New Study Pitches Telehealth as Safer Than the Doctor’s Office Eric Wicklund, mhealthintelligence August 2021 In a nod to the value of telehealth in primary care, researchers have found that a person visiting the doctor's office shortly after a visit from someone with the flu has a much higher chance of getting the flu as well. A new study makes a strong case for telehealth as an alternative to the doctor’s office, particularly during flu season. Researchers from the University of Minnesota School of Public Health, Harvard Medical School and the university’s T.H. Chan School of Public Health and athenahealth have found that people who visit their doctor’s office after someone infected with the flu has visited that office are much more likely to come down with the flu themselves. That same increase wasn’t seen in people seeking treatment for issues like urinary tract infections. The study, published this month in Health Affairs, suggests that primary care providers embrace virtual visits as a means of reducing that chance of infection. “It’s a widely accepted fact that patients can acquire infections in hospital settings, but we show that infection transmission can happen when you visit your doctor’s office, too,” Hannah Neprash, an assistant professor at UM’s School of Public Health and one of the study’s authors, said in a news release issued by the university. “Our findings highlight the importance of infection control practices and continued access to telemedicine services, as health care begins to return to pre-pandemic patterns,” she added. "In-person outpatient care for influenza may promote nontrivial transmission of these viruses. This may be true for other endemic respiratory illnesses too, including COVID-19, but more research is needed." The study, which tracked office visits from a national sample of insurance claims and EHR data compiled by athenahealth, is reportedly the first to connect the dots between office visits and the progression of a flu outbreak. According to that data, patients visits their primary care provider were almost 32 percent more likely to contract the flu within two weeks if that PCP had seen someone with the flu within the previous two weeks. In addition, that office would then serve as an incubator for the flu, infecting more patients over time. Neprash and her fellow researchers say their study supports the need for “triage to telemedicine” policies in clinics and medical offices when a patient shows signs of a contagious viral infection like the flu. “Given that upper respiratory symptoms are among the most common reasons for any patient to see a physician, these results highlight the importance of protocols to mitigate the risk for transmission,” the study notes. “Clinically, many of these patients will be at low risk for complications with telemedicine evaluation.” It also suggests that care providers develop “strict infection control practices” whenever a patient showing signs of the flu or a similar virus need to be seen in person. This would include mask-wearing, hand hygiene and putting patients in separate exam rooms that can be decontaminated after a visit. Finally, the study makes a case for continued support for telehealth coverage at a rate equal to in-person care. “Lawmakers in Congress are actively debating the future of telemedicine policy and how it should be reimbursed after the worst of the COVID-19 pandemic recedes,” the study notes. “It is possible that telemedicine reimbursement after the pandemic will be restricted to certain specialties or diagnoses or reimbursed at a rate low enough that many clinicians decide to forgo telemedicine as a mechanism for care delivery. Our results argue that clinically, for infection control, telemedicine should remain a financially viable option for clinicians to provide care for viral respiratory symptoms. < Previous News Next News >

A Decade of Telehealth Policy: A New Report From CCHP Mei Kwong- Center for Connected Health Policy August 2022 Ten years ago, in the early months of 2012, the Center for Connected Health Policy (CCHP) faced a decision of potentially great significance. The U.S. Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORPH) Office for the Advancement of Telehealth (OAT) had released a Funding Opportunity Announcement for their Telehealth Resource Center Grant Program and the incumbent contractor for the National Telehealth Resource Center for Policy (NTRC-P) contract would not be reapplying. After weighing the pros and cons of acting as the NTRC-P, CCHP decided to take the plunge and applied. On September 1, 2012, CCHP officially started its work as the federally designated National Telehealth Policy Resource Center and have been serving that role for the past decade. To mark CCHP’s ten-year anniversary as the NTRC-P, we are releasing a look back on telehealth policy in the United States. For the past decade, CCHP has tracked and followed policy development for all 51 jurisdictions in the United States (District of Columbia included) as well as at the federal level providing us with the unique opportunity to observe and study the development of telehealth policy in the United States on both the state and federal levels. This past decade also happens to be the period that encompasses some of the most significant telehealth policy developments seen thus far in the United States. The report is not intended to be an in-depth study on telehealth policy development and history as that could easily be an entire novel given the complexities and nuances that would need to be considered. The National Telehealth Resource Center for Policy Ten-Year Anniversary Report is intended to capture some of the highlights, significant changes, and environmental factors that have had an impact on telehealth policy development in the nation. Considering the increased interest in telehealth policy, CCHP believes this report also will be useful to provide context on how telehealth policy came to be where it is today, particularly for those who may be newer to the field. Additionally, the report is meant to be a celebration of the time CCHP has spent as the NTRC-P including the contributions the organization has made to the telehealth field. This report is dedicated to the memory of Mario Gutierrez, CCHP Executive Director from 2011-2017. Mario was the original visionary who decided in 2012 that CCHP should apply for the project. A special thank you must also be extended to CCHP staff, both past and present, who have truly been the engine that continues to drive the work of the organization forward. Special acknowledgment must be made of Laura Stanworth, Deputy Director, and Christine Calouro, Senior Policy Associate, both who have been with CCHP from the beginning of its role as the NTRC-P and who, along with myself, have seen this past decade of telehealth policy development, including producing all information and navigating CCHP through those first few months of the COVID-19 pandemic. We hope you will enjoy this report and find the information useful. CCHP looks forward to continuing on the ever evolving telehealth policy journey with all of you. See full report: https://mailchi.mp/cchpca/a-decade-of-telehealth-policy-our-10-year-anniversary-report < Previous News Next News >

Supreme Court Limits Medication Abortion via Telehealth Center for Connected Health Policy April 2021 Last month the U.S. Supreme Court reinstated a U.S. Food and Drug Administration (FDA) rule that requires in-person visits for patients seeking medication abortion, eliminating patient access to the abortion pill mifepristone via telehealth. Last month the U.S. Supreme Court reinstated a U.S. Food and Drug Administration (FDA) rule that requires in-person visits for patients seeking medication abortion, eliminating patient access to the abortion pill mifepristone via telehealth. Last summer, a federal district court decision suspended the FDA rule during the pandemic, allowing providers to mail the pill to patients after a telehealth visit. While a recent study showed no difference in safety and efficacy, the ruling reignited political controversy around the subject of abortion and medication abortion in particular, leading the Trump Administration to request the reversal. The lower court ruled that the in-person requirement “imposed a ‘substantial obstacle’ to abortion care that is likely unconstitutional” however, in his concurrence, Chief Justice John Roberts stated that the issue was not related to constitutionality, but whether the lower court had the authority to remove the restriction due to their own determinations related to the risks of COVID-19, when they should defer to entities with the appropriate “background, competence, and expertise to assess public health.” Justice Sonia Sotomayor and Justice Elena Kagan dissented the decision, stating that it places patients at risk, particularly minority and low-income populations, and puts “an unnecessary and undue burden on their right to abortion.” Advocacy groups, providers, and policymakers are now requesting that the Biden Administration remove the previous Administration’s policy and FDA restriction. Meanwhile, even if the federal in-person requirement is removed, 19 states have their own in-person requirements, which will continue to prohibit the ability to provide medication abortion via telehealth. < Previous News Next News >

