Update on Risks of Payments in Arrangements With Telemedicine Companies: OIG Warns of Prosecution Risks and Identifies Seven Criteria for Caution When Entering Into Telemedicine Payment Arrangements, and the Advancing Telehealth Beyond COVID-19 Act Passes Andrea M. Ferrari, Nadia de la Houssaye August 26, 2022 On July 20, 2022, the Office of Inspector General of the US Department of Health & Human Services (OIG) issued a Special Fraud Alert urging healthcare practitioners to exercise caution when entering into arrangements with telemedicine companies. OIG issued this Special Fraud Alert the same day the US Department of Justice (DOJ) announced criminal charges against 36 defendants in 13 federal districts as part of the DOJ’s Nationwide Coordinated Law Enforcement Effort to Combat Telemedicine, Clinical Laboratory, and Durable Medical Equipment Fraud.[1] The Special Fraud Alert notes that OIG has recently conducted dozens of investigations of alleged fraud schemes involving companies that provide telehealth, telemedicine, or telemarketing services (collectively, Telemedicine Companies). It also notes that in many of these investigations, OIG found evidence that the Telemedicine Companies intentionally paid physicians and non-physician practitioners (collectively, Practitioners) kickbacks to generate orders or prescriptions for medically unnecessary durable medical equipment, genetic testing, wound care items, or prescription medications. The Special Fraud Alert warns that such kickback schemes implicate the federal Anti-Kickback Statute and can lead to Practitioners, Telemedicine Companies, and others that participate in the schemes being held liable criminally, civilly, and administratively. Liability may arise from (1) paying or receiving payment in violation of the federal Anti-Kickback Statute; and (2) causing submission of fraudulent claims to federal healthcare programs such as Medicare, Medicaid, and Tricare, which may constitute a violation of the federal False Claims Act and other federal laws. As a cautionary guide, the Special Fraud Alert identifies seven arrangement characteristics that may raise OIG scrutiny: 1. The patients for whom a Practitioner orders or prescribes items or services are identified or recruited by a Telemedicine Company, sales agent, recruiter, call center, or health fair, and/or through internet, television, or social media advertising for free or low-cost out-of-pocket items or services. 2. A Practitioner does not have sufficient contact with or information from the purported patient to meaningfully assess the medical necessity of the items or services ordered or prescribed. 3. A Telemedicine Company compensates a Practitioner based on the volume of items or services ordered or prescribed, which may be characterized to the Practitioner as compensation based on the number of medical records that the Practitioner reviewed. 4. A Telemedicine Company furnishes items and services only to federal healthcare program beneficiaries and does not accept insurance from any other payor. 5. A Telemedicine Company claims to furnish items and services only to individuals who are not federal healthcare program beneficiaries but may, in fact, bill federal healthcare programs. 6. A Telemedicine Company only furnishes one product or a single class of products (e.g., durable medical equipment, genetic testing, diabetic supplies, or various prescription creams), potentially restricting a Practitioner’s treatment options to a predetermined course of treatment. 7. A Telemedicine Company does not expect Practitioners to follow up with patients, nor does it provide Practitioners with the information required to follow up with patients (e.g., the Telemedicine Company does not require Practitioners to discuss genetic testing results with each purported patient). OIG advises in the Special Fraud Alert that this list of suspect criteria is illustrative and not exhaustive. Therefore, even arrangements that do not specifically fit one or more of these suspect criteria may still be suspect. However, OIG also indicates that it recognizes there are many legitimate telemedicine and telehealth arrangements, and explicitly states that the Special Fraud Alert is not intended to discourage those legitimate arrangements. Rather, OIG is using the Special Fraud Alert to encourage Practitioners (and, by extension, their advisors) to use heightened scrutiny, exercise caution, and consider the above list of suspect criteria before entering into arrangements with Telemedicine Companies. Telehealth Expansion Legislation Significantly, a week after OIG issued the Special Fraud Alert, the US House of Representatives overwhelmingly (416-12) passed the Advancing Telehealth Beyond COVID-19 Act of 2022 (HR 4040), which encourages broad use of telehealth by expanding and extending for at least an additional two years — through December 2024 — the Medicare telemedicine payment policies that were introduced for the COVID-19 public health emergency. The House bill removes geographic restrictions and expands originating sites for telehealth services, continues expansion of the practitioners eligible to provide telehealth services, allows mental health services to be provided via telehealth and telecommunications, and continues certain COVID-19 allowances for audio-only telehealth services. The bill is now pending in the Senate. [1] Press Release, US Department of Justice, Justice Department Charges Dozens for $1.2 Billion in Health Care Fraud (July 20, 2020), https://www.justice.gov/opa/pr/justice-department-charges-dozens-12-billion-health-care-fraud. © 2022 Jones Walker LLP National Law Review, Volume XII, Number 238 See Original article: https://www.natlawreview.com/article/update-risks-payments-arrangements-telemedicine-companies-oig-warns-prosecution < Previous News Next News >

