Audio-Only Telemedicine In Primary Care: Embraced In The NHS, Second Rate In The US Rebecca Fisher, Urmimala Sarkar, Julia Adler-Milstein December 5, 2022 Use of telemedicine in primary care soared in the first wave of the COVID-19 pandemic and remains well above pre-pandemic levels. In the US, a major enabler of this shift is equal reimbursement across video, audio, and in-person visits. Policy makers must now choose whether to extend these COVID-19-era telemedicine policies. A key decision is whether audio-only telemedicine should be covered and if so, whether it should retain parity with video-based telemedicine. The dominance of video over audio in the US suggests that an appropriate policy strategy would be to not reimburse for audio-only telemedicine or reimburse at markedly lower levels. However, US policy makers would be wise to look internationally first—where experience suggests that audio-only can be an effective and more equitable means of delivering primary care. In the National Health Service (NHS) in England, almost one in three consultations in general practice is audio-only; a figure that has been stable since October 2021. This represents a major rise; pre-pandemic around 10 percent of consults were by phone. Despite efforts from UK policy makers such as fast-tracking funding for online consultation tools, the number of video consults remains stubbornly low, at just 0.4 percent of appointments. This is despite the fact that most NHS primary care practices are video-equipped, and the US and UK populations do not differ significantly in their digital literacy. What Explains The Higher Levels Of Audio-Only Telemedicine In The UK Versus US? There is no evidence that directly answers this important question. We therefore leverage circumstantial considerations to develop three possible explanations. National Policy Given the active efforts of policy makers at the start of the pandemic to expand availability of telemedicine, an initial explanation is that the countries implemented different policies regarding telemedicine provision—with the US pursuing policies that favored video while the UK pursued policies that favored audio. However, we are not aware of any such policy differences. In both countries, policy makers acted swiftly to make it easier for providers to consult using either modality. National guidance issued to practices in England encouraged use of phone and video encounters “tailored to the person, the circumstance and their needs,” but there was no directive to prioritize audio-only above video consulting. In the US, emergency legislation removed barriers to telemedicine consulting, including giving parity of reimbursement across audio and video encounters (theoretically an incentive to drive up audio-only rates). Both countries reduced regulatory barriers to video consultation, allowing providers to use non-medical video call applications such as Skype and Facetime. But neither country mandated—or strongly incentivized—provision of one telemedicine modality over the other. Path Dependence A second explanation is one of path dependence. The idea that faced with the need to act fast and little central planning or coordination, health care delivery organizations disproportionately scaled-up the form of telemedicine that made sense given prior circumstances before the pandemic. In the NHS, the use of audio-only for triage and traditional encounters in general practice was common pre-pandemic. In 2019, 10 percent of encounters in English general practice were by phone, compared to fewer than 1 percent across both telemedicine modalities in the US. The public was also used to receiving health advice by phone—the NHS 111 service is a free phoneline to help people in England access non-emergency medical advice and to link them to local NHS services. Thus, when the pandemic hit, it was easier to act quickly to scale the more familiar modality of audio. In contrast, the US did very little of either modality pre-pandemic, and in an effort to more closely replicate face-to-face care at the start of the pandemic when in-person care was not an option, US practices chose to ramp up video-based telemedicine. Provider Perceptions Of Quality While path dependence emphasizes the concept of choice driven by ease, a third potential explanation is that, instead of prior familiarity driving decisions about modality offerings, these decisions were driven by different perceptions of the strengths and limitations of each modality. In the UK, analysis of why general practitioners hadn’t used video consultations found that despite improvements in functionality and reliability of video consultation tools, practitioners viewed video encounters as logistically more challenging and more cognitively demanding than either face-to-face or telephone consulting. Physicians felt that many presenting problems could be sorted safely by telephone, with in-person assessment required for the remainder. Where problems required visual assessment, physicians preferred a combination of photograph plus telephone consultation (SMS technology is widely embedded in general practice [GP] electronic health records). Consensus from UK physicians seems to be that video provides little benefit over audio-only. Differential uptake of video over audio-consulting suggests that US physicians feel differently; surveys of US physicians have highlighted concerns about the diagnostic accuracy of telephone visits, and their suitability for new patients. The acceptability of different telemedicine modalities to patients is another dimension of quality that could have driven what health care delivery organizations offered. Evidence from the UK suggests that telephone appointments are a popular appointment modality in general practice. Indeed, analysis of 7.5 million patient-initiated requests for care across 146 primary care providers found that telephone consultation was the most popular patient preference, requested by 55 percent of people seeking care, with fewer than 1 percent of requests seeking a video consult. In the US, one trial reports similar patient satisfaction with audio and video consults, but it is possible that US physicians felt that patients expected video consultations and made efforts to oblige. Based on circumstantial evidence, we suspect that path dependence and perceptions of quality worked together to push the countries in different directions. While more conclusive evidence is needed, explanation three raises the more critical question of how to move from perceptions of quality differences to robust evidence that can inform choice of modality. What Is Currently Known About Which Modality Is Better From A Quality Perspective? The clearest evidence on differences between modalities is about access, where audio-only has clear advantages over video consults in promoting equity. People with the greatest need for health care may be least enabled to access it digitally—termed the “digital inverse care law.” In both the US and the UK, digital exclusion is socially patterned. Older people, those in lower-income groups, people with disabilities, or who do not have English as a first language are more likely to be digitally excluded. In the telemedicine context, video visits require digital literacy and access to technology and broadband/data that are not ubiquitous. On the health system side, providing video visits requires health centers and staff to overcome barriers including cost, training, and technology. These barriers may be more likely to occur in safety-net settings. In the US, video visits are more common in people earning above $100,000, White people, younger people, and people with private health insurance. In contrast, users of audio-only telemedicine are more likely to be Black people, older adults, and on Medicaid. With telephony already embedded in health centers and 97 percent of Americans owning cell phones, audio-only telemedicine represents an important means of accessing care for underserved populations. Beyond equitable access, we lack evidence on differences in other dimensions of quality between the two consultation modes, either overall or in specific clinical scenarios. Unfortunately, there is a major obstacle to such evidence generation: In the US, we do not routinely capture the specific telemedicine modality in use and therefore cannot readily compare audio-only to video encounters. Ruth Hailu and colleagues describe the range of interventions—including simplifying coding and adapting electronic health records—required to generate data that would support comparative analysis. However, even with such data available, the choice of modality is non-random, and individuals are likely to receive a blended mix of consultation types during episodes of care. Disentangling the impact of each encounter modality on a range of clinical and patient-reported outcomes would be a substantial research undertaking. Large, diverse population observational studies may be required, alongside a range of qualitative studies of patient and physician experience. Some of this evidence will take years to gather, and decisions on extending coverage beyond the pandemic emergency will likely be required before a full picture is clear. Neither health system can claim an “evidence-based” strategy—and it likely that neither the US nor the NHS has it right yet. So Where Does This Leave Policy Makers? In the UK, there is no urgent policy decision to be made around reimbursement, since all forms of telemedicine are covered by the capitated payment system for general practice. Instead, debate has focused on whether access to in-person appointments is now too limited. This is framed by decreasing public satisfaction with access to general practice, in the context of ongoing and severe shortages of primary care physicians. Despite nudges from policy makers, the pandemic has barely shifted the number of video consultations in general practice, and use of telephone consulting has expanded instead. Ongoing studies will monitor outcomes of this change and may require expansion to help the NHS identify an optimal blend of consulting modes. With UK general practitioners unconvinced of quality benefits of video consultations, it is likely that compelling evidence of their benefit would be required for use to increase. US policy makers face more difficult choices about ongoing reimbursement for audio-only telemedicine. The Consolidated Appropriations Act of 2022 extends certain telehealth coverages for 151 days after the official end of the federal public health emergency, thus going some way to preventing a “telehealth cliff.” But with the World Health Organization recently discussing for the first time the possibility of ending their emergency declaration on COVID-19, decisions about funding for audio-only and/or video will need to be made relatively soon. In the absence of robust evidence, decisions are likely to hinge on perceptions of the quality of different consultation modes. Arguments against payment parity between audio-only and video telehealth are likely to focus on early perceptions that audio is a lower-quality modality or prone to overuse. These arguments and their rebuttals have been clearly described already. However, given the clear evidence of the meaningful benefits for reaching underserved people, the US should extend coverage of audio-only telemedicine for a minimum of five years. During this time, perceptions of quality can be informed by empirical evidence, such that we can either phase out audio-only in an equitable way or give providers more flexibility to combine use of modalities. Even with reimbursement parity, policy makers will need to invest in complementary enablers of equitable telemedicine access through state-level action. As Elaine Khoong writes, avoiding a two-tier system where video encounters are disproportionately available to the wealthy requires policy makers to expand video-visit capacity in the safety net, alongside community-based strategies to improve digital literacy. Given that telehealth does not necessitate the same geographical constraints as in-person care—for example, with respect to physician licensing or online prescribing—amending policies to streamline provision across states is also vital. A Role For Payment Reform? The past two years have shown that telephone and video consultation can be combined to deliver high-quality and efficient care. Going forward, patients are likely to receive a blended mix of appointments across modalities, tailored to clinical need and individual circumstance. In the NHS, capitated payments give clinicians and managers the flexibility to offer a mix of appointment modalities, based on the clinical situation without the need to consider differential reimbursement or administrative burden. In fee-for-service models, differentiating payment levels across telemedicine modalities is likely to increase bureaucracy and risks decreasing efficiency and quality. In the longer run, experience from both systems suggests that we should move away from modality-based reimbursement. In recent testimony to the US Senate’s Committee on Finance, Robert Berenson suggested that fee-for-service is a particularly flawed payment model for telemedicine, and that the Centers for Medicare and Medicaid Services should consider paying for telehealth services in a similar model to the UK: via monthly capitated payments for primary care physicians as part of a hybrid payment model. Capitated payment systems enable physicians to use the encounter modality considered most appropriate for the situation without worrying about how they will be paid (or the patient billed). Berenson’s proposal would allow physicians and patients to tailor the type of telemedicine encounter more precisely to individual patient need and might reduce bureaucracy associated with billing, in turn increasing efficiency. As evidence on the benefits and risks of each modality emerges, such a payment model also allows rapid translation of evidence into practice. Authors’ Note Professor Sarkar holds current research funding from the National Cancer Institute, California Healthcare Foundation, the Food and Drug Administration, HopeLab, and the Commonwealth Fund. She has received prior grant funding from the Gordon and Betty Moore Foundation, the Blue Shield of California Foundation, and the Agency for Healthcare Research and Quality. She received gift funding from The Doctors Company Foundation. She holds contract funding from AppliedVR, InquisitHealth, Somnology, and RecoverX. Professor Sarkar serves as a scientific/expert adviser for nonprofit organizations HealthTech 4 Medicaid (volunteer) and for HopeLab (volunteer). She is a member of the American Medical Association’s Equity and Innovation Advisory Group (honoraria). She is an adviser for Waymark (shares) and for Ceteri Capital I GP, LLC (shares). She has been a clinical adviser for Omada Health (honoraria), and an advisory board member for Doximity (honoraria). See original article: https://www.healthaffairs.org/content/forefront/audio-only-telemedicine-primary-care-embraced-nhs-second-rate-us#.Y45MpkrZubQ.twitter < Previous News Next News >

