Telehealth Elements in American Rescue Plan COVID Relief Bill Center for Connected Health Policy April 2021 $50 million in grants for local behavioral health services, including via telehealth, and $140 million for information technology, telehealth and electronic health records at the Indian Health Service. March marked the passage of the third major COVID-9 relief bill (HR 1319), titled the American Rescue Plan. While the bill didn’t include significant changes in telehealth policy as past relief legislation has, it did have some nuggets for telehealth. For example, it establishes an Emergency Rural Development for Rural Healthcare Grant pilot that would, among other things, support telehealth programs. The bill also allots $50 million in grants for local behavioral health services, including via telehealth, and sets aside $140 million for information technology, telehealth and electronic health records at the Indian Health Service. To learn more, see the full text of the bill. American Rescue Plan: https://www.congress.gov/117/bills/hr1319/BILLS-117hr1319enr.pdf Indian Health Services: https://www.ihs.gov/ < Previous News Next News >

Senator Warner Encourages DEA Action on Telehealth & Prescribing Center for Connected Health Policy May 2021 A lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. Earlier this month Senator Mark Warner (D-VA) sent a letter to Attorney General Merrick Garland regarding the long-delayed regulations from the Drug Enforcement Agency (DEA) for a telehealth registry to prescribe controlled substances. In the letter, Senator Warner expressed great concern for the delay and that “the DEA’s failure to address this issue means that a vast majority of health care providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need.” The Ryan Haight Act of 2008 allowed for certain exemptions to the use of telehealth to provide controlled substances without the telehealth provider having seen the patient in-person first, however these exemptions are narrowly tailored. Two such exemptions are: when a public health emergency (PHE) is declared, and if a provider is registered on a telehealth registry that the DEA will create. Due to the current COVID-19 PHE, providers now are able to prescribe a controlled substance without an in-person visit, but the exemption will disappear once the PHE is declared over. In 2018 under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, Congress directed the DEA to promulgate final regulations for the registry by the end of 2019. Although a December 2019 regulatory posting indicated the DEA’s intent to publish the rule, the deadline came and went without even draft regulations being released for public comments. In March 2020, a PHE for COVID-19 was declared allowing one of the exceptions for prescribing to be activated. However, the PHE is not slated to last indefinitely and many, including Senator Warner, are looking for a more lasting change. Senator Warner also sent inquiries to the previous administration regarding the status of the registry regulations that went unanswered. During COVID-19, concern for the ability of patients with substance use disorders (SUD) to access services rose as demands on health services focused on responding to the pandemic and people sheltered in place. While much of the country is beginning to open up again, a lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. < Previous News Next News >

CCHP Leadership Provides A Look Back at Telehealth Policy in 2022: Yes...The Year is Almost Over! Mei Kwong December 20, 2022 As another full year of living under the public health emergency (PHE) for COVID-19 comes to an end, we are taking a look back to see what has happened this year with telehealth policy on both the federal and state level. Since the PHE is still in place and likely to continue into 2023, permanent changes on the federal level have been fewer in comparison to what many states have been doing. In fact, some states began making permanent telehealth policy changes as early as late 2020. Other states have taken similar actions to their federal counterparts and put a definitive future expiration date on temporary telehealth policies. FEDERAL The most significant federal legislative telehealth policy action seen this year took place in the Budget Act of 2022 which included language extending some of the temporary waivers to telehealth in Medicare for an additional 151 days after the PHE. This statutory change led to additional clarifications that the Centers for Medicare and Medicaid Services (CMS) made in their Physician Fee Schedule for 2023 (PFS). CCHP also recently released a fact sheet on the relevant telehealth policies. The final result as the policy stands now is: For 151 Days After the PHE: Certain providers including federally qualified health centers (FQHCs), Rural Health Clinics (RHCs), occupational therapists, and physical therapists may continue to provide eligible services via telehealth under the Medicare program. The list of temporary services eligible to be delivered via telehealth and covered by the Medicare program will continue to be available during this 151-day period. The geographic limitations under permanent telehealth Medicare policy will be suspended during this 151-day period and the home will continue to be an eligible originating site for all eligible services during the extension. Audio-only can continue to be used as a modality for eligible services during the 151-day extension. Permanent policy requirements such as a previous in-person visit for mental health services taking place in a non-geographically eligible location, in the home or via audio-only is suspended during this 151-day period. Certain other federal waivers that exist under the PHE are currently not included in this 151-day grace period. This includes the Office of Civil Rights (OCR) exercising discretion in enforcing HIPAA which OCR has noted will expire when the PHE is declared over or expires, whichever comes first. As can be seen by the foregoing, very little has changed this year regarding permanent policy, just what will happen in the immediate aftermath of the end of the PHE. There have been some indications that Congress may pass legislation to extend the federal waivers, or at least some of them, beyond the 151-day period. HR 4040 authored by Representative Liz Cheney (R, WY) passed the House earlier this year, but no further action was taken. That bill would have extended some of the temporary waivers for an additional two years. However, what might be considered by Congress now is rumored to be only a one-year extension. It remains to be seen if some additional action will be taken legislatively. Feeding into the federal policymakers’ decision-making process have been several reports from various federal agencies in the past year. The Office of the Inspector General (OIG) released several reports around telehealth in 2022 including: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks The last study listed above is important to take note of given the concerns raised by policymakers for the potential of abuse and fraud. However, the OIG report noted that in the first year of COVID-19, less than 1% of telehealth claims made to Medicare raised flags for potential fraud, which should provide some reassurance to policymakers. Broadband has been an issue both on federal and state policymakers’ minds. While connectivity is a greater issue beyond how it impacts telehealth, it cannot be denied that telehealth will simply not work if the patient and provider cannot connect, although policy expansions related to audio-only have sought to mitigate this gap to a certain extent. In 2022, the Federal Communications Commission transitioned the Emergency Broadband Benefit Program into the Affordable Connectivity Program which provides assistance in paying for connectivity. The National Telecommunications and Information Administration (NTIA) compiled federal funding opportunities that support broadband planning, digital inclusion and deployment projects on one site. States have also been gearing up activity around broadband, some of it funded by the federal government such as NTIA awards to Nebraska to develop strategic plans to expand high-speed broadband and other investments made by the state itself. No doubt, broadband will continue to be a significant issue in 2023. STATES As CCHP’s recent Legislative Roundup newsletter noted, 2022 was another active year for state telehealth policy legislation, though not as robust as it was in 2021. Overall, in 2022, of the bills enacted and subjects CCHP tracked, licensure proved to be the most popular policy issue addressed with 61 bills across the states passing. This was followed by 27 enacted bills related to professional regulations and telehealth, many having to do with prescribing and 18 bills for pilot/studies/demonstrations. Enacted Medicaid and private payer reimbursement bills were 17 and 12, respectively. The licensure focus is of particular interest to note. While many of the pieces of legislation passed related to joining licensure compacts, states also made exceptions to licensure for specific situations. States are starting to address the various situations usually involving an already established relationship between patients and providers that prior to the pandemic had remained grey areas. A common concern raised during the pandemic related to licensure involved a patient temporarily re-locating to another state, perhaps as a college student, going on vacation or caring for a family member, but still wanting to receive services from their own provider in their home state. Kentucky passed HB 188 that forbids a regulatory board from promulgating regulations related to telehealth that prohibit “the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person’s state of permanent residence.” While clarity is always welcomed, the exceptions individual states are passing will create more complexity in the telehealth policy landscape particularly for practitioners who provide services in multiple jurisdictions. Reimbursement is an area that generates significant interest. For Medicaid related legislation, the type of modality used and services that would be covered under the program were popular issues addressed through legislation. For example, Virginia SB 426 requires the Medicaid state plan be amended to allow for remote patient monitoring (RPM) services for patients with certain types of medical conditions such as high-risk pregnancy and transplant patients when there is evidence that use of RPM is likely to prevent readmission to a hospital. Private payer telehealth legislation can also be quite specific. Louisiana HB 304 now requires telehealth coverage and payment parity equivalent to in-person services for physical therapy in particular. However, what we also saw were legislators moving towards ensuring there were patient protections/choice codified in state laws related to private payer plans and telehealth. Mississippi SB 2738, among other things, states that insurers cannot limit coverage of services to select third-party organizations. Commercial plans only offering telehealth delivered services to enrollees through a third party and not allowing their in-network providers to use telehealth has been a concern that was growing even prior to the pandemic. This stems from concerns raised by policymakers regarding patient choice or patients being “forced” to use telehealth and continuity of care concerns that continue to exist today. Overall, the number of states expanding telehealth policies increased. As noted in CCHP’s latest update to its 50 State Telehealth Policy Summary Report, Fall 2022, compared to its Fall 2021 update, three more state Medicaid programs are covering store-and-forward telehealth, five more states are covering RPM under Medicaid, and state Medicaid programs covering audio-only went up from 22 states to 34 states and DC. Additionally, three states have added payment parity requirements to their private payer laws. WHAT’S NEXT FOR 2023? As noted above, rumors have swirled around that there may be movement on the federal level to extend some of the telehealth waivers beyond the 151-day grace period, similar to what was proposed in the Cheney bill. However, it is likely that any such change will be included in a larger bill, such as the budget bill, rather than a standalone telehealth bill. There are also several outstanding issues that continue to not be addressed such as the registry for telehealth that the Drug Enforcement Administration (DEA) was to finalize regulations for in 2019. Some may recall that among the list of exceptions to allowing telehealth to be used to prescribe a controlled substance without the telehealth provider having examined the patient in-person included when a PHE was declared and the creation of a registry. For the registry, presumably once a provider is qualified to be on the registry, they need not have to meet any of the other narrow exceptions to prescribe via telehealth. That registry has never been created, though Congress had directed the DEA to finalize regulations by the end of 2019. On the state level, we likely can expect to see continued action around coverage, licensure, and professional regulations, as well as continued discussion around patient choice. During this past year, there has been increased discussions regarding “telehealth-first” health plans and the impact on patient choice. Whether policymakers take a more active role in regulating these plans remains to be seen, but the discussion around patient choice protections will continue. One thing is clear: the telehealth policy landscape is by no means “settled” as 2022 draws to a close. Outstanding questions around temporary policies still remain and even settled policies implemented a year or so ago have been tweaked in some states. To hear more about what's occurred in 2022, plus what we can anticipate for 2023, watch CCHP's newest short video. As we head into 2023 we can be certain that the telehealth policy landscape will continue to evolve and change, and we look forward to having you continue on this journey alongside CCHP. Have a Happy New Year and see everyone in 2023! Mei Kwong, CCHP Executive Director See original article: https://mailchi.mp/cchpca/cchp-leadership-provides-a-look-back-at-telehealth-policy-in-2022-yesthe-year-is-almost-over < Previous News Next News >