The Data Challenge to Prove Telehealth’s Importance Continues Jan Ground, PT, MBA November 17, 2022 A group of telehealth leaders from 18 states worked the past two years on proving the value of telehealth with data to convince payors and legislators that continuing reimbursement post-COVID 19 is the right thing to do. Over the course of two years, 40 people, including five physicians, four nurses, four other clinicians, and 27 telehealth leaders in provider organizations, contributed to the effort. The group chose to focus initially on video visits for those in need of mental health care. We succeeded in step one: we surveyed 16 mental health provider organizations to find out what data they were collecting, and how success was being measured in 2020. The organizations ranged from large university medical centers to private practices in nine states. Not surprisingly, the data and metrics varied widely, even across large university-based systems. For example, in response to the question “What, if anything, is being measured regarding clinical outcomes?” Four organizations reported no clinical outcomes measurements Four organizations used a wide variety of validated and commonly used clinical outcome metrics: PHQ-9 (used by 3 of 4 ) Patient Health Questionnaire (columbia.edu) GAD7 (used by 2 of 4) GAD-7 (General Anxiety Disorder-7) - MDCalc BASIS-24 (use) BASIS-24® — eBASIS ACES ACE.pdf (odmhsas.org) Adverse Childhood Experiences Study EDE-Q PDFfiller - ede q online(1).pdf (uslegalforms.com) Eating Disorder Examination Questionnaire OCI-R Obsessive Compulsive Inventory - Revised (OCI-R) (psychology-tools.com) SF-12 The SF-12v2 PRO Health Survey (qualitymetric.com) Short Form Health Survey BAI beck-anxiety-inventory.pdf (jolietcenter.com) EDE-Q ede-q_quesionnaire.pdf (corc.uk.net) Eating Disorder Examination Questionnaire EDY-Q Microsoft Word - Hilbert, van Dyck_EDY-Q_English Version_2016 (harvard.edu) Eating Disorders in Youth Questionnaire McMaster Family Assessment Device STAI-C-S State-Trait Anxiety Inventory for Children (STAI-CH) - Assessments, Tests | Mind Garden - Mind Garden State Trait Anxiety Inventory – Child Version – State only DERS Difficulties in Emotion Regulation Scale (DERS) (novopsych.com.au) PCL-5 PTSD Checklist for DSM-5 (PCL-5) - Fillable Form (va.gov) Post-traumatic Checklist In another question on cost savings, the survey question was “What, if anything, is being measured regarding cost savings?” 13 organizations reported no cost savings measurements Two of the three organizations reported savings measurements shared the following metrics (video visits vs in person visits) Handouts, parking vouchers, meal vouchers In person clinicians paid salary, video visit clinicians paid per hour, Future: space cost savings (video visit clinicians providing care from home) In our next effort we wanted to add payor leaders or legislators to join the conversation to determine which, if any of the metrics being used and data being collected, might convince them to support continued reimbursement post-COVID 19. The 40 participants were all associated with provider organizations with insufficient connections with payors/legislators to successfully bring them into the conversation. The group took a break and then decided on a new approach. We came up with what we THINK would be most important to payors/legislators, based on our understanding of what drives their success. Here’s the list: Compare the following data for specific groups of mental health patients (e.g., based on location, disorder, gender, age, first time vs return patients, newly diagnosed vs existing patient, prior telemedicine use, other relevant demographics, and characteristics), with or without access to care by video: number of ED visits number of hospitalizations suicide rates survey results that measure mental health status using validated tools (e.g., PHQ9) timing to access -(i.e., length of time to get patients in front of provider for first visit) provider and patient satisfaction and retention (i.e., remain in care) Interestingly, I have since learned that, in fact, there are many data sources on these topics with many peer-reviewed articles based on well-controlled studies. That leads me to a different question: Why were none of the 40 participants, including me, aware of these data sources and how to access them? It perhaps has its roots in the type of data available. Much of the data available comes from academic institutions reporting on research studies and publishing in peer-reviewed journals. These can be readily found through a PubMed or Google Scholar search using appropriate search terms (e.g., telemental health, outcomes, cost) but if one is unfamiliar with conducting this type of search these articles will not be available to review. Other sources of information include websites of the professional societies of which the providers are members (e.g., American Psychiatric Association) and government websites (e.g., Substance Abuse and Mental Health Services Administration, but one has to know about these before they can be searched. Finally is the fact that although many healthcare systems and funders collect data, they use these data for internal purposes only and simply do not publish or share them. We are currently in search of a few provider organizations interested in/willing to collect some of these data. We have not had success. If you are interested in joining this collaborative effort, please contact me at: janground@gmail.com https://www.linkedin.com/in/jan-ground-3089742/ A new thought is to focus on a current hot topic in the US, such as COVID 19, to identify data to prove (or not!) the value of care by video. Perhaps we could find an organization willing to provide some funding to more likely successfully identify organizations willing to collect the data. It should not have to be this hard! About the Author Jan Ground PT, MBA, led innovation and virtual care at Kaiser Permanente Colorado, where she worked for 18 years. She is the Colorado Liaison to the Southwest Telehealth Resource Center and the Colorado Ambassador to Telehealth and Medicine Today, an online peer-reviewed journal. Active in the American Telemedicine Association, Jan leads a group looking to prove, with data, that telehealth is worth paying for. Jan’s expertise is in leading change, and in clearly defining a problem before implementing a new approach to care. Her greatest passion is to lower the cost of the American healthcare system without lowering clinical outcomes. See original article: https://southwesttrc.org/blog/2022/data-challenge-prove-telehealth-s-importance-continues < Previous News Next News >

Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes The National Law Review August 6, 2022 - Volume XII, Number 218 On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2023 Medicare Physician Fee Schedule (PFS) rule. The rule, if enacted as proposed, will: 1. Create three new permanent telehealth codes for prolonged E/M services; 2. Discontinue reimbursement of telephone (audio-only) E/M services; 3. Discontinue the use of virtual direct supervision; 4. Postpone the effective date of the telemental health six-month rule until 151 days after the PHE ends; 5. Extend coverage of the temporary telehealth codes until 151 days after the PHE ends; and 6. Add 54 codes to the Category 3 telehealth list. Reading between the lines, the nature of CMS’ comments and the changes it proposed (and refused to propose) suggest that CMS rulemakers anticipate the Public Health Emergency (PHE), and associated PHE waivers, will expire no later than the first half of 2023. Three New Telehealth Codes for Prolonged E/M Services: This year, CMS rejected all stakeholder requests to permanently add codes to the Medicare Telehealth Services List. Following its standard evaluation process for such requests, CMS considered whether they met appropriate categories. Category 1 services must be “similar to professional consultations, office visits, and/or office psychiatry services that are currently on the Medicare Telehealth Services List.” Category 2 services require “evidence of clinical benefit if provided as telehealth” and all necessary elements of the service must be able to be performed remotely. CMS rejected this year’s requests because none of the proposed services (e.g., therapy, electronic analysis of implanted neurostimulator pulse generator/transmitter, adaptive behavior treatment and behavior identification assessment codes) met the requirements of Category 1 or 2 services. Interested stakeholders can collect and submit better evidence to persuade CMS to add these codes on a Category 1 or 2 basis next year (submissions are due by February 10, 2023). Although it rejected stakeholder-submitted codes, CMS itself proposed three new codes to be added to the Medicare Telehealth Services list on a permanent basis: • GXXX1 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). • GXXX2 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). • GXXX3 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services). CMS added these codes because they are similar to current CPT codes 99356 and CPT 99357 and HCPCS code G2212, all listed on a permanent basis. Discontinue Reimbursement of Telephone (Audio-Only) E/M Services Under PHE waivers, CMS allowed separate reimbursement of telephone (audio-only) E/M services (CPT codes 99441-99443), something that was embraced by a sizeable cohort of practitioners and patients, particularly in rural areas or patients without suitable broadband access for audio-video. CMS rejected requests to permanently add these services to the Medicare Telehealth Services List. With the exception of certain telemental health services, CMS stated two-way interactive audio-video telecommunications technology will continue to be the Medicare requirement for telehealth services following the PHE. This is because Section 1834(m)(2)(A) of the Social Security Act requires telehealth services be analogous to in-person care by being capable of serving as a substitute for the face-to-face encounter. In CMS’ own language, “We believe that the statute requires that telehealth services be so analogous to in-person care such that the telehealth service is essentially a substitute for a face-to-face encounter.” As audio-only telephone is inherently non-face-to-face, CMS determined, that modality fails to meet the statutory standard. Therefore, 151 days after the PHE expires, audio-only telephone E/M services will revert to their pre-PHE “bundled” status under Medicare (i.e., covered but not separately payable). Practitioners will no longer receive separate reimbursement for these services. Discontinue the Use of Virtual Direct Supervision Under Medicare Part B, certain types of services (e.g., many diagnostic tests, services incident to physicians’ or practitioners’ professional services) must be furnished under the direct supervision of a physician or practitioner. For Medicare purposes, direct supervision requires the supervising professional to be physically present in the same office suite as the supervisee, and immediately available to furnish assistance and direction throughout the performance of the procedure. The supervising professional need not be present in the same room during the service, but the “immediate availability” requirement means in-person, physical - not virtual - availability. In connection with PHE waivers, CMS temporarily changed the direct supervision rules to allow the supervising professional to be remote and use real-time, interactive audio-video technology. That change did not require the professional’s real-time presence at, or live observation of, the service via interactive audio-video technology throughout the performance of the procedure. This change was temporary because CMS was concerned widespread direct supervision through virtual presence may not be safe for some clinical situations. In its proposed PFS rule, CMS rejected requests to make virtual direct supervision a permanent feature in Medicare. CMS is considering whether or not it should make virtual direct supervision a permanent feature of Medicare at some point in the future. Interested stakeholders with data are invited to submit comments and information to CMS on this topic. If the proposed rule is finalized, virtual direct supervision will expire at the end of the calendar year in which the PHE ends. If the PHE ends in October 2022, the supervision waiver will end December 31, 2022. If the PHE ends in January 2023, the supervision waiver will end December 31, 2023. Postpone the Effective Date of the Telemental Health Six-Month Rule Until 151 Days After PHE Ends In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person exam requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met: The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service; The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service. For a full understanding of the rule, read the frequently asked questions and what it means for practitioners at Medicare Telehealth Mental Health FAQs. This rule was originally scheduled to take effect the day after the PHE expires. Following an amendment to the rule, it is now set to take effect 151 days after the PHE expires. Extend Coverage of the Temporary Telehealth Codes Until 151 Days After the PHE Ends Temporary telehealth codes are those services added to the Medicare Telehealth Services List during the PHE on a temporary basis, but which were not placed into Category 1, 2, or 3. Coverage of those temporary telehealth codes had been scheduled to end when the PHE expires. In its proposed PFS rule, CMS states it will extend coverage of those temporary telehealth codes until 151 days after the PHE ends. CMS is doing so for consistency with the Consolidated Appropriations Act, 2022 (CAA). CMS stated this extension may simplify the post-PHE transition by applying the same coverage end date to all the various waiver-related telehealth codes in a hope to reduce billing errors. Note, the Category 3 codes are set to expire December 31, 2023, while the other temporary telehealth codes are set to expire 151 days after the PHE ends. This means, under the proposed rule, if the PHE ends after August 2023, the Category 3 codes would expire before the temporary telehealth codes. If finalized, health care providers would need to keep a careful eye on the calendar to ensure billing practices keep up with the various sunset dates. Add 54 Codes to the Category 3 Telehealth List CMS’ Category 3 list contains services that likely have a clinical benefit when furnished via telehealth, but lack sufficient evidence to justify permanent coverage. CMS proposed adding 54 codes to that Category 3 list. The services fall into nine categories: (1) therapy; (2) electronic analysis of implanted neurostimulator pulse generator/transmitter; (3) adaptive behavior treatment and behavior identification assessment; (4) behavioral health; (5) ophthalmologic; (6) cognition; (7) ventilator management; (8) speech therapy; and (9) audiologic. The complete list can be found at this link. Keep in mind, these codes will expire December 31, 2023.Category 3 codes were originally slated to expire at the end of the year in which the PHE ends, but CMS extended coverage of those codes through December 31, 2023. In this year’s proposed PFS rule, CMS declined any further extension, so all Category 3 codes will expire at the end of 2023. In the event the PHE extends well into 2023, CMS said it will consider a further extension of the Category 3 codes at that time. What to Do Next? Providers, facilities, technology companies, and virtual care entrepreneurs interested in changes to the telehealth codes for 2023 should consider providing comments to the proposed rule. CMS is soliciting comments on the proposed rule until 5:00 p.m. ET on September 6, 2022. Anyone may submit comments – anonymously or otherwise – via electronic submission at this link. Alternatively, commenters may submit comments by mail to: Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, P.O. Box 8016, Baltimore, MD 21244-8016. Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 If submitting via mail, please be sure to allow time for comments to be received before the closing date. For original article: https://www.natlawreview.com/article/medicare-telehealth-services-2023-cms-proposes-substantial-changes < Previous News Next News >

