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

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 >

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 >

Why is an Alliance needed? NMTHA assists with ensuring telehealth program dollars are applied effectively and efficiently through : Clinical coordination Technical coordination Health information technology Administrative Services Federal, State, and private funds are spent on telehealth programs with little or no attention to coordination with other programs, efficient reuse of existing resources, and delivering the best level of cost-effective services. Existing and proposed programs create a patchwork of telehealth solutions with overlaps, gaps, and little long-term accountability. No entity coordinates telehealth statewide and ensures that telehealth programs and dollars generate the best possible health benefits for New Mexicans. How can New Mexico ensure dollars spent on telehealth programs are applied effectively and efficiently? New Mexico needs an organization to provide the following telehealth-related services: Clinical Coordination: Identifying healthcare delivery needs, finding organizations to deliver healthcare services, monitoring the delivery, and ensuring improved health outcomes. Technical Coordination: Identifying the proper technical solution for healthcare service delivery including equipment evaluation, telecommunications connectivity, reuse of existing resources, scheduling, network management, support, and maintenance. Health Information Technology: Managing information exchange among healthcare providers and ensuring compliance with federal, state, and other standards. Administrative Services: Reimbursement issues, administrative policy and procedures, legislative issues, and general management of the telehealth process. Every dollar spent on coordination ensures that dollars spent on specific telehealth programs generate the greatest improvement in health across all programs and regions of the State. Be part of the solution! Join the New Mexico Telehealth Alliance JOIN NOW

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

Athena Health Telehealth Adoption Report Center for Connected Health Policy May 2021 How providers are taking advantage of virtual care and their perceived benefits Athena Health began conducting research in 2020 on de-identified data from across their healthcare network (which spans the nation) to understand how providers are feeling about the increased adoption of telehealth. With the onset of COVID-19, the use of telehealth has skyrocketed, and beyond understanding the increased utilization numbers, it’s also important to understand provider adoption rates, their attitudes toward telehealth, which specialties and what services telehealth is being used in the most. An interactive infographic tool on their website can be utilized to identify the amount of care across their system that has gone virtual by specialty (primary care, mental health, cardiology, pediatrics, OB/GYN or all specialties). Users can also view by specialty how providers are taking advantage of virtual care and their perceived benefits (for example, virtual appointments are more convenient), and the reasons why providers are turning to telehealth to keep their practices running. For a complete breakdown of their findings, visit Athena Health’s interactive webpage: https://www.athenahealth.com/knowledge-hub/clinical-trends/the-athenahealth-telehealth-insights-dashboard. < Previous News Next News >

