Report: Telehealth Programs Increase Workload for Nurses and Support Staff Katie Adams December 20, 2022 Many providers think their telehealth program increases the workload for nurses and support staff, according to a recent report. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators. Telehealth isn’t as widely utilized as it was at the dawn of the pandemic, but the care modality is definitely here to stay. However, many providers believe their telehealth program increases the workload for nurses and support staff, according to a recent report from research firm Sage Growth Partners. Providers also said they don’t think physicians enjoy using telehealth visits to treat patients. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators, the report said. In September, Sage Growth Partners surveyed 95 health system executives and 75 leaders of physician practices. Practices with fewer than five physicians were excluded from the survey. Most respondents said that their organizations will focus on optimizing and sustaining their current telehealth programs in 2023 rather than expanding them. In fact, only about 10% of participants — 11% of hospitals and 8% of practices — said they are looking to grow their telehealth offerings next year. Health system executives were more likely than practice leaders to say that telehealth visits should make up a higher percentage of their ideal in-person-to-telehealth visit mix. Health system leaders said the mix should be 30% telehealth and 70% office. Among practice leaders, the ideal mix looks more like 20% and 80%. Their difference of opinion also extended to another question on how they think telehealth utilization will grow by visit type over the next two years. Health system leaders said that utilization will fall slightly for most visit types — even behavioral health. They said that 36% of behavioral health visits were delivered via telehealth in September, but they expect this to fall to 33% in September 2024. Urgent care and telepathology were the two visit types for which health systems leaders predicted telehealth growth — they expect telehealth utilization to increase from 3% to 7% for urgent care and from 2% to 4% for telepathology. Practice leaders expected telehealth utilization to increase slightly or remain the same for most visit types. Specialty care was the only exception — for this visit type, practice leaders predicted utilization to fall from 23% to 20% over the next two years. Both groups agreed that telehealth actually increases burden on staff though practice leaders seem to feel it more acutely. More than half of practice leaders said telehealth has increased support staff’s workload, and 28% said it generates more work for nurses. Among health system executives, 35% said telehealth increased support staff’s workload, and 30% said it creates more work for nurses. Additionally, less than half of total respondents (46% of hospitals and 47% of practices) agreed that telehealth increases physician satisfaction and physicians like using telehealth visits to treat patients. A key reason for this is that many providers are operating their telehealth programs using inefficient workflows, according to the report. Nearly 60% of survey respondents said they have not yet created new workflows for telehealth visits. Instead, hospitals and physician practices are still relying on workflows that mirror in-person visits. In 2023, providers will need to improve these workflows, and many will consider bringing on the help of third-party telehealth administrators, such as Amwell or Caregility, the report said. Hospitals are more than twice as likely to use third-party partners to administer telehealth services — with 20% of hospitals doing this compared to 9% of practices. Hospitals were also more likely to say they would change their telehealth administering party over the next two years — with 44% of hospitals saying this compared to 25% of practices. Photo: Anastasia Usenko, Getty Images See original article: https://medcitynews.com/2022/12/report-telehealth-programs-increase-workload-for-nurses-and-support-staff/ < Previous News Next News >

