Commentary: Rethinking the Impact of Audio-Only Visits on Health Equity by Lori Uscher-Pines and Lucy Schulson December 17, 2021 New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. Prior to the outbreak of the COVID-19 pandemic in 2020, audio-only visits were rarely included in definitions of telehealth and seldom reimbursed. As clinicians were granted numerous flexibilities to deliver various care modalities at the onset of the pandemic, telephone calls were elevated to the status of reimbursable audio-only visits. Although audio-only visits were used across the health care system, federally qualified health centers (FQHCs) that provide primary care and behavioral health services to millions of Medicaid and uninsured patients were particularly likely to deliver audio-only visits in the spring of 2020. They were also more likely to rely on them as the pandemic progressed (PDF) because of patient and clinic barriers to video telehealth and a supportive policy environment. Almost two years into the pandemic, FQHCs in multiple states are reimbursed at the same Prospective Payment System (PPS) (PDF) rate for in-person, video, and audio-only visits. The new flexibility to deliver audio-only visits was a welcome change. It was widely recognized that, due to the digital divide, audio-only visits would play an essential role in maintaining access to care for many populations. An audio-only visit was far better than the alternative at the time: no visit at all. Currently, experts who call for the permanent reimbursement of audio-only visits cite concerns for the underserved. They argue that given the widespread lack of broadband, limited digital literacy, and reduced access to devices, requiring video visits may leave certain patients behind and exacerbate inequities in health care. While this argument had merit in the first year of the pandemic, the risk benefit calculation of audio-only visits has changed, and it is increasingly important to protect patients from potentially lower-quality audio-only visits. We discuss how ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. At the same time, the reliance on audio-only visits may be preventing innovation that could improve video and in-person health care visits for all populations. Ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. Share on Twitter In the spring of 2020, audio-only visits were a lifeline at a time of uncertainty and helped address a critical need when the delivery system was desperate for quick solutions. Numerous data sources showed high use of audio-only visits in this period (11–48 percent of visits), particularly among low-income and older adults. Even though estimates of audio-only use from claims data were high, they were likely underestimates of the total number of visits being delivered. This is the case because of challenges and inconsistencies with coding telehealth visits and the tendency for scheduled video visits to become audio-only visits when technical difficulties arise. For example, using claims data, Medicare estimated that one in three telehealth visits in the spring of 2020 were audio-only visits. However, data from the Medicare Current Beneficiary Survey showed that the majority of beneficiaries (56 percent) who had telehealth visits reported that they were exclusively audio-only. The Variation in Use Across Settings As the COVID-19 pandemic continued, audio-only visits retreated in some settings but remained dominant in others. Studies of the commercially insured demonstrated that as in-person visits rebounded in 2021, telehealth visits in general, and audio-only visits in particular, declined and play an increasingly minor role. In contrast, in the summer of 2021, 32 percent of FQHCs (PDF) across the United States reported that the majority of their total visits continued to be audio-only. A study of 43 large FQHC networks in California demonstrated ongoing, high-volume delivery (PDF) of audio-only visits in primary care despite receiving technical assistance and funding to grow their telehealth programs. Quality Concerns with Audio-Only Visits Audio-only visits can increase access to care, but this key advantage may come at the expense of quality. Evidence of the quality of audio-only visits in primary care is scant but concerning. First, clinicians report that audio-only visits are not as effective. Challenges range from the relatively minor (for example, not being able to assess facial expressions) to major issues (for example, not being able to verify the patient's identity). Studies have shown that clinicians can miss visual cues and struggle with