Configuring Virtual Care to Boost Pediatric Healthcare Quality, Access eVisit December 12, 2022 Virtual care can be a boon for pediatric patients and providers alike, but the key to a successful program lies in selecting and implementing the right technology. The rise in virtual care use has spurred greater access to healthcare, enabling providers to meet patients where they are. In the case of healthcare's youngest consumers, virtual care has not only helped mitigate barriers to care but also enhanced care delivery. Pediatric patients, like their adult counterparts, used virtual care in droves during the COVID-19 pandemic. One 2021 survey shows that one in five parents said their child had a virtual visit in the past year. Further, virtual care gained popularity among parents. Another survey showed that more than 60 percent of parents said they would want to continue using virtual modalities for their child's care after the pandemic, including almost 30 percent who hadn't used it previously. As a result, healthcare providers are increasingly implementing virtual care services for their pediatric populations. But selecting the right technology, and streamlining its implementation, are essential to ensuring the success of virtual pediatric care programs. BENEFITS OF PEDIATRIC VIRTUAL CARE PROGRAMS Virtual care offers pediatric patients and their providers a myriad of benefits, including expanded access to care. Many pediatric specialists treat patients across multiple states with facilities managing large patient populations. Children with chronic illnesses often have to take time out of school to see a specialist, while their parents or guardians have to take time off work. In addition, care providers may have trouble traveling to rural communities to provide care, taking unaffordable time away from the office for long periods as they care for individual patients across regions. "Virtual care not only increases efficiency but impacts access to care in ways in-person care cannot. It has helped those who don't have access to transportation, especially in the middle of the night," says Jacquelin Solomon, Implementations Project Manager at eVisit, a telemedicine solutions provider. "A parent with a sick child being able to have increased access to care — that's a huge thing that virtual care services provide now." Telehealth has been especially useful in unlocking access to specialty care for children, such as speech therapy and behavioral health services. Before the COVID-19 pandemic, many specialty care providers didn't consider virtual care a viable option to provide care, according to Jackie Thomas, Enterprise Customer Success Manager at eVisit. But following the widespread use of virtual care during the public health emergency, providers found that it can, in fact, improve care quality, particularly for children with special needs. For instance, a 2022 pre-and post-data analysis showed wrap-around virtual care programs for children and adolescents with medical complexity demonstrated a statistically significant reduction in hospitalizations and ED visits. Virtual care can also be beneficial for providers to virtually observe an autistic child in their home environment where they are most comfortable and can best demonstrate their routine to develop an appropriate treatment plan, she adds. Further, virtual care supports pediatric care providers in several ways, including by boosting operational efficiency and clinician productivity. Care coordination, education, parental support, and care triage, in particular, become easier with virtual care, Solomon and Thomas note. KEY CONSIDERATIONS WHEN SELECTING TELEHEALTH TECHNOLOGY To ensure the success of a pediatric virtual care program, healthcare providers must select the right technology. One key factor to consider is the configurability of the platform. "You do not want your highly compensated providers trying to figure out all the nooks and crannies of a platform that isn't configured and designed to their workflow," says Jason Weinrich, Senior Director of Professional Services at eVisit. Configuring the platform to clinical workflows — rather than adjusting workflows to the platform's capabilities — can support provider adoption and continuity of care. "Having that ability to quickly access the visit from their schedule, see a patient, hand off the patient to another clinician, like a nurse educator, all from one virtual care platform allows for continuity of care," Thomas states. "It also prevents burnout for the provider by allowing an MA to support rooming the patient and the entire clinical team to work at the top of their license." Additionally, customizing virtual care platforms can allow clinicians to address social determinants of health specific to the pediatric populations they serve. For instance, adding translation services to the platform can help providers engage with patients with limited English proficiency. "Providing access to these patient populations and allowing them to have the whole platform translated into Spanish increases patient satisfaction as well as adherence to care plans for non-English speaking pediatric patients and their parents or caregivers," says Solomon. Another critical consideration is whether the virtual care platform integrates into the provider's EHR, which can further streamline workflows, eliminate redundant and duplicative tasks, and increase proper visit documentation, freeing up providers for patient care, she adds. Ultimately, pediatric virtual care programs have the best chance for success when the selected technology meets the health system’s specific needs. The only way to ensure this is through detailed conversations between vendors and clinical leaders. "Clinical leaders need to have a conversation with vendors about what workflows look like with their solution, discussing what their clinical teams are doing every day, and where the pain points are,” says Weinrich. “Vendors should be able to recommend solutions to accommodate clinical workflows across multiple specialties, supporting both scheduled and on-demand visits. Bringing that insight into the conversation as opposed to just giving you their out-of-box product is key. Build that box together." BEST PRACTICES FOR IMPLEMENTATION Implementation of virtual care that supports the digitization of pediatric care requires significant efforts to ensure new care models do not inadvertently exacerbate inequities in care. Deciding on a comprehensive project plan is the first step. Platforms should be configurable to align with established workflows while also offering innovative ways to enhance workflows for greater efficiency. Then, there needs to be discussions around platform education and adoption strategies. Vendors should partner with the health system’s training teams to ensure a successful rollout. Health systems must then walk through the workflows before putting them into action. Having your providers test everything and offer real-time feedback before going live can prevent future issues. In this way, providers can ensure that the technology will power their pediatric virtual care programs and provide the necessary flexibility as virtual care preferences shift. "You want to adjust quickly because the market's adjusting quickly because patients enjoy the access virtual care gives them," Weinrich said. "It's exciting; we see our health system clinical teams getting very excited about jumping on, doing quick testing with us to make sure things work. They are excited too about where virtual care is headed." Though virtual care use has leveled off since its peak in the early months of the pandemic, virtual care has become an integral part of the healthcare delivery model. As pediatric providers optimize their programs, the right technology can go a long way toward widening access and improving the healthcare experience for patients and their families. ___________________________________ About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/configuring-virtual-care-to-boost-pediatric-healthcare-quality-access < Previous News Next News >

New SAMHSA Telehealth Guide: Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders Center for Connected Health Policy June 2021 Telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth The Substance Abuse and Mental Health Services Administration (SAMHSA) and its National Mental Health and Substance Use Policy Laboratory recently released a new evidence-based resource guide titled, Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders, to support implementation of telehealth across diverse mental health and substance use disorder treatment settings. The guide examines the current telehealth landscape, including evidence on effectiveness and examples of programs that have integrated telehealth modalities (live-video, telephone, and web-based applications) for the treatment of serious mental illness (SMI) and substance use disorders (SUDs). Also included is guidance and resources for evaluating and implementing best practices which are presented across a continuum of services, such as screening and assessment, treatment, medication management, care management, recovery support, and crisis services. The report speaks to how telehealth is known to improve access to care during emergencies and in rural and underserved areas, but stresses that implementation should be expanded outside of such situations and integrated into an organization’s standard practices to improve provider and patient communication, satisfaction, timeliness and continuity of care. The authors highlight how this is increasingly important when it comes to mental health issues, which impact millions of Americans that often face unique treatment gaps and barriers. Ultimately, it is suggested that with the right resources and upfront work, the evidence shows telehealth has the capability to address these barriers, improve health outcomes and care coordination, decrease costs and reduce health disparities. Notable findings related to telehealth use and mental health include: *Telehealth use doubled from 14% to 28% between 2016 and 2019 *Telehealth visits for mental health increased 556% between March 11 and April 22, 2020 *SUD treatment via telehealth increased from 13.5% to 17.4% between 2016 and 2019 *Telehealth use increased 425% for mental health appointments among rural Medicare beneficiaries between 2010 and 2017 The guide presents specific strategies to increase patient access and comfort using telehealth, such as providing devices to those that need them and offering trial sessions to address any technological challenges. It is also suggested that providers first screen patients for their willingness and readiness to receive care via telehealth, as it may not be appropriate for some patients. Additionally, telephone should be encouraged when it reduces prior structural and institutional barriers that have made contacting underserved communities difficult. The guide also offers strategies to increase provider comfort using telehealth, such as: *trainings and designating certain staff to support and evaluate its use *how to create a similar environment to that of an in-person visit for patients *addressing organizational infrastructure issues Understanding and knowledge of relevant and ever-evolving regulatory and reimbursement policies is included as an important consideration as well, to which the authors offer a variety of tracking resources, including the policy finder tool on CCHP’s new website. Regardless of where state and federal telehealth policies land, the guide includes a number of telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth. Additional resources can be accessed on the SAMHSA website. For more information read the full SAMHSA resource guide- https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-06-02-001.pdf < Previous News Next News >

Study: Teletherapy program reduces OCD symptoms Emily Olsen May 23, 2022 Researchers found a 43.4% mean reduction in patient-rated obsessive-compulsive symptoms. A teletherapy program reduced symptoms of obsessive-compulsive disorder, and most patients maintained improvements up to a year later, according to a study published in JMIR. The treatment, from digital mental health company NOCD, included twice-weekly video appointments that used exposure and response prevention (ERP) therapy for three weeks. Patients then underwent six weeks of weekly half-hour video check-ins. Researchers followed up with the patients three, six, nine and twelve months after the therapy program. The study found a 43.4% mean reduction in patient-rated obsessive-compulsive symptoms as well as a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety and a 37.3% mean reduction in stress symptoms. Of the more than 3,500 patients included in the study, more than 1,600 participated in follow-up surveys. The study's authors were employed by NOCD or reported they had received payments from NOCD while conducting the study. "The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD," researchers wrote. WHY IT MATTERS The study's authors noted the virtual intervention took about 12 weeks and fewer than 11 therapist hours. "Technology assistance likely played an important role in this treatment’s ability to both engage and treat a large number of patients in wide-ranging geographic locations and to achieve a high mean rate of symptom improvement and a high rate of treatment response," they wrote. "Teletherapy using video allows people in remote locations to access treatment and to be able to complete, in-session, in vivo exercises in places and situations that are most relevant to, or triggering of, their symptoms." THE LARGER TREND NOCD announced it had raised $33 million in Series B funding in September last year. That brought its total financing to $50 million, according to Crunchbase. Mental health technology funding increased 139% globally in 2021, compared with 2020, bringing in $5.5 billion, according to a CB Insights report. Meanwhile, mental healthcare makes up a large portion of telehealth utilization in the U.S. Though utilization fell nationally in February, mental health diagnoses still made up more than 64% of telehealth claim lines, according to FAIR Health's tracker. For original article: https://www.mobihealthnews.com/news/study-teletherapy-program-reduces-ocd-symptoms < Previous News Next News >