Expansion of Telehealth Services Must Be Sustained Gerald E. Harmon, MD American Medical Association President July 2021 Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. The rapid growth and large-scale adoption of telehealth services over the past 18 months has allowed physicians to deliver a broad range of badly needed services to patients nationwide in an innovative, cost-effective manner. Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. Congress can brighten this picture by passing legislation already introduced into the current session that enjoys bipartisan support. Among other steps that need to be taken, the pending legislation—CONNECT for Health Act of 2021 (S 1512) and the Telehealth Modernization Act (HR 1332)—would strip away all geographic restrictions placed on telehealth services and allow Medicare recipients to receive this care in their own homes, rather than being forced to travel to an authorized health care center to receive it. Although this provision has been waived for the duration of the public health emergency trigged by the COVID-19 pandemic, the ability to provide telehealth services directly to patients regardless of their location will be lost unless Congress acts. Physicians and their patients who have witnessed firsthand the immense benefits and value of telehealth services must not be forced to stop using these widely available tools for better health simply because the pandemic is over. Telehealth has improved health care The benefits of telehealth are obvious. Telehealth enables physicians to strengthen continuity of care, extend access outside of normal clinic hours, and ease the impact of clinician shortages in rural areas and among underserved populations. By increasing the quantity and quality of communication between patients and physicians, telehealth has strengthened the trust that lies at the center of this relationship. Telehealth can slice overall health care costs by helping physician practices and health care systems better manage diabetes, heart disease and other chronic illnesses while increasing the overall quality of care and patient satisfaction. This technology can also prevent patients from delaying care for conditions that, if undetected and untreated, can trigger emergency department visits or lengthy hospital stays. Wide-ranging case-study examples of the comprehensive value that virtual care can provide are featured in the AMA’s Return on Health research issued in May. And let’s not forget the value of telehealth services to patients with impaired mobility, the immunocompromised, frail or elderly individuals who require the aid of a caregiver to travel, and those who cannot arrange the transportation or child care they need to receive care. The enhanced opportunities telehealth affords to assess the impact of patients’ social determinants of health lays the groundwork for better treatment and improved health outcomes for historically marginalized and minoritized communities. The widespread expansion of telehealth services we have witnessed serves all of these patient populations and others in an efficient and cost-effective manner that must be sustained. While the Centers for Medicare & Medicaid Services has expanded its coverage for telehealth services during the pandemic, only action by Congress will ensure that Medicare beneficiaries will enjoy full access to those services once the pandemic is behind us. The expansion of telehealth covered by Medicare at payment parity with in-person services during the COVID-19 public health emergency includes more than 150 services, including emergency department visits, hospital admissions and discharges, critical care and home care, to name just a few. Offering this equivalency remains a critical factor in ensuring that physician practices can cover the additional costs tied to virtual care provision. How we support greater telehealth adoption Our AMA’s commitment to telehealth technologies grows stronger each day. For example, our Telehealth Immersion Program helps individual physicians, physician practices and health systems expand and optimize telehealth services through interactive peer-to-peer training sessions, curated webinars, clinical best practices, virtual care boot camps and other assets. Additional resources, including a Telehealth Quick Guide, Telehealth Playbook, and STEPS Forward™ telehealth training module, are just three more examples among many available on our website. The Digital Medicine Payment Advisory Group is a collaborative initiative convened by the AMA to help integrate digital medicine technologies into clinical practice by knocking down barriers to widespread adoption while zeroing in on comprehensive solutions for issues with coding, reimbursement, coverage and related factors. The mission of this diverse cross section of nationally recognized digital medicine experts includes: Reviewing existing code sets—particularly CPT® and HCPCS—to ensure they accurately reflect current digital medicine services and technologies. Assessing factors that affect the fair and accurate valuation of services delivered in this manner. Providing information and clinical expertise that promotes widespread coverage of telehealth, remote patient monitoring and all other digital medicine services, including increased transparency of services covered by payers and improved enforcement of parity coverage laws. The expansion of physician-based telehealth services in 2020 ranks as one of the most important advances in health care delivery in many years. Allowing this progress to slip from our hands because of outdated and arbitrary restrictions will result in higher costs and poorer health outcomes for patients everywhere. The decisions made and the policies adopted in the near future will shape the direction of telehealth services for many years to come. We urge Congress and the Biden administration to take the steps necessary to build on the progress in virtual care we’ve made thus far while laying the foundation for greater innovation going forward. < Previous News Next News >

Emergency Broadband Benefit Resources Center for Connected Health Policy April 2021 FCC recently posted a new consumer FAQ on the Emergency Broadband Benefit Program, which the FCC is still working to make available but hopes to have in place for signup by the end of April 2021. The Federal Communications Commission (FCC) recently posted a new consumer FAQ on the Emergency Broadband Benefit Program, which the FCC is still working to make available but hopes to have in place for signup by the end of April 2021. The program will help households struggling to pay for internet service during the pandemic. The FAQ provides answers to common consumer questions on benefit eligibility, how the discount will be applied to broadband service costs, and program length. It also includes information on the enhanced Tribal benefit and the connected device benefit. Additional questions can be sent to broadbandbenefit@fcc.gov and webinars, informational materials, and upcoming trainings can be found here: https://www.usac.org/about/emergency-broadband-benefit-program/webinars-and-trainings/ FCC Consumer FAQs: https://www.fcc.gov/consumer-faq-emergency-broadband-benefit < Previous News Next News >

HIMSSCast: How emerging tech is opening new avenues in telehealth, RPM Mike Miliard October 28, 2022 Virtual therapeutics, voice recognition and fast-evolving artificial intelligence tools are transforming home-based care, says Robin Farmanfarmaian, co-author of the new book How AI Can Democratize Healthcare. Remote patient monitoring and other forms of virtual care are fast finding footholds in healthcare as patients get acquainted with these new care modalities, and as health systems learn to appreciate the cost efficiencies they offer. But telehealth and RPM are still in their early days, and fast-changing as they're augmented with other new and emerging digital health and artificial intelligence technologies. Robin Farmanfarmaian, a longtime Silicon Valley entrepreneur and co-author of the new book, How AI Can Democratize Healthcare, joined us recently to discuss how the growing momentum toward home-based care is being impacted by leading-edge innovations such as natural language processing, digital therapeutics and more. leading-edge-technologies-are-transforming-telehealth-and-rpm (1).mp3 Talking points: Where remote patient monitoring is now, and where it's headed How AI is changing how virtual care is delivered New approaches to patient engagement and experience What's next for digital therapeutics and other app-based interventions Innovative use cases for NLP and machine learning models More about this episode: The intersection of remote patient monitoring and AI How remote patient monitoring is moving into the mainstream AI-powered telehealth improves PT care at Essen Health Care Mayo Clinic working with Memora Health on virtual postpartum care AI-powered RPM can help address the rural neonatal care crisis How remote patient monitoring improves care, saves money AI and IoT device connects with concierge platform for RPM Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Healthcare IT News is a HIMSS publication. See original podcast: https://www.healthcareitnews.com/news/himsscast-how-emerging-tech-opening-new-avenues-telehealth-rpm < Previous News Next News >

