Telehealth Remains Key Modality for Behavioral Healthcare Delivery eVista December 19, 2022 A Michigan-based provider leveraged a telehealth solution to expand critical access to behavioral healthcare as demand for these services skyrocketed during the COVID-19 pandemic. After reaching new heights during the first year of the COVID-19 pandemic, telehealth use is leveling off in several clinical care areas. But there is one prominent exception: behavioral healthcare. Healthcare stakeholders are continuing to flock to telehealth for behavioral health services. An analysis of data from January 2020 to March 2022 shows that mental health conditions were the most common telehealth diagnoses at the national level. In addition, data shows that amid a drop in overall telehealth use since 2020, telemental healthcare has grown. In the first quarter of 2019, 32.4 percent of all telehealth visits were related to behavioral healthcare, according to a market research report. That figure jumped to 59.9 percent by Q1 2022. This data, along with the ongoing mental health crisis in America, signifies the importance of providing virtual care options for behavioral healthcare. At Michigan-based Easterseals MORC, telehealth has been integral to behavioral healthcare delivery since 2019. Then, amid the pandemic, the organization saw its virtual visit volumes skyrocket, and they continue to show no signs of slowing down. "We went from 25 telehealth users before the pandemic to 300," says Clarissa Hulleza, Chief Information Officer of Easterseals MORC. "Those numbers are still going up. We're not seeing any decrease." WHY THE ORGANIZATION IMPLEMENTED TELEHEALTH Easterseals MORC, an affiliate of the national Easterseals organization, serves over 21,000 individuals annually. It provides a wide array of behavioral health services, including therapy, psychiatric care, and substance abuse treatment, as well as long-term care for those with intellectual and developmental disabilities. In 2019, the organization decided to implement a telehealth solution. One of the key goals of the move was to expand access to behavioral healthcare across the state. “The reason we pursued a telehealth solution was so that people who couldn't get to us regularly or at all, could be provided the opportunity to still receive care," says Hulleza. "We serve all of Michigan, and not all of Michigan has access to transportation, or maybe their closest local provider is 20 miles away. So, it was really creating more opportunities for access." Additionally, telemedicine was already becoming popular as a mode of physical healthcare delivery, prompting behavioral healthcare providers to catch up. "It was one of those, 'well, why aren't we doing the same?'" Hulleza says. Easterseals MORC partnered with eVisit to launch a telehealth pilot program in May 2019. A little under a year later, the COVID-19 pandemic hit, compelling providers across the country to rapidly scale up their telehealth programs. According to Hulleza, already having a telehealth solution and vendor partnership in place enabled Easterseals MORC to expand virtual care use seamlessly. "I would say that the absolute benefit was that we never had to close our doors," she adds. "In a time that people needed behavioral healthcare the most, we were able to provide it." IMPLEMENTATION CHALLENGES AND KEY LESSONS LEARNED Easterseals MORC leverages telehealth for nearly all of its services, including case management, one-on-one and group therapy. The organization even provided Applied Behavior Analysis (ABA) therapy virtually, which aims to improve social behaviors using interventions. But implementing a telehealth solution for behavioral healthcare has its challenges. For Easterseals MORC, those challenges ranged from clinician training to technology issues among those receiving services. Clinicians were not only providing care in a new way, they also had to become tech support in helping those they served navigate the new technology. Training is a critical aspect of telehealth technology implementation. If training is not provided proactively, it can result in clinicians avoiding virtual care use as they might find it difficult and overwhelming. “Pilot testing the solution before a full rollout was critical to ensuring that clinicians had adequate training to use the technology and that workflows were not negatively impacted,” Hulleza says. Partnering with the right vendor was a vital aspect of this effort, as the vendor was able to provide clinician training resources as well as suggest new policies and processes required to promote and support the telehealth program. “Ultimately, we selected our vendor because we were looking for a partnership that would improve the overall behavioral healthcare delivery experience. This meant that we needed a tool that offered more than a two-way video solution — one that integrated with, and empowered, the clinical workflow with value-added technology,” Hulleza shares. “There were multiple tools in the marketplace that solved the video connection challenge, but Easterseals MORC was looking to do more than simply move the clinical interaction to a video screen.” Further, choosing the right partner and then piloting the telehealth solution allowed the organization to test the supporting technology infrastructure before a full rollout. Easterseals MORC tested laptop specifications and made sure the solution worked equally well on different devices, including mobile phones and tablets. "We even went as far as making sure our bandwidth at all of our locations was increased so that if we had 20 people doing telehealth at the same time, there wouldn't be any degradation in services," Hulleza says. On the side of those receiving services, Easterseals MORC had to consider the digital divide facing its population. "[The people we serve] don't always have the newest phones, the best bandwidth," she says. "They don't have the luxury of going to a bedroom and closing the door. They might have shared living arrangements. We had to make sure we were accommodating all of those things." To address individuals' technology access needs, the organization applied for various grants and used those to provide iPads and iPhones with built-in data plans. Another essential aspect of closing the digital divide is identifying the viability of an individual to receive services via telehealth. Easterseals MORC uses a checklist tool provided by the telehealth vendor to identify these individuals and the barriers they face. "Do you have a private place? Do you have a microphone? What model phone do you have or mobile device?" Hulleza adds. "The tool goes through all of these questions and allows providers to evaluate if telehealth is an option." Easterseals MORC plans to solidify telehealth as a key behavioral health delivery mechanism within its business. It is unclear if Congress will make the temporary telehealth flexibilities enacted during the pandemic permanent — but for Hulleza, there is no going back. "I absolutely want to grow telehealth here," she says. "The need amplified because of the pandemic, but telehealth was going to exist for our organization even if the pandemic didn’t happen." ____________________________ About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/telehealth-remains-key-modality-for-behavioral-healthcare-delivery < Previous News Next News >

Can we provide care across state lines? By Jan Ground PT, MBA, SWTRC Colorado Ambassador March 3, 2021 Snow birds. Not the kind that fly (certainly not now with COVID) but the human kind. For those of you who never heard the term before, snow birds are typically retirees who travel south in the winter to states like Arizona, New Mexico and Florida to get away from the snow and cold up north than go back up north in the summer when the heat hits the south. What does this have to do with telemedicine? A lot actually and not just with snow birds. We are a mobile population. People don’t stay in one place their entire lives anymore – we move around, we travel but when we move from one place to another we don’t get to leave our health conditions behind us. They stay with us and sometimes we just get sick when we travel. Being creatures of habit, however, most people like to have consistency in their health providers. We like to think that our PCP and specialists that we see know us and our problems, that we have a relationship. Back to the snow birds – if my cardiologist lives in Chicago and I see her during the summer I want to see her during the winter as well when I’m relaxing by the pool in Tucson staying warm. Problem is she’s back in Chicago shoveling snow so how can I see her? Telemedicine of course but it’s not that easy. An interstate compact is a contract between two or more states creating an agreement on a particular policy issue, including, but not limited to, the facilitation of licensure of clinicians in states other than that in which the clinician holds his/her home state of licensure. Currently, licensure compacts exist for physicians, nurses, physical therapists, psychologists, emergency management personnel, and speech-language pathologists/audiologists. Licensure compacts for physician assistants, counselors, advanced practice nurses, and occupational therapists are under development. Interstate Compact Models Mutual Recognition (Reciprocity) allows a clinician in a compact state ("home state") to practice in any of the other compact states without obtaining additional licensure in the remote states. The clinician’s home state license is “mutually recognized” by other compact member states. This model allows a practitioner to practice in the compact member states either using a multistate license or by obtaining a “compact privilege”. Expedited Licensure Participating U.S. states work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify. These licenses are still issued by the individual states – just as they would be using the standard licensing process – but because the application for licensure in these states is routed through the Compact, the overall process of gaining a license is significantly streamlined. Physicians receive their licenses much faster and with fewer burdens. The Interstate Medical Licensure Compact is the only expedited licensure compact. With the national and state emergency orders related to COVID-19, the regulations requiring that licensed clinicians provide care only to patients who are physically located in the state(s) in which the clinician is licensed to practice have been relaxed. It is not known if, when, and how these regulations will change when the COVID-19 emergency orders have expired. This table summarizes what is going on in each state for a variety of providers with respect to pending (P) versus enacted (E) legislation as of January 2021. These are of course subject to change as each state makes progress in deciding what to do. FOR FULL ARTICLE SEE: https://southwesttrc.org/blog/2021/can-we-provide-care-across-state-lines Physicians www.lmlcc.org Nurses www.ncsbn.org/nurse-licensure-compact.htm Physical Therapists www.PTcompact.org Psychologists www.psypact.org Emergency Management Personnel ww.EMScompact.gov Speech-Language Pathologists Audiologists www.aslpcompact.com Occupational Therapists www.OTcompact.org Advanced Practice Nurses www.nscbn.org/aprn-compact.htm < Previous News Next News >

