NM Telehealth Workgroup Hosted by the New Mexico Telehealth Alliance 7/29/2021 New Community Forum for NM Healthcare Peers on Telehealth Topics This is a monthly community forum to discuss telehealth issues with your healthcare peers. The intent is to help New Mexican systems advance remote care. Topics will change monthly and be directed by what the group members ask for. Hosted by the New Mexico Telehealth Alliance, our first session on July 29 is a collaboration with Presbyterian Healthcare Services and the University of New Mexico. We will explore audio only post-pandemic billing using HCPCS code G2252. Register here: https://www.eventbrite.com/e/nm-telehealth-community-forum-registration-163947169397 < Previous News Next News >

Permanent Pay, Originating Site Policies Boost Access to Virtual Addiction Services Victoria Bailey Dec. 29, 2021 By making temporary reimbursement and site-originating policies permanent, legislators could help increase access to virtual opioid use disorder treatment, according to a new report. December 20, 2021 - Lawmakers have the power to solidify access to virtual opioid use disorder treatment by introducing policies that ensure reimbursement parity, solidify audio-only telehealth coverage, and expand the list of eligible originating sites, according to an issue brief from the Pew Charitable Trusts. During the COVID-19 pandemic, telehealth proved to be a successful care modality for delivering opioid use disorder treatment to individuals across the country. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services (SAMHSA) lifted their restrictions and allowed buprenorphine prescribers to initiate medication treatment via telehealth without requiring an in-person visit first. However, these regulations are temporary and are set to expire once the public health emergency ends. In order to ensure access to virtual opioid use disorder treatment, state Medicaid agencies and policymakers should make these and other telehealth regulations permanent, Pew said. Legislatures should require public and private payers to reimburse providers for all opioid use disorder treatment services delivered via telehealth, including clinical assessments, prescriptions, medication management, and counseling sessions. Additionally, ensuring reimbursement for a variety of providers — including physicians, nurse practitioners, physician assistants, and mental health professionals — could help solidify the virtual treatment process. According to Pew, states that offered coverage for buprenorphine prescribing via telehealth saw positive patient outcomes that were similar to in-person services. Policymakers should also establish payment parity between telehealth and in-person opioid use disorder treatment services under public and private payers alike. “Without assurances of sufficient reimbursement rates, providers may be unwilling to invest in telehealth infrastructure for their practices, or they may find it infeasible to increase the use of telehealth for OUD treatment,” researchers wrote in the brief. Medicaid programs can ensure reimbursement parity for telehealth services without submitting a plan amendment to the Centers for Medicare and Medicaid Services (CMS). Thirty-eight states and Washington D.C. have established payment parity for certain telehealth services, but not all programs include opioid use disorder services in their provisions. Originating-site restrictions must also be addressed, Pew researchers said. Some states allow patients to use telehealth but only from certain clinics that can serve as an originating site. By expanding the list of eligible originating sites to include the patient’s home, policymakers could make accessing virtual care more convenient for individuals. Medicare currently allows individuals to receive telehealth-based opioid use disorder treatment from their homes, according to the brief. Past studies have shown that patients can initiate buprenorphine safely and successfully while remaining in their homes. In addition, patients seemed to prefer receiving treatment from home. Further, Medicaid programs should make audio-only telehealth policies permanent to facilitate access to virtual care, Pew researchers recommended. Audio-only coverage is set to expire when the public health emergency ends. Ensuring that providers receive reimbursement for audio-only opioid use disorder services may help address care disparities and benefit underserved communities that tend to use the care modality most often, including Black and Hispanic populations, individuals with limited English proficiency, and communities with inadequate broadband access. At least 15 Medicaid programs offer reimbursement for audio-only telehealth as of February, but some states only provide coverage for certain services, the brief noted. Finally, Pew researchers recommended that policymakers allow correctional settings to offer telehealth-based opioid treatment. Jails and prisons typically allow incarcerated individuals to receive healthcare via telehealth but the option to receive virtual opioid use disorder treatment is far less common, the brief stated. If states allocated funding to these institutions, they could invest in the necessary telehealth resources to establish virtual opioid treatment services. A few correctional facilities, including one in Minnesota and one in Massachusetts, currently offer buprenorphine treatment, counseling sessions, and clinical assessments through telehealth. Even with these policy changes, states may face additional barriers to offering virtual opioid treatment services including a lack of funding for infrastructure and poor broadband access. Pew researchers suggested that states consider partnering with the National Consortium of Telehealth Resource Centers to receive assistance with launching a telehealth program. Additionally, state and local governments can leverage funding from the American Rescue Plan Act to invest in expanding internet access to communities that need it. https://mhealthintelligence.com/news/permanent-pay-originating-site-policies-boost-access-to-virtual-addiction-services < Previous News Next News >