CONGRESS UNVEILS TWO YEAR EXTENSION OF TELEHEALTH FLEXIBILITIES – AS URGED BY THE ATA AND ATA ACTION – AS PART OF OMNIBUS BILL The American Telemedicine Association December 20, 2022 Today, the American Telemedicine Association (ATA) and ATA Action express their gratitude to the U.S. Congress for unveiling a bipartisan, bicameral omnibus appropriations bill that includes a two-year extension for Medicare telehealth provisions put in place during the COVID-19 public health emergency (PHE). The omnibus package also includes a two-year delay in implementing the Medicare telemental health in-person requirement, a two-year extension of the safe harbor to offer telehealth in High Deductible Health Plans (HDHPs) with Health Savings Account (HSAs), and a two-year extension of the Acute Hospital Care at Home Program. Congress is expected to vote on the omnibus bill and send it to President Biden to be signed into law within the next week. The omnibus did not include a comparable extension past the end of the PHE of the Ryan Haight in-person waiver for the remote prescription of controlled substances. However, the legislation does include language directing the Drug Enforcement Administration (DEA) to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued and the procedure for obtaining the registration. “The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients. Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future,” said Kyle Zebley, senior vice president, public policy, American Telemedicine Association, and executive director, ATA Action. “We asked Congress and they listened. We are truly grateful for their staunch support of telehealth. It’s now time to swiftly bring this bill to the President, for passage into law before year-end.” Stakeholder Letter to Congressional Leadership – Urging Extension of Telehealth Flexibilities Stakeholder Letter Urging Congress to Act on the Telehealth High Deductible Health Plan Safe Harbor Tax Provision ATA’s Recommendation’s for Acute Hospital Care at Home Program Stakeholder Letter Urging the DEA to Act on the Prescription of Controlled Substances via Telehealth Before the PHE Expires “We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services. Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction. “The ATA and ATA Action are delivering on our promise, to advocate for permanent access for telehealth services and today marks a significant milestone towards that goal. But the hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff.’ Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.” About ATA Action ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 company and an affiliated trade organization of the ATA. About the ATA As the only organization completely focused on advancing telehealth, theAmerican Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models. See original article: https://www.americantelemed.org/press-releases/congress-unveils-two-year-extension-of-telehealth-flexibilities-as-urged-by-the-ata-and-ata-action-as-part-of-omnibus-bill/ < Previous News Next News >

Federal Broadband Funding Negotiations Continue Center for Connected Health Policy June 2021 As the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. President Biden’s American Jobs Plan originally totaled $2.3 trillion, $100 billion of which was designated to broadband. As noted in recent CNBC articles, as the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. While Senate Republicans then put forward a $928 billion counteroffer, there appears to be agreement on both sides with the piece of the proposal designating $65 billion to broadband. Nevertheless, discussions on other issues remain far apart and it is possible to pass the bill without Republican support in the evenly split Senate, therefore Senate Majority Leader Chuck Schumer recently expressed his desire to continue the process with or without Republicans to get comprehensive jobs and infrastructure legislation done this summer. For more information read the American Jobs Plan in its entirety - https://www.whitehouse.gov/american-jobs-plan/. < Previous News Next News >

Amazon rolls out its telehealth service nationwide Annie Palmer, Bertha Coombs February 8, 2022 Amazon is launching its telehealth program, known as Amazon Care, nationwide and has signed up a handful of new companies to use its services. Amazon is rolling out its telehealth service, known as Amazon Care, nationwide, the company announced Tuesday. Amazon Care launched in 2019 as a pilot program for employees in and around the company's Seattle headquarters. The program provides virtual-care visits, as well as free telehealth consultations and in-home visits for a fee from nurses for testing and vaccinations. It has since expanded into more of a primary care service. To read this full article: https://www-cnbc-com.cdn.ampproject.org/c/s/www.cnbc.com/amp/2022/02/08/amazon-care-telehealth-service-launches-nationwide.html < Previous News Next News >

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

Biden’s American Jobs Plan Increases Investments in Broadband Infrastructure Center for Connected Health Policy April 13, 2021 President Biden’s recently released American Jobs Plan includes $100 billion to increase access to affordable, reliable, and high-speed broadband throughout the country. President Biden’s recently released American Jobs Plan includes $100 billion to increase access to affordable, reliable, and high-speed broadband throughout the country. Comparing digital infrastructure today to affordable access to electricity in the 1930s, the Fact Sheet on the Plan released by the White House states how the pandemic has highlighted existing disparities related to the digital divide and the lack of broadband access to more than 30 million Americans. The $100 billion investment will prioritize broadband infrastructure in unserved and underserved areas to reach 100% high-speed broadband coverage. It also sets aside funds for tribal lands and promotes broadband providers less focused on profits, such as those affiliated with municipalities, and seeks to improve price transparency and competition among internet service providers. The plan will include internet subsidies to low-income consumers, but states that in the long-term, the President is committed to working with Congress to reduce internet prices negating the need for such short-term solutions. The full Fact Sheet on The American Jobs Plan can be accessed on the White House website, https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/. < 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 >