Majority of Americans Value the Convenience Associated with Telehealth Mark Melchionna December 07, 2022 New survey results released by AHIP showed that most Americans highly value the simplicity and convenience associated with telehealth and support making pre-deductible telehealth coverage permanent. America's Health Insurance Plans (AHIP) described survey results indicating that Americans value the convenience associated with telehealth, with 69 percent saying they prefer it over in-person care for this reason. As the COVID-19 pandemic became increasingly severe, many patients and providers began to use telehealth at a higher frequency. This was supported by federal and state governments allowing flexibilities that removed barriers to this type of care, leading to improved patient access. The high level of telehealth use has continued during the pandemic, even following the drop in COVID-19 severity as vaccines and treatments became widely available. According to the FAIR Health Monthly Telehealth Regional tracker, telehealth use increased by 10.2 percent in May. A survey released by AHIP aimed to gather information regarding Americans' opinions on telehealth. Conducted by NORC at the University of Chicago and using the AmeriSpeak panel, the survey polled 1,000 Americans, 498 of whom have employer-provided or individual market coverage, regarding telehealth use within one year prior. The survey was fielded in October. Among the portion of survey respondents who were commercially insured, 40 percent claimed to have used telehealth within a year prior, and 53 percent claimed to have used it between two and five times within a year prior. About 69 percent of commercially insured telehealth users said they used telehealth due to the associated high level of convenience compared to in-person care, 78 percent stated that telehealth made the process of seeking out healthcare easier, and 85 percent said there is an adequate number of providers available via telehealth for their subjective needs. Also, 73 percent of commercial telehealth users stated that Congress should make permanent arrangements that allow for the coverage of telehealth services prior to paying their full deductible. Further, female telehealth users were almost four times as likely than men to say they participated in a telehealth appointment because they lacked childcare or eldercare, the survey shows. “Patients and providers accept – and often prefer – digital technologies as an essential part of health care delivery,” said Jeanette Thornton, executive vice president of policy and strategy at AHIP, in a press release. “Telehealth can be just as effective as in-person care for many conditions and allows patients to receive more services ‘where they are.’ That’s why health insurance providers are committed to strengthening and improving both access and use for the millions of Americans who use telehealth for their health care needs.” A report from July found similar patient opinions of telehealth. Released by CVS Health, the 2022 Health Care Insights Study reported survey results from two separate questionnaires. Around 92 percent of respondents stated that convenience is a critical factor when selecting a primary care provider. The surveys also reported that many consumers find virtual appointments more convenient than in-person visits because they didn’t have to leave home (41 percent), they didn't have to pay for transportation (37 percent), and they saved time (37 percent). See original article: https://mhealthintelligence.com/news/majority-of-americans-value-the-convenience-associated-with-telehealth < Previous News Next News >