ATA AND ATA ACTION CO-LEAD LETTER TO THE U.S. SENATE SIGNED BY OVER 370 STAKEHOLDER ORGANIZATIONS SEEKING PERMANENCY FOR TELEHEALTH American Telemedicine Association September 13, 2022 WASHINGTON, DC, SEPTEMBER 13, 2022 – The American Telemedicine Association (ATA) and ATA Action co-led letter signed by 375 stakeholders urging the Senate to act this fall to ensure certainty for telehealth services. The letter asks the Senate to pass a two-year extension of the flexibilities and waivers allowing temporary access to telehealth put in place under the current public health emergency (PHE), while continuing to push for a permanent extension. Stakeholders are also pushing the Senate to include provisions to lift provider and patient location limitations, remove in-person requirements for telemental health, ensure continued access to clinically appropriate controlled substances without in-person requirements, and increase access to telehealth services in the commercial market, such as provisions in law set to expire at the end of the year that allow people with a high deductible health plan (HDHP) health savings account (HSA) to access telehealth coverage without first having to meet annual deductibles. The stakeholder letter was co-led by the Alliance for Connected Care, College of Healthcare Information Management Executives (CHIME), Connected Health Initiative, Consumer Technology Association, Executives for Health Innovation, Health Innovation Alliance, HIMSS, and Partnership to Advance Virtual Care. “This letter truly speaks from a strong, unified voice, representing the breadth of the healthcare industry. While we, over 375 strong, seek permanency for telehealth access, our hope is that the Senate will at least match the full two years of extensions envisioned by H.R. 4040,” said Kyle Zebley, senior vice president, public policy, the ATA, and executive director, ATA Action. “Further, in response to the recent actions of the House, the Senate should make great policies greater, by including those provisions left out of H.R. 4040. “Specifically, the Senate should make permanent, or at the very least extend the high deductible health plan (HDHP) health savings account (HSA) telehealth benefit set to expire at the end of the year and pass the remote prescribing provision to ensure continued access to clinically appropriate controlled substances without in-person requirements,” added Zebley. “When included with the policies recently passed with near unanimous support in the House, these additions will ensure Americans, particularly those in underserved and vulnerable communities, maintain access to quality healthcare.” To read a full copy of the stakeholder letter, please click here. About ATA Action ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 company and an affiliated trade organization of the ATA. About the ATA As the only organization completely focused on advancing telehealth, theAmerican Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models. See full article: https://www.americantelemed.org/press-releases/ata-and-ata-action-co-lead-letter-to-the-u-s-senate-signed-by-over-370-stakeholder-organizations-seeking-permanency-for-telehealth/ < Previous News Next News >

Trends in Telehealth: CCHP's 50 State Telehealth Policy Summary Report, Fall 2022 Center for Connected Health Policy October 18, 2022 Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2022. Additionally, we are also making available a summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting our key findings. The most current information in CCHP’s online policy finder tool may be exported for each state into a PDF document. The Fall 2022 summary report adds in two new jurisdictions, Puerto Rico and Virgin Islands, and covers updates in state telehealth policy made between July and early September 2022. Note that in some cases, after a state was reviewed by CCHP, it is possible that the state may have passed a significant piece of legislation or implemented an administrative policy change that CCHP may not have captured. In those instances, the changes will be reviewed and catalogued in the upcoming Spring 2023 edition of CCHP’s Summary Report. As in previous editions, information in the policy finder remains organized into three categories: Medicaid reimbursement, private payer laws and professional requirements. Additionally, for this edition, CCHP received support from the National Association of Community Health Centers (NACHC) through funding from the Health Resources and Services Administration (HRSA) to create a specific category on federally qualified health center (FQHC) Medicaid fee-for-service policies. FQHCs have many unique rules that apply to them that sometimes effect their ability to utilize telehealth, such as the definition of a visit/encounter in the Medicaid program. The new FQHC category takes these considerations into account and will help FQHCs be able to more easily navigate to the policies that specifically affect them. See full article: https://mailchi.mp/cchpca/just-released-cchps-50-state-telehealth-policy-summary-report-fall-2022trends-in-telehealth-policy < Previous News Next News >

Academy Health Report Addresses Medicaid Directors Perspective on Telehealth Center for Connected Health Policy May 2021 Views on telehealth since the COVID-19 Public Health Emergency (PHE) began In March 2021, Academy Health released a report detailing results from an environmental scan and discussions with Medicaid Medical Directors (MMDs) on their views on telehealth since the COVID-19 Public Health Emergency (PHE) began. MMDs are physicians and clinical leaders in different specialties who advise Medicaid programs on clinical matters. During the pandemic, many have weighed in on telehealth and how it should be deployed in their states Medicaid program. The report breaks down views of Medicaid directors and resulting recommendations into three topic areas: Equity, Quality and Payment. Examples of recommendations made in the equity category include: 1. Medicaid programs should clearly communicate temporary telehealth policies and when those policies will expire. 2. Medicaid programs should support expansion of telehealth for purposes of equitable access if clinically appropriate and makes sense in terms of cost and quality. 3. Medicaid programs should work to reduce barriers to telehealth, including addressing the technology divide, digital literacy and underlying health disparities. For more details and recommendations related to quality and payment, read the full report. < Previous News Next News >