A New Model For Healthcare: Adding Telehealth To Unclog Patient Flow ‘Hot Spots’ Dr. Corey Scurlock MD, MBA June 8, 2022 It may not match the scale of the exodus of nurses from the healthcare workforce, but a growing shortage of physicians is no less of a threat to patient care. A recent survey found that one in five doctors plan on leaving the profession in the next two years, hastening a projected shortfall of as many as 124,000 doctors by 2034. This has reached such a concerning level that the U.S. Department of Health and Human Services and U.S. Surgeon General Dr. Vivek Murthy have launched a strategic advisory to mitigate clinical burnout. More Information: https://www.forbes.com/sites/forbesbusinesscouncil/2022/06/08/a-new-model-for-healthcare-adding-telehealth-to-unclog-patient-flow-hot-spots/?sh=248c6d415725 Covid-19 and longstanding concerns about changes in the business of healthcare have left many physicians burned out. Older doctors are seeking early retirement, and younger doctors seek a more balanced work/life ratio. Many aren’t interested in some of the all-consuming specialties such as critical care, neurology, oncology and psychiatry. As with everything else in our world right now, supply is not meeting demand. Action is required, but it can’t just rely on yesterday’s solutions. Opening up more slots in medical schools won’t fill the immediate need for experienced, board-certified physicians. Buying up physician practices is largely played out, as most doctors are already employed. I would argue that we can’t wait for a new MD pipeline to open up. Instead, we need to fix the broken practice of medicine. Doctors are burned out because they are locked into 15-minute appointment cycles wrapped around the exigencies of electronic health records systems that demand complete documentation of each step, leaving little time for the “How are you, Ms. Jones?” moments. Patients are unhappy with eight-month waits for new patient appointments to confirm diagnoses of serious diseases. Within the hospital, a lack of staff and available expertise meets up with broken processes to choke off patient flow from the emergency department to laboratories to medical floors. Staff personnel stand around waiting for paperwork. Patients wait on gurneys for everything. By the time things are straightened out, the original order might no longer be appropriate for a patient. Discharge alone has become a major headache. One antidote to this is to create a hybrid model of care as I have done with my company and as my business helps other companies do. It relies on points in the care process being actively managed remotely by specialist physicians who also have a background in telehealth. These veterans should understand where timely intervention can unblock patient flow at “hot spots” in a patient’s journey caused by delays in care, inappropriate care transitions or potential patient harm. Telehealth-enabled monitoring can reduce transfers by accurately assessing patient acuity and overseeing the work of less-experienced hospital staff. Through these interactions, the goal is to see reduced patient readmissions and ED visits, shorter hospital stays and better utilization of resources. Of course, all of this begs the question: If the hospital can’t find enough specialists, how can virtual care physicians fill these roles? The answer is pretty simple, in my opinion. You bring back the joy of being a doctor. These telehealth doctors work from home, linked to pods of multi-specialists who work with the same hospitals, getting to know the staff. They can work when they like and as much as they like. They access the medical record but are called upon to solve problems, full stop. You can also make sure their work is always varied. Doctors want to heal, not master the intricacies of Epic’s latest software. With the tailwind of favorable policy and reimbursement the telehealth industry is experiencing right now, it might be an opportune time to consider this type of strategy. But as one explores telehealth as a business venture, it's important to recognize that all such business is still highly regulated, as it is in the field of care delivery. The core components of an end-to-end telehealth solution include people, process and technology. Here are some thoughts on each. • Technology: Audio-video providers have matured significantly, and increasing interoperability has enabled new entrants. Health systems have sought to standardize enterprise platforms versus best-of-breed applications. Clinical analytics tools can be overlaid on the EMR leading to simpler clinical insight gathering. While not mandatory, such systems target quality or performance metrics to support ROI. • Process: Efforts to virtualize care can be disruptive to care delivery. Consider what technology platforms to purchase, KPIs to measure and clinical workflow to create. • People: Delivering telehealth-enabled care will place the highest regulatory burden on an organization. Malpractice, state licensing and credentialing, and HIPAA, to name a few, are considerations that need to be tackled first. Secondly, your attention to provider experience is paramount to ensure a healthy and sustainable workforce to attract talent. As Covid-19 wanes, we are facing unprecedented change in the provisioning of care. New care models will emerge. Telehealth is not the only solution, but it is clear that it will be a primary one. A recent survey (registration required) of health system CEOs by the University of Colorado’s Health Administration Research Consortium put virtual care as the No. 1 strategy for future growth. For those looking for solutions to today’s healthcare challenges, here are three points to remember: • Telehealth is here to stay: It could be the great equalizer for care access and equity. • Patient flow is key: By focusing on the patient journey across the continuum, hot spots can be identified and targeted. • Clinical and operational alignment are needed: People, processes and technology can combine as a force multiplier to return greater value, but only if everyone has agreed on a care road map. As telehealth goes, we are not battling efficacy anymore; we are battling inaction and the cost such inaction creates. I believe unlocking the potential of all our nation's providers can deliver better care everywhere. It's time to imagine what the design of the next-generation, digitally-enabled clinical workforce looks like, and it's all about access and equity in care delivery. < Previous News Next News >