New Coding Modifier Offers Opportunity To Investigate Audio-Only Telehealth Alexander Beschloss, Ryan Van Ramshorst, Chethan Bachireddy, Christopher Chen, Andrey Ostrovsky November 18, 2022 Prior to the pandemic, Medicaid program coverage of audio-only telehealth services was limited. During the early stages of the pandemic, Medicaid beneficiaries were significantly less likely to complete telehealth visits compared to commercially insured patients. This was likely due to a series of obstacles, including: lack of access to high-quality broadband, a device with video capability, requisite digital skills, and private space to conduct the visit. For example, in 2019, roughly one in four Medicaid enrollees lived in a home without internet or with limited computer access. That said, Medicaid beneficiaries do not have significantly less access to devices with video capability (such as smartphones) than other patient populations, suggesting network connectivity poses more of a barrier than device access. Even further, nearly 50 percent of low-income patients in the US may not have requisite digital health literacy to use virtual telehealth. However, considering that 86 percent of Medicaid beneficiaries own a smartphone, it may be inferred that many more have sufficient digital literacy to engage in audio-only care rather than audio-visual telehealth. Network connectivity and low rates of digital literacy are two barriers that highlight the importance of creating the infrastructure to deliver and measure audio-only visits is of increased necessity. It was in this context that, once the pandemic struck, Medicaid agencies changed policies to augment access to telehealth services. For example, 17 state Medicaid agencies expanded reimbursement to include multiple modalities of telehealth, including audio-only. These changes particularly supported patient populations who had transportation, childcare, employment, or income barriers that prevent in-person care—challenges that are more prevalent in the Medicaid population. These policy innovations narrowed the reimbursement gap among in-person, audio-only, and audio-visual visits. In fact, the Department of Health and Human Services (HHS) recently investigated differences in patient populations who receive telehealth audio-only versus audiovisual use in 2021. For telehealth visits, Medicaid beneficiaries were more likely to use audio-only care than were privately insured patients (35.1 percent versus 45.5 percent). They discovered that compared to White patients, who used audio-only care for 38.1 percent of their telehealth visits, Latino, Black, and Asian patients did so at rates of 49.3 percent, 46.4 percent, and 48.7 percent, respectively. Patients with less than a high school education used it at 61.9 percent of their telehealth visits, compared to those with greater than a bachelor’s degree, who did such at a rate of only 32.6 percent. Across income brackets, there is an inverse relationship between household income and audio-only telehealth use. As the use of audio-only telehealth became more widespread among Medicaid beneficiaries, state Medicaid leaders needed a mechanism to measure clinical outcomes, health care costs, and patient experiences related to audio-only telehealth. Providers also needed a dedicated billing construct that could be used across public and private payers to streamline billing processes. Until recently, such mechanisms simply did not exist. And so, due to these insufficient coding constructs, several Medicaid medical directors spearheaded an application to the American Medical Association (AMA) to create a Current Procedural Terminology (CPT) modifier that would specifically designate audio-only services. In September 2021, the AMA CPT Editorial Panel accepted the addition of the CPT Modifier 93 code for synchronous audio-only telehealth, and the code became active on January 1, 2022. This article provides an overview of the rationale for and process of creating the CPT Modifier 93 code. Potential Benefits Of Audio-Only CPT Modifier Why was the creation of a new audio-only modifier necessary? Several reasons: data collection, policy implementation, health care equity, widespread need, and service specificity. The CPT 93 modifier permits differentiation among audio-only, audiovisual, and in-person care at the administrative level, which subsequently allows health service researchers to monitor and evaluate the use and clinical efficacy among these methods of care delivery. Prior to the introduction of this modifier, such high-quality analyses were impossible to do at scale. Along with the increase in all modalities of telehealth use since the COVID-19 public health emergency (63 fold increase year over year between 2019 and 2020), a survey performed by HHS (across all 50 states and the District of Columbia) discovered that 45.5 percent of all telehealth usage amongst Medicaid beneficiaries was audio-only. Taking things one step farther, several state legislatures including Washington, Connecticut, and New York have recently passed laws mandating or allowing coverage for audio-only services. Audio-only telehealth is being highly used, therefore having a mechanism to collect related data is vital. Implementing this modifier will serve as a tool for policy makers to make informed adjustments in policy around patients who use audio-only services. Implementation of this modifier will also enable claims-based research to monitor for disparities between audiovisual and audio-only care to ensure that all modalities of telehealth are provided in a sustainable, equitable, and high-quality fashion. Additionally, because different states have implemented varying strategies to cover audio-only services during the COVID-19 public health emergency (PHE), the CPT 93 modifier will help health services researchers and policy makers discern the differences between coverage approaches, information that will be crucial in standardizing telehealth data collection/storage across states. From a coding perspective, adding an audio-only modifier to existing and widely used CPT codes is a far more feasible option than alternatives such as individual payers developing their own coding modifiers. That approach would become unreasonably burdensome on providers who would subsequently have to learn and bill using the system established by each payer. Previous Codes Did Not Suffice While CPT codes for services provided through telephone exist, they do not specify the enormous range of behavioral health services, therapies, maternity-related care, post-operative guidance, and other services that have been successfully delivered via audio-only technology since the COVID-19 PHE. For example, CPT code 99441 represents a “telephone evaluation and management service; 5–10 minutes of medical discussion,” which gives no specificity regarding what type of care was delivered. In comparison, the CPT 93 modifier can be attached to theoretically any billing code that is permitted under law, thus allowing for more precise tracking and more useful follow-up research. Prior to the introduction of the CPT 93 modifier, there were seldom CPT codes that could be used to represent audio-only telehealth for specific services. Even though audio-only telehealth has been delivered at high rates, states have only been able to use temporary or workaround solutions to bill for audio-only services. For example, the Healthcare Common Procedure Coding System (HCPCS) Level II code for crisis response (CR) has been used by some states to support audio-only services during the COVID-19 pandemic. In the two and a half years since the pandemic began, however, the use of audio-only to provide health services has become normalized and may in fact now be expected by Medicaid providers and beneficiaries—a reality for which the CR code, and its temporary application, was not designed. The CPT 93 solves this challenge on a national scale. Another prior attempt to capture audio-only telehealth was the CPT modifier 95 that only indicated a telehealth service and did not differentiate between audio-only and audio-visual care. HCPCS Level II code “G0” has also been used; however, it indicates a telehealth service for diagnosis, evaluation, or treatment specific to symptoms of an acute stroke. Furthermore, CPT code 99401 can be used to reflect counseling services that may be provided via audio-only care; however, this code failed to capture all the nuance of the amount of time of care was delivered. At the end of the COVID-19 PHE, the Centers for Medicare and Medicaid Services (CMS) plans to add the “FQ” modifier on claims for HCPCS code G2080 for counseling and therapy provided using audio-only telecommunications. The HCPCS G2080 code refers to when one provides therapy services that largely exceed the amount listed in the patient’s individualized treatment plan for medication assisted treatment for opioid use disorder. This modifier exists solely for CMS’s Opioid Treatment Program and fails to account for other indications for audio-only telehealth. Creating a CPT modifier that is applicable to all service types simplifies the codification and measurement of audio-only care across all payer types. Conduct More Research On Audio-Only Telehealth Researchers, provider organizations, and policy makers must investigate and ensure that audio-only telehealth drives strong clinical outcomes. Telephone-focused care has been an important part of primary care; however, much of it was after hours, unmeasured, and not reimbursed. There is strong evidence on audio-only telehealth’s efficacy in prenatal visits and insomnia, for example. A randomized clinical control trial in a patient population of the Kaiser Permanente Washington system received audio-only cognitive behavioral therapy through the telephone demonstrated a significant benefit in improving sleep, fatigue, and osteoarthritis-associated pain. A cohort study amongst pregnant women in the Parkland Health System in Texas found that audio-only perinatal visits were not associated with changes in perinatal outcomes when compared to in-person visits in a vulnerable population. While these data are encouraging, they are sparse. Measurement of a CPT modifier may streamline the research methods used in these studies. Researchers must continue to investigate the efficacy of specific therapies when delivered via audio-only modalities. While audio-only telehealth solves several problems in health care, there are also several risks such as its potential use for inappropriate clinical indications and the risk that some may see an opportunity to overbill. An audio-only modifier—and therefore a more granular characterization of telehealth modalities—may help assuage concerns about fraud, waste, and abuse, removing existing ambiguity about the impact of different telehealth modalities on outcomes. We also know that the quality and value of these delivery modalities may vary according to the different demographics being served, including factors such as age, insurance status, payer, income, and region, among many others. Such modalities will likely vary between acuity of patient’s indication for care. Only by studying these differences amongst modalities and the populations served, can we ensure that the care delivered is equitable and valuable. Implementing the 93 modifier is a vital step toward enabling health services researchers to urgently pursue research questions that inform evidence-based policy about the best use of audio-only telehealth—especially amongst the Medicaid population. It is also essential to ensuring that the growth of audio-only health care does not create a two-tiered system between private insurance and Medicaid. For example, audio-only care may in fact be lower quality or lower value compared to audiovisual care or in-person care—although, further investigation is necessary to understand these differences. Considering that audio-only care helps remove barriers to care for underresourced patient populations, inappropriate use of audio-only care may further exacerbate the already large inequities in health care—a concern raised by both clinicians and patients. This reliance on audio-only care may also hamstring innovations that can improve the quality and access to audiovisual telehealth or in-person care. Clearly, there are legitimate concerns about the equity of audio-only health. To resolve them, more precise data and extensive investigations are necessary: Both of which will be enabled by the implementation of the CPT 93 modifier. An Opportunity For Action The new audio-only CPT 93 modifier provides meaningful potential benefits to combat barriers to care that were compounded during the COVID-19 pandemic. The new code creates a potent opportunity for conducting rigorous research into audio-only telehealth to inform federal- and state-level policy around equitable telehealth delivery. But to make the most of this opportunity, regulators, payers, providers, and researchers must take steps to increase adoption and evaluation of the audio-only modifier. To catalyze this work, large health systems should consider leading the adoption of the CPT 93 modifier while also encouraging local private providers to do the same. Payers and purchasers should consider requiring modifier submission, a step that would also facilitate further research into the field with minimal additional administrative burden on providers. Federal health agencies have a role as well. For example, the Agency for Healthcare Research and Quality (AHRQ) may increase awareness of the modifiers amongst affiliated researchers or those who use AHRQ databases while the Health Resources and Services Agency may require community health centers they fund to use the new modifier. Authors’ Note The authors would like to thank Dr. John Morgan and Amanda Brodt for their contributions to preparing this paper. Dr. Ostrovsky is an investor in the following companies, some of which provide telehealth services: https://www.socialinnovationventures.com . However, there are no direct conflicts of interest. See original article: https://www.healthaffairs.org/content/forefront/new-coding-modifier-offers-opportunity-investigate-audio-only-telehealth#.Y3feKa9vXhA.twitter < Previous News Next News >