How Americans Feel About Telehealth: One Year Later Sykes.com April 21, 2021 In March 2020 and 2021 we polled 2,000 adults to discover their perspectives on and experience with telehealth — how have opinions changed one year into the COVID-19 pandemic? Pre-pandemic, telehealth was much more of a novelty than a necessity in the healthcare industry. The idea of contacting your doctor remotely for care was promising, but there were major hurdles — obstacles that would require time, effort, and ingenuity to overcome. Then, COVID-19 created a need for safe, distant medical care and advice. And necessity, like always, is the mother of invention (or in this case, adoption). Suddenly, millions of patients who were once walk-ins became logins, and soon, all that was necessary to get a quality checkup was a stable Wi-Fi connection. SYKES’ March 2020 telehealth survey revealed new insights on what Americans thought about the rise of virtual visits to the doctor and the concept of telehealth in general. At that point, telehealth was still a radical idea, and phrases like “new normal” had yet to overstay their welcome. Research outlined in the SYKES Fall 2020 telehealth apps report made it clear that all kinds of new users had already begun scheduling consultations in cyberspace due to COVID-19. But now, with vaccines being administered all over the world, will this mean a decline in socially distanced telehealth services too? Or will patients still want access to virtual doctor visits even after distance is no longer a factor? To find out, we asked 2,000 Americans in March 2021 how their opinions on telehealth have changed over the past year, what they’ve experienced, and what they think should stick around even after vaccines are widely available. For full story: https://www.sykes.com/resources/reports/how-americans-feel-about-telehealth-now/ < Previous News Next News >

Maximizing Telemedicine Benefits Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. In many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. Further, the use of telemedicine was facilitated at the state and federal levels but widespread waivers and measures being put into place to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements. Those of us in the field for a long time are hopeful that many of these measures will stay in place, but there are clearly some that will or already have expired. We are additionally hopeful that even though in-person practices are clearly coming back full-tilt, that everyone has seen and/or experienced the benefits of telemedicine and will continue to use it to some degree as feasible and appropriate with their patients. As this occurs, however, providers will be faced with new challenges as they take their initial telemedicine set-ups and transition to this new hybrid world of services. As noted, some things will still be allowed (e.g., certain billing codes) but others will likely return to pre-COVID status (e.g., not being able to use non-HIPAA-compliant devices and software platforms). In addition to finding the best software for future telemedicine applications, there are other things to consider when trying to maximize telemedicine benefits. From my perspective, although the technology is critical, telemedicine success has very little to do with the technology and everything to do with the people and the environment within which they practice. Thus, in order to maximize telemedicine these are the elements one should consider and focus on in addition to carefully selecting the most appropriate technology for your practice and providers. First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The use cases need to be clearly defined and must match an identified need. Then the who, what, where, why and when must be carefully delineated. Who needs to be involved (e.g., providers, billing, scheduling, IT, legal, administration), what clinical tasks can be accomplished via telemedicine, where will the technology and/or providers be located (e.g., clinic, home) and where will the patients be (e.g., primary care provider office, home, work, school), why will telemedicine be offered as an option (e.g., lack of sub-specialty providers, patients need to travel long distances, no show rates are too high) and when will telemedicine be offered (e.g., certain days/times, any opening in the schedule)? All of this can be accomplished by plotting out in a workflow diagram what the current practice is and how it needs to be adjusted in order to integrate telemedicine into that workflow. Again, the expectation is that although some practices might remain essentially virtual, the majority are going to evolve into a hybrid practice – but such a hybrid will not happen overnight or automatically. Workflow integration is going to be just as critical as integrating telemedicine technologies into a practice – it really is all about the people, setting expectations and establishing standard operating procedures and protocols for everyone that is going to be involved. Another thing that can be done to maximize a telemedicine practice is to properly train everyone on standard operating procedures and protocols, especially the providers who will be interacting with the patients. To date there are very few training programs that incorporate formally telemedicine as part of the curriculum. A number of programs are increasingly exposing trainees to telemedicine if offered at their institution, but typically as an elective or chance encounter in the clinic. There are however a number of organizations that are working on developing and promoting telemedicine competencies and the Association of American Medical Colleges (AAMC) recently developed a set of Core Competencies. Although specific to medical college trainees, they are comprehensive enough to cover nearly every other specialty/profession in many respects. Very briefly, the AAMC Telehealth Competencies consist of three domains, each with a set of explicit skills that increase in complexity and responsibility across three stages of practice: entering residency, entering practice and experienced faculty physician. The skills from each prior stage of training should carry over to the next phase as the provider becomes more expert and acquires additional skill sets. The six domains are: patient safety and appropriate use of telehealth; access and equity in telehealth; communication via telehealth; data collection and assessment via telehealth; technology for telehealth; and ethical practices and legal requirements for telehealth. Patient safety and appropriate use of telehealth includes 4 skill sets ranging from being able to explain to patients are caregivers the benefits and limitations of telemedicine to knowing when a patient is at risk and how/when to escalate care (e.g., convert to in-person) during an encounter. Access and equity in telehealth has 3 skill sets including knowing your biases and implications when considering healthcare, how telehealth can mitigate or amplify access to care gaps, and taking into account all potential cultural, social, physical and other factors when considering telemedicine. Communication via telehealth has 3 skills covering establishing rapport with patients, creating the right environment (e.g., lighting, sound) and knowing how to incorporate a patient’s social support into an encounter. Data collection and assessment via telehealth covers how to obtain a patient history, how to conduct an appropriate remote exam, and how to deal with patient-generated data. Technology for telehealth does not expect everyone to be an engineer or IT expert, but they should be able to explain equipment requirements for a visit, explain limitations and minimum requirements, and explain risks of technology failure and how to respond to them. Similarly, ethical practices and legal requirements for telehealth does not expect everyone to be a lawyer but should be able to describe local legal and privacy regulations, define components of informed consent, understand ethical challenges and professional requirements, and assess potential conflicts of interest (e.g., interest in commercial products/services). Many of these skills can be acquired by those already in practice by attending the wide variety of courses and webinars available for telemedicine skill building. It is also highly recommended that before engaging with patients for the first time via telemedicine to engage in some simulated practice sessions – from start to finish practicing each skill and developing your “style” for interacting with patients via this virtual medium. Finally, in order to maximize benefits you need to assess your program. This does not require a degree in statistics or setting up a complex experimental study. It really requires just two things – a set of metrics and a process. There are lots of metrics available and most have been studied in a wide variety of clinical applications so a good lit review will always help get you started. It is important to keep in mind that the things you measure need to reflect your goals/mission for using telemedicine and the bottom line of making a profit is not always the most appropriate metric to use. There are lots of relevant metrics and as a good starting place the article by Shore et al. “A lexicon of assessment and outcome measures for telemental health” is a great place to get some ideas. Although developed for the telemental health community the metrics provided apply quite well to nearly any specialty or practice. The metrics include such things as patient/provider satisfaction, no shows, symptom outcomes, completion of treatment, wait times, number of services, cultural access, cost avoidance and patient safety. Once you decide on metrics that are appropriate for your practice (recommend starting with 2-3 then add more as your practice grows) there is a very easy, straight-forward process for getting to outcomes. First, consider a given measure an indicator – these are concrete activities, products etc. that can be measured readily (e.g., from the patient record). For example, you could measure A1C levels in patients as a function of being enrolled in a telenutrition program. The next step is to set performance targets – these are concrete goals that are time limited and based on the indicator metrics. For example, you would like to see a 25% reduction in A1C levels in at least 50% of patients enrolled in the telenutrition course at 6 months post-baseline. Finally, you will have quantifiable outcomes (without fancy statistics) at the end of your set time period – if you meet your 25% reduction goal in 50% of patients great. If not, then maybe reassess the program or whether your goals were realistic. In any case, you now have concrete outcomes of your program demonstrating its benefits that you can provide to funders, administration, your care team and even patients and the community. In order to maximize telemedicine benefits you need to get the word out about its availability and its effectiveness! < Previous News Next News >