establishing rapport with patients, and visits are shorter. Additionally, patients report lower satisfaction and comprehension rates. Even as new data emerge about the quality of audio-only visits, it is clear that some patients, including many commercially insured patients, are largely getting more evidence-based, tested services (in-person and video visits) while low-income patients are getting an untested service. Furthermore, cervical cancer screening rates, child weight assessment and counseling, and depression screening and follow-up at FQHCs declined with telehealth (predominantly audio-only) use. Drivers of Audio-Only Visits The variation in audio-only use across different populations is likely not fully explained by differences in which conditions are clinically appropriate for audio-only visits or by patient readiness for video visits. Rather, reimbursement, provider preferences, and organizational priorities are playing a significant role in determining how many in-person visit slots there are, and by extension, which patients get audio-only, video, or in-person visits. In October 2021, 33 percent of FQHC visits in California and 24 percent in Arizona, two states that reimburse FQHCs the full PPS for audio-only visits, were conducted virtually. Contrast that with South Dakota (a state that stopped reimbursing for audio-only visits in its Medicaid program as of July 2021 (PDF)), which only saw 5 percent of visits conducted virtually in the same time period. Although the digital divide is a significant problem in the United States that requires focused attention, it cannot fully explain the variation. A recent paper in Medical Care showed that provider behavior and organizational factors, as opposed to patient digital barriers, are playing the largest role in audio-only visits. Sixty-six percent of Medicare beneficiaries who were exclusively offered audio-only visits during the pandemic had access to telehealth-compatible devices and to the internet. Creating Conditions for High-Quality Telehealth Care At present, 22 state Medicaid programs allow for reimbursement for audio-only visits, with nine states adding reimbursement to permanent policy since the spring of 2021. The trend is to increase access to audio-only visits in the interest of health equity. However, telehealth experts have pointed out that failing to rein in audio-only visits risks escalating costs and creating a two-tiered system (PDF) in which affluent patients get video and in-person visits and low-income patients get telephone calls. It may be that this two-tiered system is already coming to fruition and is now harder to justify in the name of emergency response than it was in the spring of 2020. In March 2021, we argued that reimbursement of audio-only visits should continue for several years beyond the public health emergency to avoid exacerbating disparities in access. However, given emerging data about the prominence of audio-only visits in low-income communities, we now have concerns about this approach. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. It also may be stifling innovation that could be occurring in the delivery of video and in-person visits. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. Share on Twitter The patients who have challenges accessing video visits are the same patients who face barriers accessing in-person care. Instead of offering scheduled audio-only visits, health systems could be incentivized to address the social determinants of health that create barriers to higher-quality visits. For example, they could partner with community groups to provide transportation to appointments, provide access to low-cost electronic devices, invest in accessible telehealth platforms, create telehealth access points in the community, and train telehealth navigators. Audio-only visits are a powerful tool for emergency response, and over time researchers and clinicians will identify situations in which audio-only visits alone, or as a component of hybrid care models, can support comparable care. But in the coming months, it may be time to consider limiting audio-only visits in the pursuit of health equity. Lori Uscher-Pines is a senior policy researcher and Lucy Schulson is an associate physician policy researcher at the nonprofit, nonpartisan RAND Corporation. This commentary was first published on December 17, 2012 on Health Affairs Blog. Copyright ©2021 Health Affairs by Project HOPE—The People-to-People Health Foundation, Inc. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis. < 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 >