NCQA Report: 3 Strategies to Close Telehealth Access Gaps Mark Melchionna May 16, 2022 The National Committee for Quality Assurance released a telehealth report that highlighted care disparities and strategies for improvement. May 16, 2022 - Prioritizing individual preferences and patient needs, breaking down regulatory barriers, and leveraging technology in an equitable manner can go a long way toward addressing the growing disparities in telehealth use, according to a white paper released by the National Committee for Quality Assurance (NCQA). The white paper, titled The Future of Telehealth Roundtable, discusses ways to close gaps in telehealth use and access. The NCQA is a nonprofit organization that focuses on improving the quality of care and certifying various healthcare groups. Dig Deeper Pressure on Congress to Solidify Telehealth Access Builds GOP, Independent Senators Co-Sponsor Medicare Telehealth Access Bill Lawmakers Ask Congress to Create a Rural Telehealth Access Task Force As virtual care grows amid the COVID-19 pandemic, The Future of Telehealth Roundtable highlighted various areas that could be enhanced. The white paper derives from an October 2021 conference consisting of telehealth and technology experts from several prominent healthcare organizations, including MedStar Health. The experts noted that despite the expected benefits associated with telehealth, such as convenience and lower costs, disparities still exist within specific communities. According to the white paper, three strategies could help close care gaps as telehealth is further implemented. The first is creating telehealth services that cater to personal patient preferences and needs, as some individuals may face struggles due to their primary language and socioeconomic status. The second is addressing regulatory barriers to access and changing regulations to allow expanded clinician eligibility for licensure. The final strategy is ensuring that digital technology can be leveraged efficiently. For example, considering patient access levels to technology is critical because it determines how patients can be reached and how to best care for them. “Even prior to the pandemic, a change in healthcare delivery was on the horizon with ever-evolving advancements in technology,” said NCQA President Margaret E. O’Kane, in an accompanying press release. “As virtually based care expands, unique patient needs and preferences must be identified and prioritized so that telehealth can help us close the gaps in healthcare and not widen existing disparities.” The Future of Telehealth Roundtable also emphasized the continuing popularity of telehealth and that it will hold a place in the new normal. But as the implementation process continues with new technology, avoiding the digital divide is necessary to eliminate disparities. Throughout the COVID-19 pandemic, various studies have emphasized pinpointing the potential barriers to telehealth access. One study published in February revealed that Black patients with cardiovascular disease (CVD) prefer recording and sharing blood pressure (BP) via a text-based program rather than an online patient portal. This is likely because the patient portal has higher technical requirements than text-based communication. Further, research published last November shows that patients with limited English proficiency were less likely to use video when accessing virtual services during the pandemic than adults who could speak English comfortably. For full article: https://mhealthintelligence.com/news/ncqa-report-3-strategies-to-close-telehealth-access-gaps < Previous News Next News >