Bipartisan Policy Center Report Highlights Telehealth Policy Considerations CCHP November 01, 2022 Last month, the Bipartisan Policy Center (BPC) released a comprehensive report on The Future of Telehealth After COVID-19. The report is based upon an analysis of Medicare Telehealth Utilization and Spending Impacts 2019-2021, stakeholder input and interviews, a literature review, and a national consumer survey. The BPC report examines the impact of increased access to telehealth during the pandemic and makes recommendations to policymakers on which COVID-19 policy expansions should be maintained post-public health emergency (PHE). Ultimately, BPC urges the federal government to extend emergency flexibilities for two years to preserve access while further evaluating telehealth effectiveness. In its analysis, BPC made a number of key findings showcasing telehealth’s ability to alleviate access barriers for Medicare beneficiaries, address inequities in access and outcomes for racial and ethnic minorities, low-income earners, and individuals with chronic conditions, as well as improve patient continuity of care. The report also noted that patients and providers generally feel satisfied with telehealth services. Other findings include: A decrease in telehealth utilization since initial pandemic peaks, although 2021 rates remained nearly 40 times higher than pre-pandemic telehealth visits Most telehealth visits were for primary care visits and 44% of all behavioral health visits in 2021 occurred via telehealth About 1 out of 5 telehealth visits were audio-only in 2021 Telehealth utilization was higher in urban areas and for non-white beneficiaries Beneficiaries with disabilities and dually eligible for Medicare and Medicaid were more likely to use telehealth in 2021 Medicare spending on telehealth remains a small percent of overall spending – for the outpatient codes BPC examined, telehealth spending was between 1.5% and 3.3% of total spending in 2020 and 2021 In applying its findings to policy recommendations, BPC discusses an attempt to balance competing goals, for instance the need to increase access to care against the need to ensure quality and cost-effectiveness. The report also highlights areas to focus future research and notes the need to examine telehealth outside of PHE conditions to truly generalize findings. In addition, BPC acknowledges limitations in its spending analysis that don’t factor in the potential reduction in long-term costs related to emergency room visits in correlation to increased telehealth visits. In addition to extending Medicare telehealth flexibilities for two years, key BPC recommendations to Congress and the Biden administration include: Maintain access to telehealth for Medicare beneficiaries regardless of location or medical diagnosis – including the home/patient location as an authorized originating site and removing geographic limitations (with protections to require providers to see patients in-person or refer to in-person care when necessary) Authorize FQHCs/RHCs to permanently serve as distant site providers Continue access to primary care and behavioral health services with minor adjustments post-PHE (the recommendation notes that if further research supports it, CMS could consider limiting certain services to existing patient-provider relationships – except in rural areas and for alternative payment methodology (APM) providers) Continue audio-only coverage and incorporate audio-only into telehealth definition (post-PHE audio-only restrictions should limit coverage to established patients and at patient request) Permanently expand asynchronous services beyond virtual check-ins and Alaska and Hawaii demonstration projects for both new and established patients Make Health and Human Services (HHS) 1135 temporary waiver authority permanent for future PHEs Eliminate the requirement for in-person visits for telemental health services (BPC states this is an undue burden on those who cannot access behavioral health providers in-person) Require evaluation of controlled substance prescribing via telehealth and for non-hospice, non-cancer patients, first require an in-person exam prior to prescribing substances prone to abuse (BPC additionally recommends the Department of Justice (DOJ) follow through on its requirement to create a special telemedicine registration process to allow for certain in-person requirement exemptions) Refine reimbursement rates and end broad payment parity between telehealth and in-person care to offset any cost/utilization increases, including implementing different rates for audio-only and video visits In regard to transparency and consumer protections in particular, the report also recommends clear information to beneficiaries be provided regarding benefits appropriately delivered by telehealth and ensuring that beneficiaries consent to the use of telehealth. BPC additionally recommends the ability to distinguish between traditional and fully virtual providers be determined, and that enforcement resume related to HIPAA. In regard to fraud, waste, and abuse protections, the report calls for sufficient funding to the HHS Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) to modernize and track telehealth use, the requiring of outlier provider audits, and that high-cost durable medical equipment (DME) and laboratory tests be limited to established patients, unless providers are part of APMs. To improve data quality, the BPC suggests CMS simplify telehealth billing and develop additional guidance for providers to ensure uniformity and coding accuracy. Lastly, the BPC recommends requiring MedPAC complete a formal evaluation of post-PHE telehealth impacts on access, quality, patient outcomes, and cost to truly determine long-term trends and policies. BPC’s report is extremely thorough and highlights the many issues policymakers are facing in contemplating permanent telehealth policies. Some of BPC’s attempts to balance recommendations and exceptions to address concerns raise additional complexities behind the considerations further showcasing where policymakers and future research should focus. For instance, in terms of audio-only, BPC notes that continued coverage is critical for beneficiaries lacking broadband and technology access, although additional restrictions should be adopted to address concerns related to quality and potential for overuse. However, policymakers should consider whether these additional restrictions may ultimately limit the access the report describes as critical. In terms of payment parity, BPC notes that it has been an important tool to increase access to care and ensure that practitioners provide telehealth services. However, given payer and policymaker concerns, BPC recommends that perhaps the best post-PHE policy would be to cover certain telehealth services at higher rates than pre-PHE rates, but not necessarily equivalent to in-person rates. That may go against other recommendations in the BPC report to simplify telehealth billing, although ultimately BPC does state that CMS should look carefully at cost differentials when determining appropriate rates. Since many providers state that the cost and time of providing services via telehealth and in-person are equivalent it is important that researchers and policymakers look carefully at that issue. In addition, BPC suggests that different reimbursement rates may ensure access to in-person services, yet also states that parity in rates ensures access to telehealth services, showing the difficulty in sufficiently balancing these various considerations. Researchers and policymakers must pay careful attention to all perspectives and data around these issues in order to truly ensure telehealth’s ability to increase access to necessary health care. For additional details on BPC’s findings and recommendations, please view the report in its entirety. See original article: https://mailchi.mp/cchpca/bipartisanpolicycenter-report-highlights-telehealth-policy-considerations-recommends-2-year-extension-of-federal-flexibilities-further-research < Previous News Next News >

Telehealth Waivers Wind Down, Restricting Some Providers From Delivering Care Across State Lines Hailey Mensik August 2021 States allowed medical professionals licensed elsewhere to hold virtual visits with their residents during the pandemic. Some are making the rollbacks permanent, but others are reversing again. State lawmakers temporarily scrapped hundreds of regulations early in the COVID-19 pandemic to help businesses and consumers deal with widespread shutdowns, giving patients greater access to telehealth and helping spur an explosion in use of virtual care. A number of states allowed medical professionals licensed elsewhere to hold telehealth visits with residents of their state during the pandemic, and some already have or are looking to make the rollbacks permanent. Exact numbers are difficult to track because some policies overlap and are organized differently in different states, but as of July 28, 17 states and the District of Columbia still had some type of telehealth waivers in place, according to the Federation of State Medical Boards. Other states like New York, Minnesota, Florida and Alaska are among those that have pulled back emergency waivers. Alaska is going back to its old ways after its governor's emergency order ended. Patients there can only visit telehealth providers licensed in the state now after about a year without that rule. The same goes for Florida after its emergency declaration expired on June 26. Meanwhile, Arizona lawmakers passed sweeping legislation in May making the state's pandemic-related telehealth waivers permanent, including requiring insurers to cover audio-only visits and allowing out-of-state medical professionals to conduct telehealth visits with patients in the state. Advocates for allowing providers to permanently deliver virtual care across state lines say it would help ease staffing shortages, help patients and doctors maintain existing relationships and benefit patients in isolated communities by making faraway specialists more accessible. But as long as medical licensing is regulated at the state level, the broad access to services and providers that existed during the pandemic won’t continue for everyone. Patients in rural areas are often far away from a doctor's office, and in states like Alaska where flexibilities expired, can be even further from providers practicing certain specialties, such as a pediatric intensivist or certain oncologists, said Mei Kwong, executive director for the Center for Connected Health Policy. "Maybe there aren't enough of those cases in those particular states to make it worth a provider's while to go and move there, but there's still a need because they may still have people who need those services," Kwong said. The patchwork of red tape could also pose a challenge for providers who have pivoted to delivering more virtual care over the past year. Mia Finkelston, a family medicine physician in Maryland, made the switch to telehealth nearly a decade ago and has been practicing with Amwell ever since. She's currently licensed in 29 states, and said the process to get her licenses varied widely. "It's not standard as far as fees, it's not standard as far as what documents you need to give them. It really is based on those state medical boards and what they decide is important to them," Finkelston said. As more states' waivers expire and others' rules change, one option for providers who want to continue delivering care across state lines is through the Interstate Medical Licensure Compact, which currently includes 30 states, the District of Columbia and Guam. Similar to the nurse licensure compact, it allows eligible physicians to practice in other compact states. It’s worth noting, however, that the Interstate Medical Licensure Compact does not issue a compact license or a nationally recognized medical license for physicians, but rather streamlines the process for them to receive multiple licenses from individual state medical boards. Physicians pay an initial $700 compact fee, then an additional cost for each license in any compact state they want to practice in. States must pass legislation to join the compacts. "No two states are totally alike in their legal and regulatory framework for the practice of medicine, which of course, affects telehealth, which is just one aspect of the overall US healthcare system," Kyle Zebley, director of public policy at the American Telehealth Association, a coalition with a board that includes representatives from hospitals like HCA and payers like CVS, said. "Therefore a way to be consistent with our federal system, consistent with the way that the practice of medicine has been done in this country for so long, we've come up with this great model of compact, which is a way to be consistent with all that while still allowing for care across state lines," Zebley said. As lawmakers try to facilitate continued access to telemedicine for those who need it most, licensure reforms will be key, the authors of a February article in the New England Journal of Medicine argue. "The growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of health care markets beyond state borders," the authors said. They agree that a federal medical licensing system is the loftiest reform option and strengthening existing compacts is the way to go, suggesting Congress pass legislation to encourage holdout states to join the Interstate Medical Compact. Other options include encouraging states to practice reciprocity, where they automatically recognize an out-of-state license, as the Department of Veterans Affairs does with physicians in its system. Source: https://www.healthcaredive.com/news/telehealth-waivers-wind-down-restricting-some-providers-from-delivering-ca/603169/#:~:text=Healthcare%20Dive-,Telehealth%20waivers%20wind%20down%2C%20restricting%20some%20providers%20from%20delivering%20care,but%20others%20are%20reversing%20again. < 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 >