OIG Looking Closely at Telehealth as it Weighs Future Enforcement Mike Miliard, Healthcare IT News August 2021 In a HIMSS21 session with updates on the HHS inspector general's oversight and compliance efforts, officials said they plan to ensure virtual care is provided with integrity, and will take aim at telehealth fraud schemes. The Office of Inspector General for the U.S. Department of Health and Human Services works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. In a session at HIMSS21 on Tuesday, two HHS OIG leaders offered a look at the enforcement priorities the agency has in mind these days, and some hints about the compliance responsibilities healthcare organizations should be prioritizing in the coming months. OIG claims to recover three taxpayer dollars for every dollar it spends, and recoups billions in misspent money every year. Speaking via webcam, Lisa Re, assistant inspector general of legal affairs at OIG, offered an update on some of the legal liabilities and risk areas in the health IT space, related to the False Claims Act, the Anti-Kickback Statute and the Civil Monetary Penalties Law. She recounted some of the agency's enforcement actions in recent years, with companies such as athenahealth, CareCloud, eClinicalWorks and Practice Fusion required to pay millions to settle cases. Andrew Vanlandingham, senior counselor for Medicaid Policy and acting health IT lead at OIG, called attention to recent revisions to safe harbors under the Anti-Kickback Statute and Civil Monetary Penalty Rules around coordinated care. He also highlighted a major new priority at OIG: telehealth. "As policymakers, we want to look at what telehealth might look like after the pandemic," said Vanlandingham. "All of those questions are centered around where do they plan on taking this? How will this impact their expenditures for healthcare programs? How to make sure that patients are getting good quality care from telehealth? And I think it's important for us to recognize that we don't know a whole lot right now." He said the OIG is guided by a philosophy summed up in a quote from HHS Principal Deputy Inspector General Christi A. Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." When new technologies such as telehealth – with huge upside, but also potential risks – become more commonplace, "it's up to OIG and other healthcare stakeholders to make sure they do live up to that promise and aren't compromised by fraud, abuse or misuse," said Vanlandingham. "And we recognize that a lot of folks in the audience are doing just that: implementing telehealth so it works for patients, for the providers, and is a good tool to enhance care." He said OIG is "working hard to assess how telehealth utilization changed during the pandemic – what that means for corporate integrity, what that means for access, what that means for health equity. We have roughly eight audits and studies ongoing right now that we hope will really be the first down payment for OIG to be part of the broader conversation about what telehealth will look like after the pandemic." The goal is to "help the health technology community and providers as they continue to refine their development of telehealth and enhance virtual care," he said. "This is going to be a whole-of-government and whole-of-industry approach," he added. "It's really up to us to make sure that, since we are at this early stage of implementation of telehealth, that we can avoid issues to make sure that this works as intended, and really ensure that it drives the efficiency and effectiveness and really improves healthcare for all Americans." There have already been some ripe areas for enforcement, said Vanlandingham. "We've had several large-scale national takedown actions involving telefraud schemes with sham or fake telehealth companies," he said. (One of them occurred just this week.) "No one is billing for those telehealth visits fraudulently. They're not submitting a telehealth claim to Medicare. Instead, sophisticated criminal organizations are partnering with telemarketing companies and sometimes unscrupulous doctors to essentially cold call Medicare beneficiaries, get them online with a doctor. And the doctor [asks] a few questions, and then will forge or prescribe expensive equipment that Medicare will pay for durable medical equipment like back braces, or even genetic testing that beneficiaries don't need." DME fraud has been around since Medicare started reimbursing for it, of course. "But for these schemes, what used to be, let's say, $30 or $40 million dollars, maybe $100 million dollars, you've really seen an explosion of exploiting this virtual care model to really bill for a large amount of fraud," said Vanlandingham. "One scheme went for $1.6 billion, with a B, of alleged fraud. So that's obviously very alarming." No one quite knows yet what "telehealth 2.0" will look like, he said. "But I think it is a good example that, as we expand telehealth, there are likely to be instances of large-scale criminal activity that takes advantage of this. And it's up to OIG to assess those risks, and inform policymakers and stakeholders of those risks, and then from those policymakers and stakeholders to adjust." OIG's job now, he said, is to decide "how we can better increase oversight and enforcement to make sure that whatever Congress, CMS and others should decide about how telehealth should be used as providers continue to adopt it, that we've got safeguards to maximize the benefit of telehealth for patients and providers." < Previous News Next News >