Emergency telemedicine poised to grow in pandemic’s new phase Tanya Albert Henry, Contributing News Writer May 23, 2022 Emergency medicine is likely not the first specialty that comes to mind when thinking about the clinical areas that can benefit greatly from telehealth. But this digitally enabled mode of health care delivery that took off at the pandemic’s onset was helping in the emergency medicine setting before COVID-19 and will only continue to grow. An AMA Telehealth Immersion Program event co-hosted with the American College of Emergency Physicians (ACEP) provided an overview of the innovative ways telemedicine is being used in emergency settings and discussed how telehealth can continue to help physicians provide better care for patients. Emergency medicine doesn’t take place in one spot in the hospital and emergency physicians are trained to take care of emerging acute care situations in any setting, said Aditi U. Joshi, MD, chair of ACEP’s telehealth section. That includes the kind of asynchronous care that can be part of telehealth. Triage involves determining which kind of care presenting patients require. “Can they stay at home, do they need to go to an urgent care, primary care, or do they need to come into the emergency department?” she said. “We are uniquely skilled in that.” Telestroke was another form of telehealth in use before the COVID-19 pandemic, and telehealth was in use at freestanding emergency departments and urgent care centers. And here are a few ways that virtual care is poised to continue to grow: Triage. This can include, for example, talking to the emergency medical services unit on the way to the hospital, long-term acute care (LTAC) triage, and telemedicine screening exams. Direct, acute unscheduled care. For example, virtual urgent care, ED consults to help with things such as transfer stabilization treatment advice, LTAC, correctional medicine, or skilled nursing facility consults. Virtual (out of ED) observation. For example, post-ED follow-up visits, remote home monitoring, and hospital at home. The AMA helps guide physicians, practices and health systems in optimizing and sustaining telehealth at their organizations through the AMA Telehealth Immersion Program. The program builds on The Telehealth Initiative and is part of the AMA STEPS Forward® Innovation Academy, which enables physicians to learn from peers and experts and discover ways to implement time-saving practice innovation strategies. Benefits in the rural setting Over the past decade, 120 U.S. hospitals closed and 31 states have seen at least one rural hospital among those closures. With 20% of the population living and working in a rural area where hospitals often have limited staff, wait times for EDs in the rural hospitals are higher than the national average that is already at 24 minutes—and that is to see a nonphysician such as a nurse practitioner or physician assistant. It’s not uncommon for a physician to have to be called to come in from home at night because there are not enough doctors to staff the hospital 24/7. Emergency physician Kelly Rhone, MD, interim chief medical officer and vice president of innovation and outreach at Avel eCare, said their virtual health system—started in 1993—works with rural hospitals across the country to provide emergency care. They are hard-wired into EDs where health professionals with the push of a button can connect to their virtual emergency department, staffed with emergency physicians and nurses, to direct those who have their hands on the patients who may be in cardiac arrest, suffering from a stroke or facing other life-threatening injuries. “We are making a difference in rural health and bringing cutting-edge emergency medicine to the bedside,” Dr. Rhone said. Emergency telehealth in big cities too Telemedicine in the ED setting has benefits in large urban areas such as Los Angeles, too. Moshen Saidinejad, MD, directs pediatric emergency medicine at Ronald Reagan UCLA Medical Center, and said many children go to EDs that aren’t set up for pediatric patients and telemedicine allows those trained in pediatric emergency medicine to consult with those treating a child. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. For more information see full article: https://www.ama-assn.org/practice-management/digital/emergency-telemedicine-poised-grow-pandemic-s-new-phase?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Can virtual nursing help ease clinician burnout? Bill Siwicki November 14, 2022 The turnover rate for nurses stands at 27%. Can telemedicine save the day? No hospital or health system is immune from the challenges of the nationwide nursing shortage. As organizations look for ways to reduce the administrative burden on nurses and improve engagement and satisfaction, virtual nursing is one consideration. Many tasks performed by nurses in the inpatient setting are repetitive – a virtual nursing unit allows nurses to manage these tasks remotely. Bedside nurses and staff then are freed up to focus on patient-facing care, while those in the virtual unit can monitor patients, enter data in the medical record and more. To better understand the ins and outs of virtual nursing, we interviewed Dr. Shayan Vyas, senior vice president and medical director for hospitals and health systems at Teladoc Health. Q. What is the national nursing shortage like today? How does it play out in hospitals and health systems? A. Every health system I've spoken with, that we work with, says workforce challenges are among the top three issues keeping them up at night. This is particularly true for nursing staff. In 2021, nurses were leaving the profession at an alarming rate. According to NSI Nursing Solutions, the turnover rate for nurses increased by 8.4% in 2021 and currently stands at 27%. An increase in patient volume and occupancy rates, among other factors, have led to severe emotional and physical exhaustion and, ultimately, job dissatisfaction and burnout. A 2021 McKinsey survey found that 32% of nurses were likely to leave their current position due to insufficient staffing levels, a lack of support and the emotional toll of the job. President Obama once said that "nurses are the heartbeat of the United States healthcare system," and I really believe that to be true. They put their lives on the line to serve and care for others every single day, and we need to give them the tools to more effectively, efficiently and safely care for others and save lives. Virtual care offers new strategies to address these challenges; virtual nursing is an important component that health systems can include in their transformation and care delivery redesign initiatives. Q. What is virtual nursing, and how does it work? A. Virtual nursing, simply put, is the delivery of nursing care and services from a remote location. Virtual nurses are responsible for monitoring multiple patients while collaborating with the nurses, physicians, therapists and other staff who provide care at the patient's bedside. The virtual nursing unit can be centralized (for example, nurses work from a command center in a healthcare facility), distributed (nurses work from home or other remote locations) or hybrid. Adopting virtual nursing provides a way to mitigate potential staffing losses due to short-term injury or other conditions that require nurses to be off their feet. It is also a way to extend nurses' careers, for example, by offering nurses with developing or chronic physical limitations the option of working seated in a command center, instead of providing physically challenging care on a nursing unit. Virtual nursing programs also can help attract nurses by providing different options for shifts and work styles. This model supports organizations by enabling them to have virtual nurses work from anywhere – allowing them to provide much-needed care and services without requiring nurses to relocate so that they live close enough to a hospital to be able to go on-site for their shift. It also helps new nurses with clinical support, medication verifications and overall non-physical patient bedside care assistance. Health systems that have created virtual nursing programs to augment their bedside nurses have found virtual nursing can extend nurses' careers and improve job satisfaction for floor nurses by taking away responsibility for many tasks that do not require physical touch. This allows the bedside nurse to focus on hands-on patient care and contributes to higher patient satisfaction because of the responsiveness and additional attentiveness it enables. Virtual nursing can also allow advanced nurse practitioners like PAs and ARNPs the ability to connect virtually with a virtual intensivist, and the virtual nurse can help with many of the nonphysical contact needs of patient care. Q. How can virtual nursing reduce the administrative burden on nurses and improve engagement and satisfaction? A. While hands-on care will always be needed, many duties can be fulfilled virtually, including coordinating procedures, getting sign-offs from multiple care team members, reconciling medications, providing patient education, answering questions, initiating the discharge process and more. In many successful virtual nursing programs, administrative tasks like discharge paperwork, medication reconciliation, etc., have been shifted from bedside to virtual nurses. Virtual nursing systems enable virtual nurses to monitor patients and communicate with them, their families, and other visitors and care team members in real time, including responding to patient nurse calls. The goal is to provide a new level of support to patients, nurses and the bedside team. Several health systems with virtual nursing programs have reported high job satisfaction for their virtual nurses. Nurses say the virtual role enables them to spend more time with patients overall. The extra time, and the complementary nature of virtual and bedside nursing roles, contributes to improved job satisfaction for both bedside and virtual nurses, and positive experiences for patients. Q. Please talk a bit about one of your hospital clients using virtual nursing and the results they've achieved. A. Overall, the benefits of virtual nursing include staffing flexibility, potential retention and recruitment advantages, the ability to leverage staff resources, and favorable nurse and patient satisfaction. Another major benefit of virtual nursing is a reduced length of stay, resulting in improved throughput, as well as time saved in the discharge process. Some lesser-known benefits of virtual nursing are a differentiated and improved patient experience, with potential associated improvements to patient satisfaction and HCAHPS and NPS scores. Patients also are seeing a significant improvement in satisfaction as they no longer have to pull a bedside staff member to help answer questions or assist with administrative documentation. Our client, Saint Luke's Health System in Kansas City, Missouri, has helped address the nursing shortage by having virtual nurses support bedside nurses. The virtual nurses can assist with non-hands-on care, education, documentation, admission, discharge, answering questions, and reviewing the care plan or physician rounding with the patient and their loved ones, among other tasks. The unit has enhanced Saint Luke's bedside care response rates, increased patient and nurse satisfaction, reduced the burden on bedside nurses, and positively impacted quality and safety for a better work environment. Patients are discharged within two hours of the discharge order, some 20% faster than in other units, and they're also out of the hospital before noon at a 44% faster rate. This has, in turn, reduced the wait time for patients in the ED and reduces the time to treatment. What's more, these benefits have boosted nurse morale, improving workforce engagement, reducing fatigue, even improving Saint Luke's recruitment capabilities. We need to provide nurses, our frontline workers, with technology that improves their work, quality of life, and the level and effectiveness of bedside care. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/can-virtual-nursing-help-ease-clinician-burnout < Previous News Next News >

