the service to a broader audience. In December, Business Insider reported that Amazon had pitched other companies, including Seattle-based Zillow, on the health care app. Amazon has been hiring health care practitioners, research scientists and product managers for the app around the country—including in California, Georgia and Texas, according to Stat. And with a nationwide group of home health care providers, Amazon Care on Wednesday announced it would begin lobbying lawmakers to ease regulations on what kind of health services can be performed outside of a doctor's office—potentially widening the services Amazon Care can provide. Amazon has not yet received professional licenses that would allow it to operate facilities like medical testing labs in the 21 states it has filed to do business. However, that paperwork may be coming down the line: In its Georgia business registration, Amazon indicated it planned to start doing business in the state this July. Amazon began nosing around the lucrative field of health care in 2017, when it made several high-profile hires from the sector. Former One Medical Vice President Christine Henningsgaard joined Amazon, as did Missy Krasner, from the digital health-records management company Box.Henningsgaard, who left Amazon in 2019 to start the maternity-focused health care venture Quilted Health, refers to herself on her LinkedIn profile as part of the "founding team" of Amazon Care, which she described as "bringing customer obsession, advanced technology, and last mile logistics to health care." Around the same time, the company formed an ill-starred health care consortium with Berkshire Hathaway and JPMorgan Chase. The organization, later dubbed Haven, had a stated goal of offering better service and rates from health care providers on behalf of the triumvirate's nearly 1.2 million employees; Haven dissolved last month. Amazon purchased online drugstore Pillpack for $753 million in mid-2018; the next year, the company won landmark approval allowing its voice-activated artificial intelligence, Alexa, to transmit private patient information. When the coronavirus began infecting Amazon's hundreds of thousands of warehouse workers last summer, the company built hundreds of its own on-site laboratories to test employees. In November, Amazon launched an online pharmaceutical delivery service, sending drugstore share prices tumbling. Just weeks later, Amazon's cloud-computing division unveiled a health data management service for doctors and hospitals that complies with patient confidentiality regulations. Amazon Care has likely been in the works since at least early 2018, when Amazon hired Seattle geriatrician Dr. Martin Levine. Amazon Care clinicians are employed by Care Medical, formerly Oasis Medical, a company Levine founded shortly after he joined Amazon, according to business records. Amazon replaced Levine early last year with Dr. Sunita Mishra, a former executive at Providence St. Joseph, where she led the development of the health system's mobile app for on-demand medical care. Levine is now chief medical officer at The Polyclinic health system, which operates 14 sites around the Puget Sound region. Weeks after Mishra joined Amazon, the company expanded access to Amazon Care to all of its now-80,000 Washington state workers. < Previous News Next News >

How Telehealth Enabled Critical Care for Newborns During COVID-19 Kat Jercich, Healthcare IT News July 2021 When the United Kingdom went into lockdown, babies kept being born and kept needing care. That's where teleneonatology came in. When the COVID-19 pandemic began to sweep across the United Kingdom in March 2020, the government quickly moved to impose a stay-at-home order. But even as society ground to a halt, one thing stayed constant: Babies were being born, and they needed care. In Liverpool, England, the restrictions meant a sudden drop in availability for neonatologists. "There were beginning to be discussions about transferring neonatal surgical services to other centers," explained Dr. Christopher Dewhurst, the clinical director for the Family Health Division at Liverpool Women's Hospital and the Liverpool Neonatal Partnership. "Our neonatal service would not have survived in its current state without telemedicine," Dewhurst continued. Dewhurst, who will be presenting at HIMSS21 with Beth Kreofsky, operations manager of the Teleneonatology Program at the Mayo Clinic, explained how moving to telemedicine allowed his team to maintain clinical service at Liverpool Women’s Hospital and Alder Hey Children’s Hospital. Between those two locations, Liverpool has one of the largest neonatal intensive care units in the United Kingdom. "The teleneonatology solution for our city ensured that we could continue to provide safe, quality care to our babies and families across two sites," said Dewhurst. Dewhurst's team turned to InTouch Health (now part of Teladoc) to continue care. The system, he said, was "simple to use, which led to the early uptake by clinicians." And change took place quickly: The program was designed, coordinated, implemented and embraced within two weeks. Dewhurst said he hopes HIMSS21 session attendees learn that "you can make setting up a system as difficult or as easy as you want." "Time is no barrier to setting up a telemedicine service," he added. When it comes to measures of success, Dewhurst said that the team has registered a wide range of good signs. "We have financial benefits, patient satisfaction and clinicians' user feedback, which is positive," he said. In particular, caregivers mention "the speed of reviews and ability to communicate quickly and effectively with specialists from other hospitals," said Dewhurst. Overall, he said, "We showed that with passion, commitment, and [willingness] – you can set up a whole teleneonatology program quickly and safely," he said. < Previous News Next News >