Telehealth: How Asynchronous Communication Creates Provider Efficiencies Many Roth, Health Leaders April 2021 Presbyterian Healthcare Services reduces online "visits" to two minutes per encounter versus 15 to 18 minutes for real-time virtual visits. At the beginning of 2020, physicians and consumers had not yet fully embraced the concept of virtual video visits; many were skeptical about the ability to deliver care effectively in this manner. Yet after the pandemic forced the adoption of virtual visits, perceptions and usage forever changed. Today, asynchronous communication faces the same hurdles. Providers and patients don't understand how it works and question its value. "It's a technology whose time has not yet come," says Oliver Lignell, vice president of virtual health at health system consultancy AVIA, which helps members accelerate their digital transformation initiatives. "It's not yet mainstream, but it should be." Presbyterian Healthcare Services, an Albuquerque, New Mexico–based nonprofit integrated healthcare delivery system, began investigating this approach to healthcare four years ago. "It's been incredibly effective," says Ries Robinson, MD, senior vice president and chief innovation officer. Between the system's nine hospitals and a health plan it offers, the organization serves a third of the state's residents. With a shortage of practitioners in New Mexico, and 70% of the care it provides covered by capitated contracts, Presbyterian needed to find a way to operate more efficiently. Asynchronous communication worked. Last year, a designated group of employed urgent care physicians handled 50,000 asynchronous visits for low-acuity care, and spent an average of two minutes on each encounter—far less than the 15–18 minutes it takes to conduct a typical video call. This form of care does not occur in real time. Depending on the platform used, a patient completes and submits an online form via secure email, text, or an app, detailing his or her complaint and relevant history. A physician receives the information, processes it, and sends a response back to the patient with instructions and prescriptions, if necessary. Presbyterian physicians usually respond within 15 minutes; some health systems using asynchronous communication allow up to 24 hours. There is no direct audio or video exchange with the patient unless the physician thinks it is warranted and escalates the encounter. ASYNCHRONOUS COMMUNICATION OFFERS MULTIPLE ADVANTAGES Asynchronous communication offers some distinct advantages to health systems, say the experts. Synchronous care, which includes video, audio, and in-person visits, comes with an Achilles' heel: Regardless of venue, the physician spends about the same amount of one-to-one time with the patient, says digital medicine expert Ashish Atreja, MD, MPH, chief information and digital health officer at UC Davis Health in Sacramento, California. "The real growth you're going to see in value," he says, "is the ability to deliver one-to-many care." Asynchronous communication is a step in that direction. "One of the most important things asynchronous communication does is help scale response," says Ann Mond Johnson, MBA, MHA, CEO of the American Telemedicine Association. In addition, because patients can use it with a phone or the internet, it can address issues of access, she says. Robinson says the SmartExam™ platform Presbyterian is using, made by Bright.md, includes features that appeal to its physicians. It automatically enters chart-ready SOAP (Subjective, Objective, Assessment, and Plan) notes into the electronic medical record (EMR), creates billing files, and manages patient follow-up communications. "It's extremely elegant," says Robinson. SmartExam's design, which asks patients questions in an interview-style exchange, and advanced logic has earned the trust of the physicians who use it, he says. "I remember the first time [physicians] said, 'I trust it'; I thought that was kind of a funny term to use," Robinson recalls. When he asked the doctors what they meant, they explained that the tool is thorough and consistent in a way humans cannot replicate. "That's what the providers really like." Even the best medical assistant, he says, may vary in how they ask questions of patients, forget to include certain details, or package assessments differently. HOW TO CALCULATE COST SAVINGS While Robinson says the health system has detailed financial models that justify the cost of the platform, he declines to disclose the figures, but notes, "It hasn't been an astronomical investment by any stretch of the imagination." Expenses include a one-time cost for EMR integration, ongoing charges for using the platform on a per-patient per-use basis, and marketing and promotion. He also provides formulas to calculate estimated cost savings. They include: Better utilization of providers' time and related staffing expenses, by reducing each of 50,000 encounters from 15–18 minutes for a video encounter to two minutes for an asynchronous visit. More appropriate ER usage. Out of 50,000 patients, 8% were redirected away from the ER. This figure is based on patient survey responses indicating they would have visited the ER had the platform not been available. With an average ER visit costing more than $500, says Robinson, "there's a significant savings." Reduced workload at urgent care facilities. "Just assume 20,000 [of these patients] would have gone to an urgent care that we own," he says. The time and expense of urgent care staffing is used to calculate the savings. Patients also save money, says AVIA's Lignell. Nationally, he says the typical cost for an asynchronous visit is about $20, and many health systems offer these visits for free. This compares to a national average cost of $50 for a video visit and $125 for an in-person visit. THE POTENTIAL TO GROW BEYOND LOW-ACUITY CARE There is one additional element that has contributed to the success of asynchronous visits for Presbyterian: a digital front door. Patients visit the pres.today webpage, enter their condition and insurance information, and are automatically directed to the appropriate level of care, one of which includes the option for online visits (using asynchronous care). Because of the asynchronous initiative's success, the health system is expanding its use beyond low-acuity care. Future plans involve developing new uses for the platform, capturing symptoms and history to create greater efficiencies for video visits and even in-person care. "We have gotten religion around the idea of capturing as much information as you can in a sophisticated manner before the visit," says Robinson. "You maximize the quality of care and the efficiency of the visit. We're taking that idea and pushing it forward in multiple avenues of care here at Presbyterian." Value-based care will drive further adoption of these models, says Lignell. "The advantages from a total cost of care standpoint are huge," he says. "It's much less expensive to deliver care this way." While the bulk of growth has been in low-acuity primary care, he says asynchronous care is now being explored in specialty and higher-acuity care, as well as in e-consults between providers. "The asynchronous model is proving to be incredibly efficient for health systems," says Lignell. "That's one of the reasons why it has so much promise." Source: https://www.healthleadersmedia.com/innovation/telehealth-how-asynchronous-communication-creates-provider-efficiencies < 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 >