Why College Students Should Make the Most of Telehealth Justin Weinger August 2021 Telehealth means not having to miss class and then need to play catch up. This is a huge win, especially when you’re going to college full-time. Whether you’re a freshman or just about finished with your degree, you probably don’t have a lot of free time. So, when it comes to squeezing in routine healthcare, you might think you don’t have the time. However, thanks to the advances made in telehealth, you can now take care of your health from the comfort of your dorm. Here are four reasons why you should consider using telehealth for your medical care. No Need to Miss Class As exciting as it is to venture into young adulthood, it’s easy to feel overwhelmed with a heavier course load. Even if you’re still living at home and attending classes online, transitioning from high school to college means having less time to take care of yourself. Telehealth makes taking care of yourself a lot easier. In fact, telehealth means not having to miss class and then need to play catch up. This is a huge win, especially when you’re going to college full-time. Improved Health We’ve all heard of the freshman 15, so if you find yourself with a little more around your middle, utilizing telehealth services can help you lose the weight safely. In addition, having online access to medical professionals ensures that you receive proper medical care faster than you would sitting in the ER. With that said, you should also head to the nearest hospital if you’re having a medical emergency. You can also discuss ways to ward off common illnesses that are prevalent amongst college students. Meningitis, for example, has a high occurrence rate in college students, so it’s always best to know whether you’re suitable for the vaccine. If not, your medical provider can recommend ways to decrease the risk of contracting it. Online Support System Growing up isn’t easy, even when you think you have it all figured out. It’s not uncommon for college students to develop anxiety, depression and other mental health issues while going to college. In addition to reviewing specific guides that support the mental health of college students on and off campus, you can use telehealth services to manage your wellbeing as well. There are a variety of psychological services available online for college students, all of which are confidential. Personalized Care If you’ve ever been to a busy doctor’s office, you might have gotten the feeling that you were just one of many. Not to say that you doctor doesn’t care about you, but medical offices are known to book more appointments than time may allow, leaving you with less than 10 minutes to explain what the issue is and hear your doctor’s remedy. Online medical care gives you a more personalized experience, possibly better than what you’re used to having in person. You can also schedule your appointment when you have more time to discuss your problems without feeling like you need to rush to get everything done. Many doctors or nurse practitioners schedule virtual appointments early in the morning or after hours in the evening. This also works out well for your doctor. Although they may have virtual appointments booked one after another, they don’t have the same distractions they may encounter with in-person office visits. This allows them to give you their undivided attention. Source: https://telemedicine.arizona.edu/blog/why-college-students-should-make-most-telehealth < Previous News Next News >

Geisinger's journey to greatly expanded telehealth Bill Siwicki April 19, 2022 The prolific health system is now able to offer telemedicine appointments to patients for primary care, urgent care and more than 70 specialties. More than 8% of total outpatient visits now are conducted virtually. Rural Pennsylvania is bigger than the states of New Jersey, Massachusetts, New Hampshire and Vermont combined. Some 75%, or 33,394 square miles, of Pennsylvania are considered rural. The geography is diverse, from rugged mountainous terrain to large stretches of farmland. High-profile health system Geisinger and its affiliated entities serve 45 predominantly rural counties throughout central and northeastern Pennsylvania, 31 of which are a part of Appalachia, a unique region of the Appalachian Mountains that cuts through the western part of the state. THE PROBLEM "Access to specialty care for many of our communities is scarce; these communities already are faced with primary care shortages, and for those who need to seek specialists and sub-specialists, long travels often are a costly and time-consuming reality," said Tejal A. Raichura, director of the center for telehealth at Geisinger. "Surveys show that rural Pennsylvanians are not taking care of themselves as well as their urban counterparts," she continued. "Fewer rural residents than their urban counterparts get the recommended exercise. Rural residents have higher rates of obesity, with almost two-thirds at risk for chronic diseases based on their sedentary lifestyle." Rural residents are in poorer physical condition, have more health risks and are more likely to lack health insurance, she added. The wage gap between urban and rural Pennsylvanians is getting wider. In fact, it has doubled in the last 30 years. Improving the quality of healthcare while lowering costs and increasing access in rural Pennsylvania counties is challenging, she said. "In 2018, Geisinger leadership committed to expanding our telehealth program and invested in a platform that could cover various elements of virtual care, including video visits to the home and our clinics, tele-stroke visits at our various inpatient units and emergency rooms, and video visits to non-Geisinger organizations, including other hospitals, skilled nursing facilities, correctional facilities, et cetera," Raichura recalled. PROPOSAL The business plan requested support for an expanded telemedicine program, one that would connect distantly located expert physicians trained in several specialties – including neurology, stroke/intensive care, pediatrics, primary care, geriatrics, psychiatry, endocrinology, rheumatology, podiatry and several others – with rural and underserved communities, allowing residents to access specialty care where they live and work. For Full Article: https://www.healthcareitnews.com/news/geisingers-journey-greatly-expanded-telehealth < Previous News Next News >