Telehealth helps stop suicidal ideation for many patients, study finds Bill Siwicki December 29, 2022 One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. Recently, the Journal of Medical Internet Research published some significant data highlighting the efficacy of psychiatric care delivered through telehealth: Those in the treatment group were 4.3 times more likely to have suicidal ideation remission. This is noteworthy because telehealth has not traditionally been equipped to treat those with the most severe symptoms of mental health due to the oversight necessary to actually provide safe, effective treatment, said Dr. Mimi Winsberg, chief medical officer at Brightside Health, which led the study. We spoke with Winsberg to get an in-depth look at this study and what the results mean for the future of telehealth and mental healthcare. Q. Please talk about your new study that examines the impact of telepsychiatry on reduction in suicidal ideation over time. Who was involved? What kind of care did they receive? What role did technology play? A. The study, which was published in JMIR Formative Research, sought to determine if Brightside Health's telehealth platform, which is equipped with precision prescribing clinical decision support, could successfully reduce suicidal ideation among enrolled patients, versus a control group who tracked their symptoms on the platform without receiving care. Another goal of the study was to describe the symptom clusters of patients who present with suicidal ideation in order to better understand the psychiatric symptoms associated with suicidal feelings. The study was large scale including participants of diverse geography and social demographics. It included a total of 8,581 people who completed a digital intake on the Brightside platform. Of those, 8,366 elected to receive psychiatric care from Brightside, while 215 tracked their symptoms on the platform without receiving care. Those who elected to receive psychiatric care through Brightside received a minimum of 12 weeks of treatment that included video visits with their providers, asynchronous messaging, and a prescription of at least one psychiatric medication. Brightside's technology platform was used to deliver clinically validated measures of depression and anxiety, as well as questions about clinical presentation, medical history and demographics. The proprietary precision-prescribing platform embedded in the tech platform analyzes these data points using an empirically derived algorithm to provide real-time care guidelines and clinical decision support to its providers using a computerized symptom cluster analysis. Q. The study led to some very promising outcomes. Please describe them and the success you achieved with telemedicine. A. The study found that patients enrolled in Brightside Health's telehealth platform had reduced suicidal ideation after 12 weeks of treatment. Patients who received treatment via Brightside Health were also 4.3 times more likely to have remission of their suicidal ideation than the control group who were monitored on the platform but did not receive care. The results demonstrated that a telehealth platform equipped with clinical decision support was an effective intervention for the symptom of suicidal ideation. In addition, we found that suicidal ideation had higher correlations with cognitive symptoms of hopelessness and poor feelings of self-worth, than with the physical symptoms of depression such as disrupted sleep and low energy. Q. Telehealth hasn't traditionally been equipped to treat these kinds of patients. What made the difference here? A. Historically, we have not relied on telehealth solutions to address more serious symptoms of depression. Clinicians are hesitant to treat individuals with suicidal ideation over telehealth because of the perceived risks. However, the results of this study are significant because they demonstrate effectiveness in treating these symptoms through a telehealth platform with clinical decision support, which may help alleviate concerns about the use of telehealth in addressing suicidal ideation. Telehealth can involve more than simply connecting a provider and patient via video camera. The telehealth platform used for the study was equipped with novel features such as remote patient monitoring and clinical decision support. A sophisticated telehealth intervention can assiduously track symptom presentation and outcomes with measurement-based care and offer real-time interventions along with machine learning and algorithmically based clinical decision support to select the best treatment. Q. What does all of this mean for the future of telemedicine and mental health? A. The future of mental health via telemedicine promises more widespread adoption of solutions for the majority of behavioral health conditions, even those with increasing severity of symptoms. We may see telehealth deployed for more serious mental illness, particularly when the telehealth platform can incorporate novel technologies to optimize care delivery. Additionally, as payers and providers collaborate to deliver more effective care, telehealth will likely become more than a means to deliver care, but also a way to enhance care delivery and provide highly effective care to those who need it most with expediency. At Brightside Health, we will continue to research the impact of telehealth treatment across the spectrum of mental health conditions, including those on the higher end of the severity axis. To that end, we are launching Crisis Care, a first of its kind program delivered nationally and over telehealth to treat patients with active suicidal ideation. The program is grounded in the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) framework. This study in JMIR Formative Research laid the foundation for this program, and we are seeing an obvious need for such a national program in the U.S., where one person dies from suicide every 11 minutes. We look forward to furthering this important – and life-saving – work. 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-helps-stop-suicidal-ideation-many-patients-study-finds < Previous News Next News >

Amazon Healthcare Building a National Telehealth Business Dr. Maheu, Telehealt.org January 2021 Amazon Care recently announced that it will expand nationally to all Amazon workers and other interested companies across the country in the summer of 2021. Amazon, the $1.6 trillion shipping giant, is launching a new service to provide essential medical services through Amazon Healthcare as a national telehealth business. Amazon Care uses an app that allows consumers to connect with doctors, nurse practitioners, and nurses virtually, 24 hours a day, via in-app chat or video. Initially launched and tested with Washington-based employees, Amazon Care recently announced that it will expand nationally to all Amazon workers and other interested companies across the country in the summer of 2021. “Making this available to other employers is a big step,” Amazon Care Director Kristen Helton said. “It’s an opportunity for other forward-thinking employers to offer a service that helps bring high-quality care, convenience and peace of mind.” Notice the last three descriptors: “high-quality care, convenience and peace of mind.” From the perspective of many healthcare providers, healthcare in the US has been lacking in each of these three areas. For employers registering for the service, which has partnered with Care Medical, employees near their headquarters will get online and in-person doctor visits. Employees elsewhere will get just the virtual components. Through Care Medical, Amazon Care currently offers an app to connect employees to a medical professional for a video consultation. It also offers follow-up care in the home for patients. The goal is to lower healthcare costs internally for Amazon and externally for some of the world’s most influential companies, using telehealth to meet people on their terms, with good care, wherever they are. Amazon’s Multi-Layered Business Strategy Anyone watching Amazon over the last year will be well acquainted with its accelerating moves to provide the early inklings of healthcare. Early Amazon Healthcare efforts were announced by Telehealth.org’s Telehealth News on 6/4/2020. In that article, it was reported that Amazon Health announced a pilot program offering virtual medical services to employees and their families. Amazon then expanded the presence of Alexa voice assistant, announcing that it was making it possible for voice assistant developers to offer HIPAA-compliant services for the Alexa platform. Amazon Pharmacy, a drug-delivering business in 48 states with steep discounts for Prime members was also released in November of 2020. Most recently Amazon has launched another offering called Amazon HealthLake, a HIPAA-compliant service that allows healthcare providers, health insurance companies, and pharmaceutical companies to store, transform, and analyze health data at a petabyte scale. As described on the Amazon HealthLake website: Amazon HealthLake removes the heavy lifting of organizing, indexing, and structuring patient information to provide a complete view of the health of individual patients and entire patient populations in a secure, compliant, and auditable manner. Using the HealthLake APIs, healthcare organizations can easily copy health data in the Fast Healthcare Interoperability Resources (FHIR) industry standard format from on-premises systems to a secure data lake in the cloud. HealthLake transforms unstructured data using specialized machine learning models, like natural language processing, to automatically extract meaningful medical information from the data and provides powerful query and search capabilities. Organizations can use advanced analytics and ML models, such as Amazon QuickSight and Amazon SageMaker to analyze and understand relationships, identify trends, and make predictions from the newly normalized and structured data. From early detection of disease to population health trends, organizations can use Amazon HealthLake to conduct clinical data analysis powered by machine learning to improve care and reduce costs. < Previous News Next News >