HHS-OIG Reports on Pandemic Medicare Telehealth Trends to Inform Permanent Policies Center for Connected Health Policy Nov. 2, 2021 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. Interestingly, it was found that though pre-pandemic requirements limiting telehealth visits to established patients were waived, 84% of visits still occurred within those parameters. In addition, as policymakers consider making some telehealth pandemic policies permanent, some stakeholders have suggested a need to require an in-person visit within a certain period of time in order to be eligible for a telehealth visit. However, the data collected by HHS-OIG shows such requirements may not be necessary, as Medicare patients were found to already have had an in-person visit on average within four months prior to the telehealth visit without such a requirement. Additional findings included: Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management services via telehealth from providers with whom they had an established relationship Beneficiaries received about 45.5 million office visits delivered via telehealth, which accounted for nearly half of all telehealth services 86% of traditional Medicare beneficiaries received a telehealth service from providers with whom they had an established relationship, compared to 81% of Medicare Advantage Beneficiaries who received home visits via telehealth, which represented only 1% of all services provided via telehealth, were the least likely to have an established relationship with their providers The average amount of time between beneficiaries’ in-person visits and their first telehealth services varied by type of service Beneficiaries who received home visits via telehealth had an in-person visit with their providers at an average of around 9 months prior to first telehealth service Beneficiaries who received nursing home visits and assisted living visits via telehealth had an in-person visit at an average of 2 months prior to their first telehealth service HHS-OIG notes that the provision of this data seeks to inform policymakers looking at long-term telehealth policy and making certain pandemic expansions permanent, especially in light of concerns around telehealth fraud and abuse. For instance, it could help in examining the necessity of one of the most controversial, and confusing, permanent federal changes made thus far as part of the Consolidated Appropriations Act, which post-PHE will require an initial in-person visit within 6-months of a tele-behavioral health visit for purposes of Medicare reimbursement. However, the requirement only applies if the service is not provided in a geographically rural area and at a qualifying medical facility. There is also an exception for treatment of substance use disorder and co-occurring mental health treatment. In addition, CMS is proposing to make the 6-month in-person visit a requirement for subsequent visits in the proposed calendar year 2022 physician fee schedule. For non-behavioral health visits, the 6-month requirement wouldn’t apply, however patients would need to be located in a rural area and eligible facility type to qualify for Medicare reimbursement. Some Medicaid programs are considering limiting telehealth use to established patients, occasionally also applying restrictions to specific modalities and services. However, the HHS-OIG findings may suggest that it is unnecessary to limit telehealth to certain patients and services to prevent fraud and abuse as standard practice may already be providing sufficient guardrails in those respects. In addition, the study findings could indicate that the issue may be more related to general standard of care concerns that apply across all services, not just those delivered via telehealth. The balance may then include looking at how to manage health care fraud generally, which elsewhere HHS-OIG has clarified that most fraud is not telehealth specific. The issue could then boil down to how much autonomy to provide clinicians when making medical determinations, including when a telehealth visit is appropriate. Typically oversight in that respect has been under the purview of clinical licensing boards, not governed by general laws, but as we shift outside of the pandemic it is possible we may see additional shifts in terms of these policy approaches. As policymakers balance these multiple findings, perspectives and concerns, it remains to be seen how such data will be applied or used to justify permanent policies. It will also be important to continue to weigh these factors against general access to care issues so as to not inadvertently limit telehealth as a means of ensuring patients can receive necessary medical services. Additional information on the HHS-OIG study can be found by viewing the brief and complete report. < Previous News Next News >