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

Trends in Telehealth Prescription Laws Kirin Goff, Southwest Telehealth Resource Center July 2021 New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. States across the country are proposing or enacting legislation that supports making the increased access to telehealth that occurred during the pandemic permanent. However, many states seem to struggle with how to appropriately regulate remote prescribing requirements as there is wide variation in approaches and priorities emerging in these proposed and new laws. The most common approach is to carve separate requirements for controlled substances, and then clarify if and under what circumstances they can be prescribed via telehealth. Notably, concerns about addiction and access to mental healthcare are becoming increasing prevalent in telehealth legislation. Some states are attempting to address the latter by specifically expanding telehealth to meet these needs, including allowances for remote prescriptions. The Worsening Drug Epidemic As the COVID-19 pandemic took center stage, substance use also increased. Preliminary estimates indicate that in the first eight months of 2020, drug overdose deaths increased by 48.1% in Arizona and 46.8% in Colorado, compared to same period in 2019. In the U.S. as a whole, drug overdoses increased by 27% between September 2019 and August 2020, compared to the previous twelve months (all data are based on Commonwealth Fund examination of provisional data from CDC’s National Vital Statistics System). As more Americans become personally impacted by the opioid epidemic, opinions about drug policy seem to be shifting. In lieu of strict regulatory measures, harm reduction is becoming more mainstream, and approaches seem to increasingly favor policies that improve access to care for substance use disorders. For example, the American Medical Association put out an issue brief supporting policies that employ evidence-based harm reduction policies and “remove existing barriers for patients with pain to obtain necessary medications…[including] arbitrary dose, quantity and refill restrictions on controlled substances.” Controlled Substance Prescription Arizona has addressed this issue most directly and comprehensively by enacting HB 2454. This law allows providers to prescribe Schedule II drugs, which are defined as drugs with high potential for abuse, such as Vicodin, methadone, and OxyContin, via audio-visual examination and delegates review for more detailed requirements to a newly created Telehealth Advisory Committee. The committee will “review national and other standards for telehealth best practices and relevant peer-reviewed literature” and establish best practices for providers to follow. This committee must include several experts in behavioral health and substance use, indicating that optimal ways to regulate prescribing controlled substances are a high priority. In other Southwestern states, the majority of recent bills on the topic focus on cannabis. For example, New Mexico’s medical marijuana law (HB 2) allows providers to determine medical marijuana qualification via telehealth. Likewise, Utah recently passed a bill (SB 170) allowing for medical marijuana renewal via telehealth examination, although it still requires in-person exams for initial recommendations. Research and Access to Care Healthcare access issues are also of primary concern, and telehealth is seen as a potential solution, particularly in rural areas. For example, New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. Likewise, Utah attempted (HB 36) to extend the term of a grant for research about how telehealth can improve access to mental health care, particularly for underserved populations. The range of proposed and enacted laws reflects a lack of evidence as well as differing ideologies among legislators. It is unusual for such substantial changes to the legal framework to occur so quickly – without more incremental steps and without a significant body of experience and precedent to glean from other jurisdictions. Arizona’s HB 2454 provides an innovative approach to remote prescribing by providing both access and data, which will be key to watch as states continue to pass telehealth legislation. < Previous News Next News >