How Telemedicine Requirements and Policies Will Change Post-Pandemic Jordan Scott, HealthTech July 2021 The public health emergency led to a loosening of telemedicine requirements and an uptick in virtual care use, but are these changes here to stay? Telehealth was instrumental in providing care throughout the COVID-19 pandemic as people avoided in-person interactions. While many people are now comfortable returning to in-person appointments, Americans are more open to using telehealth services than they were prior to the pandemic, and telehealth use is expected to remain above pre-pandemic levels. Some telehealth restrictions were lifted at the beginning of the pandemic out of necessity, a major factor in the rapid expansion of virtual care services. However, many providers are wondering if those changes are here to stay or if a tightening of telemedicine requirements will lead to a “telehealth cliff.” The CARES Act: How the Pandemic Changed Telehealth Policy Former U.S. Secretary of Health and Human Services Alex Azar declared a public health emergency on Jan. 31, 2020, in response to growing concerns over the spread of COVID-19. And on March 13, 2020, by Proclamation 9994, President Donald Trump declared a national emergency. As a result of authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Centers for Medicare & Medicaid Services (CMS) provided flexibility for Medicare telehealth services. It did this by broadening the waiver authority under section 1135 of the Social Security Act. Before the declarations, providers were subject to CMS’ geographic and originating site requirements for telehealth reimbursement under Medicare. According to the requirements, the originating site is the patient’s location at the time telehealth services are received. Under Section 1834(m) of the Social Security Act, the originating site must be a physician’s office, skilled nursing facility or hospital. The patient must also be located within a Health Professional Shortage Area or in a county outside of any Metropolitan Statistical Area as defined by the U.S. Census Bureau. “That meant an extremely small proportion of Medicare reimbursement was going toward telehealth, well under 1 percent,” says Kyle Zebley, vice president of public policy for the American Telemedicine Association (ATA). Dr. Ezequiel Silva III, a radiologist with the South Texas Radiology Imaging Centers and a member of the American Medical Association’s Digital Medicine Payment Advisory Group, explains that the waivers also impacted licensure. Physicians enrolled in the Medicare program licensed in any state can provide telehealth services to people anywhere in the U.S. if the state allows it. Each state has its own telehealth policies. The waivers also allowed physicians to practice from home since many offices were closed at the beginning of the pandemic, says Silva. He adds that CMS’ Interim Final Rule expanded coverage of audio-only health services, which helped those without access to two-way audiovisual technology and those who weren’t comfortable using video telehealth. Telehealth policies were put into place in 1997. While there’s been incremental expansion, the regulations haven’t kept up with changes in technology and what’s now possible in virtual care, says Zebley, who adds that if the pandemic hadn’t happened, the pace of telehealth adoption would have remained slow. However, he explains that the Medicare waivers had an extraordinary impact and led to an uptick in telehealth utilization. “During the first quarter of 2020, the number of telehealth visits increased by 50 percent, compared with the same period in 2019, with a 154 percent increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019,” reads a CDC report released in October 2020. “Laws hadn’t kept up with the way providers wanted to deliver care, so it was a game-changing moment,” says Zebley. “Ninety percent of Medicare beneficiaries are satisfied with their care, and two-thirds are very satisfied.” HIPAA-Compliant Telehealth Requirements Likely to Return The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) enforces HIPAA requirements. It announced on March 17, 2020, that “OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” Telehealth creates a unique challenge for HIPAA because a physician is no longer interfacing with a patient behind a closed clinic door, says Silva. Instead, information is transferred digitally, which requires different security precautions. Silva explains that while security requirements were reduced, OCR loosely defined which communication technologies could be used for telehealth. It also encouraged healthcare organizations to notify patients of privacy risks. AMA found this guidance to be appropriate, says Silva. However, it’s likely that HIPAA requirements will be reinstated once the public health emergency ends. “The reinstatement of HIPAA requirements is inevitable, and healthcare organizations need to prepare accordingly. They need to have their regulatory and legal offices getting ready to follow the spirit and letter of the law,” says Zebley. “It’s very clear what HIPAA requires. If an organization is operating a telehealth platform or technology that’s not HIPAA compliant, I expect that it would need to be compliant perhaps in a few months’ time.” The ATA supports the reinstatement of HIPAA requirements because it’s important to protect patient data, explains Zebley. Will Telehealth Restrictions Return Post-Pandemic? The public health emergency and telehealth waivers are still in place, but if the declaration ends before Congress or CMS acts, healthcare providers could hit a “telehealth cliff.” “If that happens it’s going to be regressive,” says Zebley. “However, I’m extremely optimistic that Congress will act before the emergency ends.” The public health emergency has been renewed approximately every 90 days since it was first declared, with the most recent renewal on July 20, 2021, by U.S. Secretary of Health and Human Services Xavier Becerra. Silva says there’s been speculation that the public health emergency will last through the end of the calendar year. If it doesn’t, the previous Medicare telehealth requirements could go back into effect until CMS rule-making addresses the issue. CMS released its 2022 Medicare Physician Fee Schedule Proposed Rule on July 19, 2021, which would extend the waivers on some telehealth services, especially those that address mental health, through the end of 2023. Comments are due on Sept. 17, 2021 “As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of Dec. 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE,” reads the CMS fact sheet. The CONNECT for Health Act of 2021, introduced in the U.S. Senate on April 29, 2021, aims to expand the use of telehealth by removing geographic requirements for telehealth services and expanding originating sites permanently. It’s one of several bills that could address the long-term expansion of telemedicine. Organizations such as the ATA and AMA have been advocating for a permanent expansion of telehealth services on federal and state levels. AMA published a telehealth implementation playbook for those looking to implement telehealth. Silva says the healthcare industry needs to look at the data around patient experience and the value of telehealth to determine how to proceed with virtual care policy going forward. Zebley encourages those who are concerned about the possible loss of telehealth flexibility to reach out to their elected officials. Source: https://healthtechmagazine.net/article/2021/07/how-telemedicine-requirements-and-policies-will-change-post-pandemic-perfcon < Previous News Next News >