Memorial Hermann to provide school-based pediatric telehealth Naomi Diaz October 18, 2022 Houston-based Children's Memorial Hermann has partnered with telehealth company Hazel Health to provide outpatient pediatric care to K-12 students in Houston. Under the partnership, schools that have agreements with Hazel will be able to offer their students access to health services via virtual telehealth sessions, according to an Oct. 17 press release. Children's Memorial Hermann pediatricians or specialists will connect with the students through the program for follow-up or long-term care management. The aim of the partnership is to increase access to pediatric care in schools across 12 counties in southeast Texas. See original article: https://www.beckershospitalreview.com/telehealth/memorial-hermann-to-provide-school-based-pediatric-telehealth.html < Previous News Next News >

Digital Health Tools Transforming Pediatric Telemedicine, Teletherapy & Telehealth Dr. Maheu February 24, 2022 The COVID-19 pandemic has led to an unprecedented rise in pediatric telemedicine to alleviate the strain of behavioral health issues. Unprecedented stressors abound. Children are now more often confined to their homes and are less able to socialize. They may be forced to adjust to their parents’ working from home. They may witness economic and emotional fluctuations that leave them more anxious than at any time in recent history. With the increased demand for care with a shortage of available pediatric behavioral professionals, many organizations have shifted to pediatric telemedicine and telehealth or teletherapy tools.. COVID 19 and Challenges for Pediatric Telemedicine for Behavioral Health A meta-analysis published in JAMA Network, pediatrics found that one in every four children suffered depression during the COVID-19 lockdown and the anxiety prevalence rate was 20.5%. According to the Centers for Disease Control and Prevention (CDC), compared to 2019, the number of mental health-related emergency visits in 2020 went up by 24% for children in the 5-11 age group and 31% in the 12-17 age group. The American Association of Pediatrics and the American Association of Child and Adolescent Psychiatry have officially declared an emergency as pediatric behavioral health went through a crisis countrywide. Parents had pretty tough times getting support for pediatric behavioral health following the closure of clinics and shortage of pediatric-trained therapists. Digital health tools primarily developed for adult health care have been adapted to connect parents to trained child therapists to overcome geographical and pandemic-related barriers. Full article here: https://telehealth.org/pediatric-telemedicine-2/?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&smconv=5bc4c379-a4c1-484f-a411-33ec93777504&smlid=12&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