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

OCR Clarifies Post-PHE HIPAA Compliance for Audio-Only Telehealth Center for Connected Health Policy June 21, 2022image The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently released guidance on the use of remote communication technologies for audio-only telehealth to assist health care providers and health plans, or covered entities, bound by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules (HIPAA Rules). The goal of the guidance as stated by OCR is to support continued access to audio-only telehealth post-public health emergency (PHE) and make clear that audio-only telehealth is permissible under HIPAA Rules. One of the main federal public health emergency (PHE) flexibilities instituted at the beginning of the pandemic included relaxed enforcement of certain federal privacy laws related to the use of various telehealth technologies (see OCR’s Notification of Enforcement Discretion for Telehealth Remote Communications (Telehealth Notification)). The Telehealth Notification states that OCR will not penalize providers under HIPAA related to their good faith use of audio or video remote communication technologies during the PHE. While it appears likely that the PHE will be further extended one more time until mid-October, this guidance seeks to prepare providers for a return to compliance once the PHE and enforcement relaxations are no longer in effect. HIPAA Allows Audio-Only OCR first and foremost confirms the ability to comply with HIPAA when using remote communications to provide audio-only telehealth services. The guidance states the expectation of privacy of protected health information (PHI) from impermissible uses or disclosures and the importance of providing telehealth services in private settings. If the setting is not fully private, however, it is stressed that other safeguards must be put in place, such as speaking in low voices and not using speakerphone functions. In addition, entities must verify the individual’s identity if they are unknown. While verification can be completed orally or in writing, the HIPAA Rules do not require any specific method of identity verification. The guidance also highlights that this requirement may entail the use of language assistance services with individuals with limited English proficiency. HIPAA Only Applies to Electronic Information via Electronic Media In addressing the need to meet HIPAA Security Rule requirements to use remote communication technologies, OCR clarifies that the Rule only applies to electronic PHI (ePHI) transmitted over electronic media. Therefore, the Rule does not apply to audio-only telehealth services provided over a traditional landline, however it does apply to landlines being replaced with Voice over Internet Protocol (VoIP) and other electronic technologies that involve the internet, cellular, and Wi-Fi, as well as smartphone apps and messaging services that electronically store audio messages. These requirements again only apply to covered entities, noting that patients receiving telehealth services via remote technologies are not obligated by HIPAA and therefore covered entities aren’t responsible for the privacy of information once it has been received by the patient’s device. To ensure compliance with the HIPAA Security Rule the guidance states that all potential risks should be identified and addressed as part of risk analysis and risk management processes required under HIPAA, including the risk for interception of information during transmission, the ability for devices to encrypt transmitted information, and other device security and authentication processes. Business Associate Agreements & Payer Rules A business associate agreement (BAA) with a telecommunication service provider (TSP) is not always necessary to utilize audio-only technologies, as long as the TSP is just a conduit for the PHI being transmitted and does not have the ability to access the information being shared. If, however, the provider wants to use an app that does store information, then a BAA is required with the app developer, including apps that may provide translation services. The guidance states that whether or not audio-only services are covered by the patient’s health insurer does not impact a provider’s ability to provide those services in compliance with HIPAA, as payer rules and requirements are separate from HIPAA Rules. While continuation of PHE telehealth flexibilities remains a policy focus in Congress, it is likely that the flexibilities related to privacy enforcement will not be continued post-PHE making the technologies used to provide telehealth services an area of focus for providers looking to continue providing telehealth access moving forward. Continuing use of audio-only telehealth is also an area of policy focus post-PHE, therefore this guidance is very timely. While the guidance is technically specific to just one telehealth modality, it does speak to audio-only through electronic technologies, generally encapsulating other remote communications using electronic means, such as video and store-and-forward telehealth. For more information on OCR’s guidance related to audio-only communications post-PHE, as well as general telehealth guidance, please view the OCR FAQs and other resources listed in their entirety. For more information: https://mailchi.mp/cchpca/ocr-clarifies-post-phe-hipaa-compliance-for-audio-only-telehealth < Previous News Next News >

Suicide Prevention and Stigma Reduction with Dr. Alison Arnold Dr. Alison Arnold November 18, 2022 Danielle speaks with Dr. Alison Arnold, the Director Interdisciplinary Center for Community Health & Wellness at Central Michigan University (CMU). In this episode we discuss CMU's Preventing Suicide in Michigan Men (PRiSMM) program and how we utilize telehealth to address mental health disparities and increase access to care. See original article with audio: https://www.umtrc.org/podcasts/season-2-episode-19/ < Previous News Next News >

How Telehealth Enabled Critical Care for Newborns During COVID-19 Kat Jercich, Healthcare IT News July 2021 When the United Kingdom went into lockdown, babies kept being born and kept needing care. That's where teleneonatology came in. When the COVID-19 pandemic began to sweep across the United Kingdom in March 2020, the government quickly moved to impose a stay-at-home order. But even as society ground to a halt, one thing stayed constant: Babies were being born, and they needed care. In Liverpool, England, the restrictions meant a sudden drop in availability for neonatologists. "There were beginning to be discussions about transferring neonatal surgical services to other centers," explained Dr. Christopher Dewhurst, the clinical director for the Family Health Division at Liverpool Women's Hospital and the Liverpool Neonatal Partnership. "Our neonatal service would not have survived in its current state without telemedicine," Dewhurst continued. Dewhurst, who will be presenting at HIMSS21 with Beth Kreofsky, operations manager of the Teleneonatology Program at the Mayo Clinic, explained how moving to telemedicine allowed his team to maintain clinical service at Liverpool Women’s Hospital and Alder Hey Children’s Hospital. Between those two locations, Liverpool has one of the largest neonatal intensive care units in the United Kingdom. "The teleneonatology solution for our city ensured that we could continue to provide safe, quality care to our babies and families across two sites," said Dewhurst. Dewhurst's team turned to InTouch Health (now part of Teladoc) to continue care. The system, he said, was "simple to use, which led to the early uptake by clinicians." And change took place quickly: The program was designed, coordinated, implemented and embraced within two weeks. Dewhurst said he hopes HIMSS21 session attendees learn that "you can make setting up a system as difficult or as easy as you want." "Time is no barrier to setting up a telemedicine service," he added. When it comes to measures of success, Dewhurst said that the team has registered a wide range of good signs. "We have financial benefits, patient satisfaction and clinicians' user feedback, which is positive," he said. In particular, caregivers mention "the speed of reviews and ability to communicate quickly and effectively with specialists from other hospitals," said Dewhurst. Overall, he said, "We showed that with passion, commitment, and [willingness] – you can set up a whole teleneonatology program quickly and safely," he said. < Previous News Next News >