Now is the time for doctors to shape what’s next on telehealth Tanya Albert Henry, Contributing News Writer, American Medical Assoc. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. Telehealth, which a minority of patients and physicians used prior to COVID-19’s emergence, is now a household word. And survey after survey shows that patients like the convenience, believe they are getting quality care and still feel connected to their physicians. Most physicians, too, have found telehealth to be a great way to connect with patients when appropriate. “There is no question at this point in time, when you think back on the past 18 months, it’s our opportunity to change completely how we deliver care,” according to Joseph C. Kvedar, MD, professor of dermatology at Harvard Medical School and the American Telemedicine Association’s board chair. Dr. Kvedar made that point during a virtual gathering as part of the AMA Telehealth Immersion Program. The boot camp event featured experts and stakeholders from around the country, who discussed the potential for long-term telehealth programs, raised the questions that need to be considered as telemedicine evolves, and examined the challenges that physicians and patients face moving forward. “I would urge you not to think of virtual video visits as the sky or the ceiling or the vision, but as the floor and the beginning, and the first step into what I would call a real hybrid world with digital-first, with digital tools for our patients where patients instinctively turn to a digital device when they need health care and go from there,” Dr. Kvedar said. The boot camp also included a panel discussion about health-at-home models and strategies, as well as breakout sessions on creating telehealth value in obstetrics and gynecology, and renal medicine. The Telehealth Immersion Program 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. Many questions to answer Data may show that the percentage of telehealth visits as a whole are down compared with the beginning of the pandemic, but Dr. Kvedar said there’s another story to be told. Data from one large payer shows that telehealth is shifting from local physicians and health care organizations to national care providers. In April 2020, 96% of all telehealth claims were local, while national providers accounted for just 4%. One year later, the share of national-provider claims rose to 11%. One big question going forward, he asked, is who is going to deliver telehealth services? “Do we want our own doctors to be providing these telehealth services or do we want to go through a third party,” said Dr. Kvedar, co-chair of the AMA Digital Medicine Payment Advisory Group. “The good news is you will have access either way. But … we have to ponder how we want that to go, and I think we have a role to play in making those decisions or at least in influencing them.” Among the other questions that need to be answered going forward: How do you plan while facing payment uncertainty? What will it cost a practice to offer telehealth and what will make the most financial sense for each practice? How do you rethink calculations of overhead? What are the workforce implications? For example, what new roles will be needed to accommodate telehealth properly? How do you define when it will be best to see a patient via telehealth versus coming into the office? Advocate, advocate, advocate Dr. Kvedar asked the boot-camp attendees to send their elected officials a letter describing what has worked in telemedicine and what is needed. He also recommended talking to your human resource professional and health plan contact to let them know what you and your patients need to create a health system that works best. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. https://www.ama-assn.org/practice-management/digital/now-time-doctors-shape-what-s-next-telehealth?smclient=9a5368e1-1650-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Q&A: How retail healthcare, telehealth trends could evolve in 2023 Emily Olsen December 16, 2022 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. As another year shaken by the lingering COVID-19 pandemic ends, stakeholders are still exploring how virtual care trends that accelerated in 2020 will affect the healthcare industry long term. Though telehealth use spiked out of necessity during the early months and remains higher than pre-pandemic levels, utilization has slowed over the past two years. Meanwhile, big retail companies and pharmacies are offering more care options to patients. Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, sat down with MobiHealthNews to discuss the future of virtual care, how big retail entrants will affect the industry, and the importance of care coordination between traditional health systems and emerging retail players. MobiHealthNews: What are some of your big takeaways from 2022 when you're thinking about telehealth, digital health and other tech-enabled care? Sanjula Jain: A big thing that I'm thinking a lot about is that patients aren't coming back to care, despite all the investments in more supply or access points, whether that be virtual care access points or new retail entrants or traditional urgent care. We've just had this huge mismatch between supply and demand. We're kind of post-vaccines; we have Americans returning to work to some extent. A lot of folks are going into an office a couple of days a week, folks are traveling, yet they're not going back to see their doctors. We've tried to make care more convenient and more accessible. And some of these new supply points are lower cost, and yet, they're still not engaging. I think there are many reasons for that. COVID scared away a lot of patients, and I think we're starting to see signs of more distrust in the healthcare system. And then cost and affordability, with a lot of the price pressures and inflation and recession discussions. That's going to continue to be a factor. There's a lot of health consequences for when patients don't actually engage in necessary healthcare. MHN: What do you think is the future of virtual care when you're looking at 2023 and beyond? Jain: The market for virtual care is a commoditized market. So, we're seeing that generally it's being used amongst a discrete subset of the population. And we have to think about, who are the individuals who like to use virtual care and what are they using it for? Primarily, as a health economist, I think a lot about substitute goods. We are seeing that virtual care is really only a substitute good for behavioral health. It's both a clinical and financial substitute, right? Clinically, having some distance between you and your provider in a behavioral health interaction is probably preferred when you're talking about your feelings and being very vulnerable. And there's no lab work or poking and prodding that actually needs to happen. So it's a viable clinical alternative. Financially, we've been talking a lot about payment parity. Because behavioral health interactions often don't need imaging and lab work, you're kind of making the same amount for an office visit that you are in a virtual care environment. For other use cases like primary care, we see that's not actually the case. The patient goes in for a virtual care visit, and then what really ends up happening is the physician says, "I need you to come in to get some imaging done or get some lab work done." The payment parity, despite the policy incentives to increase telehealth payment rates, it's not true parity. And so, that's why we don't see the full substitute effect. When you boil the ocean down, you see that the market for telehealth continues to be pretty discrete and concentrated to a handful of consumers. That's really where I think the future is, thinking about whether they will continue to use it. The data shows that, in the pandemic, we've seen this tapering. When Americans are given the option for in-person or virtual, they're still preferring to go in-person with that exception of behavioral health. So, I think the market is going to have to be more realistic about the total addressable market size in terms of discrete number of users, the number of visits per user, and then invest accordingly. I think that's a large part of why we've seen a lot of struggling amongst some digital health players, because I think they've overestimated the amount of utilization of virtual care modalities. But the number of discrete users just isn't up to par with what individuals had estimated it to be. MHN: Going back to those retail entrants, Amazon made a ton of news this year. Walgreens, CVS, Walmart — they're also boosting their care delivery operations. How do you think these moves will affect the healthcare industry overall? Jain: It ultimately comes down to, who is your customer or your consumer or patient persona? Who is Amazon actually going after? Who is their target patient population, and for what services? Amazon is really focusing on more low-acuity services, and health systems are particularly good at the higher acuity things like surgeries. What Amazon and other new entrants mean is that they provide the consumer with more care options. But it also creates a need to coordinate care better and create these really strong referral relationships. To go back to my earlier point about patients not coming back, of the patients we do see coming back, we're seeing them really seek out care in these low-acuity, commoditized care settings. They're going in for flu and strep, but they're not getting their screenings. It's going to be really important for groups like Amazon to coordinate with health systems to actually get patients to go follow up for those necessary services and figure out how to refer them out. MHN: How do you think the growth of these retail players will affect patients? Jain: I think it's a bit of a toss up. For some patients, they're going to view it as a better experience, because they can get what they want when they want it. But I think from a clinical perspective, it creates a lot of risks and challenges for the health of the patient. There really isn't someone owning the care or steering the patient through their healthcare journey. Have you gotten this lab workup? Have you gotten this mammogram? For some of these more retail players, it's consumer-directed. You can walk into urgent care and you can go to a telehealth visit, and it's really up to the consumer. But healthcare is complicated, and the average consumer may not have all the necessary information to go make those decisions. I think that there's a lot of positives to retail players in terms of catering to consumer preferences and providing care in a more convenient way. But for a lot of complex care, acute care — that every American is going to need at some point in their life — there is a little bit more fragmentation. MHN: Do you think there's an appetite among health systems to partner with Walgreens or CVS or Amazon and say, "If you see someone, send them to me when they need a cancer screening?" Jain: Absolutely. So, I actually just this week was with one of the health systems, talking to their leadership team. That's very much a conversation that is happening in the boardrooms — what is the right partnership structure with some of these new entrants and primary care providers? I think the challenge is, you could have those great partnerships. But ultimately, it's the consumer and the patient that's still having to make the decision. Are they going to follow up on those recommendations? Where are they going to go next? So, I think it's something that we're going to have to spend more time thinking about as an industry, how to coordinate that care for that patient over time, but with more choice and options in the market. See original article: https://www.mobihealthnews.com/news/qa-how-retail-healthcare-telehealth-trends-could-evolve-2023 < Previous News Next News >