Telehealth and Maternal Mental Health Needs Two recent studies show telehealth can help new and expectant mothers. Psychology Today April 30, 2021 Telehealth measures decreased prenatal distress, pregnancy-related anxiety, and postpartum depression. Telemedicine has skyrocketed since the start of the pandemic. According to The New York Times, just short of May 2020, the Johns Hopkins neurology department was seeing 95 percent of patients virtually. The rise in telemedicine to address maternal mental health has also seen unprecedented growth during the pandemic. Meanwhile, Mental Health America states that the mental health needs of Americans have skyrocketed. Anxiety and depression screenings increased nearly four-fold in 2020, from nearly 2,000 screenings per day to roughly 8,000 per day. Women, and in particular pregnant women, are vulnerable to hormonal fluctuations that make them twice as likely to experience depression during their lifetime compared to men. Research in the past year and a half has shown that telehealth can be substantially as effective as in-person care. (Telehealth, more encompassing than telemedicine but inclusive of it, may include only educational components.) With respect to maternal mental health, there are two studies highlighted herein that demonstrate telehealth's promise when it comes to improving maternal mental health in terms of prenatal distress, pregnancy-related anxiety, and the postpartum period. Of note, one of the studies was conducted prior March 11, 2020, or the official start of the pandemic, which makes it non-COVID-19 related. Maternal mental health, or perinatal mental health, is defined by the Maternal Health Task Force as a woman’s mental health during pregnancy and in the postpartum period. The significance of this period is multifold. It includes increased risk of the following: preterm delivery, low birth weight, impaired postnatal infant growth, insecure infant-mother attachments, and suboptimal breastfeeding practices. The first study published in Midwifery in 2021 supports the use of tele-education in improving prenatal distress and pregnancy-related anxiety. Specifically, the Midwifery study showed that “tele-education offered to the pregnant women on pregnancy and birth planning during COVID-19 decreased their prenatal distress and anxiety levels.” What the pregnant women received were phone calls, text messages, and a digital education pdf file, all of which educated women on a variety of topics, including “general methods of protection from coronavirus, coronavirus prevention methods during pregnancy, coronavirus and delivery process, measures to be taken during the coronavirus pandemic and postpartum process, measures to be taken during the coronavirus pandemic and breastfeeding, and how to manage stress, anxiety, and depression in these processes.” The tele-education included a digital pdf file called the “Booklet for Pregnancy and Birth Planning Education during Coronavirus (COVID-19).” All the of the educational content was developed with suggestions from medical and public health experts. A major takeaway from the above Midwifery study is that tele-education is effective in reducing the fears pregnant women have about giving birth as well as about their babies’ health in the context of a pandemic; in summary, prenatal distress and pregnancy-related anxiety were significantly decreased (p-value <0.05). Significantly lower scores on pregnancy-related anxiety questionnaires developed by van den Bergh (1990) and revised by Huizink et al. (2016) demonstrated the effective role played by tele-education. The second study published in Midwifery in 2021 supports the use of telemedicine interventions in treating postpartum depression symptoms. While the study’s timeframe was not during COVID, the results are helpful in understanding the beneficial role telemedicine has played in the past couple of years. Previous research has shown it can be a challenge for postpartum women to seek care for the “baby blues” or depressive symptoms, either of which could be significant. This may be due to perceived stigma, time, financial constraints, transportation, or childcare concerns. In this study, the telemedicine modalities included: telephone support, mobile applications, social media, and websites. This meta-analysis reviewed at least seven randomized controlled trials that largely used cognitive behavioral therapy (CBT) or psychoeducation to help pregnant women participants. The second Midwifery study concluded that telemedicine interventions “significantly decreased postpartum depression symptoms” and “demonstrated feasibility and acceptability among mothers in the postnatal period.” A major takeaway from the second Midwifery study is that telemedicine appears to be “promising in preventing and improving postpartum depression.” Of note, the study looked at women without a history of mental health conditions. Meanwhile, Hanach et al. highlight the need for larger-scale, future research to figure out the structure, content, and type of providers recommended within future telemedicine interventions. In conclusion, the benefits of telehealth—especially during COVID-19—appear to help women in the prenatal and postpartum phases of pregnancy. While the research is still growing, and quite limited, such positive signs are helpful in understanding the role that technology can play in addressing maternal mental health needs. Future studies that reflect on the benefits of telehealth are vital and will be particularly useful in supporting new and expectant mothers, especially in times of adversity. Source: https://www.psychologytoday.com/ca/blog/healthy-mothers-healthy-families-and-healthier-world/202104/telehealth-and-maternal-mental < Previous News Next News >

Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017–20 Juan J. Andino, Ziwei Zhu, Mihir Surapaneni, Rodney L. Dunn, and Chad Ellimoottil Abstract During the COVID-19 pandemic, all fifty states and Washington, D.C., passed licensure waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (that is, interstate telehealth). Because many of these temporary flexibilities have expired or are set to expire, we analyzed trends in interstate telehealth use by Medicare beneficiaries during 2017–20, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth made up a small share of all outpatient visits (0.8 percent) and of all telehealth visits (5 percent) overall. For individual states, out-of-state telehealth made up between 0.2 percent and 9.3 percent of all outpatient visits. We found that most out-of-state telehealth use was for established patient care and that a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who did not receive care outside of their state (28 percent versus 23 percent). Our collective findings suggest that the elimination of pandemic licensure flexibilities will affect different states to varying degrees and will also affect the delivery of care for both established patients and rural patients. View Full Article: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01825?journalCode=hlthaff ​ ​ < Previous News Next News >