Telehealth and Maternal Mental Health Needs Two recent studies show telehealth can help new and expectant mothers. Psychology Today April 30, 2021 Telehealth measures decreased prenatal distress, pregnancy-related anxiety, and postpartum depression. Telemedicine has skyrocketed since the start of the pandemic. According to The New York Times, just short of May 2020, the Johns Hopkins neurology department was seeing 95 percent of patients virtually. The rise in telemedicine to address maternal mental health has also seen unprecedented growth during the pandemic. Meanwhile, Mental Health America states that the mental health needs of Americans have skyrocketed. Anxiety and depression screenings increased nearly four-fold in 2020, from nearly 2,000 screenings per day to roughly 8,000 per day. Women, and in particular pregnant women, are vulnerable to hormonal fluctuations that make them twice as likely to experience depression during their lifetime compared to men. Research in the past year and a half has shown that telehealth can be substantially as effective as in-person care. (Telehealth, more encompassing than telemedicine but inclusive of it, may include only educational components.) With respect to maternal mental health, there are two studies highlighted herein that demonstrate telehealth's promise when it comes to improving maternal mental health in terms of prenatal distress, pregnancy-related anxiety, and the postpartum period. Of note, one of the studies was conducted prior March 11, 2020, or the official start of the pandemic, which makes it non-COVID-19 related. Maternal mental health, or perinatal mental health, is defined by the Maternal Health Task Force as a woman’s mental health during pregnancy and in the postpartum period. The significance of this period is multifold. It includes increased risk of the following: preterm delivery, low birth weight, impaired postnatal infant growth, insecure infant-mother attachments, and suboptimal breastfeeding practices. The first study published in Midwifery in 2021 supports the use of tele-education in improving prenatal distress and pregnancy-related anxiety. Specifically, the Midwifery study showed that “tele-education offered to the pregnant women on pregnancy and birth planning during COVID-19 decreased their prenatal distress and anxiety levels.” What the pregnant women received were phone calls, text messages, and a digital education pdf file, all of which educated women on a variety of topics, including “general methods of protection from coronavirus, coronavirus prevention methods during pregnancy, coronavirus and delivery process, measures to be taken during the coronavirus pandemic and postpartum process, measures to be taken during the coronavirus pandemic and breastfeeding, and how to manage stress, anxiety, and depression in these processes.” The tele-education included a digital pdf file called the “Booklet for Pregnancy and Birth Planning Education during Coronavirus (COVID-19).” All the of the educational content was developed with suggestions from medical and public health experts. A major takeaway from the above Midwifery study is that tele-education is effective in reducing the fears pregnant women have about giving birth as well as about their babies’ health in the context of a pandemic; in summary, prenatal distress and pregnancy-related anxiety were significantly decreased (p-value <0.05). Significantly lower scores on pregnancy-related anxiety questionnaires developed by van den Bergh (1990) and revised by Huizink et al. (2016) demonstrated the effective role played by tele-education. The second study published in Midwifery in 2021 supports the use of telemedicine interventions in treating postpartum depression symptoms. While the study’s timeframe was not during COVID, the results are helpful in understanding the beneficial role telemedicine has played in the past couple of years. Previous research has shown it can be a challenge for postpartum women to seek care for the “baby blues” or depressive symptoms, either of which could be significant. This may be due to perceived stigma, time, financial constraints, transportation, or childcare concerns. In this study, the telemedicine modalities included: telephone support, mobile applications, social media, and websites. This meta-analysis reviewed at least seven randomized controlled trials that largely used cognitive behavioral therapy (CBT) or psychoeducation to help pregnant women participants. The second Midwifery study concluded that telemedicine interventions “significantly decreased postpartum depression symptoms” and “demonstrated feasibility and acceptability among mothers in the postnatal period.” A major takeaway from the second Midwifery study is that telemedicine appears to be “promising in preventing and improving postpartum depression.” Of note, the study looked at women without a history of mental health conditions. Meanwhile, Hanach et al. highlight the need for larger-scale, future research to figure out the structure, content, and type of providers recommended within future telemedicine interventions. In conclusion, the benefits of telehealth—especially during COVID-19—appear to help women in the prenatal and postpartum phases of pregnancy. While the research is still growing, and quite limited, such positive signs are helpful in understanding the role that technology can play in addressing maternal mental health needs. Future studies that reflect on the benefits of telehealth are vital and will be particularly useful in supporting new and expectant mothers, especially in times of adversity. Source: https://www.psychologytoday.com/ca/blog/healthy-mothers-healthy-families-and-healthier-world/202104/telehealth-and-maternal-mental < Previous News Next News >