Telemedicine boosts access, decreases inequities in Montana Bill Siwicki October 10, 2022 The University of Montana College of Health has expanded its telehealth offerings across many disciplines to reach more people, especially in tribal communities. Montana has unique challenges in providing healthcare to its widely dispersed population of just over 1 million people. THE PROBLEM Out of 56 counties in Montana, 55 are designated as Health Professional Shortage Areas (HPSAs), limiting access to both urgent and routine medical visits. The cost of travel and long distances between healthcare providers and patients are commonly cited reasons for patients to delay or avoid medical care. The use of telehealth technology can improve healthcare access for Montanans living in rural and tribal communities by providing access to primary care and specialty services. Montana also is home to a significant Native American population, which makes up about 7% of residents. Tribal members experience significant health disparities due partly to inequitable healthcare access. "These pre-existing strains have left many rural and tribal communities particularly vulnerable to broad-reaching impacts of the COVID-19 pandemic," said Erica Woodahl, director of the L.S. Skaggs Institute for Health Innovation and a professor at the Skaggs School of Pharmacy at the University of Montana. "Rural and tribal populations have a higher burden of chronic disease and comorbidities known to increase the risk of morbidity and mortality associated with COVID-19," she continued. "Life expectancy of all Americans has decreased during the two years since the pandemic, but no group more than tribal people whose life expectancy has dropped almost seven years." The pandemic also further reduced access to routine care leading to an increase in preventable complications due to chronic conditions, including emergency room visits, hospitalizations and overall healthcare costs, she added. "Additionally, communities without nearby clinics or hospitals have not had adequate access to coronavirus testing or care, leaving rural and tribal patients vulnerable to the spread of COVID-19," she noted. "This increases pre-existing strains on rural healthcare systems due to provider shortages, limited hospital beds and other resource constraints." PROPOSAL In the telemedicine work of the University of Montana College of Health in Missoula, services would be provided through a centralized hub at the university with synchronous and asynchronous telehealth services provided to rural and tribal communities in partnership with clinics, hospitals and pharmacies across the state. The equipment purchased with help from a grant from the FCC telehealth grant program would allow for the expansion of services within UM's College of Health. "While the initial utility of telehealth technologies to improve care for underserved populations focused on immediate provision of clinical services disrupted by the COVID-19 pandemic, benefits to patients will extend beyond the pandemic to address the challenges of providing healthcare to Montanans," explained Shayna Killam, PharmD, a postdoctoral fellow at the Skaggs School of Pharmacy at the University of Montana. "Telehealth technologies provide clinicians with the tools necessary to bridge the gap in healthcare access and offer quality healthcare to Montana patients," she continued. "Services will specifically target patients living in rural and tribal communities with chronic medical conditions and comorbidities." The organization anticipates a broad reach across Montana, leveraging partnerships with clinical training sites and clinical affiliates to provide centralized telehealth services to a wide range of patients. "Programs in UM's College of Health were awarded $684,593 from the FCC," Killam reported. "Funds were used to purchase telehealth equipment and connected medical devices, providing critical and remote services for patients in Montana." Telehealth equipment will be used by faculty, residents and students affiliated with the University of Montana College of Health. Recipients of funding include the following: Skaggs School of Pharmacy (SSOP). Family Medicine Residency of Western Montana (FMRWM). School of Physical Therapy and Rehabilitation Science (UMPT). School of Speech, Language, Hearing and Occupational Sciences (SLHOS). 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 Pharmacist-driven programs provide services for community-based chronic disease screening, education and management, including management of diabetes, asthma, cardiovascular risk and mental health through point-of-care testing, medication therapy management visits and consultations with telehealth pharmacists. "Connected medical devices and video conferencing hardware will be used to provide routine and urgent care visits with medical residents and providers affiliated with the FMRWM, including diagnostics and monitoring, chronic disease management, prenatal care and mental health services," Woodahl said. "UMPT programs offer home-based visits and services in end-user sites in rural and tribal communities, including remote evaluations enhanced with telehealth technology, such as vestibular function testing and gait monitoring devices, telepresence robots, and video consults with patients and other healthcare professionals," she added. Clinicians and students in SLHOS will conduct telehealth visits via high-quality video and audio equipment, which facilitate effective evaluation and treatment for articulation and voice disorders. USING FCC AWARD FUNDS The University of Montana College of Health was awarded $684,593 from the FCC telehealth grant fund to purchase telemedicine kits to enable critical, remote telehealth services and to provide internet-connected devices for remote patient monitoring services for underserved, rural and tribal populations within the state. "UM's College of Health has used the FCC telehealth award funds to expand telehealth programs offered by the interprofessional disciplines with an overarching goal of increasing healthcare access and addressing inequities in care," Killam explained. "In addition to providing accessible and equitable healthcare, telehealth technologies will be used to train future health professionals," she continued. "Proactive training of our health professions students has the potential to transform the healthcare landscape in Montana and to overcome the challenges presented by traditional models of care." The equipment purchased has empowered physical therapists to engage in remote monitoring of patients as they complete interventions within their home, said Jennifer Bell, PT, clinical associate professor, school of physical therapy and rehabilitation science. "Oftentimes, patients have difficulty with balance and functional mobility within their home," she noted. "By utilizing technology, we are able to see a patient's home environment and support their ability to move around, minimize the risk of falls and complete a home exercise program." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telemedicine-boosts-access-decreases-inequities-montana?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