Physician fee schedule final rule opens up telehealth access Susan Morse, Managing Editor, Healthcare Finance Nov. 5, 2021 AMA wants Congress to avert physician payment cuts it says will amount to 9.75% for 2022. For the first time outside of the COVID-19 public health emergency, Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including audio-only telephone calls. This will expand access for rural and other vulnerable populations. The Centers for Medicare and Medicaid Services announced this and other actions in the 2022 Physician Fee Schedule final rule released late Tuesday. In line with legislation enacted last year, CMS is eliminating geographic barriers and allowing patients at home to access telehealth services for diagnosis, evaluation and treatment of mental health disorders. Certain mental and behavioral health services via audio-only telephone calls that are being covered include counseling and therapy for the treatment of substance use disorders and services provided through opioid treatment programs. WHY THIS MATTERS While expanded telehealth coverage is supported by providers and others who responded to the final rule, the update to the clinical labor rates for 2022 got harsh feedback from the American Medical Association. With the budget neutrality adjustment to account for changes in Relative Value Units, as required by law, and expiration of the 3.75% temporary 2021 payment increase provided by the Consolidated Appropriations Act, the 2022 physician fee schedule conversion factor is $33.59, a decrease of $1.30 from the 2021 rate of $34.89. The AMA wants Congress to intervene to stop the physician payment cuts. "While the American Medical Association will thoroughly analyze the 2,400+ page rule, it is a reminder of the financial peril facing physician practices at the end of the year," said AMA president Dr. Gerald E. Harmon. "The final rule includes a reduction in the 2022 Medicare conversion factor of about 3.85%. "The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75% cut for 2022. This comes at a time when physician practices are still recovering the personal and financial impacts of the COVID public health emergency." Other actions in the final rule include: Promoting growth in Medicare diabetes prevention program CMS is expanding the Medicare Diabetes Prevention Program (MDDP) model, in which local suppliers provide structured, coach-led sessions in community and healthcare settings using a Centers for Disease Control and Prevention-approved curriculum to provide training in dietary change, increased physical activity and weight-loss strategies. CMS is waiving the Medicare enrollment fee for all organizations that apply to enroll as an MDPP supplier on or after January 1, 2022. CMS has been waiving this fee during the COVID-19 PHE for new suppliers, and said it has witnessed increased supplier enrollment. The agency is shortening the model services period to one year instead of two years and is restructuring payments so suppliers receive larger payments for participants who reach milestones for attendance. Increased access to medical nutrition therapy services The PFS final rule also streamlines access to Medical Nutrition Therapy, which includes services provided by registered dietitians or nutrition professionals to help people with Medicare better manage their diabetes or renal disease. CMS has removed a requirement that limited who could refer people with Medicare to these services, allowing any physician to do so. This change should particularly benefit people living in rural areas as the services are provided to eligible individuals with no out-of-pocket costs and may be provided via telehealth. Encouraging vaccines to protect against preventable illness CMS will maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends. Effective January 1 of the year following the year in which the PHE ends, the payment rate for COVID-19 vaccine administration will be set at a rate to align with the payment rate for the administration of other Part B preventive vaccines. CMS will also continue to facilitate vaccinations for common diseases such as influenza, pneumonia, and hepatitis B. This year, Medicare reviewed payments for vaccinations to ensure doctors and other health professionals are paid appropriately for providing vaccinations. This final rule will nearly double Medicare Part B payment rates for influenza, pneumococcal and hepatitis B vaccine administration from roughly $17 to $30. Expanded pulmonary rehabilitation coverage As part of CMS' continuing efforts to address the current PHE, the agency finalized expanded coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to individuals who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least four weeks. This goes beyond the physician fee schedule proposed rule, which would have focused the expanded coverage to those hospitalized with COVID-19. CMS also finalized a temporary extension of certain cardiac and intensive cardiac rehabilitation services available via telehealth for people with Medicare until the end of December 2023. Advancing the Quality Payment Program and MIPS Value Pathways The final rule makes several changes to CMS' Quality Payment Program to promote the delivery of high-value care by clinicians through a combination of financial incentives and disincentives. For example, CMS finalized a higher performance threshold that clinicians will be required to exceed in 2022 to be eligible for positive payment incentives. This new threshold was determined in accordance with statutory requirements for the Merit-based Incentive Payment System. CMS has introduced the first seven MIPS Value Pathways in the clinical areas of rheumatology, stroke care and prevention, heart disease, chronic-disease management, lower-extremity joint repair (e.g. knee replacement), emergency medicine, and anesthesia. To incentivize high-quality care for professionals that are often key points of contact for underserved communities with acute healthcare needs, CMS has also revised the current eligible clinician definition to include clinical social workers and certified nurse-midwives among those participating in MIPS. Ensuring accurate payments through clinical labor update For the first time in nearly 20 years, CMS is updating the clinical labor rates that are used to calculate practice expense. As a result, payments to primary care specialists that involve more clinical labor, such as family practice, geriatrics, and internal medicine specialties, are expected to increase. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on healthcare providers by gradually phasing in the changes over time. Increasing access to physician assistants' services Finally, CMS is implementing a recent statutory change that authorizes Medicare to make direct Medicare payments to Physician Assistants for professional services they furnish under Part B. For the first time, beginning January 1, 2022, PAs will be able to bill Medicare directly. THE LARGER TREND The final rule advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes. That will advance its strategic commitment to drive innovation to support health equity and high-quality, person-centered care, CMS said. ON THE RECORD "Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS," said CMS Administrator Chiquita Brooks-LaSure. "The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future." https://www.healthcarefinancenews.com/news/cms-physician-payment-rule-promotes-greater-access-telehealth-services-diabetes-prevention#.YYK9zyVXS6A.twitter < Previous News Next News >

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

Common Wealth Fund Analyzes State COVID-19 Telehealth Changes Center for Connected Health Policy July 2021 Recommending Longer Term Expansion Data to Determine Permanent Policies The Commonwealth Fund recently released an issue brief titled, States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations, to help inform future policy considerations for telehealth post-pandemic. Focusing on private insurance coverage, the authors reviewed pre-pandemic state telehealth statutes as well as state emergency actions related to telehealth between March 2020 and March 2021. The study found that 22 states made telehealth policy changes, mostly in regard to audio-only coverage, cost-sharing requirements, and reimbursement parity. Audio-only coverage and reimbursement parity were the most popular changes made to ensure expanded access to telehealth. Notable pre-pandemic findings include: -35 states required private insurance telehealth coverage -25 states required insurers to limit cost-sharing -15 states required private payer reimbursement parity -3 states explicitly required audio-only coverage Notable policy expansions during the pandemic included: -5 additional states required telehealth coverage -4 new states eliminated cost-sharing for services via telehealth -10 states added a requirement for private payer reimbursement parity -18 states moved to require audio-only coverage The report also looked at methods of emergency telehealth expansion by states, finding that policy changes came in a combination of legislation, executive orders, and other agency actions such as bulletins and notices. The study found 8 states passed legislation, but that the primary method was administrative action, given its ability to be made quickly. Administrative changes also appeared to often hinge on existing statutory authority or executive orders creating such authority. As part of the study’s methodology, the authors additionally interviewed insurance regulators in 10 states that had made telehealth expansions. Regulators highlighted the importance of audio-only coverage, both for older patients and their ease of use, as well as patients with behavioral health conditions that find it more comfortable. While some regulators expressed concerns related to increased costs with audio-only coverage, others highlighted billing parameters and how insurers have the ability to determine which audio-only visits qualify for reimbursement. The regulators also noted that almost all insurers were supportive of the temporary expansions, but that they’d likely oppose long-term payment parity requirements, even though one regulator commented how the work may be the same for a visit via telehealth as in-person. Interviews also revealed an insurer desire to pay lower rates for their third-party corporate telehealth providers, which regulators said may be less costly but also may fragment care, which can result in lower quality care and higher health care costs. The report also covers existing research around the benefits of telehealth and suggests the need to address insurance and audio-only coverage long-term to reduce access issues and stabilize the coverage landscape for providers to continue investing in telehealth use. The study concludes with the recommendation that maintaining telehealth expansions may benefit payers and consumers if telehealth can be shown to reduce health care costs. This will require access to longer-term information to monitor its use, including stakeholder workgroups and formal data collection mechanisms. Of course, longer-term data requires longer-term expansions, which could trend states toward temporary extensions in the short-term, such as those recently enacted in Connecticut and proposed in California. As policymakers continue the call for telehealth data, the primary response from researchers seems to be the same call. In addition to telehealth expansion impacts on health care costs, the issue of improved access to care must remain a primary focus of data collection and evaluation as well to truly result in equitable policy adoption. For more information on the actions states took to expand telehealth during COVID-19, read the Commonwealth Fund’s issue brief in its entirety - https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/states-actions-expand-telemedicine-access-covid-19. CCHP’s Policy Finder tool can also be used to look up COVID telehealth policy documents by state. New Mexico policy finder - https://www.cchpca.org/new-mexico/. < Previous News Next News >