My Story: A Patient’s Perspective Tara Barry January 27, 2022 The pandemic has created a lot of new realities throughout the world, telemedicine being one of them. As someone with thyroid disease and other ailments, I have to get regular check-ups (sometimes every month when it’s really flaring up). With my health issues, I see multiple different doctors (primary, cardiologist, endocrinologist, allergist), and it’s often very hard for me to find time to fit them all in to my already jam-packed schedule. Telemedicine has been such a welcome adaption for me, as it has truly taken a lot of the usual “appointment” stress, like commute time, completely out of the equation. During the pandemic, I’ve been particularly cautious about in-person appointments. Since I am someone with a weakened immune system, it makes me nervous going into such a historically germ-filled location such as a doctors’ office. Telemedicine appointments truly put me at ease. I have had experience with ‘televisits’ for both primary care and specialty care. I’ve been able to have a quick appointment on my lunch break and sometimes even during a short 15-minute break. When I made my first appointment I was a little nervous about how it would be. I didn’t know if I’d feel more rushed and like they were just squeezing me into their busy day or not. It was a relief to find that wasn’t the case at all. I find these appointments to actually be much more conversational than in-person visits, and also feel like they really get down to the issues faster. You can learn about treatment options in mere minutes and have your prescriptions sent in while you’re still on the call! I am someone who is technologically savvy so I wasn’t too worried about being able to successfully hop on to a telemedicine call. I think the various systems different doctor’s offices use make all the difference. In my experience, I have always been given the telehealth links ahead of time and the instructions have been very clear and concise. Typically, the medical assistant will call prior to the appointment to go over your medical history, insurance information, what your appointment will be focused on, and the instructions to get on the call. Sure, there’s been a few times we’ve had some connection issues, but they always seem to resolve themselves quickly and don’t take away from the appointment itself. To read full article: https://telemedicine.arizona.edu/blog/my-story-patient-s-perspective < Previous News Next News >

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 >

October 2022: Funding and Grant Opportunities Southwest Telehealth Resource Center October 2022 SWTRC NEWSLETTER- OCTOBER 2022 Bringing you up-to-date telehealth information resources on the southwest region and the USA Funding and Grant Opportunities There are many funding and grant opportunities for community and health-related organizations wanting to increase broadband capabilities and bring in needed funds for unique community health programming. Here’s a list of funding sources in the Southwest focused on broadband and health: AZ HEALTH Legacy Foundation of Southeast Arizona Grants | Legacy Foundation of Southeast Arizona (lfsaz.org) The Legacy Foundation of Southeast Arizona (LFSAZ) is a private foundation that grants funds to nonprofit organizations promoting population health and community wellness in Cochise and eastern Santa Cruz counties. Arizona Systems Change Grants Grants Archive - Vitalyst Health Vitalyst Health Foundation provides Systems Change Grants for collaborative work designed to transform systems through changes to policies and practices to improve health in Arizona communities. Applicants from tribes and rural areas are encouraged to apply. Successful applications will propose projects designed to make a significant, sustainable impact that address the intersection of 2 or more elements of a healthy community through an equity lens. Flinn Foundation Seed Grants Program Seed Grants Program - Flinn Foundation The Flinn Foundation’s 2022 Seed Grants to Promote Translational Research Program is funding 10 research teams, affiliated with an Arizona university, research institution, or health-care system, focused on advancing new products or services to improve patient care. The proposed projects must address compelling clinical needs in the areas of precision medicine, diagnostics, devices, therapeutics, or health-care-delivery processes and have significant potential to turn bench results into viable products or systems impacting patients in Arizona and beyond. CO BROADBAND Colorado Broadband Deployment Board Grant Cycles The Broadband Fund | DORA - COPRRR (colorado.gov) Access to broadband has a strong correlation with economic well-being. Nationwide, the impact it has on the communities it connects is real and measurable. The Broadband Fund exists to connect communities and fuel economic growth in unserved areas across Colorado. The Broadband Deployment Board provides grants through the Broadband Fund to deploy broadband service in unserved areas of the state. The Board has awarded $19.6 million in grants to 29 projects since 2016. As a result, over 17,000 rural households across Colorado will benefit from Broadband Internet access. HEALTH Anschutz Family Foundation Grants Funding Details: Anschutz Family Foundation Grants - Rural Health Information Hub The Anschutz Family Foundation provides grants to organizations in Colorado that work to strengthen families and communities and help individuals become productive and responsible citizens. In 2021, 45% of funding was dedicated to efforts in rural Colorado. Colorado Capital Infrastructure – Increasing Access to Care for Coloradans of Color Funding Opportunity: Capital Infrastructure – Increasing Access to Care for Coloradans of Color | The Colorado Health Foundation This funding opportunity is designed to improve the capacity of clinics to serve more Coloradans of color with high-quality, comprehensive team-based primary care centered on patients’ preferences, needs and values. It will provide shovel-ready capital funding to safety net practices in Colorado. NV BROADBAND Broadband Funding Opportunities Funding Opportunities (nv.gov) Grants are funded on a competitive basis. The evaluation criteria and selection process is outlined in each Request for Applications (RFA). Each grant proposal is evaluated by a team of experts assembled by OSIT. Generally, proposals are evaluated based on: the quality of the proposal and adherence to RFA guidelines; the ability of the organization to accomplish the proposal’s goals; and the impact the proposal will have on Nevada. Applicants that are awarded funding are required to submit regular fiscal and programmatic reports that detail progress toward agreed upon performance metrics and meet State and/or federal reporting guidelines. Awarded projects are subject to inspection and testing prior to final reimbursement. HEALTH Notice of Special Interest (NOSI): Research on Barriers to Care and Risk of HIV-Associated Comorbidities among Vulnerable Population Groups NOT-HL-22-010: Notice of Special Interest (NOSI): Research on barriers to care and risk of HIV-associated comorbidities among vulnerable population groups (nih.gov) This opportunity is a Notice of Special Interest (NOSI) for research that analyzes barriers to care and risk of HIV-associated comorbidities among disproportionally vulnerable and affected population groups of people living with or at risk for HIV infection. Notice of Funding Opportunity (NOFO) for Community-Based Behavioral Health Services and Support SAPTAGrants (nv.gov) This Notice of Funding Opportunity (NOFO) is intended to solicit applications from private, public, non-profit and coalitions for the Community Mental Health and the Community Substance Abuse Prevention and Treatment Agency Block Grant funds which includes COVID-19 Supplemental and the American Rescue Plan Act (ARPA). Behavioral Health grants reflect Nevada's health care system's strong emphasis on coordinated and integrated care along with the need to improve services for persons in crisis or with behavioral health disorders. These funds will provide Nevada the opportunity to focus on the specific needs of our State to address gaps in the behavioral health delivery system and crisis services focusing on direct and preventative services. NM BROADBAND Connect New Mexico Pilot Program Connect New Mexico Pilot Program - New Mexico Department of Information Technology (nm.gov) The Connect New Mexico Pilot Program (“Pilot Program”) aims to bridge the digital divide and foster socioeconomic progress by providing infrastructure grants for broadband deployment to unserved and underserved communities across New Mexico. HEALTH CDC Traditional Food Sovereignty and Tribal Workforce Development Fellowship Zintellect - Climb Higher The Centers for Disease Control offers a one year fellowship in Albuquerque, New Mexico working with the Healthy Tribes Program. The program is designed to strengthen the public health infrastructure, promote cultural and traditional practices that support health and wellness, and integrate evidence-based chronic disease interventions to improve the health of tribal communities. New Mexico McCune Charitable Foundation Grants Apply - McCune Charitable Foundation (nmmccune.org) McCune Charitable Foundation Grants are awarded to New Mexico community-based organizations working in one of the following areas: leveraging opportunities in healthcare, local food industry development, strategies for rural development, capacity building in the nonprofit sector, economic development and family asset building, education transformation, building links between arts and community engagement, stewardship of community and natural resources, and influencing planning of built environments. Tribal BROADBAND NTIA Tribal Broadband Connectivity Program Tribal Broadband Connectivity Program | National Telecommunications and Information Administration (ntia.gov) A $980 million program directed to tribal governments to be used for broadband deployment on tribal lands, as well as for telehealth, distance learning, broadband affordability, and digital inclusion. NTIA Digital Equity Program Digital Equity Programs | BroadbandUSA (doc.gov) Too many communities lack access to high-speed internet. Many more can't afford it or don't know how to use it. The divide between those who have internet access and those who don't is stark. To create an equitable economy, we all need access to reliable and affordable high-speed internet. The Digital Equity Act provides $2.75 billion to establish three grant programs that promote digital equity and inclusion. They aim to ensure that all people and communities have the skills, technology, and capacity needed to reap the full benefits of our digital economy. HEALTH Support for 988 Tribal Response Cooperative Agreements Funding Details: Support for 988 Tribal Response Cooperative Agreements - Rural Health Information Hub Resources to improve response to 988 crisis contacts (including calls, chats, and texts) originating in tribal communities and/or activated by American Indians/Alaskan Natives. National BROADBAND State Digital Equity Program Department of Commerce - State Digital Equity Planning Grant Program | BroadbandUSA (doc.gov) The Digital Equity Act, established by the Infrastructure Investment and Jobs Act (IIJA), dedicates $2.75 billion to establish three grant programs that promote digital inclusion and equity to ensure that all individuals and communities have access to the skills and tools needed to for full participation in the society and economy of the United States. The goal of these programs is to promote digital inclusion and advance equity for all to ensure all communities have affordable access and can use the Internet to improve their lives, including low-income households, aging populations, incarcerated individuals, veterans, individuals with disabilities, individuals with a language barrier, racial and ethnic minorities, and rural inhabitants. State Digital Equity Planning Grant Program: $60 million formula grant program for states and territories to develop digital equity plans. FCC Affordable Connectivity Outreach Grant Program FCC Establishes Affordable Connectivity Outreach Grant Program | Federal Communications Commission The Affordable Connectivity Outreach Grant Program will provide funding to support eligible partners in their outreach efforts to increase awareness of the ACP. In the Order, the FCC recognizes the importance of accessible outreach and strongly encourages grantees to make ACP outreach funded through the grant program accessible to individuals with disabilities. A key objective of the grant program is to expand and support diverse and impactful outreach efforts to diverse communities, including persons with disabilities. The FCC encourages entities of all types and diverse organizations, including organizations serving, led, or owned by persons with disabilities, to submit applications for the Outreach Grant Program once a Notice of Funding Opportunity is released. HEALTH Barclay-Giel Seed Grants Barclay-Giel ​Seed Grants - PHS (phscof.org) Grants for public health projects that have a strong disease and/or injury prevention component that impacts the health of a community by promoting wellness, early detection, and early interventions. Past awards have been given for projects in rural and tribal communities. See full article: https://southwesttrc.org/resources/newsletters/2022/2022-10 < Previous News Next News >