CHOP Study Explores the Use of Telemedicine in Child Neurology in Largest Study to Date Children's Hospital of Philadelphia September 16, 2022 -- Certain patients were more likely to use telemedicine even with the reopening of in-person appointments, while barriers to telemedicine remained for some families -- PHILADELPHIA, Sept. 16, 2022 /PRNewswire/ -- Researchers from the Epilepsy Neurogenetics Initiative (ENGIN) at Children's Hospital of Philadelphia (CHOP) found that across nearly 50,000 visits, patients continued to use telemedicine effectively even with the reopening of outpatient clinics a year after the onset of the COVID-19 pandemic. However, prominent barriers for socially vulnerable families and racial and ethnic minorities persist, suggesting more work is required to reach a wider population with telemedicine. The findings, which represent the largest study of telemedicine in child neurology to date, were published today by the journal Developmental Medicine & Child Neurology. The COVID-19 pandemic prompted a rapid and unprecedented conversion of outpatient clinical care from in-person visits to remote telehealth visits. While telemedicine had been used to deliver care for specific adult patient populations prior to the pandemic, the effectiveness of telemedicine in child neurology as a novel method of care had not been systematically explored. In a prior study published by Neurology in 2020, CHOP researchers found that patients and clinicians had a high rate of satisfaction with telemedicine and many on both sides were interested in using telemedicine for future visits. To that end, the study team wanted to determine the long-term impact of telemedicine on child neurology care during the COVID-19 pandemic, factoring in the reopening of outpatient clinics. The observational study was based on a cohort of 34,837 in-person visits and 14,820 telemedicine outpatient visits between October 2019 and April 2021 across a total of 26,399 child neurology patients. "In 2020, the COVID-19 pandemic necessitated the use of telemedicine visits, but now that telemedicine visits have been established as part of the care we are able to deliver, we had the opportunity to compare them more thoroughly to in-person visits," said the study's first author Michael Kaufman, MS, a data scientist with ENGIN at CHOP. "With data on nearly 15,000 telemedicine visits, we were able to identify trends in how telemedicine was being used by individuals of different demographic backgrounds, neurological conditions and other variables." The researchers found that telemedicine was a viable option for many patients and was utilized more often than in-person visits for certain patients, such as those with epilepsy and attention-deficit hyperactivity disorder. Other patients, such as those with certain neuromuscular and movement disorders, younger patients, and those needing specific procedures were less likely to receive care by telemedicine. Additionally, the researchers found that self-reported racial and ethnic minority populations in the study as well as those with the highest social vulnerability – a measure of community resilience to stressors on human health – were less likely to participate in telemedicine visits. Two novel metrics were developed to determine access to telemedicine and track delayed care, which revealed further disparities. Some of the most vulnerable individuals were less likely to activate their online patient portals and were more likely to receive delayed care, compared to less vulnerable individuals. "Our group has studied telemedicine extensively, and our findings demonstrate how telemedicine has become a standard component of child neurology care for many patients," said Ingo Helbig, MD, a pediatric neurologist at CHOP, director of the genomic and data science core of CHOP's Epilepsy Neurogenetics Initiative (ENGIN) and senior author on this study. "Increased use of telemedicine was prompted by a public health emergency, and so we need to make sure, as these new tools for patient care remain prevalent, that we're continuing to learn about and address disparities in care and optimize access for socially vulnerable families, so that they have the tools necessary should another similar public health crisis occur." This study was supported by The Hartwell Foundation through an Individual Biomedical Research Award; the National Institute for Neurological Disorders and Stroke grants K02 NS112600 and K23 NS102521; the Center Without Walls on ion channel function in epilepsy "Channelopathy-associated Research Center" grant U54 NS108874; the Eunice Kennedy Shriver National Institute of Child Health and Human Development through the Intellectual and Developmental Disabilities Research Center (IDDRC) at Children's Hospital of Philadelphia and the University of Pennsylvania grant U54 HD086984; intramural funds of Children's Hospital of Philadelphia through the Epilepsy NeuroGenetics Initiative (ENGIN); and the National Center for Advancing Translational Sciences of the National Institutes of Health through the Institute for Translational Medicine and Therapeutics' (ITMAT) Transdisciplinary Program in Translational Medicine and Therapeutics at the Perelman School of Medicine of the University of Pennsylvania grant UL1TR001878. Kaufman et al, "Child neurology telemedicine: analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic." Dev Med Child Neurol. Online September 16, 2022. DOI: 10.1111/dmcn.15406. About Children's Hospital of Philadelphia: A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as a new inpatient hospital with a dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu . Contact: Ben Leach Children's Hospital of Philadelphia (609) 634-7906 Leachb@email.chop.edu See original article: https://finance.yahoo.com/news/chop-study-explores-telemedicine-child-154000001.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr < Previous News Next News >