Telehealth Legislation Re-Introduced National Council for Behavioral Health March 12, 2021 This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. < Previous News Next News >

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

Teledentistry – Lights. Camera. Open Wide. By Trudy Bearden April 7, 2021 The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. Well… not quite; but it may not be what you think. I’m not here to make the case about the importance of good oral health, the impacts of poor oral health on overall health and chronic disease, the potential to lower health care costs and our countless opportunities to integrate oral health into health care services. Rather I ask that you join me to learn just a bit more about what teledentistry is and how it can be used to expand access, provide education and elevate team-based care. Teledentistry. The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. According to the ADA, teledentistry includes patient care and patient education delivery using (but not limited to) four modalities: Synchronous (live video) – use of audio and video for real-time communication Asynchronous (store and forward) – secure electronic transmission of radiographs, photos, video, digital impressions or photomicrographs, etc. to evaluate, render an opinion or service or develop a treatment plan Remote physiologic monitoring – electronic transmission of physiologic data (e.g., weight, oxygen saturation, blood glucose levels) Mobile health (mHealth) – sharing of education and/or information by mobile communications or use of apps (e.g., reminds or monitors oral hygiene activities) Store and forward. Dental hygienists can assess the mouths of patients, chart areas of concern, decay or periodontal disease, take high-resolution photographs and x-rays and transmit that information to a dentist who can review the materials and develop a treatment plan for a patient. Expand access. In rural areas with shortages of dentists, primary care clinics can “bring” a dentist or other oral health specialist into the exam room by synchronous (live video) communication to assess and discuss a dental issue and subsequent treatment plan for a patient. This is a far superior option than just prescribing antibiotics and pain medications, which may end with the patient in the emergency department. Education. Using a synchronous modality, there are ample opportunities for providing oral health education to patients and families, those in dentistry, those in the medical field, teams considering oral health integration and more. While there are several teledentistry modalities available, the following are the high leverage applications: Using store and forward technology for dental hygienists and others on dental and medical care teams Including dentists and other oral health and dental specialists (e.g., orthodontist) to join primary care office visits Using synchronous and asynchronous (e.g., secure messaging/email) options for provider-to-provider consults Providing synchronous and broad oral health education What’s in it for us and ours? How do we harness teledentistry to improve oral health? As an individual, it’s reasonable to ask your dentist what they are doing or are planning to do to implement or expand teledentistry to know whether there are additional options for you. If delivering health care services to patients, whether in the outpatient, inpatient, specialist, long-term service supports or elsewhere, we should: Know what the teledentistry options are in our area, especially if we are in a rural area with a shortage of dentists Ensure that all patients have a dental home and are receiving preventive and curative dental services – by teledentistry if necessary and available to them Consider an oral health education program that is delivered virtually or remotely and/or includes mHealth or app-based options If you are particularly passionate about the potential of teledentistry, know the barriers in your state and area and find ways to overcome those barriers, which include parity of coverage, parity of payment, and statutes governing teledentistry in your state. Checking this interactive map from the Center for Connected Health Policy is a good starting place. Adequate and access to bandwidth and provider, patient and family buy-in can be significant factors as well. Either way – let’s get our teeth into teledentistry and do what we can to leverage the full range of options to help individuals optimize their oral health. Interactive map: https://www.cchpca.org/ < Previous News Next News >

CCHP: Audio only vs. Live Video Use... Center for Connected Health Policy February 15, 2022 The National Telehealth Policy Resource Center The Office of the Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy recently released a new Issue Brief titled National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. The analysis found a number of trends that can be helpful in understanding remaining telehealth barriers and their interaction with health care disparities. Utilizing Census Bureau’s Household Pulse Survey (HPS) information from 2021, the study focused on differences in use between live video and audio-only telehealth modalities. Overall findings showed that telehealth use was common and utilization rates were generally similar across most demographic subgroups, except those that were uninsured. Utilization rates of live-video telehealth, however, were found to be lower among underserved populations, such as those with lower incomes and Black, Latino, and Asian respondents. To read the full article: https://mailchi.mp/cchpca/new-aspe-issue-brief-addresses-audio-only-vs-live-video-use-and-interaction-with-healthcare-disparities < Previous News Next News >

Effects on Patient Access to Telehealth as Some State Emergencies End Center for Connected Health Policy July 2021 With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. According to the National Academy for State Health Policy (NASHP), nearly 20 states no longer are under emergency orders, with many soon to follow. Many states attached telehealth flexibilities to the federal public health emergency (PHE) while others made them contingent on state emergency declarations. Some states have successfully passed legislation to extend certain telehealth flexibilities in advance of state of emergency expirations, such as Connecticut and Delaware. The federal government Emergency Preparedness and Response for Home and Community Based (HCBS) 1915(c) Waivers were often originally tied to state emergencies, but appear to now extend 6 months after the federal PHE ends. Alaska is one of the states no longer under a state of emergency. During the pandemic a local outlet reported thousands of patients were being referred to out-of-state providers, especially in Washington, via telehealth for a variety of reasons including lack of specialty care and long wait times. Once the emergency licensing waivers expired, however, Seattle hospitals were sent rushing to reschedule Alaska patients and resume the more stringent process of becoming licensed in Alaska. According to recent local reports, Florida’s emergency expiration also took away audio-only and the ability to use telehealth to prescribe controlled substances and recertify medical cannabis patients. The Florida Medical Association told the local news outlet they will continue the push to make telehealth changes permanent in the next state legislative session, especially those requiring insurer reimbursement and payment parity, without which they say telehealth will simply no longer be made available to patients. For more information on the status of the emergency orders in each state visit the NASHP website - https://www.nashp.org/governors-prioritize-health-for-all/. < Previous News Next News >