How Amazon, Walmart & 7 Others are Expanding Their Telehealth Business Katie Adams, Becker's Hospital Review July 2021 Companies are remaining active in their efforts to grow their telehealth businesses. It's unclear how widely telehealth services will be used once the pandemic subsides, but companies are remaining active in their efforts to grow their telehealth businesses. Below are updates on how nine companies are expanding their telehealth business, as covered by Becker's Hospital Review during the past three months. UnitedHealth Group subsidiary Optum on April 15 deployed a new telehealth product across all 50 states. The product, dubbed Optum Virtual Care, aims to integrate physical care, virtual care, home care and behavioral care. Amwell on April 28 unveiled its new Converge telehealth platform, which can host and operate digital offerings from Cleveland Clinic, Google Cloud and others. Ro, a direct-to-consumer telehealth app for pharmacy services, inked its first retail collaboration with Walmart April 28. Under the new partnership, Ro will launch its Roman health and wellness products and digital services in more than 4,600 Walmart stores across the country. On May 19, Ro acquired reproductive health company Modern Fertility for more than $225 million. Amazon on May 5 signed its first enterprise client for its telehealth service, Amazon Care. It has since secured multiple companies as clients for the telehealth service, and it is eyeing expansion into rural markets. Walmart Health on May 6 entered an agreement to acquire on-demand, multispecialty telehealth provider MeMD. By acquiring MeMD, Walmart will begin providing virtual care services for urgent, behavioral and primary care to complement its in-person Walmart Health Centers. Telehealth provider Doctor On Demand and clinical navigation platform Grand Rounds completed their merger May 11. On May 26, the combined company signed a definitive agreement to acquire Included Health, a comprehensive healthcare platform for patients who are LGBTQ and BIPOC. Teladoc Health on May 11 launched its new mental healthcare service MyStrength Complete, which offers personalized mental health services to consumers as an integration of Teladoc's virtual platform. On July 14, Teladoc integrated its hospital telehealth platform with Microsoft Teams. The Clinic, a joint digital health venture between Cleveland Clinic and Amwell, on May 18 launched new health offerings as part of its virtual second opinion service. The offering expansion is for patients with brain tumors and prostate cancers, since there are multiple treatment options for these conditions. Membership-based primary care network One Medical on June 7 entered an agreement to acquire Iora Health, a tech-powered primary care provider focusing on serving Medicare patients. The acquisition will allow One Medical to offer 24/7 digital and in-person care, as well as extend the provider into full-risk Medicare reimbursement models. < 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 >

Patients prefer telehealth for common illnesses, study shows Bill Siwicki November 23, 2022 But more than half are concerned about the quality of care they're receiving, according to the Software Advice survey. One of the firm's analysts dives into the results. Telemedicine has, at long last, become very popular. But lingering concerns remain on its effectiveness for certain diagnoses and treatments. Software Advice's 2022 State of Telemedicine Survey finds that while a majority of people prefer virtual appointments for common illnesses, more than half of patients still are concerned about the quality of care they're receiving. Software Advice, a Gartner company, polled more than 1,000 patients on telemedicine usage after the worst of the pandemic – regarding whether they intend to keep using it and improvements that can be made. We interviewed Lisa Hedges, associate principal analyst at Software Advice, to discuss the findings of the study and talk about the future of telemedicine. Q. What is the overarching message healthcare CIOs and other health IT leaders should take from your study? A. That failure to invest in telemedicine is downright foolish at this point. It's been around for a long time and fully took off during the pandemic. It isn't going anywhere now that so many patients have experienced the convenience it offers. This also means if you are one of the healthcare organizations that adopted telehealth during the pandemic and plan to eliminate those tools in the near future, you're making a mistake. The bottom line here is that telemedicine is a valuable tool for patients, and providers who offer remote care services for certain conditions and symptoms are going to have the edge over providers who don't. Q. About 86% of patients rate their telemedicine experience as positive; 91% are more likely to choose a provider that offers telemedicine. Why do you think this is, and what does it mean for healthcare provider organizations? A. Convenience and ease of use are top reasons patients like telemedicine, and that certainly makes sense when you consider the time it saves. Patients don't have to drive to a physical office, find parking, spend time in a waiting room (where they may be exposed to other contagions), and then drive back home once the appointment is over. All of that is hassle enough even without considering the fact that most people going to see doctors don't feel great, so their baseline before doing any of that is discomfort. What this means for providers is they're looking at a great opportunity. We're all well aware of the current shortage of qualified healthcare workers, and we know that the working conditions for healthcare staff have been particularly brutal during the pandemic. With so many employees quitting, it's left a lot of extra work behind for those who have stayed on, which leads to more burnout and even more turnover. If practices can find a way to alleviate that burden, though, they're going to make life better for their employees. Telemedicine can do this by shortening the average exam time, nearly eliminating patient wait times, reducing the average number of no-shows, and saving money by cutting down on operational costs. All of these things can directly or indirectly impact the quality of life for healthcare workers and for patients. Q. Only 49% prefer telemedicine visits for mental health treatment, despite it being one of the more remote-ready specialties. What does this finding say for the future of telepsychiatry? A. This is a great question that a lot of people are puzzling over. Mental healthcare does seem to be an ideal match for telemedicine, specifically the use of video conferencing to conduct therapy sessions. So, I was a little surprised that more patients in our survey didn't indicate a preference for telemedicine. But there are a couple of things to consider here. First, we didn't collect data on patient history, so not every participant in our survey has experience seeking mental health treatment. That could be a factor in this dataset. Second, 19% indicated no preference between telehealth and in-person appointments for mental health treatment when we asked this question, which means only 32% prefer in-person mental health appointments. So, it's still the majority of patients saying telehealth is their favorite option for mental healthcare. As far as what this means for the future of teletherapy, I don't think it's any huge concern. It could simply be that some patients are still warming up to the idea of having intimate conversations with a therapist through a computer screen. It could be an age thing. It could be something else. Regardless, I suspect that if we were to run this survey annually for the next few years, that 49% would increase every time. Q. One-third of patients worry that an in-person exam, lab work or other testing is critical to properly diagnose and treat patients. How can telemedicine jump this hurdle? A. I'm not convinced telemedicine needs to jump this hurdle to prove itself valuable. Sure, there are incredible advancements being made in remote patient monitoring tools and other wearable devices that can help diagnose patients from a distance, but I think it's equally worth noting that telemedicine is a tool to be used in the right circumstances – it's not a one-size-fits-all approach to medicine. Yes, for a lot of medical conditions, doctors actually have to see the patient to perform physical tests. Those situations aren't ideal for telemedicine, and we shouldn't be thinking of them as hurdles – or even failures. If, instead, we reframe our thinking so that we recognize the situations that are ideal for telemedicine appointments – those that don't require physical tests for diagnosis, such as mental healthcare or common ailments like upper respiratory infection – we can see that telemedicine is a deeply valuable tool as it stands. So, to answer your question, the real hurdle for telemedicine here is teaching patients when it is best used instead of needing to find ways to provide lab work or physical exams remotely. In essence: It's a messaging problem instead of a technology problem. The good news is patients seem to be recognizing this on their own. If you look at patient preferences for in-person appointments versus telemedicine appointments broken down by symptom in our report, you see that patients intuitively understand which symptoms are best treated remotely and which are more likely to need physical exams. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/patients-prefer-telehealth-common-illnesses-study-shows < Previous News Next News >