CDC: Increased Use of Telehealth Reduces Risk of Overdose Brendan Rodenberg August 31, 2022 BISMARCK, ND (KXNET) — A new study done by the Centers for Disease Control (CDC) suggests the expansion of ‘telehealth’ programs plays an important part in reducing the risk of drug overdoses and keeping people in treatment. The term ‘telehealth’ often refers to the distribution of health services and health-related information — including long-distance consultation with medical professionals, medical education, counseling, and intervention — via social technology such as phones and computers. A study published in the journal JAMA Psychiatry noted that during the pandemic, individuals with opioid use disorders (OUDs) who took part in telehealth services not only remained in treatment longer than usual but were also less likely to suffer drug-related overdoses. An increase in individuals taking MOUD (medications for opioid use disorder) was also reported. The key takeaways from the study include the following information: When two groups of Medicare beneficiaries (one that received OUD care before the COVID-19 pandemic and one that received OUD during the pandemic) were compared, people in the pandemic group were much more likely to receive OUD-related telehealth services compared to the pre-pandemic group (19.6% compared to the pre-pandemic’s 0.6%). They were also more likely to receive MOUD services (12.6% compared to pre-pandemic’s 10.8%) Among the COVID-19 pandemic group, receipt of OUD-related telehealth services was associated with significantly better MOUD treatment retention and lower risk of medically-treated overdoses. “Strategies to increase access to care and MOUD receipt and retention are urgently needed, and the results of this study add to the growing research documenting the benefits of expanding the use of telehealth services for people with OUD,” said the acting director of the National Center for Injury Prevention and Control at the CDC and study’s lead author Dr. Christopher M. Jones in a press release. “The findings from this collaborative study also highlight the importance of working across agencies to identify successful approaches to address the escalating overdose crisis.” Mass-overdose events happening across US, DEA warns While successful health services were reported in the study, and telehealth programs have been associated with reduced overdoses and increased treatment, it was also noted that some groups — particularly non-Hispanic black persons and individuals living in the southern United States — were less likely to receive these services. The study and CDC state that this information further highlights the need for more efforts to eliminate the ‘digital divide’ and reduce inequalities in access to care and services. “The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” said deputy director of the National Institute on Drug Abuse and senior author of the study Wilson Compton, M.D., in the release. “Telehealth is a valuable service and when coupled with medications for opioid use disorder can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.” If you or someone close to you needs help for a substance use disorder, talk to your doctor or call SAMHSA’s National Helpline at 1-800-662-HELP or go to SAMHSA’s Behavioral Health Treatment Services  website. See original article: https://www.kxnet.com/news/national-news/cdc-increased-use-of-telehealth-reduces-risk-of-overdose/ < Previous News Next News >

Final CY 2023 PHYSICIAN FEE SCHEDULE FACT SHEET CCHP November 1, 2022 On November 1, 2022, the Center for Medicare and Medicaid Services (CMS) released their final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS had previously released their proposed version on July 7, 2022. After receiving submitted feedback from the public during the comment period, CMS published the final version that, unless otherwise stated, will have policies going into effect January 1, 2023. Much of what was proposed in July remains in this final version. End of the Public Health Emergency (PHE) CMS is going forward with the policies required of the Medicare program that were in the 2022 Budget Act. These policies included allowing some of the temporary telehealth COVID policies to continue through a 151-day grace period after the end of the PHE and delaying other permanent policies: • Federally qualified health centers (FQHCs), rural health clinics (RHCs), physical therapists, occupational therapists, audiologists and speech-language pathologists remain eligible providers to be reimbursed by Medicare if they provide certain services via telehealth during this grace period. • The patient may be in the home when receiving these services and the geographic limitation would also not apply during the 151 day grace period. • Policies around the provision of mental health via telehealth that were put into law by the Consolidated Appropriations Act (CAA) passed in December 2020 and administrative policies from the 2022 PFS are also delayed during this 151 day grace period. • The temporary telehealth eligible services COVID-19 list will remain fully available during this 151-day grace period. See full fact sheet: https://www.cchpca.org/2022/11/FINAL-2023-MEDICARE-PHYSICIAN-FEE-SCHEDULE.pdf < Previous News Next News >