How Telemedicine and Digital Therapeutics can Improve Orthopedic Care and PT Bill Siwicki October 11, 2022 A physical therapist and telehealth expert shows how the technologies can help patients, especially in disadvantaged populations, access the care they need and stick to a care plan. Minority and lower-income populations are less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do. Untreated musculoskeletal conditions can result in sedentary behavior that leads to or worsens co-morbidities, including diabetes, obesity, depression and opioid misuse. Access challenges are partly to blame. Disadvantaged populations face many barriers to care, including low referral rates, lack of Medicaid acceptance and transportation difficulties. Telehealth experts say that offering remote education and physical therapy to patients can improve access for vulnerable populations, including: ● Patients in rural communities who live far away from brick-and-mortar care facilities. ● Patients who cannot afford copays for doctor or outpatient PT appointments. ● Patients in urban communities whose mobility issues make leaving home difficult. ● Patients whose inability to take time off work or secure childcare limits in-person visits. ● Patients who speak English as a second language. Healthcare IT News interviewed physical therapist Bronwyn Spira, founder and CEO of Force Therapeutics, to discuss the challenges and opportunities surrounding this area of virtual care. Q. Why are minority and lower-income populations less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do? A. Musculoskeletal disorders are extremely common in our country. At least 60% of American adults are affected by a musculoskeletal disorder, and more than 75% of those 65 and older are living with at least one musculoskeletal condition, which ranges from tendonitis to arthritis, degenerative disc disease, and chronic lower back pain. Lower-income and minority populations face multiple barriers to accessing the right healthcare and are typically less likely to utilize orthopedic care, which can result in significant functional impairment. Untreated musculoskeletal conditions also can result in sedentary behaviors that lead to or worsen comorbidities such as diabetes, obesity and depression. In one study of more than 7,000 individuals with arthritis, the incidence rates of developing disabilities in activities of daily living (ADL) over a six-year period were significantly higher for Blacks (28%) and Spanish-speaking Hispanics (28.5%) as compared to whites (16.2%). As I mentioned, disadvantaged populations often lack sufficient access to care, which can manifest in a few different ways. Many cannot afford the financial burden of co-pays, childcare, transportation, time off work or the out-of-pocket cost of receiving care when uninsured. The Commonwealth Fund found that 50% of low-income adults in the U.S. skipped at least one medical visit, test, treatment or prescription per year due to its cost. Patients with state-funded Medicaid and federally funded Medicare plans also encounter logistical barriers to securing musculoskeletal care, including lower referral rates to orthopedic surgeons. Orthopedic specialists are 13% less likely to accept new Medicaid patients than they are Medicare patients or those with commercial insurance plans. Lastly, more than a third of Americans (36%) have low health literacy, which can be defined as the degree to which individuals can obtain, process and understand health information. Older age, minority membership and low socioeconomic status are disproportionately correlated with poor functional health literacy in both urban and rural populations. Language barriers also impact care utilization and success rates, as individuals who cannot fully understand the directions they are given will not be able to adhere to a care plan. One study on healthcare utilization among Hispanic adults found that limited English proficiency contributes to the underuse of medical services. For all of these reasons, members of disadvantaged populations are far less likely to have orthopedic surgery to correct their musculoskeletal conditions. The data also indicates stark disparities in orthopedic care utilization among racial and ethnic minority groups. Researchers have found that even after adjustments are made for age, sex and income, Black patients are 30% less likely to receive a total hip or knee replacement than white patients. A systematic review of the literature reveals that members of minority populations who do have joint replacement surgery also are at a higher risk for early complications within the first 90 days, leading to higher hospital readmission rates. While there is no consensus as to the cause of these disparities, research suggests that multiple comorbidities, lower income, poor health literacy, provider bias and insufficient interventions are contributing factors. Q. How does offering remote education and remote physical therapy to patients improve access for vulnerable populations? A. First and foremost, remote education and physical therapy platforms reduce the need for patients to attend appointments in person. When hospitals, health systems and ambulatory surgical centers (ASCs) implement care management and remote monitoring tools, they set the stage for achieving greater health equity by removing some of the physical barriers to care. At the start of a surgical episode, for example, replacing preoperative in-person appointments with virtual education classes means that patients can get all the information they need to prepare for surgery without leaving the house. Educating patients about what they can expect for their surgery – including what outcomes are typical, and how long their healing will take – helps them set appropriate goals for their recovery. All remote education content must be tailored to the patient and their condition, and ideally should reflect their comorbidities, medication and social determinants of health, as these factors influence how a patient is likely to respond to treatment. Content should be delivered in the patient's native language, and should feature clear and easily understood directions. Engaging a care partner who can support the patient's recovery journey also can be extremely beneficial. Many patients find it helpful to return to valuable content as questions arise, and care partners can assist by reinforcing the care team's instructions along the way. Content also should be easily digestible and should arrive at the appropriate point