Zoom's Head of Healthcare Talks the Future of Telemedicine Bill Siwicki, Healthcare IT News August 2021 Heidi West discusses telehealth/hybrid in-person care, the communities that could suffer without virtual care and the remaining obstacles to mainstreaming telemedicine. Telehealth continues to be a priority for the healthcare industry. It has proven itself throughout the ongoing COVID-19 pandemic. Recent Zoom research found that in the U.S., 72% of survey respondents want to attend healthcare appointments both virtually and in-person post-pandemic, demonstrating the clear need for telehealth as an option for this hybrid approach to healthcare. Despite the success of telehealth during the last year and a half, some have questioned its broader use as healthcare returns to in-person office visits. However, this reversal could put certain communities and demographic populations at a disadvantage, such as those in rural areas or ones without reliable transportation. Healthcare IT News sat down with Heidi West, head of healthcare at Zoom, to discuss telemedicine's future, hybrid in-person/telehealth care, communities that could be hurt without virtual care, and challenges to telemedicine becoming fully mainstream. Q. Telemedicine visits have tapered off some since their pandemic peak in 2020. Will telemedicine remain popular? If so, what will drive its continued popularity? A. During a year full of stay-at-home mandates and concerns about public safety, it makes sense as to why we saw such a sharp increase in the use of telemedicine solutions – virtual care offerings made it possible for us to get the help we needed while largely staying out of harm's way, and protecting ourselves and loved ones. Yes, there will always be a need to provide in-person care – surgical procedures, imaging and specific hands-on care still will require actual office visits. However, the opportunity for telemedicine is tremendous, and physicians should consider a virtual-first mentality to support the convenience and safety of the patient. Some forms of medical care can easily be managed over virtual platforms, and by continuing to be available virtually, providers can reach new audiences, regularly track existing ones and even grow stronger patient-provider relationships than before. One area that is particularly well-suited for this is psychiatry and psychotherapy. With online therapy, providers can meet with patients far from their physical office space, opening up opportunities to take on new business outside of the immediate neighborhood, as well as meet with patients at different times, since travelling will not need to be taken into consideration. There also is untapped potential for video communications and telehealth platforms to help aid and enhance group therapy experiences. Studies have already shown higher demand for online group therapy and fewer no-shows among the participants who sign up for sessions. We also will see some medical practitioners such as nutritionists and dermatologists continue to use telehealth solutions in their practices. There are many cases in which doctors in these fields can provide expertise and recommendations to patients via video conferencing in the same way they would in person. Telemedicine will continue to bring a level of flexibility and accessibility to the patients that need it in these realms, and it will only continue to grow as we become an even more digitally connected society. Q. In your recent study, the clear majority of consumers want both virtual and in-person care. This seems to show a need for telehealth as an option for a hybrid approach to healthcare. What will this hybrid look like, more specifically? A. We will see this hybrid approach combine the best of both the physical and digital worlds to offer an incredible experience. Generally, we'll see more primary consultations conducted via virtual platforms, with providers then asking patients to come in or engage with a specialist either remotely or in person as needed. This provides a greater number of patients with a greater level of convenience. Because of the pandemic, there also has been a heightened awareness and preference to manage post-acute care and chronic conditions at home. Providing accessibility to care in the home will be one of the greatest growth areas for telehealth. We'll likely see more outpatient care or physical rehab programs conducted over video calls for patients who have recently undergone surgery and are resting at home. New hybrid experiences also will improve information sharing and precision among doctors in their respective fields. Rather than waiting for hours across time zones for emails to be read and sent about a specific case, videoconferencing can allow doctors that are physically in a room examining a patient to digitally share information with consultants or experienced professionals outside of the room – or even in other parts of the world – in real time. Additionally, no longer do smaller hospitals or doctor's offices have to solely rely on experts in or near the local community – the talent pool for a given procedure or evaluation vastly expands when video conferencing is a part of the equation. Q. While telehealth has indeed been very successful amid the pandemic, some experts have questioned its broader use as the industry returns to in-person care. You've said this reversal could put certain communities and demographic populations at a disadvantage, such as patients in rural areas or without reliable transportation. Please elaborate. A. Yes, a great deal of the population lacks the accessibility to healthcare in the same ways that people in affluent and urban areas often have. Urban dwellers generally come across a greater number of doctors' offices, specialized care facilities and treatment options, whereas those on the outskirts or those without reliable transportation have limited choices in when and who they see as medical issues arise. The evolution of telehealth and its swift adoption during the pandemic gave many communities access to doctors and other medical professionals that they normally wouldn't be able to see. As an example, before committing to buying an expensive plane ticket and hotel room in order to see a specialist in a city far away, a patient in a more rural area can join a video conference to discuss any issues with the specialist ahead of time and determine if the trip is truly needed. This saves both parties time, money and peace of mind. Certain demographic populations also have seen the positive effects of virtual care in a way that wasn't as prevalent before the pandemic. For example, minority race groups and people of color oftentimes have difficulty finding therapists or psychiatrists that understand or align with their cultural beliefs. However, the proliferation of online therapy sessions during the pandemic has drastically changed this. Virtual health services have allowed patients to find and connect with the mental health professionals that have academic, personal and professional backgrounds that align with their existing values and beliefs, even if the practitioner lives outside the immediate region of the patient. For the first time, many marginalized groups are getting the care they need from people they trust and connect with on a deeper level. Removing telehealth as an option for care also removes a great deal of accessibility for people in similar situations to the above, or those who previously were not able to nor offered an opportunity to get the care they needed. Losing these options could mean driving a greater divide between socioeconomic groups and regions throughout the U.S. Lastly, and conversely, many physicians need to consider the increased competition threatening their patient population by not prioritizing digital health solutions. Between direct-to-consumer telehealth apps being developed daily, and retail health becoming more prevalent, there is a significant risk to not offering virtual care. Doctors and other providers could lose their patients to other companies and practices that are ahead of the curve. Q. What are remaining challenges to telemedicine being fully mainstream, including permanent reimbursement? How will healthcare provider organizations overcome these challenges? A. There are a couple of challenges that come to mind. The first that inhibits a large portion of the global population from widely leveraging telemedicine is lack of Internet connection. Without broadband and easy access to the web, telemedicine is nearly impossible. In time and with strong partnerships with Internet service providers and telecommunications organizations, the two industries will be able to offer greater accessibility to consumers and potential new patients. The second is the issue of reimbursement. There still is a lengthy discussion to be had about if payers should be required to reimburse for a telehealth appointment or service the same as they would for an in-office one. Some view a virtual care experience as less valuable and therefore, financially, worth less, as well. Providers and payers must work with legislators to combat this notion, and instead recognize the importance of telehealth, focusing on the needs of the consumer and potential to actualize value-based care. Virtual healthcare services will only continue to proliferate due to consumer demand and market competition. Regardless of reimbursement structure, the requirements and advancements in telehealth will dictate continued interest and opportunities. < Previous News Next News >

Epic research shows telehealth efficacy, makes case for more reimbursement Andrea Fox December 15, 2022 The study of 35 million telehealth visits found that most patients did not require in-person visits within 90 days of online appointments, indicating virtual visits as an effective "alternative, rather than duplicative" care modality. A dual team study of in-person, same-specialty follow-up rates after telehealth appointments published by Epic Research examined the cadence of care and found virtual medicine to be an effective tool. WHY IT MATTERS Analyzing the effectiveness of different methods for delivering care is important to guide decisions about how to allocate resources, according to the study's key findings report. To determine which specialties were able to fulfill patient needs using telehealth and which required in-person follow-up visits more often, two teams of researchers examined more than 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022. What they found, according to the report, is that high in-person follow-up rates within three months were present only in specialties that require regular hands-on care, such as obstetrics and surgery. Follow-up visits within 90 days of telehealth appointments were not, by and large, instances of duplicative care, but a method of care delivery that can increase healthcare access, the researchers say. "Healthcare providers should continue to educate policymakers and administrators on the function telehealth plays as an alternative, rather than duplicative, encounter," they said in the report, adding that payers should extend telehealth visit coverage. The researchers also found that genetics and nutrition are the specialties that made the most efficient use of telemedicine. And while 15% of mental healthcare and psychiatry telehealth appointments required in-person follow-up in the next three months, that specialty had the largest volume of all studied for telehealth utilization. Of the more than 4.3 million telehealth visits during the study period, nearly 3.7 million mental health and psychiatry telehealth visits did not require in-person follow-up. THE LARGER TREND While telehealth use increased during the COVID-19 pandemic, one study of 40.7 million adults found telehealth comparable for chronic conditions. However, some experts quickly found telemedicine well-suited for use in behavioral health after the onset of the pandemic. Also, the COVID-19 public health emergency eliminated the requirement to have an in-person visit with a patient before prescribing medication-assisted treatment (MAT) for opioid use disorder (OUD). While an end to the PHE would signal a return to the in-person visit requirement for OUD prescriptions, several healthcare organizations have urged the U.S. Justice Department and the Drug Enforcement Agency to revise telehealth controlled substance rules. In rural areas, telehealth has increased access to care, including the ability to treat OUD with MAT. "Telehealth flexibilities and ePrescribing waivers have been crucial in enabling providers to care for patients during the pandemic and have greatly expanded access to care in situations where patients were unable or unwilling to travel to a physical location," Dr. Maroof Ahmed, co-founder of Quit Genius, told Healthcare IT News by email in October. ON THE RECORD "These findings suggest that, for many specialties, telehealth visits are typically an efficient use of resources and are unlikely to require in-person follow-up care," according to the researchers' key findings report. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org Healthcare IT News is a HIMSS publication. See original article: https://www.healthcareitnews.com/news/epic-research-shows-telehealth-efficacy-makes-case-more-reimbursement < Previous News Next News >