Healthcare Breaches: 40.7 Million Patients Affected By Dr. Maheu April 5, 2021 There were 758 breaches publicly posted to the Department of Health and Human Services (HHS) breach portal in 2020, affecting 40.7 million patients. However, the breaches listed on the HHS breach portal only reflect breaches affecting 500 or more patients, making it likely that the number of breaches was much higher. Each year Protenus, along with databreaches.net, conducts a breach report to assess the state of healthcare cybersecurity. Their 2021 Breach Barometer examined healthcare breaches occurring in 2020 and compared the findings to 2019 breaches. Read more about previous healthcare breaches on TBHI blogs: Healthcare Data Breach compromised 295,617 patients, Major Healthcare Hack Targets Mental Health Provider and Healthcare Breach: Email Breach Affects Behavioral Health Organization. More details on healthcare breaches, hacking incidents, insider breaches of 2020 are discussed below. Healthcare Breaches in 2020 There were 758 breaches publicly posted to the Department of Health and Human Services (HHS) breach portal in 2020, affecting 40.7 million patients. However, the breaches listed on the HHS breach portal only reflect breaches affecting 500 or more patients, making it likely that the number of breaches was much higher. Through their analysis of 2020 breaches, Protenus determined a 30% increase in healthcare breaches compared to 2019. Hacking Incidents in 2020 The leading cause of 2020 healthcare breaches resulted from hacking incidents representing 62% of reported incidents, with a 42% increase in these types of incidents from the previous year. The 277 hacking incidents compromised the protected health information (PHI) of more than 31 million patients. Part of the reason hacking skyrocketed in the healthcare sector is due to hackers exploiting the COVID pandemic, in some cases posing as government agencies to gain access to sensitive information. The issue was a major cause for concern, with the FBI and HHS warning healthcare organizations against “an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.” Researchers stated, “By making investments to protect patients, health systems, in turn, protect themselves from severe reputational damage, financial penalties, or care disruptions stemming from hacking incidents. Under obligation to do no harm, healthcare organizations must adopt advanced tools capable of preventing hacks and their frightening consequences for patients.” Insider Breaches in 2020 The second most common cause behind healthcare breaches in 2020 was insider breaches. Insider breaches occur when an employee of a healthcare organization accesses PHI without cause. Insider breaches represented 20% of reported incidents, with 111 incidents of insider breaches compromising the PHI of 8.5 million patients. “A zero-tolerance stance on snooping is important, but it will never be enough to prevent innocent mistakes or nefarious hackers,” researchers wrote. “Only by using compliance analytics to calculate the risk score of any anomalous access can organizations surface and prioritize interactions with data that truly warrant attention…. Noncompliance is critically important to identify and prevent, especially when organizations are struggling financially. Compliance incidents are costly because of all that goes into reconciling them. On top of paying penalties, health systems must do damage control,” they added. HIPAA Resources Need assistance with HIPAA compliance? Compliancy Group can help! They help you achieve HIPAA compliance, with Compliance Coaches® guiding you through the entire process. Find out more about the HIPAA Seal of Compliance® and Compliancy Group. Get HIPAA compliant today! Link: https://telehealth.org/healthcare-breaches-2/?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 News Next News >

Telehealth May Help Reduce Medicine's Carbon Footprint Kat Jercich, Healthcare IT News July 2021 A wide-ranging study recently found that an increase in telehealth over the past six years corresponded with a decrease in greenhouse gas emissions due to transportation. A large-scale study recently published in The Journal of Climate Change and Health found that an increase in telehealth use in the Pacific Northwest corresponded to a dramatic decrease in transportation-related greenhouse gas emissions. The study – a collaboration among researchers from Northwest Permanente, Brigham and Women's Hospital and Harvard Medical School – examined six years of outpatient care at Kaiser Permanente Northwest, which serves more than 600,000 people in Oregon and Washington. "Prior to the pandemic, despite rising total visit volume, transportation-associated emissions were already declining due to a greater proportion of telehealth visits," observed the researchers. WHY IT MATTERS As the study notes, the healthcare sector is a "significant source" of greenhouse gas emissions. From 2010 to 2018, emissions from the U.S. healthcare industry increased by 6 percent. Although many of those emissions arise directly from facilities or indirectly from the supply chain, researchers note that patient transportation to clinics also plays a role in healthcare's carbon footprint. "To date, there are no large-scale studies of emissions reductions due to telehealth across an entire ambulatory system of a regional healthcare system in the United States, nor any studies showing the impact of COVID-19 on healthcare-associated [greenhouse gas] emissions as a result of rapid telehealth adoption," they explained. Team members looked back at the total number of in-person and telehealth visits from 2015 through 2020. They calculated the average distance between patients' home addresses and their assigned primary care clinics, and used Oregon Department of Transportation data about how individuals run errands to estimate what percentage of in-person trips were taken by car. They also assumed that telehealth visits replaced in-person visits on a 1:1 ratio (which may not be true, as other studies about downstream care have shown). Overall, in-person outpatient visits had increased at 1.5% per year through 2019 – but declined by 46.2% in 2020. Meanwhile, telehealth visits – which had already been increasing – jumped in 2020 by 108.5%. Researchers calculated that greenhouse gas emissions from patient travel due to transportation for primary care, specialty care and mental health visits fell from 19,659 tons CO2-eq in 2019 to 10,537 tons CO2-eq in 2020. "This reduction is primarily due to increased use of telehealth services as opposed to a decline in total annual visits during the pandemic and is evidenced by the total number of visits in 2020 being greater than prior years that had much larger total emissions," said researchers. "Nor is this reduction attributable to changes in fuel efficiency or transportation mode share over time, which are likely minimal on this time scale and were not modeled in this analysis," they added. The researchers argue that reductions in transportation-related greenhouse gas emissions "greatly eclipse" smaller increases associated with the use of computer equipment. The study has limitations: In addition to the 1:1 assumption mentioned above, researchers also pointed out that some visits would not have been conducted at a primary care clinic. In addition, they acknowledge that the Oregon DOT estimates may not represent medical appointment visits accurately. Still, "our study likely underestimates emissions reductions as we did not account for decreased commuting by healthcare providers conducting telehealth visits from home," the researchers wrote. "Furthermore, the environmental benefit of telehealth may not be limited to reductions in transportation-associated emissions if increased virtual care permits healthcare systems to care for more patients without increasing outpatient clinic space," they added. THE LARGER TREND Given the effect of climate change on the environment – and, in turn, on wellness, particularly for already vulnerable communities – many healthcare experts have called for action, with some noting the role that digital tools can play. In addition to preventative measures such as those outlined in the study, digital health tools may also help in the shorter term with regard to the consequences of climate change. When a winter storm tore through the southern United States earlier this year, for example, clinicians were able to keep seeing patients from their own homes. "If there are natural disasters, which we're seeing more and more of, because of global warming, we're hoping we'll be able to continue to provide care [via telehealth] through more weather events – like the freeze, like the hurricanes, and things of that nature," said William Kiefer, CEO of Chambers Health, a community-based system in Texas, in March. ON THE RECORD "If the U.S. healthcare system were to maintain or expand upon current levels of telehealth utilization, additional reductions in [greenhouse gas] emissions would potentially be achieved through impacts on practice design," said researchers in the new study. "Ambulatory visit carbon intensity would be an effective way to measure these changes." < Previous News Next News >

Advances in telemedicine are on the way in 2022 Bill Siwicki Dec. 20, 2021 A physician expert in virtual care talks technological advances, reimbursement legislation and the continued evolution of remote patient monitoring. 2020 and 2021 saw the mainstreaming of telehealth and the rise of remote patient monitoring. These changes to the healthcare landscape were helped partly by requirements of the COVID-19 pandemic and partly by the subsequent loosening of telemedicine reimbursement and licensure regulations by the government. But what's to happen in 2022? Will the government and commercial payers continue to reimburse for telemedicine? Will new virtual-care legislation pass? Will there be technological advances that push the care paradigm further forward? And what of the future of remote patient monitoring? Healthcare IT News sat down with Dr. Ian Tong, chief medical officer at Included Health, a telehealth technology and services company, to get his read on these questions and his predictions for telehealth in 2022 and beyond. Q. What do you see in the realm of technological advances in telemedicine in 2022? A. While 2021 saw many healthcare technology mergers and acquisitions in response to the pandemic, and growing virtual-care adoption among payers, providers and consumers, much of the technology of these combined entities remains fractured. Though promoted as one offering, consumers still are having to navigate two or more platforms and work to connect the dots themselves. The technology needs to become invisible – so good that you don't even realize it's there. The technology for virtual-care appointments also will continue to advance beyond 1:1 doctor-patient video conferencing. For example, in response to the rising behavioral health provider shortage, we can expect to see technology that can enable group sessions with multiple patients receiving counsel and support at once. Whether it's behavioral, acute or chronic care, the most important role that technology will play is enabling all physicians to have the same window into a patient's medical history and care plan so they can provide integrated, longitudinal care. The technology is what will enable this industry to realize the full potential of virtual care beyond transactional, one-time interactions. Q. All the temporary reimbursement moves by government and payers for the sake of the pandemic really pushed telehealth into the mainstream. What do you foresee happening with reimbursement for virtual care in 2022? Will it become permanent? Will it be expanded? A. With usage rates 38 times higher than pre-pandemic, and the inarguable value for the people who need it most – seniors and the immunocompromised who can't afford in-person exposure – I believe the government will and should expand virtual-care access. Pre-pandemic virtual care was used for urgent, low-complexity issues – cough, cold, rashes. But today, the real value is for integrated chronic-disease management or ongoing behavioral-health therapy, where people need not be burdened by the constant travel in and out of doctors' offices. The more care that shifts to virtual, the less burden of disease the patients will have, which will lead to better outcomes. This is an opportunity that should be afforded to everyone, especially our most vulnerable and historically underserved communities. Q. Remote patient monitoring is a form of telehealth that is of growing interest to healthcare provider organizations. What do you see happening with RPM in 2022? A. Adoption of remote patient monitoring devices continues to rise, and we don't see it slowing down any time soon. Today, one third of consumers are more likely to choose a provider that allows them to share data from a connected health device, which only promotes more positive outcomes. The more real-time data that we can collect in the comfort of people's homes, the more personalized, data-driven virtual care we can provide. However, to really launch adoption in this sector, the costs of these devices need to come down. As costs come down, health plans can more easily find an ROI [return on investment] to subsidize the use of these devices. https://www.healthcareitnews.com/news/advances-telemedicine-are-way-2022 < Previous News Next News >