Medicare Telehealth: Actions Needed to Strengthen Oversight and Help Providers Educate Patients on Privacy and Security Risks U.S. Government Accountability Office (GAO) September 26, 2022 To help patients access care during the pandemic, Medicare temporarily waived restrictions on telehealth—health care services delivered via phone or video. The use of telehealth services rose tenfold: 53 million telehealth visits in Apr.-Dec. 2020 vs. 5 million during the same period in 2019. But Medicare hasn't comprehensively assessed the quality of care patients received, and lacks data on telehealth services delivered in patients' homes or via phone. Patients may also be unaware that their private health information could be overheard or inappropriately disclosed during their video appointment. Our recommendations address these issues. Highlights What GAO Found In response to the COVID-19 pandemic, the Department of Health and Human Services (HHS) temporarily waived certain Medicare restrictions on telehealth—the delivery of some services via audio-only or video technology. Use of telehealth services increased from about 5 million services pre-waiver (April to December 2019) to more than 53 million services post-waiver (April to December 2020). Total utilization of all Medicare services declined by about 14 percent post-waiver due to a 25 percent drop in in-person service use. GAO also found that, post-waiver, telehealth services increased across all provider specialties, and 5 percent of providers delivered over 40 percent of services. Urban providers delivered a greater percentage of their services via telehealth compared to rural providers; office visits and psychotherapy were the most common services. See full article: https://www.gao.gov/products/gao-22-104454 < Previous News Next News >

What You Need to Know About the Telehealth Extension and Evaluation Act Dr. Maheu February 24, 2022 The Telehealth Extension and Evaluation Act was introduced on February 7, 2022, to ensure a continuation of public access to telehealth after the end of a public health emergency. If passed, it will allow time to gather data concerning virtual care utilization and prevent a sudden drop-off in access to care, also known as the telehealth cliff. What is the Telehealth Extension and Evaluation Act? The Telehealth Extension and Evaluation Act establishes a two-year extension for certain coronavirus-related telehealth waivers. It will extend geographic and site restrictions waivers and allow Medicare beneficiaries to access telehealth from various locations. It also provides flexibility for prescribing drugs via telehealth and extends flexible Medicare payment plans for Rural Health Centers (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs). The bill follows an advocacy letter signed by 336 organizations, co-led by the American Telemedicine Association (ATA) and others, urging Congressional leaders to continue the current telehealth waivers and pass permanent, evidence-based telehealth legislation for implementation in 2024. Key Takeaways for the Telehealth Industry The telehealth industry should be aware of the critical points of the Telehealth Extension and Evaluation Act. Extension of Medicare Payment for Telehealth Services. The CARES ACT allowed the Centers for Medicare and Medicaid Services (CMS) to waive specific Medicare coverage and payment limitations, allowing Medicare beneficiaries to receive telehealth care at home. If the Telehealth Extension and Evaluation passes, it will extend certain telehealth coverage waivers on originating site and geographic location limitations, expand the list of telehealth providers, and increase the availability of audio-only telehealth services to Medicare beneficiaries for two years after the public health emergency ends. Telemedicine Drug Prescribing. The Ryan Haight Act prohibits the prescribing of medicine without an in-person visit. Federal law allowed DEA registered practitioners to prescribe to patients without in-person visits during the pandemic. See TBHI’s previous article Telehealth Opioids, and Ryan Haight Act Update, for more information. The proposed legislation would extend this flexibility two years after the public health emergency. Extension of FQHCs and RHCs. Before the pandemic, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) could only provide telehealth services to patients near their locations. The CARES Act allowed these facilities to provide care to patients in distant areas, a practice the legislation would continue for two years after the public health emergency expires. Extension for CAHs. The 2020 Hospitals Without Walls program allowed hospitals to provide telehealth care during a public health emergency. The proposed legislation would add Critical Access Hospitals (CAHs) as distant site providers of telehealth services to continue offering off-site care. Restrictions for Certain DMEs and Lab Tests. The legislation would require an ordering physician to conduct an in-person examination of a patient no more than 12 months before ordering specific high-cost lab tests and Durable Medical Equipment (DME) products via telehealth. It would also instruct Medicare Administrative Contractors to audit practitioners and clinicians who do 90% or more of their orders of DME and lab tests via telehealth. This would continue for two years after the health emergency ends. It is meant to reduce instances of fraud and abuse. NPI Number for Telehealth Billing. Healthcare providers need a national provider identifier (NPI) number to bill Medicare directly. Under certain conditions, Medicare pays for services billed by physicians but performed by non-physician staff acting under the physician’s supervision. This practice is known as “incident to” billing. The proposed legislation requires all practitioners to obtain an NPI number to receive Medicare payment for telehealth services two years after the public health emergency. Your Advocacy Is Needed The pandemic has caused an increased reliance on the telehealth industry. If passed, the Telehealth Extension and Evaluation Act will ensure that patients can continue to access the virtual care they need. Contact your elected officials at the federal level to ask them to support this crucial bill. https://telehealth.org/what-you-need-to-know-about-the-telehealth-extension-and-evaluation-act/?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&smconv=5bc4c379-a4c1-484f-a411-33ec93777504&smlid=9&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Most Americans Support Expansion of Asynchronous Telehealth Options Mark Melchionna July 21, 2022 A new survey shows that a majority of Americans support legislation that would expand asynchronous telehealth, thereby increasing access to care, particularly mental healthcare. Two-thirds (69 percent) of Americans are in favor of legislation to expand access to asynchronous telehealth, according to a new survey. Telehealth company Hims & Hers Health worked with polling firm Public Opinion Strategies to conduct a survey of 1,301 US adults between Feb. 13 and 17. The results indicate that optimizing telehealth and changing policies are critical. The COVID-19 pandemic significantly affected healthcare overall, resulting in an increased need for care, especially for behavioral healthcare. Dig Deeper Why Asynchronous Telehealth Has Been a Boon for Patients, Providers New Bill Seeks Nationwide Medicare Coverage for Asynchronous Telehealth Services Asynchronous Telehealth Can Extend Primary Care at Community Health Networks The survey found that only 38 percent of respondents reported having good mental health, which was lower than the 52 percent who said the same in February 2021. But about 60 percent of respondents said that accessing care is a problem. Researchers then collected data regarding virtual care methods that could help widen mental and physical healthcare access. About 55 percent of survey respondents said they have participated in a telehealth visit, higher than the 10 percent who reported the same in June 2019, 29 percent in April 2020, 43 percent in August 2020, and 51 percent in February 2021, according to the survey. In addition, asynchronous telehealth use is of high interest among survey respondents. About 69 percent of respondents favor legislation that could increase access to asynchronous telehealth. These types of legislation are most popular among Democrats (77 percent) and Black adults (76 percent), though high proportions of Republicans (60 percent) and Hispanic adults (70 percent) are also in support. In addition, a vast majority of healthcare workers (82 percent) indicated high levels of support for expanding asynchronous telehealth. “Patients want to receive care in the way that works best for them, and this is increasingly a combination of telehealth support via synchronous real-time video consultation and asynchronous interactions, as well as in-person care between providers and patients," said Galen Alexander, director of public affairs at Hims & Hers, in an email. "Telehealth, both synchronous and asynchronous, can help address some of the mental health crises our country is facing. Based on this representative survey, Americans want to be in control of their care and would like to see legislators allow for different modes of receiving care.” Previous research has also indicated an increasing need for telemental healthcare. A study published in January showed that despite a slight decline in overall telehealth use, virtual mental healthcare remained popular. It also revealed that mental health conditions were the most common telehealth diagnosis in September and October 2021. Lawmakers do appear to be taking steps to expand telemental healthcare. In May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives that focus on increasing access and directing insurers to support virtual care. For original article: https://mhealthintelligence.com/news/most-americans-support-expansion-of-asynchronous-telehealth-options < Previous News Next News >