Principal Deputy Inspector General Grimm on Telehealth By Christi A. Grimm, HHS-OIG Principal Deputy Inspector General February 26, 2021 It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. Early in the pandemic, OIG, along with many others, recognized the value of expanding options for accessing health care services. Telehealth is a prime example. Where telehealth and other remote access technologies were once a matter of convenience, the public health emergency made them a matter of safety for many beneficiaries. In some cases, health care providers needed regulatory flexibility to provide safe and effective care remotely during the ongoing pandemic. In March 2020, we issued policy statements and FAQs in support of increased telehealth flexibilities. A year later, there is a robust national conversation about expanding coverage for telehealth services based on the experience providers and patients have had during the pandemic. For most, telehealth expansion is viewed positively, offering opportunities to increase access to services, decrease burdens for both patients and providers, and enable better care, including enhanced mental health care. A 2019 OIG study found that telehealth can be an important tool to improve patient access to behavioral health services. And as we observed in recent rulemaking, OIG recognizes the promise that telehealth and other digital health technologies have for improving care coordination and health outcomes. It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse, or misuse. OIG is conducting significant oversight work assessing telehealth services during the public health emergency. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs. We anticipate the first work products to be published later this year. We are aware of concerns raised regarding enforcement actions related to "telefraud" schemes, and it is important to distinguish those schemes from telehealth fraud. In the last few years, OIG has conducted several large investigations of fraud schemes that inappropriately leveraged the reach of telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator's criminal operations. In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests. We will continue to vigilantly pursue these "telefraud" schemes and monitor the evolution of scams that may relate to telehealth. As our work and the national conversation continues, OIG believes there is a shared goal: ensuring that telehealth delivers quality, convenient care for patients and is not compromised by fraud. As we continue our COVID-19 oversight and enforcement work, we look forward to providing objective, independent information to stakeholders and policymakers. < Previous News Next News >

Permanent Pay, Originating Site Policies Boost Access to Virtual Addiction Services Victoria Bailey Dec. 29, 2021 By making temporary reimbursement and site-originating policies permanent, legislators could help increase access to virtual opioid use disorder treatment, according to a new report. December 20, 2021 - Lawmakers have the power to solidify access to virtual opioid use disorder treatment by introducing policies that ensure reimbursement parity, solidify audio-only telehealth coverage, and expand the list of eligible originating sites, according to an issue brief from the Pew Charitable Trusts. During the COVID-19 pandemic, telehealth proved to be a successful care modality for delivering opioid use disorder treatment to individuals across the country. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services (SAMHSA) lifted their restrictions and allowed buprenorphine prescribers to initiate medication treatment via telehealth without requiring an in-person visit first. However, these regulations are temporary and are set to expire once the public health emergency ends. In order to ensure access to virtual opioid use disorder treatment, state Medicaid agencies and policymakers should make these and other telehealth regulations permanent, Pew said. Legislatures should require public and private payers to reimburse providers for all opioid use disorder treatment services delivered via telehealth, including clinical assessments, prescriptions, medication management, and counseling sessions. Additionally, ensuring reimbursement for a variety of providers — including physicians, nurse practitioners, physician assistants, and mental health professionals — could help solidify the virtual treatment process. According to Pew, states that offered coverage for buprenorphine prescribing via telehealth saw positive patient outcomes that were similar to in-person services. Policymakers should also establish payment parity between telehealth and in-person opioid use disorder treatment services under public and private payers alike. “Without assurances of sufficient reimbursement rates, providers may be unwilling to invest in telehealth infrastructure for their practices, or they may find it infeasible to increase the use of telehealth for OUD treatment,” researchers wrote in the brief. Medicaid programs can ensure reimbursement parity for telehealth services without submitting a plan amendment to the Centers for Medicare and Medicaid Services (CMS). Thirty-eight states and Washington D.C. have established payment parity for certain telehealth services, but not all programs include opioid use disorder services in their provisions. Originating-site restrictions must also be addressed, Pew researchers said. Some states allow patients to use telehealth but only from certain clinics that can serve as an originating site. By expanding the list of eligible originating sites to include the patient’s home, policymakers could make accessing virtual care more convenient for individuals. Medicare currently allows individuals to receive telehealth-based opioid use disorder treatment from their homes, according to the brief. Past studies have shown that patients can initiate buprenorphine safely and successfully while remaining in their homes. In addition, patients seemed to prefer receiving treatment from home. Further, Medicaid programs should make audio-only telehealth policies permanent to facilitate access to virtual care, Pew researchers recommended. Audio-only coverage is set to expire when the public health emergency ends. Ensuring that providers receive reimbursement for audio-only opioid use disorder services may help address care disparities and benefit underserved communities that tend to use the care modality most often, including Black and Hispanic populations, individuals with limited English proficiency, and communities with inadequate broadband access. At least 15 Medicaid programs offer reimbursement for audio-only telehealth as of February, but some states only provide coverage for certain services, the brief noted. Finally, Pew researchers recommended that policymakers allow correctional settings to offer telehealth-based opioid treatment. Jails and prisons typically allow incarcerated individuals to receive healthcare via telehealth but the option to receive virtual opioid use disorder treatment is far less common, the brief stated. If states allocated funding to these institutions, they could invest in the necessary telehealth resources to establish virtual opioid treatment services. A few correctional facilities, including one in Minnesota and one in Massachusetts, currently offer buprenorphine treatment, counseling sessions, and clinical assessments through telehealth. Even with these policy changes, states may face additional barriers to offering virtual opioid treatment services including a lack of funding for infrastructure and poor broadband access. Pew researchers suggested that states consider partnering with the National Consortium of Telehealth Resource Centers to receive assistance with launching a telehealth program. Additionally, state and local governments can leverage funding from the American Rescue Plan Act to invest in expanding internet access to communities that need it. https://mhealthintelligence.com/news/permanent-pay-originating-site-policies-boost-access-to-virtual-addiction-services < Previous News Next News >

States Expand Medicaid Reimbursement of School-Based Telehealth Services Center for Connected Health Policy June 2021 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. The National Academy for State Health Policy released a report last month on how states are increasing Medicaid coverage of school-based telehealth during COVID-19, as well as assessing which services can be effectively delivered via telehealth and how to best support equitable access to services via telehealth for students. The authors found that 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. As far as services, the brief showed that most states cover audiology and speech-language therapy via telehealth, although behavioral health services had the greatest expansion and providing telemental health they found to be a recognized best practice. Half of all states cover individualized education program (IEP) plan services or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as well. The report also suggests that moving forward states should explore federal funding opportunities to expand technology and broadband access for students facing disparities in access to care. < Previous News Next News >