Telehealth heavy hitter Dr. Roy Schoenberg on virtual care in 2023 Bill Siwicki December 14, 2022 The Amwell CEO reviews his successful predictions from last year and looks ahead at clinician-initiated telemedicine and virtual care shifting from transactional to transformational. From the distant past of the 1990s up to just a few years ago, many healthcare technologists have predicted that telemedicine would make it into the mainstream of healthcare delivery. Well, today, thanks to many factors surrounding the COVID-19 pandemic, telemedicine has finally made it into the mainstream. And now that it is being so robustly used across the country, the big question is: What's next? We spoke with a heavy hitter in the world of telehealth, Dr. Roy Schoenberg, president and CEO of Amwell, one of the big players in telemedicine technology and services, to get his views on how his predictions from last year turned out and where virtual care is headed in 2023. Q. You predicted last year that in 2022 we'd see exciting advancements in remote patient monitoring and automation powered by the patients who need them most. How did that prediction turn out? A. Not only has the technology for remote patient monitoring and care automation become more advanced, but the use cases they are powering are maturing rapidly. Today, we're seeing applications of automation that go beyond mimicking clinicians and instead are being used to help patients manage the reality they face in the moments in between visits when they are not in front of clinicians. It's this area that I predict will grow more rapidly in the years ahead as it means that technology can actually assist clinicians in being there for their patients more frequently in a cost-effective way. As the industry struggles to keep up with workforce shortages and deal with financial constraints, technology that can serve clinicians and patients, while being financially viable, will become pervasive. Still, we've only just begun to scratch the surface of what RPM and automated care programs can do to drive more patient-centric, value-driven care. We can transform lives and quality of life by extending the reach of clinicians through digital technology and empowering people to live their healthiest life. Q. You also predicted that in 2022 patients will be interacting with healthcare both physically and through technology – hybrid care. How did that turn out? A. 2022 was a year of advancing the understanding that digital care is much more than videoconferencing. People now are coming to terms with the fact digital care is not just about changing where care happens but how care happens. By thinking about it as a true distribution arm, you can see how you can manage patient conditions differently, you can reach customers differently, you can motivate patients to play a more active role in their healthcare – this is a powerful reimagination of traditional care models. Hybrid care models that combine physical and virtual interactions was the first iteration of seeing this understanding play out; and we saw these models accelerate significantly. The next phase is hybrid care models that combine physical, virtual and automated interactions. It's this type of digital care delivery that we are focused on enabling our clients to achieve through an integrated platform approach that allows for a well-coordinated, seamless care experience across all settings. Q. What are two predictions you have for 2023 on technological advances in telemedicine? A. In 2023, we'll continue to see digital health's influence in completely reimagining how care is accessed and delivered. It's a transformation that will be sparked not just by consumer demand for digital care, but also by clinician preference. In fact, clinician-initiated digital care will far outpace patient-initiated virtual interactions going forward, with clinicians becoming the top utilization driver. It's a trend we've already started to see. We've reached a point where physicians and nurses are prescribing virtual care. Within physician practices, medical assistants are triaging patients for virtual encounters when the manner in which they are seen – in person or virtually – is less important than the need for speedy access to care. In an era when patients are surrounded by devices, we'll not only gain greater knowledge of potential use cases for RPM and automated care, but also a wealth of data around which approaches work best in specific circumstances. These findings will further advance digital care from a "nice to have," convenient feature to an integral aspect of the continuum of care. Additionally, I predict digital care will continue to shift from transactional to transformational. Virtual primary care is becoming ubiquitous, however the opportunity for virtual primary care is dramatically extended when it's tightly integrated with escalation paths to create a more comprehensive care experience. Discussions around digital care's trajectory will increasingly examine how to more tightly integrate virtual care and digital health within the complete patient journey. It will be a time of reinvigoration around the power of what is still a relatively new component of care. Some of our best learnings around digital health will take place in this space where the immediate pressures of COVID-19 have passed, and clinicians feel more free to imagine: "What's next?" Q. What's a prediction you have for 2023 regarding telemedicine public policy? A. One of the biggest challenges for the digital care industry continues to be around state licensure. It's clear we need to allow healthcare to be distributed around the country through technology – the internet does not stop at state lines. What's less clear, however, is who on Capitol Hill will be the one to say, "We have to find another way." Change must occur in partnership with medical boards that will continue to play an important role in enabling the safe practice of medicine. It's inevitable this will be the biggest war we'll see play out over the next few years and it will greatly impact the future of care distribution. 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/telehealth-heavy-hitter-dr-roy-schoenberg-virtual-care-2023 < Previous News Next News >

The Punctuated Equilibrium Of Telemedicine: Digital Health Solutions And Government’s Role Richard Schwabacher September 14, 2022 As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. Action was taken at the state and federal levels, as well as by payers and employers, to make telehealth easily accessible. Nearly overnight, swift changes in payment, reimbursement, coverage and licensing policies were made as the pandemic disrupted every facet of life. Telehelth benefits have proven to be popular, so much so that Congress recently voted 416-12 to extend benefits. Simultaneously, investment in the digital health market has soared to a record $29.1 billion in 2021 to transform a healthcare system that could support digital capabilities. Patients, already accustomed to digital services, like banking, quickly adapted to the change. When radical change occurs in a short period of time and then finds a new balance, we call that a punctuated equilibrium. With respect to telemedicine, we don’t expect to return to life as we knew it before Covid-19 or, at the other end of the spectrum, settle in a place where high rates of telemedicine adoption were during the surges. Ultimately, there will be a new equilibrium that nestles between those two polar opposites. Despite overwhelming investment and adoption of virtual care and telehealth options by patients and providers, barriers still exist. There are specific actions government and businesses can take and should, to support healthcare programs born out of the pandemic—but only if the economics and incentives are aligned. Spotlight Moment For Laboratory Diagnostics Laboratory diagnostics has always been a critical component of healthcare—diagnosis, prevention, management, and so forth—but the pandemic put lab testing and access to it squarely in the spotlight. It became an urgent need that nearly everyone had. The value and role of laboratory diagnostics cannot be understated. According to the CDC, 70% of high-quality care depends on diagnostic testing to make medical decisions by equipping providers with the necessary information to properly address patient needs. Diagnostics are most often the healthcare tools providers rely on when diagnosing, managing and treating a variety of diseases and conditions; for instance, 12 of the 15 most clinically and economically significant disease categories in the U.S. dictate using laboratory diagnostics as the standard of care. Lack of access to laboratory diagnostics for patients has wide-ranging effects, including implications for medication nonadherence that will continue to grow as the burden of chronic diseases grows. The Role Of Government Policy The patchwork approach to solving these problems will not suffice in the long run, which is why the role of government in the sustained expansion of virtual care services is so important. Healthcare policy ought to keep pace with the evolution of healthcare technology. It’s encouraging to see the current administration invest in and promote innovation with information technology to better serve community health. The investment not only includes $34 billion initially invested through the HITECH sections of the American Recovery and Reinvestment Act but also many billions of dollars expended by U.S. industries, including laboratories. Three specific policies can help direct and reward innovation leading to better outcomes. • Ensure that all patient data needed by clinicians for individual and population care is available. While the CURES Act and the ONC CURES Act Final Rules aim to prevent data blocking, business practices among providers and payers sometimes serve as effective barriers to serving patients in their communities. ONC and CMS can refine the rules to ensure data is available in all EHRs from all appropriate sources, facilitating timely availability of all patient data wherever it is needed. • CMS should develop companion coding for telemedicine services and home-based specimen collection for lab testing. The value of telehealth is compromised if the patient must travel to a distant site for lab testing in support of the telehealth intervention. • While the government can mandate that providers report specified data, the results from home-administered testing are not available in standardized electronic formats and do not get reported. This has created barriers to public health responses in communities most at risk. What Can Businesses Do? There are ways for businesses and the government to collaborate that can improve the telemedicine landscape that benefits patients and consumers, as the clear, quantifiable health outcomes speak for themselves and can help influence further adoption and integration. For instance, the number of Medicare beneficiary telehealth visits increased 63-fold in 2020 to more than 52.7 million. While at the Mayo Clinic, ambulatory management of Covid-19 showed effective use of remote patient monitoring with a 78.9% engagement rate. These are just two examples that illustrate the increased adoption and success of making telemedicine an integral part of healthcare protocols. Companies that move to a value-based incentive model from a fee-for-service model and move toward reimbursement models that reward quality can be an alternative to the status quo. Telemedicine can be part of the solution when addressing inequities in access to care, including specialty care and at-risk populations. We already know that lack of access to laboratory diagnostics for patients has wide-ranging effects that will continue to grow as the burden of chronic diseases grows. Virtual Care Is Here To Stay Digital healthcare models are changing the landscape of the healthcare system as we know it, and this is good news for patients and providers. The changes empower patients to take more control of their health, give them more options that cater more to their needs, lower costs for “virtual-first” or “hybrid care” healthcare plans and improve access. Our collective experience during the pandemic has shown that people need healthcare and clear access points. The expanded use, adoption and successful integration of digital healthcare solutions have been received positively and have encouraged more participation. We need to continue to expand telehealth and remote options with policy that supports it—to backtrack on the progress we’ve made would be a mistake. See original article: https://www.forbes.com/sites/forbestechcouncil/2022/09/14/the-punctuated-equilibrium-of-telemedicine-digital-health-solutions-and-governments-role/?sh=523fd49e2deb < Previous News Next News >