Telehealth regulations don't go far enough for some Georgina Gonzalez April 21, 2022 Telehealth protections are fading as pandemic era waivers, which allowed providers to treat patients across state lines, are expiring. Many lobbyists are worried about the future of the industry and believe that the current proposals don't do enough to help secure its future, Politico reported April 20. More than 30 states have signed onto the American Medical Association favored Interstate Medical Licensure Compact, which creates a common application for providers, allowing them to more easily apply for licenses to practice in other states. However, some lobbying groups don't think the compact is enough. "[The compact] streamlines the application process, but it doesn't do a lot to reduce the burdens and costs of maintaining a multistate licensure footprint. That is a source of a lot of frustration for physicians in telemedicine," Nate Lacktman, partner at Foley & Lardner's law firm told Politico. The American Telehealth Association believes states should recognize each other's licenses, but acknowledges that due to the federal nature of the country, more compacts will have to be created to get around the problem. Another advocacy group, the Alliance for Connected Care, has proposed a voluntary national system that would recognize licenses from other states. However, the ATA thinks the federal government could tie federal funding to the proposal to encourage states to sign on. For Full Posting: https://www.beckershospitalreview.com/telehealth/telehealth-regulations-don-t-go-far-enough-for-some.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < 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 >

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 >

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

Joint Commission Updates Telemedicine Accreditation Rules Center for Connected Health Policy April 2021 Before a practitioner may provide services in a hospital, he or she must have their qualifications evaluated and verified. According to an article in The National Law Review, The Joint Commission recently announced slightly revised ‘credentialing by proxy rules’. Before a practitioner may provide services in a hospital, he or she must have their qualifications evaluated and verified. This process, known as credentialing, ensures an individual possesses the necessary qualifications to provide medical services to patients. ‘Credentialing by proxy’ allows a hospital receiving services to accept the distant site hospital’s credentialing and privileging decisions. Certain criteria must be met in order for a hospital to qualify to utilize credentialing by proxy. Previously, this included requiring both the originating site hospital and distant site hospital to be accredited with the Joint Commission. The new change allows the distant site telemedicine entity to be accredited with The Joint Commission or, alternatively, enrolled in the Medicare program. The affected standard is MS.13.01.01, EP 1, and is reflected in the Joint Commission’s 2021 update to their Comprehensive Accreditation Manuals. Comprehensive Accreditation Manuals: https://store.jcrinc.com/2021-comprehensive-accreditation-manuals/ < Previous News Next News >

River Valley Counseling Center boosts productivity and experience with telehealth Bill Siwicki June 01, 2022 From putting band-aids on decades-old computers to conducting high-quality telemedicine visits, the mental health organization is making its clinicians and patients happy. River Valley counseling Center's Holyoke Clinic in Holyoke, Massachusetts, always was trying to make ends meet with its technology. THE PROBLEM Its efforts to revamp and improve its technology were merely trial and error. Staff were putting band-aids on their technologies, struggling to figure out what the root of the issues were when disruptions would occur. Was it the computer itself? Network connectivity? A glitch in the signal? To put the extent of the issues in perspective, some hardware was more than a decade old; it could easily take clinicians five minutes just to reach the login screen. "When we thought one thing was addressed, another hurdle would pop up," recalled Chassity Crowell-Miller, LICSW, a clinical social worker at the clinic. "This element of touch and go was particularly challenging for mental healthcare, in which providers may be helping with sensitive, traumatic issues and were unnecessarily disrupted and inhibited by the outdated technology. "Overall, our clinicians' ability to help, as well as our patients' treatment and overall experiences, were negatively impacted," she added. It's important to note that the organization's Holyoke Clinic tends to an underserved population, with many patients being of low socioeconomic status. Across the community, there are high poverty, school dropout, substance abuse and violence rates. "For providers in our community and beyond, the past two years have been like nothing they have ever seen in the field," Crowell-Miller observed. "At the onset of COVID, while many organizations and communities were able to transition seamlessly to virtual learning and working in order to continue their work, River Valley counseling Center's Holyoke Clinic was not set up for this abrupt move to technology. "While telehealth has improved access to many outpatient services, marginalized patients – rural, poor, older and minority patients – may not have benefited equally from telehealth's expansion," she continued. "With all this in mind, River Valley counseling Center needed to receive the equipment, infrastructure and IT counsel necessary to support its people in our Holyoke location – both in person and via telehealth." PROPOSAL The cost of outdated technology often is not discussed, but for providers to do their jobs effectively, sound technology infrastructure is a table-stakes requirement, said Stephen Moss, senior vice president and general manager, connected workforce, at Insight, a health IT and infrastructure company. "The last two years have forced health providers to play IT catchup and significantly accelerate digital transformation," he said. "For many like River Valley counseling Center, it calls for starting with the basics. "They are navigating the impact of legacy infrastructure that is sometimes decades old, not to mention extremely outdated devices that magnify the frustration of resources that should make their work easier actually impeding their ability to care for patients," he continued. River Valley's challenges stood out to Insight. "To help, we focused on how to improve productivity and the client experience, particularly to address the lag and frozen sessions during telehealth consultations," Moss explained. "A simple upgrade to 50 new Intel-powered desktops and laptops has made daily multitasking an afterthought rather than a source of frustration for clinic staff. "To be able to hold a telehealth session without hang-ups not only allows River Valley's medical providers to more effectively address their clients' needs, by eliminating disruptions, they're gaining credibility and the ability to treat more people on a daily basis," he added. The Insight and Intel teams took a hands-on approach to provide and implement the right technology, at the right price, said Jason Kimrey, vice president, U.S. channel and partner programs, at Intel. "The strategy was informed by the mindset that having the best technology was the most effective way to maximize productivity for River Valley and its counselors," he said. "To help guide the process, we collaborated and leveraged our partner ecosystem to understand the unique challenges and pain points for the organization." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE With River Valley's considerations in mind, Intel prioritized implementing more modernized devices and hardware that provided an opportunity to update core infrastructures, Kimrey said. Intel upgraded network switches, physical hard drives, chips and more to accommodate for the increased bandwidth necessary for telehealth usage, he added. "As a team, Insight's counsel helped combine and implement all of this," Moss explained. "Going from barely conducting any services remotely before the pandemic to now doing most of their work via telehealth is a monumental culture change. Coping with new technology shouldn't be a burden on caregivers; it needs to be an intuitive, simplified experience. "When we work with organizations like River Valley, we start with understanding what their unique challenges are, who is impacted and what they need to accomplish in their daily work," he continued. "Then we figure out the right technology based on individual caregiver personas and their needs to optimize their user experience, productivity and ability to help their clients." Insight handles rapid provisioning, configuration and deployment for virtual desktop environments so new devices are ready to go out of the box with minimal setup and networking connection required by the organization's IT team or employees, he added. "Insight also has the ability to provide virtual IT support for day-to-day management of the health of the devices, which frees up organizations with limited internal IT resources, such as River Valley counseling Center, to focus on more meaningful transformative projects," Moss said. "For River Valley, they've gained the ability to quickly provide new devices to their staff that are ready to go with the applications they need," he added. "Their care providers now can work just as effectively from home or at the clinic." RESULTS Technology is critical to making peoples' lives better, and River Valley has really felt that, Crowell-Miller stated. Thus far, highlights for River Valley, she reported, have included: Improved client and clinician experience. There have been tangible benefits for the client experience – both internally and externally. The provider organization has increased its telehealth services from 5% pre-pandemic to 95% during the height of the pandemic, while removing common barriers like lag time and income lost from prior no-show rates. Now, because of the ability to adapt, adjust and shift to telehealth, when necessary, clinicians can meet the patients where they're at. Increased productivity. The technology addressed a loss of productivity and slowness for River Valley counseling Center, which impacted the quality of services it was able to provide. Even just logging onto computers is much faster and happens within seconds. Specifically, the organization has dramatically improved productivity by up to an estimated 25% for clinicians with minimal access to technology at home, making it easier to use the office for virtual or in-person visits when necessary. Providing community resources. River Valley counseling Center now is able to get a better foothold to help and serve the community. This technology isn't just transactional from a healthcare provider standpoint; having this infrastructure in place is mutually beneficial for the clinicians and the patients in ways beyond traditional appointments and hosting telehealth sessions. This technology has helped River Valley counseling Center put the resources in the hands of clients. River Valley works on these computers while seeing a patient in person, and staff are able to help provide resources like databases, printed materials and more for the patients. ADVICE FOR OTHERS "Because every organization is different, it's really important to ensure you're working with a technology partner that understands not only the healthcare sector and how technology plays a vital role in patient care, but also the unique challenges and needs of your operations, clinicians, patients and the community you serve," said Crowell-Miller. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/river-valley-counseling-center-boosts-productivity-and-experience-telehealth < Previous News Next News >