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

Over-the-Phone-Therapy: Rand Report Findings Dr. Maheu May 8, 2022 Preference for Over-the-Phone Therapy Visits A recently published RAND Corporation report confirms telehealth can improve healthcare access and high utilization of over-the-phone-therapy visits, also known as audio-only telehealth visits. Suggestions regarding reimbursement are included. However, the report cautions that more research is needed to ensure the equitable delivery of quality healthcare when using audio-only telehealth. In a bid to assist healthcare centers, the California Healthcare Foundation established a quality assurance program, the Connected Care Accelerator program (CCA), in July 2020. RAND researchers worked with 45 CCA health centers in compiling the report, “Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic.” RAND Report Findings The RAND report found that the number of clinical visits remained the same during the study period compared to before COVID-19. However, over-the-phone therapy for behavioral health issues was a standout in terms of services received by patients. Audio-only visits were favored for both primary health and behavioral health practitioners when the study started. Many primary health visits had reverted to in-person consultations, but over-the-phone therapy for behavioral health care remained high by the end of the study. There were significant differences in video consultations across health centers, particularly behavioral healthcare. Health centers transitioning from audio-only telehealth visits to video visits had varying degrees of success. Of those that transitioned to video visits, the most successful shared these characteristics: Telehealth video platforms were easy to use. Clinicians obtained leadership support and staff training. Everyone involved experienced a sense of urgency. Patients were willing to try the technology. Health center staff who took part in the study noted that it was challenging to set up video calls, which led to the preference for over-the-phone therapy. Also significant were the changes in the telehealth reimbursement policy. Audio Telehealth Can Bridge the Digital Gap According to the RAND report, healthcare centers had varying degrees of success in implementing telehealth. The availability of digital assets is one of the barriers to entry regarding telehealth access. The report suggested that telehealth phone calls offer the next best option where other telehealth resources are lacking. The American Medical Association (AMA) issued a brief, Equity in Telehealth: Taking Key Steps Forward, which recently provided more data about audio-only telehealth. The report points out that one in five adults in the US does not have broadband, which means that these people cannot avail themselves of the benefits of video-based telehealth. The study also reported that 15% of patients don’t have a smartphone to facilitate a video connection with a provider. AMA suggests that hospitals and healthcare providers should invest in initiatives to broaden the reach of telehealth for the inclusion of marginalized communities. According to the brief, some health centers have increased their support staff to help bridge the digital gap. They have also made available wi-fi and telehealth booths. The AMA report also states: The AMA urges health plans to be required to cover telemedicine-provided services on the same basis as in-person services and not limit coverage only to services provided by select corporate telemedicine providers. Telehealth Reimbursement for Over-the-Phone-Therapy In recent years, telehealth reimbursements and healthcare coverage changes are another reason why over-the-phone therapy and audio-only telehealth visits have gained popularity. Before the pandemic, telehealth reimbursement for over-the-phone therapy was rare. Medicare and many states did not classify audio-only calls as part of telehealth services. Many have now increased telehealth reimbursement to include audio-only telehealth visits. See TBHI’s previous articles related to telehealth reimbursement for more information: 7 States Change Telehealth Coverage for Telehealth Reimbursement Telehealth Expansion: 6 Additional States Announce Telehealth Coverage Audio-Only & Other Telehealth Services Approved for Reimbursement Moving Forward with Over-the-Phone-Therapy and Audio-Only Telehealth Reimbursement It is difficult to monitor how audio-only telehealth visits are now being used because historically there were no codes and modifiers on the claims applications. Medicare and Medicaid providers have recently added audio-only modifiers and coding to their listings. See Telehealth Reimbursement Alert: 2022 Telehealth CPT Codes Released. Data collection regarding telehealth phone calls will be forthcoming as a result. There is a general belief that over-the-phone therapy is open to improper use and can lead to increased costs and inequitable use. Data transparency may help mitigate this belief as clinicians’ preference for other modalities is revealed. See Audio-Only Telehealth: A Classic Solution to a Modern Crisis. RAND Report Recommendations The RAND report concluded that audio-only telehealth policies should be limited until evidence is better gathered and understood since audio-only telehealth data is lacking. Implementing policies with in-person and video requirements and different telehealth reimbursement rates is recommended. It pointed out that healthcare centers and professionals need support and resources for effective telehealth implementation. Professional training is also available. A complementary and recently published report described telehealth systems’ use, access, and quality. It showed how telehealth reimbursement and services have spread into all primary forms of healthcare to the satisfaction of providers and their clients. Over-the-phone therapy will remain an essential part of ensuring that clients receive the care they need until we bridge the digital divide. Policymakers need to balance their concerns with interpretations that support audio-only telehealth policies to reduce digital inequities while efforts are made to reduce the digital divide. < 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 >

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

The 13 telehealth platforms physicians use the most Katie Adams March 24, 2022 Telephone and Zoom are the two telehealth platforms physicians use the most, according to survey results released March 23 by the American Medical Association. Between Nov. 1 and Dec. 31, the AMA presented 1,657 physicians with a list of telehealth platforms and asked them to identify which ones they have used. Here are those platforms, along with the number of physicians who use them: 1. Audio-only telephone visits (723) 2. Zoom (600) 3. Doximity Video (439) 4. EHR telehealth module or tools (433) 5. Doxy.me (344) 6. Telehealth vendor (340) 7. FaceTime (269) 8. Patient Portal (234) 9. Microsoft Teams (92) 10. Texting (89) 11. Skype (48) 12. Remote patient monitoring tools (46) 13. Asynchronous messaging app (30) Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy. < Previous News Next News >