Updated Version of CONNECT for Health Act Introduced in Congress Center for Connected Health Policy May 4, 2021 Last week an updated version of the CONNECT for Health Act was introduced in Congress. Last week an updated version of the CONNECT for Health Act was introduced in Congress. The bill, which was first introduced in 2016 but has been repurposed in this newest version to remove restrictions on telehealth for mental health, stroke care and home dialysis in certain circumstances. It also addresses several of the restrictions in Medicare, including geographic limitations, expanding originating sites to include the home, restrictions on federally qualified health centers (FQHCs) and rural health clinics (RHCs) reimbursement and gives the Secretary of Health and Human Services the ability to waive other telehealth restrictions permanently. For more information, see the press release, or read the bill’s summary published by Senator Schatz office. Stay tuned for a deeper dive and further analysis from CCHP next week. Press Release: https://www.schatz.senate.gov/press-releases/schatz-wicker-lead-bipartisan-group-of-50-senators-in-reintroducing-legislation-to-expand-telehealth-access-make-permanent-telehealth-flexibilities-available-during-covid-19-pandemic Summary: https://www.schatz.senate.gov/imo/media/doc/CONNECT%20for%20Health%20Act%20of%202021_Summary.pdf < Previous News Next News >

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

Pandemic broadens NMDOT’s outlook to lay groundwork for a connected future By NMDOT February 8, 2021 “The pandemic forced New Mexico to rely heavily on internet access, making broadband even more essential,” SANTA FE – The New Mexico Department of Transportation is committed to helping build out the information highways in New Mexico to connect rural communities to vital digital resources while enhancing mobility and safety on state highways. “The pandemic forced New Mexico to rely heavily on internet access, making broadband even more essential,” said Transportation Secretary Mike Sandoval. “Digital expansion has been a passion project of the department for a while, but the urgent need for telecommuting, distance learning and telemedicine has fueled the drive to make internet access for every New Mexican a reality.” The DOT is looking ahead at what it would take to piggyback fiber optic infrastructure with current and future road construction projects to achieve dig once practices and help make future broadband expansion projects more welcoming for industry partners. Additional fiber infrastructure would also enhance the department’s Intelligent Transportation Systems (ITS) which allows DOT to install additional digital message boards, cameras, and weather sensors, to provide real-time road condition information through the NMRoads application. “As existing roads are reconstructed, there’s an opportunity to install fiber conduit while the road is torn up, so you’re not digging twice, which minimizes the impact on the environment,” said Sandoval. “Building both literal and digital highways will provide innovative, sustainable infrastructure that serves the entire state.” NMDOT is also partnering with the New Mexico Economic Development Department (NMEDD) to conduct a stratospheric broadband infrastructure assessment which will not only evaluate the connectivity opportunities for rural New Mexico, but also identify the same prospects for the state’s transportation needs. “We have a long way to go, but the department is gathering data and taking the necessary steps to ensure DOT plays a significant role in broadband accessibility,” adds Sandoval. < Previous News Next News >