in the patient's journey, so as not to overwhelm patients with too much information. For example, before surgery, patients need information about how long they will be out of commission and how to prepare their space for moving around with an assistive device. A few days after surgery, they need information on how to manage their swelling and control their pain. Many hospitals and ASCs also are offering patients the option of virtual PT to supplement or replace traditional outpatient PT, as remote therapy delivers similar results at a much lower opportunity cost for the patient. Randomized trials have shown that virtual PT produces similar outcomes to outpatient PT after total knee and hip arthroplasty procedures, as long as the virtual program is prescribed by the treating clinical team. In addition to the time savings involved, replacing traditional PT with remote PT can save patients hundreds of dollars in copays and convenience, as patients can complete the rehab in their own home at a convenient time. Q. How does telehealth technology serve as a digital bridge to, for example, patients who cannot afford copays for doctor or outpatient PT appointments, patients in urban communities whose mobility issues make leaving home difficult, patients whose inability to take time off work or secure childcare limits in-person visits, and patients who speak English as a second language? A. Digital therapeutics can help orthopedic teams build stronger relationships with their patients, especially those who are members of disadvantaged populations and who are likely to need additional support. Standardizing patient access to preoperative and postoperative education through remote technology can help practices correct against implicit bias and ensure consistent communication with all patient populations, including the 13% of Americans who speak Spanish at home. For patients living in rural communities, telehealth tools can close the access gap imposed by geography. For patients in urban areas, who may struggle to use public transportation or navigate the stairs in a fifth-floor walk-up, telehealth tools can mean the difference between skipping necessary appointments and following their care plan. Ideally, telehealth technology can serve as a digital bridge to connect vulnerable patients to their care teams. However, the infrastructure of any such tool must support all patient populations, including the 43% of lower-income adults without broadband services at home. In many low-income communities, insufficient access to a computer also hinders the use of digital care management and remote monitoring solutions. Applications must compensate for the digital divide in their system design to ensure content does not require internet access, which can be poor or non-existent in certain areas. Patients should be able to access their care plans via mobile device with a secure login. According to the Pew Research Center, 27% of adults living in households earning less than $30,000 a year are smartphone-only internet users. As disadvantaged populations are far less likely to own a tablet, laptop or desktop computer, telehealth tools must be mobile-friendly and SMS-enabled. Two-way text messaging between patients and clinicians is a proven health intervention tool, as patients are much more likely to read and respond to a text than an email. Direct messaging via telehealth platforms also can improve outcomes for disadvantaged populations. When postoperative patients have a question about their pain levels, they can text their care team for answers instead of making an unnecessary trip to urgent care or the ER – or simply ignoring the problem until later, when interventions are less likely to be successful. Research shows that providing a care management platform with direct messaging decreases readmission rates across musculoskeletal procedures. Q. On a personal note, how does telehealth help you, the provider, with all these challenges? A. Early on in my career as a physical therapist, I managed and founded a number of orthopedics and sports medicine clinics in New York. My colleagues and I were constantly frustrated by how basic patient challenges – from inadequate healthcare access to poor health literacy and a lack of motivation – impacted our patients' outcomes. Similarly, we had very little or no visibility into how patients were managing at home, and whether the patients were achieving the outcomes that mattered to them. There wasn't a reliable closed-loop connection that provided the data we needed to make the right care decisions. Many patients would drop out of a treatment regimen due to access or cost challenges. There often were protracted gaps in care, and by the time the patient returned for treatment, they had often regressed or developed complications. That period led me to believe that evidence-based remote therapy and education could play a pivotal role in helping disadvantaged populations follow their postoperative care plan. In the traditional system, clinicians spend much of their valuable time in preoperative education visits, repeating the same things over and over to patients who are not likely to retain the bulk of this information. After surgery, nurses and care coordinators then work overtime to return patients' phone calls and fill in the knowledge gaps for patients. Digital care management systems allow orthopedic practices to scale valuable in-person time by automating low-touch interactions, while identifying the patients who need targeted one-to-one intervention. With the benefit of technology, practices can create high-value, repeatable workflows to fully prepare patients for surgery by giving patients what they need to know as they need to know it. This phased, segmented approach to education has been proven to correct for the retention gap of in-person education. The addition of patient messaging and remote monitoring tools enables the delivery of patient-reported outcomes data and care plan progression feedback to be returned in real time to the care team, who then can intervene as necessary. Orthopedic practices are much less likely to miss a patient who has stalled in their recovery and is at a high risk of developing complications. When digital therapeutics are designed to be inclusive of all patient populations, they can transform the way we practice orthopedics to improve health equity. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/how-telemedicine-and-digital-therapeutics-can-improve-orthopedic-care-and-pt < Previous News Next News >