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

DOJ Prosecutes Several Telemedicine Fraud Cases Center for Connected Health Policy May 2021 Department of Justice is currently on an offensive against telemedicine fraud According to an article in the National Law Review, the Department of Justice is currently on an offensive against telemedicine fraud. The article cites the following DOJ operations as evidence of the current crack down on telemedicine: *Operation Brace Yourself targeting an international fraud ring that defrauded $1 billion from Medicare for unnecessary devices. *A series of telemedicine fraud prosecutions that occurred in 2020 that found more than $1.5 billion in fraudulent Medicare billing. *On April 22, 2021 the latest crackdown came to light with charges for the owners of orthotic brace suppliers and some marketing companies for a $65 million nationwide kickback and bribery conspiracy. The scheme involved call centers soliciting customers to accept braces even though they didn’t need them and charging Medicare, Medicaid and Tricare. The telemedicine companies involved were paid illegal kickback and bribes for their doctors signing the brace orders and swearing to their medical necessity. These types of incidents are what makes some regulators warry of telehealth. With the increased widespread use of telehealth due to the pandemic, incidents of fraud will likely increase for telehealth. The key will be to ensure that the bad actions of a few don’t interfere with a modality of care that increases access and quality care for so many. Read the full National Law Review article for more information on these fraud cases. Full National Law Review article: https://www.natlawreview.com/article/doj-telemedicine-offensive-pushes-forward-new-charges < Previous News Next News >