NEWS A collection of relevant articles providing: Telemedicine trends Industry insights Innovation updates Funding developments Legislation tracking Statutory analysis And more... Industry News Q&A: How retail healthcare, telehealth trends could evolve in 2023 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. December 16, 2022 Read More UCHealth slashes code blues up to 70% with telehealth technologies The academic medical center uses tele-sitter and virtual ICU platforms for a program it calls Virtual Deterioration. December 20, 2022 Read More Leveraging Telehealth Platforms to Enhance Provider Workflows, Adoption Implementing a telehealth platform can positively impact provider workflows in numerous ways, including easing administrative burdens, thereby leading to greater provider adoption and satisfaction. December 28, 2022 Read More Telehealth helps stop suicidal ideation for many patients, study finds One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. December 29, 2022 Read More Telehealth May Be Rural Healthcare’s Lifeline As a new year dawns, it seems like a stock-taking time in U.S. healthcare. Skyrocketing costs, underwater margins, a depleted workforce and sicker patients have most hospitals and systems thinking existential thoughts about 2023, none more so than rural facilities. December 28, 2022 Read More

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State Telehealth Laws and Reimbursement Policies Report, Fall 2021 Center for Connected Health Policy October 2021 Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2021. Our semi-annual report has gone digital Historically, our twice-yearly updates to the “State Telehealth Laws and Reimbursement Policies” report have been published as a PDF document, and included the telehealth policies for all 50 states and the District of Columbia. Earlier this year, we transitioned exclusively to our new and improved online Policy Finder. This online database allows the CCHP team to easily update each state’s information whenever there is a change, instead of waiting for the spring and fall to roll out the report. Now, you can look up (or download a PDF) of the most up-to-date information on each state from that state’s page. We hope this transition will result in more timely policy information that is easier for you to navigate and understand. Read the Executive Summary We will continue to produce bi-annual summary reports of the status of telehealth policies across the United States to provide a snapshot of the progress made in the past six months. The information for this summary report covers updates in state telehealth policy made between June and September 2021. DOWNLOAD SUMMARY This report is for informational purposes only, and is not intended as a comprehensive statement of the law on this topic, nor to be relied upon as authoritative. Always consult with counsel or appropriate program administrators. Introduction The Center for Connected Health Policy’s (CCHP) Fall 2021 analysis and summary of telehealth policies is based on its online Policy Finder database tool. It highlights the changes that have taken place in state telehealth policy between the initial release of CCHP’s Policy Finder in Spring 2021, and Fall 2021. The research for this Fall 2021 executive summary was conducted between June and September 2021. This summary offers policymakers, health advocates, and other interested health care professionals an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder tool which breaks down policy for all 50 states and the District of Columbia. Please note that many states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in this executive summary, although they are listed under each state in the online Policy Finder under the COVID-19 category. In instances where the state has made policies permanent, or extended policies for multiple years, CCHP has incorporated those policies into this report. DOWNLOAD INFOGRAPH WITH KEY FINDINGS Methodology CCHP examined state law, state administrative codes, and Medicaid provider manuals as the primary resources for the online telehealth policy database tool, from which the findings in this summary are taken. Additionally, other potential sources such as releases from a state’s executive office, Medicaid notices, transmittals or Agency newsletters were also examined for relevant information. In some cases, CCHP directly contacted state Medicaid personnel in order to clarify specific policy issues. Most of the information contained in the database tool specifically focuses on fee-for-service; however, information on managed care plans has also been included if available from the utilized sources. Every effort was made to capture the most recent policy language in each state at the time it was reviewed between the months of June and September 2021. In some cases, after a state was reviewed, they passed a significant piece of legislation. In order to incorporate those significant changes, CCHP conducted a scan for these instances in late September and incorporated language from those enacted bills where appropriate. It should be noted that even if a state has enacted telehealth policies in statute, these policies may not have been incorporated into its Medicaid program. For purposes of this summary, CCHP only counts states as reimbursing for a specific modality or removing a restriction if there is documentation to show that the Medicaid program has implemented a statutory requirement for that policy. Requirements in newly passed legislation will be incorporated into the findings section of future editions of CCHP’s summary report once they are implemented in the Medicaid program, and CCHP has located official documentation confirming this. This survey focused on three primary areas for telehealth policy including Medicaid reimbursement, private payer laws and professional requirements. Within each category, information is organized into various topic and subtopic areas. These topic areas include: Medicaid Reimbursement Definition of the term telemedicine/telehealth Reimbursement for live video Reimbursement for store-and-forward Reimbursement for remote patient monitoring (RPM) Reimbursement for email/phone/fax Consent issues Out-of-state providers Private Payer Laws Definitions Requirements Parity (service and payment) Professional Regulation Definitions Consent Online Prescribing Cross-State Licensing Licensure Compacts Professional Boards Standards Key Findings No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. The main areas where changes were made over the past six months fall in the three buckets that CCHP uses to categorize information within its policy finder: Medicaid policy, private payer policy, and regulation of health professionals. Changes were also highly influenced by temporary expansions made during the COVID-19 pandemic. Some states took approaches to extend their pandemic policies multiple years into the future, while others made policies (or portions of their COVID policies) permanent. Still others have not adopted their more lenient COVID policies at all. Connecticut, for example, passed a new temporary law (active until June 30, 2023) which not only requires Medicaid to reimburse for synchronous, asynchronous store-and-forward transfers, remote patient monitoring and audio-only modalities if the provider is in-network, but also places similar requirements on private payers as well. In Medicaid, it was common for states to make slight adjustments to their telehealth policies to add or clarify the services that can be delivered via telehealth, types of professionals that can deliver care through telehealth or the types of settings a patient could be in during a telehealth interaction. For example, Iowa clarified that an intern psychologist can provide telehealth services to Medicaid members. Mississippi clarified federally qualified health centers (FQHC) and rural health clinics (RHC) could be distant site providers, and added the home as an originating site. And, Arkansas now specifies that both the home is an eligible patient site and that group meetings may be performed via telemedicine. Although reimbursement for audio-only telephone has become pretty standard during the COVID-19 public health emergency (PHE), less than half of state Medicaid programs explicitly are reimbursing for the modality permanently, and many that are have placed restrictive parameters around its reimbursement. It was also common for states to make modifications to their telehealth private payer reimbursement law language to alter the definition of telehealth/ telemedicine. This typically included an expansion of the definition to be broader in scope so that it entails more than just live video, although often with some caveats. For example, Arkansas’ private payer law now stipulates that telemedicine does not include audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan. Iowa revised their law to include ‘real-time interactive electronic media’, but still excludes audio-only telephone from the definition of telehealth. Requirements around payment parity were also a common change, with eight states passing a law requiring the reimbursement amount is the same whether a service is provided via telehealth or in-person since Spring 2021. Illinois, for example, now requires reimbursement parity for in-network or tiered network health care professionals or facilities, including services provided via audio-only. Iowa is another example of a state requiring reimbursement of covered services is made on the same basis and same rate as in-person mental health services. Finally, there is a noticeable shift in telehealth policy towards tightening of professional requirements around the use of telehealth by providers. For example, Michigan passed new consent requirements for social work, athletic trainers, massage therapists, acupuncturists and veterinary medicine. Texas is another state that added practice standards (including a consent requirement and prescribing rules) for teledentistry specifically. West Virginia adopted emergency telehealth practice standard regulations to implement a previous law that passed (W. VA Code 30-1-26(b)) for five professions, including dentistry, nursing, osteopathic medicine, social work and medicine. While many states have had these types of standards for several years, the rate at which new telehealth standards are being adopted has increased significantly within the last six months. Additional findings include: Fifty states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. Twenty-two state Medicaid programs reimburse for store-and-forward. However, three states (NC, OH, VT) solely reimburse store-and-forward as a part of CTBS, which is limited to specific codes and reimbursement amounts. Michigan is the only state to add reimbursement for store-and-forward since Spring 2021. Additionally, three jurisdictions (MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of the creation of this edition, don’t have any official Medicaid policy indicating this is occurring. Twenty-nine state Medicaid programs provide reimbursement for RPM. States that added RPM since Spring 2021 included Washington, Michigan and California. As is the case for store-and-forward, three Medicaid programs (NH, HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this report was written, did not have any official Medicaid policy. Additionally, two of the states (OH and CA) only reimburse the remote physiologic monitoring codes CMS does. Twenty-two states reimburse for audio-only telephone in some capacity (often limitations apply); however, Michigan only reimburses for it when used for provider to- provider electronic consultations. Eleven state Medicaid programs including Arizona, California, Maine, Michigan, Minnesota, North Carolina, Ohio, Oregon, South Carolina, Texas, Washington, reimburse for all four modalities, although certain limitations apply. While this Executive Summary provides an overview of findings, it must be stressed that there are nuances in many of the telehealth policies. To fully understand a specific policy and all its intricacies, the full language of it must be read utilizing CCHP’s telehealth Policy Finder. Below are summarized key findings in each category area contained in the Policy Finder as of September 2021. Read more: https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2021/ < 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 >