Transforming Homes And Communities Into Healthcare Hubs In The Post-Covid Future Ryan Hullinger and Sarah Markovitz August 2021 Hospital design experts Ryan Hullinger and Sarah Markovitz discuss the inevitable shifts in healthcare delivery as technology leads to new care settings and rethinking hospitals. The explosion of telehealth prompted by the Covid-19 pandemic has accelerated a shift in care delivery away from the hospital and clinic and into homes and communities. While hospitals have historically been the main hub of care, technology and new care models are enabling a different approach to care delivery. Rather than episodic preventative care, in which a patient periodically goes to a physician or hospital with a health concern, this new model of care is continuous and ubiquitous—with ongoing care reinforced in the home, office, school and throughout the community. There are three key aspects to this shift: advancing technology, new care settings, and the future evolution of hospitals. Advancing Technology Healthcare may follow a familiar path blazed by online retail. It was not that long ago that virtually everyone preferred in-person retail experiences to shopping online. The technology that would later make online shopping experiences superior to brick and mortar just didn’t exist. Telehealth, by comparison, is still in the dial-up days. It’s difficult to imagine now, but based on the patterns we have seen clearly in other technology sectors, it’s probable that some healthcare experiences will be better remotely than in-person—more convenient, and less stressful and time consuming. The technology that will transform telehealth is on the horizon. It will take several R&D cycles, but it will come. In fact, there’s evidence that in areas like behavioral health telehealth is already comparable in efficacy to in-person care. What might the next generation of telehealth look like? For one, rather than sequential visits with separate specialists, patients may be able to connect to a suite of caregivers, all working collaboratively to provide more coordinated, effective care. The type of continuous, convenient touch-bases and flow of information enabled by telehealth and wearable devices could be particularly effective for the elderly and those with chronic conditions, where communication and ensuring compliance with medication and preventive care are often an issue. There will also likely be an expansion in the types of care and services that can be provided, including everything from post-surgical appointments, to ED triaging, and eventually more complex tests as new diagnostic technologies emerge. Automated technologies and artificial intelligence will also play an increasingly vital role in improving health throughout the community. AI technologies are being used to scan patient records, identify patients with hypertension and diabetes, and remind physicians to check in regularly with them. Hospitals have already shown good results using telehealth, texting and improved monitoring to help vulnerable populations and those with chronic conditions. Improved telehealth and health data capabilities could extend widescale efforts like these, improving population health efforts. New Care Settings With technology acting as a facilitator, more and more forms of care, especially routine procedures, will migrate away from hospitals and clinics. The home could become the new healthcare hub, with prefabricated telehealth units for the home that integrate medical technologies with telehealth capabilities. The explosion of smart home, home health and health monitoring devices, encompassing everything from sensors that detect sudden falls to smart watches that monitor heart rate and O2 levels, is only the tip of the iceberg. With the ability to monitor health data and communicate effectively with caregivers, the home could be a crucial site for preventive medicine, chronic disease management and ongoing care. The home health model is only one possible model—the technologies that enable it may have shortcomings, or prove unaffordable to large segments of the population, further exacerbating health inequities and the digital divide. But healthcare can still be provided in a wide range of locations distributed throughout communities. Libraries, schools, community centers, homeless shelters and pharmacies could become hubs for telehealth resources and care, serving a vital role in improving the health of communities. A key consideration will be access and location—ensuring that healthy equity and care for vulnerable populations drives where these new care hubs emerge. How Hospitals May Evolve As care becomes increasingly continuous and ubiquitous, the role of the hospital may evolve. Rather than serving as a destination for all patient types, it will become increasingly specialized and streamlined, focusing on high acuity cases. They may expand their capabilities and efficiency in areas like perioperative and high-end imaging that are not available in community settings. In the process, hospitals are likely to become more compact, high performing and efficient by narrowing their focus. As part of this evolution, hospitals may also need to bolster their ability to expand capacity by 50-100% in anticipation of