USDA Invests in Four New Mexico Projects for Distance Learning and Telemedicine Infrastructure to Improve Education and Health Outcomes By Amy Mund February 25, 2021 The United States Department of Agriculture (USDA) today announced it is investing $42.3 million to help rural residents gain access to health care and educational opportunities. Rural areas are seeing higher infection and death rates related to COVID-19 due to several factors, including a much higher percentage of underlying conditions, difficulty accessing medical care, and lack of health insurance. The $42.3 million in awards includes $24 million provided through the CARES Act. In total, these investments will benefit 5 million rural residents. “The coronavirus pandemic is a national emergency that requires an historic federal response. These investments by the Biden Administration will help millions of people living in rural places access health care and education opportunities that could change and save lives,” said Agriculture Secretary Tom Vilsack. “USDA is helping rural America build back better using technology as a cornerstone to create more equitable communities. With health care and education increasingly moving to online platforms, the time is now to make historic investments in rural America to improve quality of life for decades to come.” USDA is funding 86 projects through the Distance Learning and Telemedicine (DLT) grant program. The program helps rural education and health care entities remotely reach students, patients and outside expertise. These capabilities make world-class education and health care opportunities accessible in rural communities. The ability to use telehealth resources is critical, especially now during a global pandemic. “The funding will provide new technology to expand learning beyond the classroom, healthcare beyond the doctor’s office and extend the reach of services to the respective regions,” said Acting New Mexico Rural Development State Director Eric Vigil. Fort Lewis College (FLC) in Durango, CO will use a $950,060 grant to strategically align technology that facilitates distance learning, improving access for roughly 3,270 students in the communities where they live. This HyFlex course design will be provided at four rural connectivity centers in La Plata and Conejos Counties in Colorado, Apache County in Arizona, and San Juan County in New Mexico. A HyFlex course design allows students to attend face-to-face classes, through synchronous sessions, fully online, allowing FLC to continue innovative delivering of quality education and support to students despite the continuing challenges presented by COVID-19. The rural connectivity centers will help mitigate the digital divide for the learning communities that are most affected by digital inequities by providing rural students with the internet and technology necessary to fully engage in courses from afar. They will also allow students from each community to access their professors as well as fully engage with the services that students on-campus are able to access including the student health center, faculty office hours, academic support such as tutoring and library services, and student-run organizations. Tanya V. Marin PC will utilize a $263,640 DLT Grant to purchase telemedicine equipment to help Santa Teresa Children's Day and Night Clinic implement a comprehensive health care and wellness programs. Six fully-equipped and upgraded telemedicine carts will be provided to five hub/end-user sites. These sites include three elementary schools and two community clinics. Each site will have the capacity to receive primary care services for children and adults, women's health, and mental health and behavior services, including substance misuse prevention and treatment. The sites are expected to serve approximately 14,000 people in Dona Ana, Socorro, Sierra and Union counties. Ben Archer Health Center Inc. was awarded a $153,963 DLT Grant to provide remote medical, dental and behavioral health care services for underserved and uninsured patients, and distance learning education for health care professionals in Dona Ana, Luna, Otero and Sierra counties. An interactive system involving telemedicine carts with accessories will enable live audio-video interactions between health care professionals and patients. Teleconference equipment for conference rooms will facilitate distance learning and group sessions, and laptops for medical, dental and behavioral providers will be used to provide services to patients in rural communities. New Mexico Highlands University received a $510,363 DLT Grant to create a distance learning hub/end-user site at the main campus in Las Vegas, and at a second end-user site in Mora, N.M. The system will eliminate barriers to higher education for residents of remote communities in San Miguel and Mora counties. This funding will enable New Mexico Highlands University to offer remote courses and to implement remote student support programs (especially for STEM students). In addition to equipping the remote site, the project will fund the purchase of computers configured specifically for distance learning. These computers will be loaned to students. The Mora site also be made available to community members for activities such as workforce development. A recent report by the Rural Policy Research Institute’s Center for Rural Health Policy Analysis found infection and death rates in rural America due to COVID-19 are 13.4 percent higher than in urban areas. A recent report from USDA’s Economic Research Service, USDA ERS - Rural Residents Appear to be More Vulnerable to Serious Infection or Death From Coronavirus COVID-19, underscored the challenges facing rural Americans amidst the COVID-19 pandemic with even greater detail. Due to a confluence of factors, including higher percentages of underlying conditions, lack of health insurance, and lower access to medical facilities/care than urban counterparts, ERS analysts found rural Americans are suffering more severe illness or death due to COVID-19. Rural Residents Appear to be More Vulnerable to Serious Infection or Death from Coronavirus COVID-19 Underlying health conditions (ages 20 to 84) Rural Percent, 23.7 Urban Percent, 3.0 Older adult population scale Rural Percent, 15.9 Urban Percent, 4.0 Lacking health insurance (ages 25 to 64) Rural Percent, 20.2 Urban Percent, 10.5 Distance to county with an intensive care hospital Rural Percent, 11.3 Urban Percent, 0.3 The table above is from the USDA ERS January 2021 report: Rural Residents Appear to be More Vulnerable to Serious Infection or Death from Coronavirus COVID-19 In January, President Biden requested all parts of the federal government to contribute resources to contain the coronavirus pandemic. USDA is responding to the President’s call to action. To date, more than 350 USDA personnel have deployed to assist with standing up vaccination sites, for example. In addition to personnel, USDA is offering its facilities, cold chain infrastructure, public health experts, disaster response specialists, and footprint in rural and Tribal communities across the country. USDA’s commitment to control the pandemic extends to our own staff and facilities, with masking and physical distancing requirements across USDA, a commitment to provide PPE to our front-line workers, and working with states to prioritize vaccinations for our workforce. For more information, visit www.usda.gov/coronavirus. USDA also encourages people seeking health insurance to go to HealthCare.gov now through May 15th due to a special enrollment period. If you are recently uninsured due to a job loss or between jobs, find a plan at HealthCare.gov and keep it for as long as you need it. USDA Rural Development provides loans and grants to help expand economic opportunities and create jobs in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural areas. For more information, visit www.rd.usda.gov/nm. USDA touches the lives of all Americans each day in so many positive ways. In the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, ensuring access to healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate-smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov . < Previous News Next News >

New MACPAC Report to Congress: Recommendations to improve mental health access include telehealth Center for Connected Health Policy June 2021 Recommended ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2021 Report to Congress last week that recommends ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP). While the report and recommendations did not evaluate telehealth directly, they did occasionally reference telehealth’s ability to increase access to mental health services and recommend that the promotion of telehealth be included in various programmatic guidance. For instance, the report highlights telehealth programs that connect youth to telehealth counseling services and recommends the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issue joint guidance addressing how Medicaid and CHIP can be used to fund a behavioral health crisis continuum that includes how telehealth can be used to ensure access to crisis care. They also recommend that opportunities to cover telehealth and other technology-enabled services be described in CMS and SAMHSA guidance specific to children and adolescents with significant mental health conditions. The report additionally looks at how to promote care integration through electronic health records (EHRs) and value-based payment (VBP) programs, which include measures related to expanded use of telehealth. It also discusses the non-emergency transportation (NEMT) benefit in Medicaid, mentioning that many changes in how the program is administered are occurring which require additional data to assess its value, such as how expanded availability of telehealth services may lessen its need in certain circumstances. For more information, please access the full MACPAC report - https://www.macpac.gov/wp-content/uploads/2021/06/June-2021-Report-to-Congress-on-Medicaid-and-CHIP.pdf < Previous News Next News >