KFF Report on Telehealth - Medicare Use Offers Future Policy Implications Center for Connected Health Policy June 2021 Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. More work will need to be done to further education around telehealth and ensure its availability to all communities. A Kaiser Family Foundation brief presents new information and analysis of Medicare beneficiaries’ utilization of telehealth using Centers for Medicare & Medicaid Services (CMS) survey data from between summer and fall of 2020 while CMS emergency telehealth expansions were in effect. Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. For instance, while 64% of beneficiaries said their provider currently offers telehealth appointments, only 18% said their provider offered telehealth prior to the pandemic. However, nearly a quarter of beneficiaries said they don’t know if their provider offers telehealth appointments, with the percentage even larger among rural beneficiaries. Therefore, while expanded policies appear to have increased access to services via telehealth, more work will need to be done to further education around telehealth and ensure its availability to all communities. Additional findings from the study include: -Over 1 in 4 (27% or 15 million) of Medicare beneficiaries had a telehealth visit between the summer and fall of 2020 -The majority of Medicare beneficiaries (56%) used telephone only *Video was 28% *Both video and telephone was 16% -The share of Medicare beneficiaries who had a telehealth visit using telephone only was higher among: *Those age 75 and older (65%) *Hispanic beneficiaries (61%) *Those living in rural areas (65%) *Those enrolled in both Medicare and Medicaid (67%) The report also found that rural Medicare beneficiaries were less likely than urban beneficiaries to have a telehealth visit with a doctor or other health professional (21% vs. 28%, respectively). However, among Medicare beneficiaries with a usual source of care and whose usual provider offers telehealth, they found no significant difference between the share of rural and urban Medicare beneficiaries who had a telehealth visit (43% and 45%, respectively). They note this difference is likely driven by the fact that rural Medicare beneficiaries were more likely than urban Medicare beneficiaries to say they do not know if their usual provider offers telehealth (30% vs. 21%, respectively). Similarly, among Medicare beneficiaries with a usual source of care whose usual provider offers telehealth, they found that a larger share of Black and Hispanic beneficiaries had a telehealth visit compared to White beneficiaries (52%, 52%, and 43%). However, among the total Medicare population, the difference in the share of Black and White beneficiaries who reported having a telehealth visit was not statistically significant (30% vs. 26%), while a larger share of Hispanic beneficiaries than White beneficiaries had a telehealth visit (33% vs. 26%). They note that for Black Medicare beneficiaries, this result is likely related to the fact that nearly a quarter of Black beneficiaries overall (23%) say their usual provider does not offer telehealth appointments, compared to 12% of White beneficiaries and 15% of Hispanic beneficiaries. Looking forward, the authors suggest that since they found greater usage of telehealth amongst those with disabilities, low incomes, and in communities of color, the temporary expansions of coverage may be helping more disadvantaged populations access care. In addition, since most services are being provided via audio-only, they state going back to requiring two-way video could be a barrier for many subgroups of the Medicare population. As policymakers continue to request data on telehealth and consider making certain emergency policies permanent, many are looking to Medicare to lead the way, and this information further confirms the importance of maintaining access to all telehealth modalities in all communities, or risk potentially exacerbating existing disparities even further post-pandemic. Additional expansion and education of telehealth availability will continue to remain necessary as well. More information on the survey and analysis can be found in the full issue brief - https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/. < Previous News Next News >