emergencies like epidemics, mass casualties and weather-related crises. In the last 20 years, many hospitals have invested heavily in improving patient comfort and satisfaction, and have even borrowed processes and designs directly from the hospitality industry—creating patient environments that nearly resemble hotel lobbies and guestrooms. Patient satisfaction will continue to be a driver, but the environments that promote satisfaction are likely to change drastically. New environments that convey a sense of safety and cleanness will begin to feel more comfortable than the hospitality-informed designs of the past. As this shift and gradual downsizing takes place, there may be opportunities to adapt existing space for other uses. The Covid-19 pandemic has demonstrated the dramatic impact of stress on healthcare workers. Hospitals now have an opportunity to provide sufficient and appropriate space for staff, helping to build resiliency to counter staff burnout and ensure the well-being of these truly essential workers. Hospitals could also aim to provide more community, patient and staff resources, such as spaces to demonstrate telehealth technologies and how to use them, or new hybrid offices equipped for telehealth. As technologies, new care settings, and hospitals evolve, care will become more embedded in our daily lives. The pandemic may have spurred new interest in telehealth, but the trends shaping the future of care predate social distancing. They will continue to transform how and where care is delivered, ushering in a new era of ubiquitous healthcare. Source: https://www.forbes.com/sites/coronavirusfrontlines/2020/10/26/transforming-homes-and-communities-into-healthcare-hubs-in-the-post-covid-future/?sh=133370e04153 < Previous News Next News >

Telehealth Resources NMTHA's Telehealth Resources provide information on the following topics: New Mexico Organizations New Mexico Broadband Interstate Telemedicine Licensure Telehealth Organizations & Associations Teleheath Training COVID & Telemedicine NM Based Orgs NEW MEXICO ORGANIZATIONS Health Insight New Mexico New Mexico Association for Home & Hospice Care New Mexico Health Resources New Mexico Primary Care Association SYNCRONYS (New Mexico Health Information Exchange) University of New Mexico Center fo r Telehealth UNM Project ECHO NEW MEXICO BROADBAND NM Broadband Program Overview of Broadband Program - Videos Mapping Training Resources Strategic Planning INTERSTATE & TELEMEDICINE LICENSURE Interstate Medical Licensure Compact (NM is not yet a participant) Federation of State Medical Boards New Mexico Physician Licensure Requirements (including telemedicine) New Mexico Physician License Application instructions (see last page for telemedicine) NM Broadband Interstate Licensure TELEMEDICINE ASSOCIATIONS & ORGANIZATIONS American Telemedicine Association (ATA) Center for Connected Health Policy Center for Telehealth & e-Health Law Southwest Telehealth Resource Center National Library of Medicine National Telemedicine Initiative Office for the Advancement of Telehealth (Health Resources and Services Administration, DHHS) Telemed Associations Org. TELEHEALTH TRAINING Telemental Health Training : Providing healthcare organizations and clinicians with ethical, legal, technological, and clinical frameworks for conducting effective telehealth sessions. Telehealth Trainings : The Arizona Telemedicine Training Program and Southwest Telehealth Resource Center offer 1-day training courses on telemedicine and telehealth. National Consortium of Telehealth Resources : Building a telehealth program? Browse through our offerings from Telehealth Resource Centers. If you can’t find what you’re looking for, use our contact form or give us a call. We have an abundance of resources available! Weitzman Institute : Weitzman ECHO (Extension for Community Health Outcomes) provides specialty support for primary care providers seeking to gain expertise in management of certain complex illnesses and conditions, including COVID-19, MAT, Chronic Pain, and more. TH trainings New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. View Statutes Experts in Telehealth: An Interview Series A series of brief interviews from local and regional experts sharing experience, insights, and guidance on telehealth. Access Interviews Get answers from the NM Department of Information Technology (NM DoIT). Contact NM DoIT Broadband Questions? Contact U.S. Senator Ben Ray Lujan to discuss you r telehealth issues, ideas, and goals. Policy & Advocacy Contact Senator Lujan COVID & TELEMEDICINE NEWMEXICO.gov (Guidance for Providing Patient Care by Electronic Means During the COVID-19 Public Health Emergency.) NM Medicaid, COVID-19, and Telehealth Resources NM-HSD April 6, 2020: Special COVID-19 Supplement #3 – Guidance for New Mexico Medicaid Providers NRTRC COVID-19 and Telehealth Resources ATA COVID-19 Response Webinar Series eHealth Initiative COVID-19 News, Resources, and Events Weitzman Institute COVID-19 Resource Page An Analysis of Private Payer Telehealth Coverage During the COVID-19 Pandemic (Center for Connected Health Policy) UNM Resources: COVID-19 briefings COVID-19 practice guidelines COVID-19 therapeutic evidence Covid resources Top of Page NM Based Orgs NM Broadband Interstate Licensure Telemed Associations Org. TH trainings Covid resources