What an eventual end to the PHE would mean for telehealth Andrea Fox October 17, 2022 Among other impacts, ending the PHE would represent access challenges and a loss of Medicaid coverage for millions, and would end medication-assisted treatment for opioid use disorder without an in-person exam. Since the COVID-19 public health emergency was declared in 2020, the Department of Health and Human Services has renewed the legislation every 90 days. Close to the end of the most recent expiration date, October 13, HHS Secretary Xavier Becerra again signed a renewal determination and it was posted without announcement late in the day. There had been no official news, but a lot of hearsay that the PHE would be renewed once more, because the Biden Administration indicated it would give two months' notice before its expiration. There is also the matter that open enrollment begins on November 1, and without the relaxed enrollment provisions for Medicaid that the PHE provides, the national uninsured rate along with health premium costs would certainly rise. But by definition an "emergency" can't last forever. The inevitable end of the PHE could result in the loss of Medicaid to millions when states review enrollee eligibility and in other impacts to healthcare operations. Questions regarding what will happen to telehealth benefits and the continuum of care in the absence of the PHE loom large. There has been extensive support for making the changes that have launched telehealth and provided the opportunity to serve more patients, but some people want to halt the prescribing of controlled substances via telehealth for mental health and substance abuse disorders and see the Ryan Haight Act – the online pharmacy consumer protection act of 2008 – reinstated. What's at stake Despite the Consolidated Appropriations Act of 2022, which provides a 151-day extension on some flexibilities granted during the COVID-19 public health emergency once the PHE ends, providers and other healthcare professionals engaged in telehealth are eager to prepare for the expiration date. There has been mounting pressure from the Republican Party, including a September 19 letter from Sen. Richard Burr, R-N.C., with numerous questions about ending emergency powers after President Joe Biden remarked during his September 60 Minutes appearance that "the pandemic is over." "Without a clear plan to wind down pandemic-era policies, the deficit will continue to balloon and the effectiveness of public health measures will wane as the American people continue to be confused by mixed messages and distrust of federal officials," wrote Burr. Despite economic concerns, ending the legal waivers afforded under the PHE could ricochet, hammering against gains made in increased patient access. Dr. Adrienne Boissy, Qualtrics chief medical officer (and former Cleveland Clinic chief experience officer), notes that patients continue to rely on expanded digital access as mental health effects from the pandemic linger. She says that a reversal would limit digital health access, which an overly burdened and understaffed industry has come to rely on. "The ease and convenience telehealth provides are consistent sources of positive patient experiences, as well as decreased total costs of care and less time away from the workplace," she said in a statement to Healthcare IT News. "Comparing 2016 to 2022, clinicians also report better health outcomes for patients, efficiency and less stress/burnout as major drivers for adopting digital tools, including telehealth," she said. "With the PHE, we saw the industry put patients and their access to care first – no longer hindered by location or demographics. "To revert back to reimbursement models that only support in-person care unravels the gains of meeting people where they are – physically and emotionally," said Boissy. "We can’t turn back now," Boissy said. Brad Kittredge, CEO and cofounder of Brightside Health, adds that the country will be short of psychiatrists – by 14,280 to 31,109 – in just a few years. Ending the PHE presents a reduced ability to serve the growing number of patients in need of or seeking mental healthcare, he said. "While there’s no silver bullet solution, telehealth offers the best and most immediate solution to this growing challenge by increasing patient access to mental health specialists without being limited to geographic regions or facilities," Kittredge explained in a statement sent to HITN. "More significantly, telehealth enables us to use technology and data to help clinicians be more efficient and effective at treating their patients, maximizing the impact they can make," he said. Telehealth in legislative limbo During a recent American Telemedicine Association policy update, the ATA's federal and state-level telehealth policy experts described efforts to develop a consistent regulatory framework so telehealth can be deployed across states, be fully leveraged and address the patchwork of 50 different state requirements. Legislators have also proposed broadening access to telehealth through the Telehealth Benefit Expansion for Workers Act, the Telehealth Extension Act and the Advancing Telehealth Beyond COVID-19 Act of 2021, which was passed by the House of Representatives in July, received in the Senate and referred to the Committee on Finance, where it sits. Also at play are a number of loosened restrictions that opened the gateway to online treatment of certain conditions when uptake surged and access to in-person medical care was restricted. Healthcare organizations and retailers entering the space through mergers and acquisitions with healthcare providers have urged the U.S. Justice Department and the Drug Enforcement Agency to revise telehealth controlled substance rules. The bill H.R. 7666 – the Restoring Hope for Mental Health and Well-Being Act of 2022 – introduced by Rep. Frank Pallone Jr., D-N.J., which was passed in the House, aims to address this hot-button issue for mental telehealth providers. The bill would permanently eliminate the X waiver, currently not required under the PHE. To qualify for the waiver to dispense buprenorphine for maintenance or detoxification treatment, the practitioner must take an eight-hour training and may only treat up to 30 opioid use disorder patients. Dr. Kristin Mack, a physician in Ticonderoga, N.Y., told MedPage Today that she would like to see the X waiver eliminated permanently. According to the story, rural communities are some of the hardest hit by the opiate epidemic. "We work really hard with community resources to provide counseling and things like that. But if I were to tell somebody, 'Oh, you have to go an hour away to a city to get care for this,' and then they need to be seen monthly, it's just not an option," she said. The Restoring Hope for Mental Health and Well-Being Act of 2022 was received in the Senate and was referred to its Committee on Health, Education, Labor and Pensions at the time of reporting. Treating opioid use disorders via telehealth It has been more than 10 years since the Ryan Haight Act mandated that DEA establish a rule ensuring that healthcare providers can successfully prescribe controlled substances via telehealth, but there has been no rule set forward. The SUPPORT Act again mandated the DEA issue rulemaking by October 2019 and the fiscal year 2021 final appropriations report requested that the agency establish these rules, according to the website of Sen. Mark Warner, D-Va. This past year he urged the Biden Administration to finalize regulations that allow doctors to prescribe controlled substances through telehealth. "In practice, the DEA’s failure to address this issue means that a vast majority of healthcare 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. These restrictions have been temporarily waived during the COVID-19 public health emergency, and I welcome that, but patients and providers need a more permanent and long-term solution to this long-delayed rulemaking," Warner wrote in May 2021. Under the PHE, several virtual behavioral health startups focused on medication-assisted treatment for substance abuse disorder received investment rounds, according to Chris Larson at Behavioral Health Business. According to the story, Doug Nemecek, the chief medical officer of behavioral health for Evernorth, said that not enough people are accessing MAT, and that overdose rates have reached historic highs. "If regulations come back that prevent those companies from being able to deliver care in that way, we’re concerned that it’s going to have a negative impact on patients and our ability to make sure that people have access to the MAT that we want them to have access to," Nemecek said. Evernorth, part of Cigna Corp., is connected to digital MAT companies like Quit Genius. The cofounder of Quit Genius, Dr. Maroof Ahmed, explained in an email to Healthcare IT News that telehealth has filled a void that existed before the PHE. "Telehealth flexibilities and ePrescribing waivers have been crucial in enabling providers to care for patients during the pandemic and have greatly expanded access to care in situations where patients were unable or unwilling to travel to a physical location," he insists. Reinstating Ryan Haight Act requirements also has support Amending the Ryan Haight Act law is an effort largely supported in the healthcare and mental health space. However, Dr. Mimi Winsberg, CMO and the other cofounder of Brightside Health, shared another point of view regarding the dubious practice of prescribing controlled substances without an initial in-person visit. "To count on a public health emergency temporary lifting of laws in order to stimulate growth of your business is perhaps a questionable practice," she told Healthcare IT News, noting that Brightside adhered to not prescribing controlled substances over telemedicine despite the legal waivers. "While a lot of medical visits moved to tele during this sort of difficult part of the pandemic, that now in most specialties, they have gone back to in-person, but what we are seeing in mental health is about 80% have stayed remote," she added. "And so patients are continuing to get their mental healthcare largely through telemedicine." Winsberg entertained the question out loud: "Will they be resistant to in-person appointments if they need certain kinds of prescriptions?" "I don't think they will because we have seen that they're willing to go back to the doctor for other reasons," she added. The net growth of prescription drugs issued – stimulants and other controlled substances – grew during the pandemic, and she says she questions if the growth was largely driven by online practices "that were taking advantage of the lifting of the Ryan Haight Act." Winsberg did acknowledge, however, that an inability to prescribe buprenorphine via telehealth for substance abuse disorder, "is potentially an issue," she said. "These laws exist for a reason, and what we have to balance in medicine is the willingness to help people with the do no harm principle." Establishing systematic monitoring of controlled-substance prescribing via telehealth could be achievable, Winsberg said. "But, we'd like to move towards appropriate prescriptions of controlled substances, and if we can find a way to meaningfully regulate that online, then great," she concluded. Equal treatment for mental health disorders In January, Dr. Robert Field and doctoral candidate Kimberly Williams at Drexel University published a commentary on the National Academy of Medicine website on the long overdue policy update needed to prescribe buprenorphine via telehealth. The authors say that those who need treatment for opioid use disorder should have the same level of telehealth access as others who receive treatment for other medical concerns. They also noted that the DEA has not created a registration process through the online pharmacy consumer protection act, despite Congressional requests and statutory actions. "Doing so would not only ensure increased access to treatment but also set the stage for systematic monitoring of telemedicine and telephone services to confirm they meet the same rigorous standards of care as in-person services. "Such quality assurance efforts could promote the development of best practice guidelines and reduce variations in care as usage of these modalities increases," they argue. For the mental telehealth provider community wondering if the ability to prescribe buprenorphine via telehealth fades away in five months – if the Biden Administration does not intervene and extend the PHE, Congress does not pass legislation and the DEA does not create a registration process for prescribing controlled substances for opioid use disorder via telehealth – the U.S. may face even higher overdose rates. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org Healthcare IT News is a HIMSS publication. See original article: https://www.healthcareitnews.com/news/what-eventual-end-phe-would-mean-telehealth < Previous News Next News >