City of Hope advances cancer care with hybrid telehealth and in-person visits. Bill Siwicki November 29, 2021 City of Hope envisions expanding the use of telemedicine to include telegenetic consultations, remote chemotherapy support, remote monitoring via wearables and palliative care. City of Hope, based near Los Angeles, is a research and treatment organization for cancer, diabetes and other life-threatening diseases. In 2018, it made strategic moves to more easily meet the needs of its patients and communities by investing in telehealth. Part of that strategic direction was working with technology companies to ensure that City of Hope leveraged telehealth in a high-quality, patient-centric way, while easing the burden of travel times for patients undergoing treatment. With every visit, the organization's team evaluates whether patients are best served by either a virtual or an in-person appointment. THE PROBLEM Then COVID-19 emerged. Suddenly, City of Hope needed to rapidly scale its telehealth infrastructure to meet the needs of patients. In doing so, its work with telemedicine technology and services vendor Amwell helped the healthcare provider organization reimagine the delivery of oncology services. "For example, when a physician delivers a cancer diagnosis to a patient, it can be a lot easier to do so when the patient is at home, in a space that feels comfortable, surrounded by family," noted Dr. Paul Fu, chief medical information officer at City of Hope. "At a time when the American Cancer Society estimates 87% of cancer patients and survivors had their care disrupted due to the coronavirus, City of Hope offered uninterrupted cancer care and used telehealth when appropriate to evaluate patients, manage side effects of treatment, review labs and scans, answer questions, and offer reassurance to patients and their families." Even when patients came in person, City of Hope used telehealth to include family members and other members of a patient's care team seamlessly in the visits. It's an approach that has enabled the organization to more easily and conveniently surround patients with specialized cancer care and eliminate unnecessary travel. "Moving forward, City of Hope envisions expanding our use of telehealth to include services such as telegenetic consultations, remote chemotherapy support, remote monitoring using wearables, expedited condition triage and palliative care," Fu said. "By fully addressing each patient's needs, we're making a deep impact on personalized patient care and satisfaction." PROPOSAL Prior to working with Amwell, City of Hope delivered telehealth services, but the technology it used was not integrated with other systems, leaving room for an improved care journey for patients and providers. "We started with Amwell by launching our patient app to enable virtual connections between our patients and their providers," Fu explained. "Since launching our app, we've been able to rapidly scale up our telehealth program both in terms of patients and providers using it and in terms of use cases and modalities. "We've also been able to integrate the platform with other systems we have in place to improve the patient experience," he continued. "These were key elements – scalability and integration capabilities – that we looked for in selecting our telehealth provider as we knew we would want to grow the program." MARKETPLACE There is a wide variety of telehealth technology and services vendors on the health IT market today. Healthcare IT News published a special report listing these vendors and details about their offerings. Click here to read the special report. MEETING THE CHALLENGE Having a well-integrated telehealth platform enabled City of Hope to develop consistent workflows around telehealth that supported an enhanced patient experience. Further, an integrated platform allows the organization to track telehealth visits within the same quality improvement framework that it uses for in-person visits. "We integrated the Amwell platform with our Epic EHR to provide a more seamless experience for patients and our provider teams," Fu noted. "Now, physicians can simply click a video icon in Epic to get to the telehealth screen and start their session. "Before each visit, nurses or medical assistants initiate the session, talking with patients to gather the information needed to inform the session. When an interpreter is needed, the platform makes it easy to incorporate these services during a live session with the click of a button." City of Hope also uses the Doximity Dialer to facilitate patient telephone calls straight from the Epic Haiku mobile app with a caller ID registered to City of Hope. This gives patients a greater feeling of trust from the start of the call, knowing that the telehealth call is a legitimate service coming from their healthcare institution. "Another crucial technology feature is the ability to easily bring other members of the care team into the video encounter," Fu said. "It's not uncommon for our patients to have a person they want to be involved in the discussion, such as a family member or other caregiver – even interpreters can be added to visits. This feature, which allows the sharing of screens, significantly enhances satisfaction among our patients. "However, what really makes our telehealth service unique is the network of services the patient receives via telehealth," he continued. "City of Hope offers concierge-like specialized healthcare services that help patients navigate their care journey and gain answers to questions about medication management, alternative treatments that can reduce side effects and more." The organization also connects patients with supportive care services that deliver in-person support when needed, such as when patients face mobility issues or when child life specialists can work with the children of adult patients or the siblings of pediatric patients. RESULTS "We looked at several different success metrics and largely chose to focus on process measures, including how likely patients are to recommend our telehealth services," Fu said. "We also looked at the number of successful completions to ensure our process and the use of the technology was easy for patients, as well as satisfaction with the use of telehealth services. "We're now beginning to look at health outcomes achieved via telehealth," he added. "Early data show that similar to many organizations, cancer screening procedures dropped during the pandemic, but we observed that the decrease was uneven across specialties." To measure clinical outcomes, City of Hope is tracking its patients as well as referrals into its system who had delayed screening. Based on the data it receives, City of Hope continually refines and improves its virtual care services to meet patients' needs, Fu said. ADVICE FOR OTHERS "When launching or expanding a telehealth program, ensure patients are kept at the center," Fu advised. "Telehealth services should be deployed in such a way that they cause the least amount of stress for patients, especially those who are dealing with complex conditions. "This can be achieved by mapping out the patient journey for both virtual and in-person care and looking for opportunities to strengthen care coordination and management, the quality of care that patients receive, and more." Even during the madness of the first months of COVID-19, City of Hope's patient-centric approach to cancer care, including use of telemedicine, strengthened its ability to optimize patient outcomes, improve the patient experience and provide uninterrupted cancer care, Fu added. "Our telemedicine use is just one of the ways City of Hope has expanded our reach beyond patients in the Los Angeles area," he concluded. "We reach cancer patients around the globe, including those taking part in clinical trials. In an era of digitally augmented patient care, a continual focus on meeting a patient's holistic care needs will become a competitive differentiator for healthcare providers." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication https://www.healthcareitnews.com/news/city-hope-advances-cancer-care-hybrid-telehealth-and-person-visits < Previous News Next News >