Leveraging Telehealth Platforms to Enhance Provider Workflows, Adoption eVisit December 28, 2022 Implementing a telehealth platform can positively impact provider workflows in numerous ways, including easing administrative burdens, thereby leading to greater provider adoption and satisfaction. The pandemic drove telehealth use to new heights. Even though usage appears to be stabilizing, healthcare stakeholders largely agree that telehealth is here to stay, and they are making virtual care a vital part of their care delivery model. Polls conducted by the American Medical Association show that 80 percent of physicians said they were using telehealth tools in 2022, up from 28 percent in 2019 and only 14 percent in 2016. Further, in 2022, about 75 percent of physicians said being able to offer remote care was an important reason to use digital health tools, up from 60 percent in 2016. From the patient perspective, the benefits of telehealth, such as improved healthcare quality and patient experience, have become increasingly apparent. Epic conducted a research study analyzing 35 million telehealth visits between March 1, 2020, and May 31, 2022. They found that "in nearly every specialty studied, most patients who had a telehealth visit did not require an in-person follow-up appointment in that specialty in the next three months." Only two of the 31 specialties — fertility and obstetrics — saw in-person follow-up rates above 50 percent, while genetics, nutrition, endocrinology, and mental health/psychiatry had in-person follow-up rates of 15 percent or less. But, as telehealth is integrated alongside in-person care, provider organizations must ensure they are selecting the right platform for their facility's unique needs and implementing them in a way that addresses — rather than adds to — clinician workflow challenges. KEY TELEHEALTH CAPABILITIES TO IMPROVE PROVIDER WORKFLOWS Amid the rapid rise in the adoption and use of telehealth during the pandemic, providers have faced several challenges in setting up telehealth programs. One of the most significant difficulties is related to the technology available, notes Eric Thrailkill, Venture Partner, Founder of the Telehealth Academy, and Chairman of Project Healthcare at the Nashville Entrepreneur Center. "While these solutions 'worked' per se, they were not designed to help health systems facilitate a hybrid care model with a goal to provide personalized care, regardless of location," he says. "During the shutdowns, almost all provider organizations were completely dedicated to supporting COVID-related patients and/or working through the backlog of previously scheduled appointments. Telehealth, due to the relaxation of certain federal and state regulatory requirements, consisted of phone-based services and two-way video technologies — speed to deploy was the operating mantra." Provider organizations succeeded in rapidly deploying new technologies, but they did not have time to optimize their workflows to account for certain processes — like documentation and revenue cycle — and support overarching population health and chronic care goals. During the pandemic, 'offering telehealth' could simply mean offering a two-way video solution. But now, with a couple of years of experience and data to pull from, providers are able to build robust telehealth programs to pair with in-person care. In short, a telehealth program looks at creating both a personal and efficient experience for the provider and patient before, during, and after the visit. Two-way video technology is just one piece of the puzzle. "Telehealth platforms should contain a virtual triage where location and assignment of a provider could occur," Thrailkill says. "This would also enable an appropriate assessment to ensure higher acuity visits are prioritized over lower acuity visits." For effective triage, relevant care teams must be able to easily coordinate their team and the patients in the virtual waiting room, chat with the patient ahead of, during, and post-visit, access the appointment, and interact with the patients while accurately documenting the encounter in their EHR and scheduling follow-up appointments. The digital experience should be smooth and the UI/UX strong to support adoption and satisfaction. Anything captured by the telehealth platform, say an image or an attachment, must have bidirectional clinical data flows enabled with the EHR to ensure the complete patient picture is captured for the patient's health record and billing and reporting purposes. Additionally, Thrailkill notes that as provider organizations become increasingly focused on addressing social determinants of health needs, they should consider telehealth platforms that can ingest data from multiple sources. Having this data at their fingertips at the point of care can help clinicians provide wraparound care services, including connecting patients with social services and community resources. Not only is a platform's ability to gather data from various sources essential to the success of hybrid care models, but so is seamless data exchange, which helps ensure continuity of care. "Continuity of care is the set of processes whereby the patient and his/her physician-led care team are involved and cooperating over time to achieve the highest level of quality of care," Thrailkill says. "This is difficult, if not impossible, given the fragmentation and healthcare data silos that exist today — both outside and inside provider organizations and health systems." Thus, telehealth platforms should have integration capabilities that provide clinicians with data from prior visits and information from facilities outside the organization where the patient has received care. But Thrailkill also cautions that providers should keep in mind patient rights regarding consent, privacy, and security when developing hybrid care models that leverage telehealth. IMPROVING WORKFLOWS ENHANCES PROVIDER SATISFACTION Selecting the right platform can help healthcare organizations optimize provider workflows, thereby boosting provider adoption and satisfaction. Providers at every level want to practice at "the top of their license," that is, utilize the highest level of their education and experience to deliver care, Thrailkill notes. For physicians, the health system's most expensive clinician, tasks like documentation and prior authorization processes can get in the way of this goal. Prior authorization, in particular, is a critical pain point, as some healthcare payers have complex processes that require much time and effort. "All of these administrative burdens are no doubt contributing to workforce challenges present today across essentially every professional level," Thrailkill says. But by using telehealth platforms with integration capabilities and Fast Healthcare Interoperability Resources (FHIR)-based application programming interface structures, provider organizations can reduce administrative burdens like prior authorization processes through automation and enable them to lean on their medical assistants during the triage process of the telehealth visit. This increases the time available for patient care and optimizes capacity for the clinical team, he adds. Further, when implementing telehealth into hybrid care models, healthcare organizations should take a long-term view rather than regard telemedicine as a replacement for in-person care. "This will challenge the organization to think about the role of medical assistants, nurses, and specialty consult providers — not as follow-on activity, but incorporated into the visit," Thrailkill says. "This will ultimately lead to operational efficiencies and reduce the amount of administrative burden existing in early deployments of telehealth." As noted above, reducing administrative burdens and improving care delivery processes can lead to higher provider satisfaction, engagement levels, and adoption of virtual care across the health system. Incorporating telehealth is not a passing phase, and demand will likely grow in the years ahead. But to ensure its success, provider organizations must select technology that enhances provider workflows, thereby improving satisfaction and adoption. About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/leveraging-telehealth-platforms-to-enhance-provider-workflows-adoption < Previous News Next News >