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

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

New Wave of Federal Bipartisan Bills to Expand Telehealth Center for Connected Health Policy June 2021 A good majority of the recently introduced bills focus on increasing telehealth reimbursement, however a few look to increase funding for telehealth services and infrastructure. At present, CCHP is tracking over 100 pieces of telehealth legislation in the current federal legislative session. This month we have seen a number of bipartisan bills introduced, continuing the federal push to expand telehealth availability and codify flexibilities allowed during the COVID-19 public health emergency (PHE). A good majority of the recently introduced bills focus on increasing telehealth reimbursement, however a few look to increase funding for telehealth services and infrastructure. It is notable the significant amount of support from both sides of the aisle for telehealth. For instance, representatives Dan Newhouse (R-WA) and Tom O’Halleran (D-AZ) introduced the Rural Remote Monitoring Patient Act (HR 4008) that would establish a pilot grant program to support the use of remote patient monitoring in rural areas. Senator John Kennedy (R-LA) introduced as part of a package of telehealth bills a reintroduction of a bill similar to legislation from 2020 titled the Telehealth Health Savings Account (HSA) Act (S 2097). The Telehealth HSA Act would allow employers to offer high-deductible health plans that include telehealth services without limiting employees’ ability to use health savings accounts. According to Kennedy’s press release, “a current IRS regulation stops employees from making or receiving contributions to HSAs if they hold a high-deductible health plan that waives the deductible for telehealth services, meaning employees holding high-deductible health plans often need to pay out of pocket for telehealth services. The Coronavirus Aid, Relief and Economic Security (CARES) Act (HR 748) temporarily waived this regulation, but S 2110 would make the waiver permanent.” We have also seen a few of the recent bills look at audio-only and codifying pandemic telehealth flexibilities. The Protecting Rural Telehealth Access Act (S 1988) by Senator Joni Ernst (R-Iowa) and also sponsored by Senators Jerry Moran (R-Kan.), Joe Manchin (D-W.Va.), and Jeanne Shaheen (D-N.H.), would: *Allow payment parity for audio-only telehealth services *Make permanent the ability for patients to be treated at home *Let rural health clinics (RHCs) and federally qualified health centers (FQHCs) serve as distant sites for telehealth services The Advancing Telehealth Beyond COVID-19 Act of 2021 by Representative Liz Cheney (R-Wyo.), introduced with Representative Debbie Dingell (D-MI), makes the following permanent changes: *Removes originating site and geographical limitations *Maintains telehealth flexibilities for RHCs/FQHCs *Expands coverage for audio-only services *Removes restrictions that limit clinicians’ ability to remotely monitor and track patient health and provide them access to innovative digital devices Additionally, we have seen bipartisan support around broadband legislation, such as from Senators Michael Bennet (D-Colo.), Angus King (I-Maine), and Rob Portman (R-Ohio), who recently introduced legislation which seeks to address the digital divide. Their Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act of 2021 would allow states to deploy “future-proof” networks able to meet communities’ broadband needs, including supporting local initiatives on affordability, adoption, and inclusion. According to Bennet’s press release, The BRIDGE Act would: *Provide $40 billion to States, Tribal Governments, and U.S. Territories for affordable, high- speed broadband *Prioritize unserved, underserved, and high-cost areas with investments in “future proof” networks *Encourage gigabit-level internet wherever possible while raising the minimum speeds for new broadband networks to at least 100/100 Mbps, with flexibility for areas where this is technologically or financially impracticable *Emphasize affordability and inclusion by requiring at least one affordable option *Increase choice and competition by empowering local and state decision-making, lifting bans against municipal broadband networks, and allowing more entities to compete for funding Lastly, additional information was just released regarding Cures 2.0 – another bipartisan bill, which creates the Advanced Research Projects Agency for Health (ARPA-H), a President Biden budget request proposal. According to a discussion draft and section-by-section summary, Cures 2.0 will address a variety of areas, including telehealth access, while incorporating and building upon several additional bipartisan bills, such as the Telehealth Improvement for Kids’ Essential Services (TIKES) Act (H.R. 1397 / S. 1798) and Telehealth Modernization Act (H.R. 1332 / S. 368). The telehealth provisions proposed in Cures 2.0 include: *Review the impact of telehealth on patient health and encourage better collaboration *Provide guidance and strategies to states on effectively integrating telehealth into their Medicaid program and Children’s Health Insurance Program (CHIP) *Make many of the COVID-19 PHE flexibilities post-pandemic permanent, such as: -Removing the geographic and originating site restrictions -Expanding the range of health care providers that can be reimbursed by Medicare for furnishing telehealth services to any health care professional eligible to bill Medicare -Enhancing telehealth services for use by FQHCs, RHCs, hospices, and for home dialysis The authors anticipate that the Cures 2.0 bill will be introduced in the coming weeks and hope to see it signed in the fall. While the fate of these telehealth bills is yet to be seen, it does seem to highlight strong federal support for expanding access to telehealth post PHE with such a large amount of bipartisanship support behind them. Given Medicare’s historically conservative approach in regard to telehealth pre-PHE, any additional shift would be significant. CCHP will continue to update its tracking tools and monitor the ever evolving telehealth landscape as we continue to move through the current federal legislative session. < Previous News Next News >

Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care Emily C. Webber, Brock D. McMillen, and Deanna R. Willis May 11, 2022 Abstract Background:In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services. Methods:In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services. Results:In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (p < 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey. Conclusions:This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access. Introduction Telemedicine and virtual care expanded rapidly during the COVID-19 pandemic of 2020. Fueled by necessity among health care providers and systems to deliver patient care, adoption was also driven by removal of barriers and expanded Centers for Medicare & Medicaid Services (CMS) reimbursement models. In March 2020, CMS authorized Medicare beneficiaries to receive telehealth at any location, including their homes.1 Subsequent waivers increased the scope of Medicare telehealth services, including a wider array of practitioners. Finally, the Department of Health and Human Services Office for Civil Rights announced that it would waive penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers who were using everyday communication technologies to provide telehealth services.2 These combined changes resulted in millions of additional telehealth visits. CMS data from March and June of 2020 showed an increase from 13,000 beneficiaries using telehealth before the public health emergency to 1.7 million in the last week of April 2020.3 These CMS expansions were made permanent in January 2021.4 Despite these expansions, not all patients are positioned to take advantage of the adoption of telemedicine and virtual care. The digital divide or lack of access to reliable high-speed internet is a well-described gap, made worse in 2020, as many entities turned to virtual solutions to work, study, and conduct business as usual. Nearly 42 million people in the United States may not have the ability to purchase broadband internet as of February 2020,5 disproportionately impacting communities of color as well as low socioeconomic status.6 Finally, according to BroadbandNow, an estimated 1.35 million (20%) residents in Indiana are unserved by broadband internet providers at their home address.7 At the height of the COVID-19 pandemic, precautions such as stay-at-home orders and business, municipal, and school shutdowns eliminated public options for internet access. Addressing these gaps is a critical step in preventing worsening inequities in access to care.8 In this study, we surveyed patients in an urban primary care clinic to determine their access to internet and devices, readiness, and barriers to utilizing telemedicine and virtual health care. Methods In August 2019, patients from a primary care clinic located in central Indianapolis, Indiana, participated in a 10-question quality improvement survey. The Institutional Review Board reviewed and determined the survey to be exempt. Each patient arriving at the clinic over a 2-day period was given the chance to participate. The paper survey included questions about home internet and device access, phone plan and phone data adequacy, and interest in virtual visits (see Supplementary Data for full survey). The patient's insurance coverage information was captured on the paper survey form by the staff before handing the form to the patient. The results were assessed using chi-square tests to determine differences between payor groups. A linear regression model was utilized to analyze the association of phone plan data adequacy with interest in video visits. Following the results of the first survey, efforts to improve adoption of virtual visits were undertaken, including office signage promoting virtual visits, offering a virtual visit follow-up at checkout, visual cues to prompt providers to schedule virtual follow-ups, and scripting for appointment schedulers to include offering virtual visits at the time of scheduling. In September 2020, the same quality improvement survey was repeated from the same clinic during an active time period of COVID-19 to see if additional quality improvement efforts were warranted. One additional question was added to the 2020 survey: “How has your ability to do a video visit changed since the onset of COVID-19?” The results were assessed using chi-square tests between payor groups. A linear regression model was utilized to analyze the association of phone plan data adequacy with interest in video visits. Scheduled appointments were tracked weekly by type and audited for completion throughout the study period. Video visits that could not be completed using video were converted to telephone visits and counted as telephone visits. For FULL article: https://www.liebertpub.com/doi/10.1089/tmj.2021.0126 Published Online:11 May 2022https://doi.org/10.1089/tmj.2021.0126 < Previous News Next News >