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

New Coding Modifier Offers Opportunity To Investigate Audio-Only Telehealth Alexander Beschloss, Ryan Van Ramshorst, Chethan Bachireddy, Christopher Chen, Andrey Ostrovsky November 18, 2022 Prior to the pandemic, Medicaid program coverage of audio-only telehealth services was limited. During the early stages of the pandemic, Medicaid beneficiaries were significantly less likely to complete telehealth visits compared to commercially insured patients. This was likely due to a series of obstacles, including: lack of access to high-quality broadband, a device with video capability, requisite digital skills, and private space to conduct the visit. For example, in 2019, roughly one in four Medicaid enrollees lived in a home without internet or with limited computer access. That said, Medicaid beneficiaries do not have significantly less access to devices with video capability (such as smartphones) than other patient populations, suggesting network connectivity poses more of a barrier than device access. Even further, nearly 50 percent of low-income patients in the US may not have requisite digital health literacy to use virtual telehealth. However, considering that 86 percent of Medicaid beneficiaries own a smartphone, it may be inferred that many more have sufficient digital literacy to engage in audio-only care rather than audio-visual telehealth. Network connectivity and low rates of digital literacy are two barriers that highlight the importance of creating the infrastructure to deliver and measure audio-only visits is of increased necessity. It was in this context that, once the pandemic struck, Medicaid agencies changed policies to augment access to telehealth services. For example, 17 state Medicaid agencies expanded reimbursement to include multiple modalities of telehealth, including audio-only. These changes particularly supported patient populations who had transportation, childcare, employment, or income barriers that prevent in-person care—challenges that are more prevalent in the Medicaid population. These policy innovations narrowed the reimbursement gap among in-person, audio-only, and audio-visual visits. In fact, the Department of Health and Human Services (HHS) recently investigated differences in patient populations who receive telehealth audio-only versus audiovisual use in 2021. For telehealth visits, Medicaid beneficiaries were more likely to use audio-only care than were privately insured patients (35.1 percent versus 45.5 percent). They discovered that compared to White patients, who used audio-only care for 38.1 percent of their telehealth visits, Latino, Black, and Asian patients did so at rates of 49.3 percent, 46.4 percent, and 48.7 percent, respectively. Patients with less than a high school education used it at 61.9 percent of their telehealth visits, compared to those with greater than a bachelor’s degree, who did such at a rate of only 32.6 percent. Across income brackets, there is an inverse relationship between household income and audio-only telehealth use. As the use of audio-only telehealth became more widespread among Medicaid beneficiaries, state Medicaid leaders needed a mechanism to measure clinical outcomes, health care costs, and patient experiences related to audio-only telehealth. Providers also needed a dedicated billing construct that could be used across public and private payers to streamline billing processes. Until recently, such mechanisms simply did not exist. And so, due to these insufficient coding constructs, several Medicaid medical directors spearheaded an application to the American Medical Association (AMA) to create a Current Procedural Terminology (CPT) modifier that would specifically designate audio-only services. In September 2021, the AMA CPT Editorial Panel accepted the addition of the CPT Modifier 93 code for synchronous audio-only telehealth, and the code became active on January 1, 2022. This article provides an overview of the rationale for and process of creating the CPT Modifier 93 code. Potential Benefits Of Audio-Only CPT Modifier Why was the creation of a new audio-only modifier necessary? Several reasons: data collection, policy implementation, health care equity, widespread need, and service specificity. The CPT 93 modifier permits differentiation among audio-only, audiovisual, and in-person care at the administrative level, which subsequently allows health service researchers to monitor and evaluate the use and clinical efficacy among these methods of care delivery. Prior to the introduction of this modifier, such high-quality analyses were impossible to do at scale. Along with the increase in all modalities of telehealth use since the COVID-19 public health emergency (63 fold increase year over year between 2019 and 2020), a survey performed by HHS (across all 50 states and the District of Columbia) discovered that 45.5 percent of all telehealth usage amongst Medicaid beneficiaries was audio-only. Taking things one step farther, several state legislatures including Washington, Connecticut, and New York have recently passed laws mandating or allowing coverage for audio-only services. Audio-only telehealth is being highly used, therefore having a mechanism to collect related data is vital. Implementing this modifier will serve as a tool for policy makers to make informed adjustments in policy around patients who use audio-only services. Implementation of this modifier will also enable claims-based research to monitor for disparities between audiovisual and audio-only care to ensure that all modalities of telehealth are provided in a sustainable, equitable, and high-quality fashion. Additionally, because different states have implemented varying strategies to cover audio-only services during the COVID-19 public health emergency (PHE), the CPT 93 modifier will help health services researchers and policy makers discern the differences between coverage approaches, information that will be crucial in standardizing telehealth data collection/storage across states. From a coding perspective, adding an audio-only modifier to existing and widely used CPT codes is a far more feasible option than alternatives such as individual payers developing their own coding modifiers. That approach would become unreasonably burdensome on providers who would subsequently have to learn and bill using the system established by each payer. Previous Codes Did Not Suffice While CPT codes for services provided through telephone exist, they do not specify the enormous range of behavioral health services, therapies, maternity-related care, post-operative guidance, and other services that have been successfully delivered via audio-only technology since the COVID-19 PHE. For example, CPT code 99441 represents a “telephone evaluation and management service; 5–10 minutes of medical discussion,” which gives no specificity regarding what type of care was delivered. In comparison, the CPT 93 modifier can be attached to theoretically any billing code that is permitted under law, thus allowing for more precise tracking and more useful follow-up research. Prior to the introduction of the CPT 93 modifier, there were seldom CPT codes that could be used to represent audio-only telehealth for specific services. Even though audio-only telehealth has been delivered at high rates, states have only been able to use temporary or workaround solutions to bill for audio-only services. For example, the Healthcare