Telemental Health Collaborative Care Medication Management: Implementation and Outcomes Smita Das, Jane Wang, Shih-Yin Chen, and Connie E. Chen Dec. 22, 2021 Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Abstract Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Materials and Methods: CoCM MM was available to adult employees/dependents through their employer benefits, in addition to therapy. Outcomes included Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) collected at baseline and throughout participation. This analysis was not deemed to be human subjects research by the Western Institutional Review Board. Results: Over 17 months, 212 people enrolled and completed >2 assessments; the enrollees were 58.96% female with average age of 32.00 years (standard deviation [SD] = 7.38). In people with moderate to severe depression or anxiety, PHQ-9 and GAD-7 scores reduced by an average of 7.27 (SD = 4.80) and 6.71 (SD = 5.18) points after at least 12 ± 4 weeks in the program. At 24 ± 4 weeks, the PHQ-9 and GAD-7 reductions were on average 7.17 (SD = 5.00) and 6.03 (SD = 5.37), respectively. Approximately 65.88% of participants with either baseline depression or anxiety had a response on either the PHQ-9 or GAD-7 at 12 ± 4 weeks and 44.71% of participants experienced remission; at 24 ± 4 weeks, 56.41% had response and 41.03% experienced remission. Conclusions: An evidence-based CoCM telemedicine service within an employee behavioral health benefit is feasible and effective in reducing anxiety and depression symptoms when using measurement-based care. Widespread implementation of a benefit like this could expand access to evidence-based mental health MM. Read more here: https://www.liebertpub.com/doi/full/10.1089/tmj.2021.0401 < Previous News Next News >

Review of Veterans Health Administration’s Use of Telehealth During Pandemic Center for Connected Health Policy April 2021 Veteran’s Affairs Office of the Inspector General (OIG) assessed the Veterans Health Administration’s virtual primary care response to the COVID-19 pandemic. From February 7 to June 16, 2020, the Veteran’s Affairs Office of the Inspector General (OIG) assessed the Veterans Health Administration’s virtual primary care response to the COVID-19 pandemic, based upon reviewing primary care encounter data, interviews with VHA leaders, and use of primary care provider questionnaires. In its report, the OIG found that face-to-face primary care visits decreased by 75% and contact by telephone represented 81% of all primary care encounters. In regards to VA Video Connect (VVC), providers stated that not only were there technical complications related to specifically scheduling VVC visits, but many patients didn’t have internet access or the appropriate equipment needed for video calls. The OIG identified the need for additional training and support for veterans and test visits with patients and staff to walk through the process before the visit. In addition, the OIG recommended the Under Secretary for Health evaluate veteran access to reliable internet connectivity necessary for use of VVC and take appropriate action. Department of Veterans Affairs, Office of Inspector General: https://www.va.gov/oig/ Veterans Health Administration: https://www.va.gov/health/ < 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 >

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

The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Centers for Medicare and Medicaid Services Nov. 10, 2021 CY 2022 Physician Fee Schedule (PFS) policies for Medicare The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Unless otherwise noted, the policies will take effect on January 1, 2022. Much of the proposals published in July 2021 for public commentary remain intact, but CMS did make several modifications and clarifications. https://public-inspection.federalregister.gov/2021-23972.pdf < Previous News Next News >

AHA Statement Stresses Importance of Telehealth in CVD Care Yael L. Maxwell November 16, 2022 With ongoing challenges related to reimbursement, access, and acceptance, the writing committee offers potential solutions. Stressing the importance of telehealth in cardiovascular care, especially given its increased prevalence during the COVID-19 pandemic, a new scientific statement from the American Heart Association (AHA) outlines the current barriers to this type of care and offers some strategies for continued access. As in-person visits were shut down in the spring of 2020, many clinicians and patients turned to telehealth, with subsequent studies and surveys showing related gains in heart failure and nonemergent cardiovascular care. Other research showed that patients who were more likely to use telehealth tended to be younger and privately insured, have more comorbidities, and be from underrepresented racial/ethnic groups. As the pandemic has waned, however, reimbursement for telephone and video visits has been a larger concern. Earlier this month, the US Centers for Medicare & Medicaid Services (CMS) released its 2023 Physician Fee Schedule, which includes continued coverage for telehealth, but only for 5 months following the end of the public health emergency, which some say is not long enough for clinicians to make long-term plans and invest in necessary infrastructure. “This paper in a way summarizes the importance of telehealth and the benefits of telehealth in patient care,” writing committee chair Edwin A. Takahashi, MD (Mayo Clinic, Rochester, MN), told TCTMD. “Payment parity is so important in sustaining telehealth. So I hope that CMS and insurance companies will see the importance highlighted in this paper and reconsider their reimbursement plans with it.” What Is Telehealth? The statement, published online this week in Circulation, begins by defining the concept of telehealth, breaking it down into clinician-to-patient visits and clinician-to-clinician consults. The former includes real-time virtual visits, either video or audio, as well as digital communication, called eVisits, initiated by either the physician or patient. The latter includes both real-time virtual consults, which may also include the patient, as well as digital exchange of low-complexity medical information between clinicians, called eConsults, or second opinions on more-complex concerns. A final hybrid category includes remote monitoring for patients and predictive analysis for clinicians—both machine initiated. Takahashi and colleagues point out some commonly used telehealth tools for cardiovascular home monitoring, including machines for monitoring risk factors like blood pressure, weight, smoking, and diet; medication tracking apps and smart pillboxes for managing medication adherence; and tools like home EGC, pulse oximeter, and pulmonary artery pressure monitoring devices. While there are an undefined number of ways in which telehealth can be useful within cardiovascular care, Takahashi said it’s most effective in tracking disease progression for heart failure and CAD, improving stroke outcomes by decreasing time to diagnosis, and monitoring PAD progression, as well as preventing ulcers and tracking patients postoperatively. The paper outlines advances in telestroke, teleradiology, and telehealth in PAD management. Challenges and Potential Solutions Many challenges remain in order for telehealth to flourish in a nonpandemic era. In his experience, Takahashi said, the biggest barrier to using telehealth relates to “having patients accept it as a replacement for inpatient visits.” But overall, challenges like infrastructure—including broadband internet and hardware for patients—to complete telehealth visits as well as reimbursement stand in the way of telehealth use more generally, he said. “In order for people to adopt and use telehealth, people need to be able to bill for using it. Otherwise, it just is not sustainable.” The statement also stresses the importance that clinician attitude, biases, and acceptance play in the success of telehealth. Difficult to use technological platforms hindered by HIPAA-compliant encryption can also make it more difficult for clinicians to access telehealth appointments. Beyond increases in reimbursement for telehealth, the authors propose a few strategies for continued success. They advocate for government programs to improve broadband internet access across the country, more research to elucidate the specific benefits telehealth can have across the spectrum of cardiovascular disease care, and increased standardization for methods in assessing telehealth quality. “The COVID-19 pandemic improved the telehealth infrastructure through necessity but also uncovered systemic weakness, limitations, and inequities,” they conclude. “Further research into barriers for telehealth implementation and equitable execution are important to ensure the delivery of high-quality care for patients.” Yael L. Maxwell by Yael L. Maxwell Editor, Fellows Forum Yael L. Maxwell is Senior Medical Journalist for TCTMD and Section Editor of TCTMD's Fellows Forum. She served as the inaugural… Read Full Bio See original article: https://www.tctmd.com/news/aha-statement-stresses-importance-telehealth-cvd-care < Previous News Next News >