As 'telehealth cliff' Looms, Hundreds of Healthcare Orgs Urge Congress to Act Mike Miliard, Healthcare IT News July 2021 More than 400 healthcare and technology organizations are calling on Capitol Hill to eliminate arbitrary restrictions, while helping FQHCs and critical access hospitals offer wider access to virtual care. Leading healthcare industry stakeholders on Monday implored top leaders in the House and Senate to help ensure, among other imperatives, that "Medicare beneficiaries [don't] abruptly lose access to nearly all recently expanded coverage of telehealth." WHY IT MATTERS In a letter to Senate Majority Leader Chuck Schumer, House Speaker Nancy Pelosi, Senate Minority Leader Mitch McConnell and House Minority Leader Kevin McCarthy, 430 organizations – including the American Telemedicine Association, HIMSS (parent company of Healthcare IT News), Amazon, Amwell, Teladoc, Zoom, Epic, Allscripts, Kaiser Permanente, Mayo Clinic, Mass General Brigham, UPMC and many others – called on them to capitalize on the progress that's been made on telehealth before it's too late. If they don't act before the end of the COVID-19 public health emergency, the groups said, Medicare beneficiaries "will lose access to virtual care options which have become a lifeline to many." The groups also called on Congress to get rid of arbitrary restrictions on where patients can use telehealth services, remove limitations on telemental health services, authorize the Secretary of Health and Human Services to allow additional telehealth "practitioners, services and modalities," and help ensuring that federally qualified health centers, critical access hospitals, rural health centers and providers like them can can furnish telehealth services. Flexibilities enabled under the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act "have allowed clinicians across the country to scale delivery and provide all Americans – many for the first time – access to high-quality virtual care," the groups wrote," the groups said. "In response, health care organizations across the nation have dramatically transformed and made significant investments in new technologies and care delivery models, not only to meet COVID driven patient demand, but to prepare for America’s future health care needs. "Unfortunately, this progress is in jeopardy," they wrote. "Many of the telehealth flexibilities are temporary and limited to the duration of the COVID-19 public health emergency. Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 PHE ends. This would have a chilling effect on access to care across the entire U.S. healthcare system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health." Telehealth, these stakeholders argue, "is not a COVID-19 novelty, and the regulatory flexibilities granted by Congress must not be viewed solely as pandemic response measures. Patient satisfaction surveys and claims data from CMS and private health plans tell a compelling story of the large-scale transformation of our nation’s health care system over the past year and, importantly, demonstrate strong patient interest and demand for telehealth access post-pandemic." The letter notes that over the past year and half, virtual care has become ubiquitous, popular, efficient – and has helped address care disparities. One in four Medicare beneficiaries – 15 million – accessed telehealth between the summer and fall of 2020, and 91% of them said they were satisfied with their video visits. Some 75% oof Americans "now report having a strong interest in using telehealth moving forward," the letter notes. "Congress not only has the opportunity to bring the U.S. health care system into the 21st century, but the responsibility to ensure that the billions in taxpayer funded COVID investments made during the pandemic are not simply wasted but used to accelerate the transformation of care delivery, ensuring access to high quality virtual care for all Americans," the groups said. The letter calls on Congress to ensure HHS Secretary Xavier Becerra "has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services." In addition, it asks lawmakers to attend to four key priorities: 1. Remove Obsolete Restrictions on the Location of the Patient and Provider. Congress must permanently remove the Section 1834(m) geographic and originating site restrictions to ensure that all patients can access care where they are. The response to COVID-19 has shown the importance of making telehealth services available in rural and urban areas alike. To bring clarity and provide certainty to patients and providers, we strongly urge Congress to address these restrictions in statute by striking the geographic limitation on originating sites and allow beneficiaries across the country to receive virtual care in their homes, or the location of their choosing, where clinically appropriate and with appropriate beneficiary protections and guardrails in place. 2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and Modalities for Telehealth. Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, Congress should ensure that HHS and CMS maintain the authority to add or remove eligible telehealth services – as supported by data and demonstrated to be safe, effective, and clinically appropriate – through a predictable regulatory process that gives patients and providers transparency and clarity. Finally, Congress should give CMS the authority to reimburse for multiple telehealth modalities, including audio-only services, when clinically appropriate. 3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics Can Furnish Telehealth Services After the PHE. FQHCs, CAHs, and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act and through executive actions. Congress should ensure that FQHCs, CAHs, and RHCs can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers and better equip our healthcare system to address health disparities. 4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services Offered Through Telehealth. Without Congressional action, a new requirement for an in-person visit prior to access to mental health services through telehealth will go into effect for most Medicare beneficiaries. We urge Congress to reject arbitrary restrictions that would require an in-person visit prior to a telehealth visit. Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities by restricting access for those individuals with barriers preventing them from traveling to in-person care.15 Removing geographic and originating site restrictions only to replace them with in-person restrictions is short-sighted and will create additional barriers to care. THE LARGER TREND The concept of a "telehealth cliff" – an abrupt end to the progress made in expanding and enabling virtual care once the pandemic is finally over – has been of concern for some time. Since early 2021, an array of telehealth-focused bills have been introduced in the House and Senate, but the major concerns outlined in the July 26 letter are still outstanding and yet to be addressed by statute. ON THE RECORD "With 430 stakeholders in lockstep, and unprecedented bipartisan support for these legislative priorities, we urge Congress to act swiftly to ensure that telehealth remains permanently available following expiration of the public health emergency," said Kyle Zebley, VP of public policy at the American Telemedicine Association in a statement. "The ATA remains committed to working collaboratively to ensure Medicare beneficiaries can continue to access care when and where they need it." “Evidence-based connected care has been at the core of our nation’s health resiliency throughout the COVID-19 pandemic and has established its important role in improving healthcare quality, access, and value for all Americans," added Rob Havasy, managing director of the Personal Connected Health Alliance. "HIMSS and PCHAlliance urge Congress to swiftly act to make the Medicare coverage changes permanent, to give patients and providers access to the tools they need and deserve." < 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 >

Celebrating 2021 National Rural Health Day Southwest Telehealth Resource Center Dec. 1, 2021 Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. This webinar streamed live to a national audience on November 15th and the recording and presentation slides are available at: https://telemedicine.arizona.edu/webinars/previous for on-demand playback. Each year the National Organization of State Offices of Rural Health selects a Community Star from each of the 50 states. The 2021 Community Star report, https://en.calameo.com/read/0045723395dc12ef8ac48, includes stories of how each Community Star is working to improve life in their rural community. Congratulations to all of the 2021 Community Stars! Matthew Probst, PA-C Chief Quality Officer and Medical Director El Centro Family Health Mathew Probst is the Chief Quality Officer and Medical Director for a Federally Qualified Health Center located Northeast of Albuquerque, New Mexico. Under his leadership, Mr. Probst was able to implement initiatives at the start of the pandemic which resulted in his county having one of the lowest fatality rates and one of the highest vaccination rates in the county. Read more about why Mr. Probst was featured in an award-winning documentary named The Providers: https://en.calameo.com/read/0045723395dc12ef8ac48 < Previous News Next News >