State Telehealth Laws and Reimbursement Policies Report, Fall 2022 CCHP October 2022 The Center for Connected Health Policy’s (CCHP) Fall 2022 Summary Report of the state telehealth laws and Medicaid program policies is now available as well as updated information on our online Policy Finder tool. The most current information in the online tool may be exported for each state into a PDF document. The following is a summary of the current status of telehealth policy in the states given these new updates. CCHP provides these bi-annual summary reports in the Spring and Fall each year to provide a snapshot of the progress made in the past six months. CCHP is committed to providing timely policy information that is easy for users to navigate and understand through our Policy Finder. The information for this summary report covers updates in state telehealth policy made between July and early September 2022. Read the executive summary While this Executive Summary provides an overview of findings, it must be stressed that there are nuances in many of the telehealth policies. To fully understand a specific policy and all its intricacies, the full language of it must be read utilizing CCHP’s telehealth Policy Finder. For further information, visit cchpca.org. We hope you find the report useful, and welcome your feedback and questions. You can direct your inquiries to Amy Durbin, Policy Advisor or Christine Calouro, Policy Associate at info@cchpca.org . A special thank you to CCHP Policy Associate Veronica Collins for her invaluable contributions to this report. INTRODUCTION The Center for Connected Health Policy’s (CCHP) Fall 2022 analysis and summary of telehealth policies are based on information contained in its online Policy Finder. The Summary Report provides highlights on certain aspects of telehealth policy and the changes that have taken place between now and the previous edition, Spring 2022. The research for this edition of the Summary was conducted between July and early September 2022. This summary offers the reader an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder which breaks down policy for all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. Please note that many states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in this summary, although they are listed under each state in the online Policy Finder under the COVID-19 category. In instances where the state has made policies permanent, or extended policies for multiple years, CCHP has incorporated those policies into this report. See full report: https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2022/ < Previous News Next News >

Broadband Funding Frameworks and Updates Center for Connected Health Policy July 2021 The report released last month suggests the need for $106 - $179 billion to future-proof networks and get higher broadband speeds to those that currently need them. Addressing Gaps in Broadband Infrastructure Availability and Service Adoption: A Cost Estimation & Prioritization Framework is an analysis conducted by ACA Connects, an association representing small and rural broadband providers which projects that broadband funding levels should be higher than recent federal funding proposals offer. The report released last month suggests the need for $106 - $179 billion to future-proof networks and get higher broadband speeds to those that currently need them. Although President Biden’s initial proposal put $100 billion toward broadband, the latest bipartisan agreement, or Bipartisan Infrastructure Framework, currently only designates $65 billion to broadband. The details of the new agreement are still unclear and issues of contention remain. It is also, uncertain how the funding is proposed to be allocated. Some articles and insiders suggest the majority of the funding will be given to states and the rest split between smaller federal programs, leaving out the FCC, which is the main agency currently administering broadband programs. In addition, the White House recently released fact sheets for each individual state, to show the needs and impacts the framework proposes to provide across the country. As additional details come together, the ACA Connects study framework could be helpful for policymakers in determining both appropriate funding levels and allocations to truly improve and expand broadband access. In particular, the report recommends policymakers look at their funding priorities through an availability lens and an adoption lens, both of which require setting eligibility thresholds. For instance, how will “unserved” be defined and which households should be eligible for support. In addition, they suggest funding allocations be determined by what subsidy amount would actually be needed by each household and how many are likely to participate. Using such calculations, the analysis provides sample funding approaches and cost assessments in addition to its overall estimate. The report suggests that with $35-67 billion the U.S. could increase broadband availability to 19 million locations. Whether policymakers will consider the analysis remains as unknown as whether they will complete the current federal infrastructure deal as proposed. One thing does remain clear - even if a deal is finalized and passed, how the funding is targeted will remain vital to its success at improving broadband access. For more information review the ACA Connects full analysis - https://acaconnects.org/wp-content/uploads/2021/06/Addressing-Gaps-in-Broadband-Infrastructure-Availability-and-Service-Adoption-ACA-Connects-and-Cartesian-June2021.pdf. < Previous News Next News >

2021 National Telemedicine Summit World Conference Forum, LLC Sept. 13, 2021 Key Strategies to Revolutionize & Transform Healthcare Delivery, Optimize Quality Patient Care & Outcomes, Increase Accessibility, Enhance Data Analytics, and Reduce Costs! September 13 – 14, 2021 • The Ritz-Carlton, South Beach • Miami, FL Today, telemedicine is one of the fastest growing sectors in healthcare. Specifically, COVID-19 has enhanced and accelerated the role that telemedicine plays within our healthcare system. It is reshaping the landscape of healthcare delivery in the United States, and is being recognized as the future of global healthcare. Telehealth addresses and achieves the basic tenants of Healthcare Reform: providing the population with access to improved and convenient, high quality patient centric care, enhancing outcomes, while reducing per capita expenditures. Today, more than 70 percent of hospitals throughout the United States are engaged in telehealth programs. Studies have shown that the benefits of telehealth include significantly improved outcomes, efficient care delivery as well as reduction in mortality rates, hospitalizations, length of stay, readmissions and healthcare costs. Telehealth has greatly enhanced access to quality care in rural areas and patient satisfaction has increased due to its convenience and patient centric approach. We have created an exciting, high level forum featuring knowledgeable leaders and executives from the nation's leading Hospitals and Health Systems who will share their perspectives, valuable insights and expertise on how to be best equipped for the rapidly evolving and exciting landscape of telehealth. This exclusive event targets senior level executives in order to maximize educational and networking opportunities. By attending the 2021 National Telemedicine Summit, you will learn what highly regarded Hospitals and Health Systems are doing to be prepared for the challenges that lie ahead in 2021 and beyond! We look forward to greeting you in Miami! Link: https://www.wcforum.com/conferences/telemedicine < Previous News Next News >