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

Access and Equity in Medicaid Telehealth Policy Webinar Center for Connected Health Policy April 30, 2021 Access and Equity in Medicaid Telehealth Policy Webinar April 30 Telehealth has demonstrated that it has the potential to make healthcare more accessible for hard-to-reach patient populations in medically underserved communities. However, some lessons from telehealth utilization during the COVID-19 pandemic have raised concerns about access gaps for these patients. Join the Center for Connected Health Policy (CCHP) and leading Medicaid experts on Friday, April 30, 2021 for the first webinar in our Spring webinar series, Access and Equity in Medicaid Telehealth Policy. This webinar will feature presentations from Medicaid administrators and policy staff on trends in telehealth access and equity and strategies to address these gaps. Stay tuned for more information on confirmed speakers for this webinar. This event is free and open to the public. Register: https://us02web.zoom.us/webinar/register/WN_B-EIOkBkQW-QvcxUcqHxKA < Previous News Next News >

New Study Finds Telehealth Outperforms In-Person Care in HEDIS Measures Eric Wicklund October 06, 2022 Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit. KEY TAKEAWAYS A recent study of more than 526,000 patients receiveing care at Wellspan Health sites in 2020 and 2021 found that telehealth outperformed in-person care in 11 of 16 HEDIS quality improvement measures for primary care. The research indicated in-person care was better in medication-based measures, while telehealth scored higher in testing and counseling measures. Researchers stressed that the results show a need for health systems to integrate telehealth with in-person care, enabling patients and providers to select the venue that most suits them and the treatment. New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care. The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements. The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care. The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings. "Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer." "Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care." Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person, and perhaps shifted to virtual platforms for follow-up. "Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models." Eric Wicklund is the Innovation and Technology Editor for HealthLeaders. See original article: https://www.healthleadersmedia.com/telehealth/new-study-finds-telehealth-outperforms-person-care-hedis-measures < Previous News Next News >

7 ways asynchronous telehealth powers digital-first health systems Bright MD February 11, 2022 As the consumerization of healthcare becomes more of a reality, a digital-first approach to care is being explored by more and more systems throughout the U.S. Today’s top tech advancements range from remote patient monitoring to AI & machine learning to virtual reality—and to asynchronous telehealth. Couple the desire to keep revenue flowing with crippling capacity constraints, and it’s no wonder many are looking to asynchronous telehealth options. With the right solution, systems can lower overall costs of care, increase patient satisfaction, and reduce administrative burden on doctors. Below, we rounded up the top seven ways asynchronous telehealth helps power a digital-first approach to healthcare. Asynchronous telehealth improves patient access to quality care. If used correctly, asynchronous technology can help improve access to quality care, and at Bright.md, that remains at the core of our product. Bright.md’s asynchronous platform addresses key barriers to access, including transportation, language, technology, cost, wait times, health literacy and inclusivity. An asynchronous platform that helps with care access and health equity should also allow for connection without broadband—Bright.md operates on any device with an Internet connection. Our team of developers, writers, and clinicians constantly ensures the platform is built and maintained for a diverse patient population and is continually updating the interface to be inclusive of gender identities, socioeconomic background, and other factors. Read full article here: https://bright.md/blog/7-ways-asynchronous-telehealth-powers-digital-first-health-systems/?utm_source=bmd&utm_medium=email&utm_campaign=digest&mkt_tok=OTE3LUNaTy01MjgAAAGCxeGYND3bypsZRJow17HWYcm7FV1UodVW5MMo0KV-rlLhWbj7O4nds9NlFF4YftlRgpIV3qUhHg3ujjoEwJyrxYI6TzFC91UMO3Svi7Y9xSA < Previous News Next News >

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

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

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

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

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

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

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

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