Studies Show How Telehealth Can Increase Equitable Access to Care Center for Connected Health Policy May 24, 2022 Focus on the relationship between telehealth and disparities in access to care continues to result in new research examining pandemic era data and the use of telehealth among disadvantaged populations. While policymakers and studies often try to put findings into two groups, whether telehealth increases or decreases inequities, recent research shows that the study framework used and considerations made may impact outcomes more so than telehealth itself. For instance, this month a new study published in Health Affairs found that as a result of emergency federal telemedicine coverage expansions access increased for all Medicare populations, including those in the most disadvantaged areas. The study was framed to examine the impact of expanded telehealth coverage policies on different populations, rather than looking at access generally where inequities have unfortunately always existed. Comparing pre-COVID temporary waiver data with post-waiver implementation data, the authors discovered that the highest odds of utilization were among those in disadvantaged and metropolitan areas. As reported in a Managed Healthcare Executive article on the study, the Johns Hopkins researchers concluded that the results suggest that increased Medicare telemedicine coverage policies improve access to underserved populations without worsening disparities. An additional study just published in Telemedicine Journal and e-Health and covered in a healthleaders article showed that a virtual care program at Penn Medicine is reducing barriers to access specifically for Black patients and eliminating historic disparities. The authors looked at approximately one million appointments per year in both 2019 and 2020 for Philadelphia area patients and found that Black patients used telehealth more than non-Black patients and that appointment completion gaps between Black and non-Black patients closed. Also recently released, the National Committee for Quality Assurance (NCQA) produced a white paper titled The Future of Telehealth Roundtable: The Potential Impact of Emerging Technologies on Health Equity, which focuses on how to ensure telehealth increases equitable access to care. Following up on its previous pandemic telehealth work, in late 2021 NCQA pulled together a multidisciplinary panel of equity and technology experts for a discussion on equitable access and virtual health care delivery. Reviewing hypothetical case studies and responding to various questions, participants highlighted potential challenges and identified three primary ways to ensure equitable access in telehealth delivery: Tailoring Telehealth Use and Access to Individual Preferences and Needs Addressing Regulatory, Policy and Infrastructure Barriers to Fair Telehealth Access Leveraging Telehealth and Digital Technologies to Promote Equitable Care Delivery The white paper suggests the need to prioritize language and cultural humility, address digital literacy, and optimize telehealth for people with disabilities. In addition, in terms of barriers, the authors stress the need to address broadband infrastructure and licensure limitations, while also updating laws and regulations that restrict telehealth use, including payment policies. Another Health Affairs article published this month, Policy Considerations to Ensure Telemedicine Equity, also looked at various factors that must be taken into account to allow telehealth to increase equitable access to care. The author clarifies that equity is a matter beyond telehealth and is related to patient-level barriers that include family, community, and general health care delivery level factors, such as issues related to the digital divide. In addition, the article cautions against policies focusing on increased utilization concerns, stating that increased use may mean that patients are finally attaining the care they need, in addition to the fact that increased access may reduce overall health care costs. Therefore, policies seeking to reduce reimbursement or limit audio-only modalities to address utilization and cost concerns may instead primarily reduce clinicians’ willingness to offer telehealth and modalities that mitigate access barriers for historically excluded groups. The article also highlights how varying payer policies, such as those that allow reimbursement for telehealth visits with new patients versus those that do not, creates inequities, and that differing medical licensing and/or prescribing regulations by state can create inequitable access issues on top of differing coverage policies. These policy considerations are key to ensuring telemedicine mitigates inequities rather than exacerbates them. While the pandemic generally has highlighted and exacerbated existing inequities, it has also provided the information necessary to show telehealth’s ability to address disparities and increase equitable access to care. It is important that policymakers take such findings and opportunities from studies on telehealth equity into account when looking to potentially make pandemic policies permanent in order to properly preserve telehealth’s positive impacts. It is also important that the framework used in the study be placed in context to help explain why some research speaks to telehealth disparities, or health care disparities, versus how telehealth is decreasing health care disparities. As shown in the aforementioned studies and articles, the difference in framing showcases that telehealth in and of itself does not create or exacerbate disparities, rather it is a tool that can be utilized to decrease disparities in access to care. The tool has to be allowed to be effective, however, and that is where the role of public policy comes in. Policies must support broadband and telehealth infrastructure and promote the use of technology to deliver care equal to the delivery of in-person care. For instance, Medicaid policies that limit when telehealth can be used and/or certain allowable modalities can create inequities in comparison to more expansive commercial policies that guarantee better telehealth access to non-Medicaid patients. Therefore, policymakers must recognize that regulatory restrictions around telehealth cannot prevent already existing general access disparities, rather it is often the regulatory restrictions around telehealth that lead to exacerbating disparities. It becomes vital that research be put into context so that subsequent policies are implemented that allow telehealth to reach its full potential to reduce disparities. For full article: https://mailchi.mp/cchpca/the-latest-telehealth-research-studies-show-how-telehealth-can-increase-equitable-access-to-care < Previous News Next News >