The Center for Connected Health Policy (CCHP) released its bi-annual summary of state telehealth policy changes for Spring 2022 Center for Connected Health Policy Spring 2022 The Center for Connected Health Policy’s (CCHP) Spring 2022 analysis and summary of telehealth policies is based on its online Policy Finder. It highlights the changes that have taken place in state telehealth policy between the Fall 2021 Summary Report, and Spring 2022. The research for this Spring 2022 executive summary was conducted between January and April 2022. This summary offers policymakers, health advocates, and other interested health care professionals an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder which breaks down policy for all 50 states and the District of Columbia. The Center for Connected Health Policy (CCHP) is releasing its Spring 2022 Summary Report of the state telehealth laws and Medicaid program policies catalogued in CCHP’s online Policy Finder tool. Prior to Spring 2021, this same information was released at least twice a year in the form of a 500+ page PDF report titled, “the State Telehealth Laws and Reimbursement Report” since 2012. With the transition to the online Policy Finder, users are able to navigate each state’s updated information as soon as CCHP makes it available. Additionally, the information from the online tool can be exported for each state into a PDF document using the most current information available on CCHP’s website. CCHP plans to continue to produce these bi-annual summary reports of the status of telehealth policies across the United States in the Spring and Fall each year to provide a snapshot of the progress made in the past six months. CCHP is committed to providing timely policy information that is easy for users to navigate and understand through our Policy Finder. The information for this summary report covers updates in state telehealth policy made between January and mid-April 2022. For full report: https://www.cchpca.org/2022/05/Spring2022_ExecutiveSummaryfinal.pdf < Previous News Next News >

CONNECT for Health Act Recently Reintroduced Center for Connected Health Policy May 2021 CCHP Breaks Down Key Elements in New Fact Sheet * < Previous News Next News >

Academy Health Report Addresses Medicaid Directors Perspective on Telehealth Center for Connected Health Policy May 2021 Views on telehealth since the COVID-19 Public Health Emergency (PHE) began In March 2021, Academy Health released a report detailing results from an environmental scan and discussions with Medicaid Medical Directors (MMDs) on their views on telehealth since the COVID-19 Public Health Emergency (PHE) began. MMDs are physicians and clinical leaders in different specialties who advise Medicaid programs on clinical matters. During the pandemic, many have weighed in on telehealth and how it should be deployed in their states Medicaid program. The report breaks down views of Medicaid directors and resulting recommendations into three topic areas: Equity, Quality and Payment. Examples of recommendations made in the equity category include: 1. Medicaid programs should clearly communicate temporary telehealth policies and when those policies will expire. 2. Medicaid programs should support expansion of telehealth for purposes of equitable access if clinically appropriate and makes sense in terms of cost and quality. 3. Medicaid programs should work to reduce barriers to telehealth, including addressing the technology divide, digital literacy and underlying health disparities. For more details and recommendations related to quality and payment, read the full report. < Previous News Next News >

COVID-19 Policy Playbook Recommends Removal of Telehealth Restrictions for OUD Treatment Center for Connected Health Policy May 2021 Legal recommendations for a safer more equitable future Researchers from the Network for Public Health Law have published a COVID-19 Policy Playbook, that outlines legal recommendations for a safer more equitable future. Chapter 18 of the playbook features access issues to treat individuals with opioid use disorder (OUD). The chapter outlines several of the federal concessions made for telehealth during the PHE, including the ability to utilize non-public facing audio-visual communication technology regardless of their level of HIPAA compliance, and the ability to prescribe controlled substances, particularly buprenorphine via telemedicine. They also note that states have made similar flexibilities available at the state level in many cases. The chapter concludes with a list of recommendations, including the following: *The Secretary of Health and Human Services (HHS) should permit treatment to be initiated via telehealth *Restrictions should be removed on who can receive treatment via telehealth. *States should authorize provision of buprenorphine via telehealth where applicable. COVID-19 Policy Playbook: https://static1.squarespace.com/static/5956e16e6b8f5b8c45f1c216/t/6064ad386b6e756cabb56f96/1617210684660/COVIDPolicyPlaybook-March2021.pdf < Previous News Next News >

Increased Access to Care Via Telehealth in CHCs: NACHC Survey on Audio-Only Telehealth and Health Centers Center for Connected Health Policy July 2021 The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Temporary telehealth policies during the pandemic, particularly those related to audio-only, highlighted the capacity of community health centers (CHCs) to increase patient access to care in underserved communities. The National Association of Community Health Centers (NACHC) recently released a report on their survey of CHCs to assess their telehealth experiences over the course of the public health emergency and determine what the effects would be upon termination of temporary policies, and how that would impact their providers and patients. The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Overall, the report suggested that losing audio-only coverage would likely exacerbate existing health disparities. Prior to the pandemic, health centers faced numerous federal restrictions that limited their ability to use telehealth. According to the report, previously only around 40% had used telehealth and audio-only modalities. Once allowed during the pandemic, however, nearly all CHCs utilized telehealth and delivered critical health care services to 30 million patients. Urban health centers and those serving low-income populations were also found to have higher rates of providing services via telehealth and audio-only, and 92% of health centers said audio-only improved patient access to care. To continue to provide this expanded access to care post-pandemic via telehealth the report discussed the need for Congressional action to permanently remove restrictions around use of audio-only and originating/distant site limitations, as well as ensuring reimbursement parity. In addition, as many states struggle to determine their post-pandemic policies related to telehealth, it has become apparent that the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) must also clarify whether states can continue to allow audio-only coverage under Medicaid and still receive federal matching funds. The value and necessity of audio-only was stressed throughout the survey. Benefits of audio-only telehealth included: *Reduced no-show rates *Improved patient/provider relationships *Better coordination of care amongst providers and families *Improved chronic care management The report concludes that without continued telehealth coverage for CHCs, all of the stated benefits will disappear, create a barrier to the provision of quality health care, and negate the ability for health centers to bring equity and access to underserved communities that would otherwise likely go without needed services. The authors urge the federal government to act and preserve access to care via telehealth in health centers across the country. Currently, there is active legislation federally and in many states that seeks to expand and extend telehealth and audio-only policies, including those for health centers. The fate of these bills remains unknown, but it is clear that the ideal resolution would need both federal direction and state engagement. A small but limited step was taken with CMS’s newly proposed physician fee schedule (PFS) for 2022. CMS is proposing to expand the definition of a “mental health visit” for CHCs by including mental health services provided through “interactive, real-time telecommunications technology”, including audio-only if the patient is not capable or does not consent to the use of live video. Additionally, the rate paid for eligible services would be at parity. This proposal is still rather narrow, but many of the existing restrictions, as mentioned previously, live in federal statute and must first be addressed by Congress. < Previous News Next News >