Transgender Telemedicine and Telehealth Services: A Tremendous Asset Dr. Maheu, Telehealth.org August 2021 Telehealth services can also be effective in reaching communities not isolated by location but marginalized by identity. One of the most significant arguments for telehealth services is their ability to reach people in underserved communities. Telehealth.org described some of the foundational issues in its article The Future of Telehealth, Teletherapy, and Telemedicine. The article specifically highlighted telehealth as a means of overcoming geographic limitations. However, telehealth services can also be similarly effective in reaching communities not isolated by location but marginalized by identity. In particular, transgender telemedicine & telehealth services provide significant benefits to the trans community. Challenges Facing the Transgender Community Telehealth.org outlined many challenges facing transgender individuals seeking services in its article Transgender Telemedicine: Inequities and Barriers in Health Care Access. In seeking therapy services, one of the most substantial dissuading factors reported by transgender individuals is fear of discrimination. This fear does not come without significant evidence. Last year, the Supreme Court decided to extend trans individuals the same discrimination protections other groups already experience under employment laws. Even after that landmark decision, 38% of Americans still indicate they do not support the rights of trans people. With so-called bathroom bills and legislation that prevents trans girls and women from participating on sports teams for women, the current American legislative landscape continues to be challenging. Location and marginalization often intersect. Trans individuals living in rural areas often face a general lack of available services. Additionally, available clinicians usually do not have a trans-informed perspective. Similar concerns exist in politically conservative areas. How Transgender Telemedicine and Telehealth Services Help the Trans Community As noted above, telehealth services have already been an asset to assist individuals who are geographically isolated. It should be just as effective in reaching trans individuals in those areas as helping others. For those isolated by discrimination and fear of discrimination due to their trans status, telehealth can also help. By allowing people in the trans community to reach beyond their geographic limitations, they immediately have access to a larger pool of supportive clinicians who can provide trans-informed services. Telehealth transgender services also provide increased anonymity to a degree for trans people. In many of rural America’s small towns, people know each other by vehicle. Seeing someone’s vehicle parked in front of a mental health or drug treatment facility can often send the town’s gossip mill into a tailspin. By accessing discrete trans telemedicine or telehealth services to their homes, people avoid this harmful exposure. Can Transgender Telemedicine & Telehealth Services Continue? Trans individuals used telehealth 20 times more in the past 18 months than they ever have before. This new safe therapy avenue, however, may not last. Just two weeks ago, four states either ended many of their telehealth expansion policies or announced their intention to do so. Federally, the waivers introduced by the CARES Act will expire in October unless renewed or made permanent. The system is in transition and it may well end up leaving behind some of the progress it has made. Transgender Telemedicine and Telehealth Advocacy The time is now to reach out to your officials, state and federal, and advocate for more permanent laws that expand telehealth services and reimbursement. Sharing case examples without client identifying information and your passion for the issue could be just the sort of personal advocacy needed. Your voice may persuade elected officials to act quickly and empathetically on behalf of the trans community and everyone else who will benefit from telehealth support. Rural Transgender Report: https://www.lgbtmap.org/file/Rural-Trans-Report-Nov2019.pdf < Previous News Next News >

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

Recent DOJ Fraud Charges Include Few Details and Links to Telehealth Center for Connected Health Policy June 2021 The Department of Justice (DOJ) recently announced criminal charges against a variety of individuals related to various alleged COVID-19 fraud schemes. One of the kickback schemes does appear to include a telehealth element. The Department of Justice (DOJ) recently announced criminal charges against a variety of individuals related to various alleged COVID-19 fraud schemes. Most of the new cases appear to be related to fraudulent testing claims and kickback schemes, although one of the kickback schemes does appear to include a telehealth element. According to the DOJ press release, two Florida men – a consultant as well as a Texas laboratory owner – allegedly exploited temporary telehealth waivers by offering providers access to Medicare beneficiaries for whom they could bill consultations. In return, the providers referred the patients to that laboratory for potentially unnecessary cancer and cardiovascular genetic testing. Despite potentially misleading headlines, most charges appear to only be against executives and additional details directly tying the fraud to telehealth and the correspondence, billing, and waivers in question have yet to be released. As one updated mHealth Intelligence article later noted, “the charges try to link fraud cases to telehealth coverage, but are more closely aligned with telefraud.” For more information read the full DOJ press release - https://www.justice.gov/opa/pr/doj-announces-coordinated-law-enforcement-action-combat-health-care-fraud-related-covid-19. < Previous News Next News >