Telemedicine and diagnosis Adriana Albini September 27, 2022 The adoption of telemedicine and its range of applications grew exponentially in the early days of the Covid-19 pandemic, and the general consensus now is that it is here to stay, albeit perhaps with a more hybrid bias of in-person and remote visits. Telediagnosis, or TeleDx, i.e., the identification of a disease at a site remote from the patient, has expanded to include primary care, revolutionising the way in which patients and doctors communicate with each other and establish rapport. It is still early days to fully evaluate the effect of virtual vs in-person visit on diagnostic error, but there are guidelines for health professionals to conduct effective virtual examinations, and many best practice examples, both in terms of ways to gather information from the patient (from wording of questionnaires to digital records, home environment, and so on) and technological innovations. In cancer care, pathology plays a central role in the final diagnosis upon which clinicians will develop treatment for their patient, and remote pathology can offer many advantages, such as easier access to pathology experts, consultation among specialists, timely and secure availability of images, and so on. Up until the 1990s, pathologists worked almost entirely within the constraints of the analogue world, with physical glass slides and microscopes. Some attempts were made at capturing virtual images of slides through a tiling method, which was time consuming and prone to error, as it required accurate placing and extensive stitching together of images. But at the end of that decade, engineer Dirk G. Soenksen (founder, and CEO of Aperio) devised a much more efficient system based on a linear scanner, the ScanScope, that allowed for tightly focussed and fast slide image capture, opening a new era for the practice of pathology. Whole slide imaging, or WSI, was first employed in education and research but in recent years, with the improvement of its technology, it has received regulatory approval by the FDA and around the world for diagnostic use as well. The potential for feeding AI algorithms to provide diagnostical support is massive, as virtual slides are accumulating fast and standardised databases are being built. “Telemedicine in Cancer Care Continuum: implementation and integration”, was an online conference developed by the SPCC in collaboration with the American Society of Clinical Oncology (ASCO), which took place on 6-7 May 2022. In his presentation, Liron Pantanowitz, Professor of Pathology, and Director of Anatomical Pathology at the University of Michigan, talked about telepathology in both its non-acute and acute settings, focussing more extensively on the latter. The term ‘telepathology’ was coined by Ronald S. Weinstein in 1986, after he organised the first public event of satellite-enabled dynamic-robotic distant pathology, but the very first live telepathology ever performed dates as far back as to 1968. Massachusetts General Hospital set up a two-way television link with Boston’s Logan Airport that enabled doctors at the hospital to remotely study blood smears, urine samples and X-rays for patients at the airport, and even listen to their heartbeat with an electronic stethoscope. However, as in the case of telehealth in general, the adoption of digital pathology had to wait until the Covid-19 pandemic to be widely implemented. To facilitate continuity of healthcare while social distancing, certain restrictions were lifted, such as CLIA in the US, allowing pathologists to work from home and sign out cases. The first use of telepathology Prof. Pantanowitz looked at was for frozen section consultation. There are several challenges when a pathologist is asked to provide an intraoperative consultation. The pathology specimen is fresh, not easy to cut. The frozen section itself is difficult to prepare and is often filled with artifacts. These artifacts not only make it hard to read the glass slides but can compound the problem when using digital images. The turnaround time needs to be rapid. Usually, pathologists strive for less than 20 minutes to provide the surgeon with an answer. And they are under serious diagnostic pressure because if they get it wrong, it is difficult to reverse the surgical decision that has been made based on their diagnosis. Over the past 54 years different modes of practising telepathology have been developed. A pathologist on site can take static images, which is easy but too time-consuming. There is also video microscopy, live streaming from one pathologist to another. If there is no pathologist present on site to read the slides, there are systems such as robotic microscopy, where the pathologist can remotely take control of the functions on a microscope, such as navigation and focus. And there is also Whole Slide Imaging, which is the entire digitization of a slide to be remotely reviewed. Thanks to advancements in technology, hybrid devices are now available from many vendors with robotics and Whole Slide Imaging functions in one scanner. See full article: https://cancerworld.net/telemedicine-and-diagnosis/ < Previous News Next News >

Telehealth QA – Is it all it’s QAcked up to be? Trudy Bearden, PA-C, MPAS February 16, 2022 In hopes of sparking renewed commitment to applying improvement science to telehealth, we offer this Telehealth QI and QA Miniseries. Today is the fourth in the series. Require expertise and excellence in telehealth service delivery. Expertise with telehealth requires deliberate practice which builds on or modifies existing skills, usually with the help and guidance of a coach or teacher with targeted feedback on what to improve and how to improve those skills. Send staff through telehealth training either internally or externally. The California Telehealth Resource Center Telehealth Course Finder is a great place to start for external telehealth trainings. Provide peer review of telehealth sessions by inviting a trusted clinician to join a telehealth visit – with patient permission. Debrief after the session to provide feedback and to discuss what went well, what did not go well and what changes can be made to improve Implement written triage protocols that are easily accessible by all staff to clarify which patients or patient issues are appropriate for telehealth and which need to be seen in person. Make a commitment to exceptional service delivery. Solicit and act on patient and staff feedback. Consider including a patient partner or advisor in these efforts. Below are some sample staff and clinician satisfaction survey questions. Some institutions may already incorporate some of these into their existing patient feedback systems (e.g., Press Ganey) so check to see if they are before duplicating efforts. Sometimes it’s best to collect feedback simply and in real time by asking, “How was your visit? What could have gone better?” Read full article here: https://southwesttrc.org/blog/2022/telehealth-qa-it-all-it-s-qacked-be < Previous News Next News >

22 States Changed Telemedicine Laws During the Pandemic Kat Jercich June 2021 Most pursued changes via administrative action, according to a new Commonwealth Fund report, which may not be a permanent solution after the COVID-19 public health emergency ends. The Commonwealth Fund released an issue brief this week reviewing state actions to expand individual and group health insurance coverage of telemedicine between March 2020 and March 2021. It found that 22 states changed laws or policies during that time period to require more robust insurance coverage of telemedicine. "If telemedicine proves to be a less costly way to deliver care, payers and consumers may benefit from expanding coverage of telemedicine after the pandemic," wrote report authors. WHY IT MATTERS In March 2020, federal regulators temporarily relaxed restrictions for telemedicine visits for Medicare patients, raising payments to the same level as in-person visits and reducing cost-sharing, among other changes. Officials encouraged states and insurers to provide similar flexibility under private insurance – and many took that encouragement to heart. Of the 22 states that expanded access to telemedicine during the pandemic, the report found that most pursued changes via administrative action. "Use of executive authority allowed states to move relatively quickly during the crisis, though it has meant that the new telemedicine coverage requirements are temporary," wrote the researchers. They noted, for example, that seven governors included specific telemedicine coverage requirements in executive orders, which will expire after the public health emergency. Some states used bulletins, notices, or executive orders from the department of insurance or a similar agency to enhance coverage. New legislation, which takes more time, but is necessary for permanent changes, passed in eight states. Utah, Illinois, West Virginia, New Hampshire and Massachusetts – which had not previously required coverage – changed their policies during the pandemic. At this point, 40 states require coverage. These policies do not all carry equal impact. Eighteen states required coverage of audio-only services for the first time during the pandemic, bringing the total number up to 21. Four states eliminated cost-sharing for telemedicine services, and three added a requirement that cost sharing not exceed in-person identical services. And 10 states newly required insurers to pay providers the same for telemedicine and in-person visits. Report authors noted that insurers were cooperative with these changes, but longer-term adoption of policies like reimbursement parity "would likely be contentious." They pointed out the states will need data to inform debates on how best to regulate telemedicine. In 2021, at least 30 states have weighed legislation that would revise telemedicine coverage standards, found the Commonwealth Fund. Despite the known benefits of telemedicine, researchers also cautioned that it has not been equally beneficial to all patients. "Research shows telemedicine use is lower in communities with higher rates of poverty and among patients with limited English proficiency, potentially undermining goals of expanding access to underserved communities and exacerbating health inequities," read the report. THE LARGER TREND As the report notes, multiple states have implemented pro-telehealth policies to enable access during and beyond the COVID-19 public health emergency. But a major question remains regarding federal legislation, which could fill in many state-by-state gaps and prevent a so-called "telehealth cliff." "If Congress does not act before the public health emergency ends, regulatory flexibilities that now ensure all Medicare beneficiaries maintain access to telehealth will go away," said Kyle Zebley, director of public policy at the American Telemedicine Association, during a conference panel earlier this month. ON THE RECORD "Whether telemedicine reduces overall healthcare costs depends on how services are reimbursed and if virtual visits reduce other services or simply add to utilization," said Commonwealth researchers. "Having access to data can help stakeholders understand how longer-term expansion of telemedicine affects access, cost, and quality of care." Source: https://www.healthcareitnews.com/news/22-states-changed-telemedicine-laws-during-pandemic < Previous News Next News >