Citing Medicaid misery, 25 governors push for PHE's end in April Molly Gamble December 21, 2022 In a letter sent to President Joe Biden this week, 25 governors ask for the end of the COVID-19 public health emergency in April. HHS last renewed the federal PHE in October for another increment of 90 days — until January 11 — with the pledge to provide states with 60 days' notice if it decided to terminate the declaration or allow it to expire. Since those 60 days came and went without notice, states are operating under the assumption the PHE will be renewed for another 90 days and expire in April, unless extended again. "We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration," the governors urged Mr. Biden in their Dec. 19 letter. The governors claim the PHE hurts states, largely through the Medicaid flexibilities costing states "hundreds of millions of dollars." Under the continuous coverage requirement of the Families First Coronavirus Response Act, state Medicaid agencies are barred from disenrolling people during the PHE — unless they request it — in exchange for an enhanced federal match. HHS estimates up to 15 million people will be disenrolled from Medicaid and the Children's Health Insurance Program when the PHE ends. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," the governors wrote to Mr. Biden. "Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share." The governors sent their letter a day before Congress released its omnibus spending bill, which contains working language for states to be able to start evaluating Medicaid enrollees' eligibility as of April 1 in a redetermination process that would take place over at least 12 months. The measure also calls for phasing down the enhanced federal Medicaid funding through December 31, 2023, though states would have to meet certain conditions during that period. The American Hospital Association advocated for the latest extension of the PHE in October, noting that the majority of the hospital members it polled said they still depend on the flexibilities provided by the PHE waivers to deliver care. The letter was initiated by Chris Sununu, governor of New Hampshire, and signed by the following: Kay Ivey, Alabama Mike Dunleavy, Alaska Asa Hutchinson, Arkansas Doug Ducey, Arizona Ron DeSantis, Florida Brian Kemp, Georgia Brad Little, Idaho Eric Holcomb, Indiana Kim Reynolds, Iowa Charlie Baker, Massachusetts Tate Reeves, Mississippi Mike Parson, Missouri Greg Gianforte, Montana Pete Ricketts, Nebraska Doug Burgum, North Dakota Mike DeWine, Ohio Kevin Stitt, Oklahoma Henry McMaster, South Carolina Kristi Noem, South Dakota Bill Lee, Tennessee Greg Abbott, Texas Spencer Cox, Utah Glenn Youngkin, Virginia Mark Gordon, Wyoming See original article: https://www.beckershospitalreview.com/finance/citing-medicaid-misery-25-governors-push-for-phes-end-in-april.html?utm_medium=email&utm_content=newsletter < Previous News Next News >

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

FCC Announces Application Filing Window for Round Two of COVID-19 Telehealth Program Center for Connected Health Policy April 27, 2021 The application filing window for the second round of the COVID-19 Telehealth Program will open Thursday, April 29, 2021 at 12:00 PM ET The application filing window for the second round of the COVID-19 Telehealth Program will open Thursday, April 29, 2021 at 12:00 PM ET. Running one week, the filing window will close Thursday, May 6, 2021. The Program under the Federal Communications Commission was first established in April 2020 and provided with $200 million through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Congress provided an additional $249.95 million to the Program late last year through the Consolidated Appropriations Act, to support this second round of funding and further assist health care providers setting up the infrastructure necessary to provide services via telehealth. The new round of the program will be administered by the Universal Service Administrative Company (USAC). Applications for the Program may be filed through a dedicated application portal, available on the COVID-19 Telehealth Program webpage. Round 1 applicants that were not funded will need to submit a new application. For additional information on Round 2, please refer to the Universal Service Administrative Company’s website. If you have specific questions regarding the Round 2 application process, please reach out to USAC at Round2TelehealthApplicationSupport@usac.org . COVID-19 Telehealth Program (Invoices & Reimbursements): https://www.fcc.gov/covid-19-telehealth-program-invoices-reimbursements Universal Service Administrative Company: https://www.usac.org/about/covid-19-telehealth-program/ < Previous News Next News >

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

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