Libraries Add Telehealth to the Rural Communities They Serve Mari Herreras October 20, 2022 In the early days of the Covid pandemic, Dianne Connery realized something needed to be done for people in her rural Texas community to help connect folks to their medical appointments. Connery, director of the Pottsboro Area Library in Pottsboro, Texas, said it started when one woman with pulmonary disease came to the library for help, desperate to meet with her doctor but too high risk to come to his office—a two-hour drive south to Dallas. “Libraries are such perfect places for this because often we have the fastest internet in town, and we are used to helping people with technology,” Connery said. Connery and her fellow librarians sprang into action—creating a private space in Connery’s office with her laptop that had a camera. That gesture allowed the woman to meet with her doctor and go over recent MRI results. “I had never lived in a rural town until 2010 and didn’t realize how hard it is to access digital technology. You need a solid infrastructure for robust internet. Rural communities like ours don’t have that,” she said. From that first telehealth appointment in Connery’s office grew the library’s telehealth program that’s received national recognition. However, it never would have happened without Connery, with support from the town council, having fiber installed to support a teen eSports program long before the start of the pandemic. More community members used Connery’s office those early telehealth appointments, but through a National Library of Medicine grant and a community appeal, she was able to create a private appointment space from an old junk room and purchase the needed hardware and equipment. The next step was a unique partnership she developed with the University of North Texas Health Sciences Center to pair patients with the medical providers they needed. People can be seen two days a week for those using Medicare and Medicaid. Another day of the week is reserved for behavioral health appointments and another day is reserved for folks seeing their regular health providers. Connery’s work on the telehealth program doesn’t end there. The American Heart Association recently provided her library with blood pressure kits members of the community can check out. They also received a grant to hire a community health care worker to do outreach and education at the library and community spaces like the American Legion and the VFW. Now she’s focused on developing a digital literacy curriculum with the help of a three-year grant that helped her hire a digital navigator. Connery said she’s excited to see other rural libraries in Texas start telehealth programs but hopes more funding loops back to libraries desperate for increases in their own budgets. Connery is part of a national consortium of libraries who meet monthly to discuss telehealth programming—a growing interest in other rural communities beyond her Texas borders. Last month, a new telehealth program recently launched at two rural Pima County Library branches in Ajo and Arivaca—the first of its kind in Arizona—allowing folks with transportation or internet issues access to their doctors without having to drive several hours across the desert to nearby Tucson. “A huge sense of relief,” is how one Ajo resident recently described her experience that helped her connect with her primary care doctor in Tucson about worrisome symptoms she experienced after recovering from Covid. At the Salazar-Ajo Library she was able to collect the vitals her doctor needed using equipment provided by the library. And in the privacy of the library’s meeting room, she met with her doctor via a laptop and the internet provided by the library to go over her symptoms and vitals. “Being able to take my vitals and provide those to my doctor seems really important,” the Ajo resident said. “… while I was on my call with her, she had me do my vitals. We started with the blood pressure cuff, and how to apply it. Then my oxygen with the pulse rate oximeter.” The end of the appointment her doctor determined that the symptoms were not uncommon for someone who has had Covid, allowing the Ajo resident some relief and a better understanding of her recovery. Daniela Buchberger, Pima County Library’s Ajo branch managing librarian, said the new program, Health Connect, provides a private room for telehealth medical appointments. Inside is a laptop with a camera and equipment needed for a patient to take their own vitals: a digital scale, a thermometer, a blood pressure cuff, and a pulse rate oximeter. A patient will need to have the link provided by their doctor, usually via email. Library staff, due to privacy restrictions, aren’t going to be able to help someone log-on or use the equipment although the patient can bring someone with them to their appointment in the study room. Each library has written instructions on laminated cards as well as easy-to-follow visuals to help guide their experience. According to the Pima County Library, Health Connect is made possible by the Arizona State Library, Archives, and Public Records, a division of the Secretary of State, with federal funds from the Institute of Museum and Library Services. It is a joint effort between the Library, Pima County Health Department, University of Arizona’s College of Nursing, the Arizona Telemedicine Program, and United Community Health Care. "Access to telehealth is essential for people to get the care they need when traveling to an in-person visit isn't possible,” said Ken Zambos, program manager for Workforce and Economic Development in Pima County. “By providing this service, the library is providing access to equipment that transforms healthcare delivery and positively affects healthcare outcomes." Buchberger said a library card isn’t needed to use the room. However, reservations are needed and available in hour and half increments. Each person using a room is expected to clean all equipment after use with alcohol wipes provided. A fan in the room will be used to provide white noise to help with privacy as much as possible. “We may not have as much traffic as other libraries, but we are an important part of the community. The library is free, so is the internet,” Buchberger said. “Not everyone here has a car or a computer, but they have us.” About the Author Mari Herreras is the newest member of the Arizona Telemedicine Program and Southwest Telehealth Resource Center teams, serving as Communications Manager. She has worked in marketing and communications in publishing and nonprofits, as well as an award-winning journalism career for community and alternative newsweeklies in Tucson, Los Angeles, Seattle, and Wenatchee, Washington. See original article: https://southwesttrc.org/blog/2022/libraries-add-telehealth-rural-communities-they-serve < 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 >