Common Procedure Coding System (HCPCS) Level II code for crisis response (CR) has been used by some states to support audio-only services during the COVID-19 pandemic. In the two and a half years since the pandemic began, however, the use of audio-only to provide health services has become normalized and may in fact now be expected by Medicaid providers and beneficiaries—a reality for which the CR code, and its temporary application, was not designed. The CPT 93 solves this challenge on a national scale. Another prior attempt to capture audio-only telehealth was the CPT modifier 95 that only indicated a telehealth service and did not differentiate between audio-only and audio-visual care. HCPCS Level II code “G0” has also been used; however, it indicates a telehealth service for diagnosis, evaluation, or treatment specific to symptoms of an acute stroke. Furthermore, CPT code 99401 can be used to reflect counseling services that may be provided via audio-only care; however, this code failed to capture all the nuance of the amount of time of care was delivered. At the end of the COVID-19 PHE, the Centers for Medicare and Medicaid Services (CMS) plans to add the “FQ” modifier on claims for HCPCS code G2080 for counseling and therapy provided using audio-only telecommunications. The HCPCS G2080 code refers to when one provides therapy services that largely exceed the amount listed in the patient’s individualized treatment plan for medication assisted treatment for opioid use disorder. This modifier exists solely for CMS’s Opioid Treatment Program and fails to account for other indications for audio-only telehealth. Creating a CPT modifier that is applicable to all service types simplifies the codification and measurement of audio-only care across all payer types. Conduct More Research On Audio-Only Telehealth Researchers, provider organizations, and policy makers must investigate and ensure that audio-only telehealth drives strong clinical outcomes. Telephone-focused care has been an important part of primary care; however, much of it was after hours, unmeasured, and not reimbursed. There is strong evidence on audio-only telehealth’s efficacy in prenatal visits and insomnia, for example. A randomized clinical control trial in a patient population of the Kaiser Permanente Washington system received audio-only cognitive behavioral therapy through the telephone demonstrated a significant benefit in improving sleep, fatigue, and osteoarthritis-associated pain. A cohort study amongst pregnant women in the Parkland Health System in Texas found that audio-only perinatal visits were not associated with changes in perinatal outcomes when compared to in-person visits in a vulnerable population. While these data are encouraging, they are sparse. Measurement of a CPT modifier may streamline the research methods used in these studies. Researchers must continue to investigate the efficacy of specific therapies when delivered via audio-only modalities. While audio-only telehealth solves several problems in health care, there are also several risks such as its potential use for inappropriate clinical indications and the risk that some may see an opportunity to overbill. An audio-only modifier—and therefore a more granular characterization of telehealth modalities—may help assuage concerns about fraud, waste, and abuse, removing existing ambiguity about the impact of different telehealth modalities on outcomes. We also know that the quality and value of these delivery modalities may vary according to the different demographics being served, including factors such as age, insurance status, payer, income, and region, among many others. Such modalities will likely vary between acuity of patient’s indication for care. Only by studying these differences amongst modalities and the populations served, can we ensure that the care delivered is equitable and valuable. Implementing the 93 modifier is a vital step toward enabling health services researchers to urgently pursue research questions that inform evidence-based policy about the best use of audio-only telehealth—especially amongst the Medicaid population. It is also essential to ensuring that the growth of audio-only health care does not create a two-tiered system between private insurance and Medicaid. For example, audio-only care may in fact be lower quality or lower value compared to audiovisual care or in-person care—although, further investigation is necessary to understand these differences. Considering that audio-only care helps remove barriers to care for underresourced patient populations, inappropriate use of audio-only care may further exacerbate the already large inequities in health care—a concern raised by both clinicians and patients. This reliance on audio-only care may also hamstring innovations that can improve the quality and access to audiovisual telehealth or in-person care. Clearly, there are legitimate concerns about the equity of audio-only health. To resolve them, more precise data and extensive investigations are necessary: Both of which will be enabled by the implementation of the CPT 93 modifier. An Opportunity For Action The new audio-only CPT 93 modifier provides meaningful potential benefits to combat barriers to care that were compounded during the COVID-19 pandemic. The new code creates a potent opportunity for conducting rigorous research into audio-only telehealth to inform federal- and state-level policy around equitable telehealth delivery. But to make the most of this opportunity, regulators, payers, providers, and researchers must take steps to increase adoption and evaluation of the audio-only modifier. To catalyze this work, large health systems should consider leading the adoption of the CPT 93 modifier while also encouraging local private providers to do the same. Payers and purchasers should consider requiring modifier submission, a step that would also facilitate further research into the field with minimal additional administrative burden on providers. Federal health agencies have a role as well. For example, the Agency for Healthcare Research and Quality (AHRQ) may increase awareness of the modifiers amongst affiliated researchers or those who use AHRQ databases while the Health Resources and Services Agency may require community health centers they fund to use the new modifier. Authors’ Note The authors would like to thank Dr. John Morgan and Amanda Brodt for their contributions to preparing this paper. Dr. Ostrovsky is an investor in the following companies, some of which provide telehealth services: https://www.socialinnovationventures.com . However, there are no direct conflicts of interest. See original article: https://www.healthaffairs.org/content/forefront/new-coding-modifier-offers-opportunity-investigate-audio-only-telehealth#.Y3feKa9vXhA.twitter < Previous News Next News >

Is telemedicine an answer to physician burnout and staffing shortages? Bill Siwicki May 24, 2022 A physician who works full time via telehealth – and in brick-and-mortar ERs on the side – discusses the benefits to herself and the industry. With the huge initial swell in the use of virtual care in the rearview mirror, many industry experts – from health plans to big tech and practicing clinicians – are considering whether a doubling down on telehealth is just what the doctor ordered for the future of patient care. Many clinicians are hungry for new opportunities that allow them to continue to serve patients without dealing with long-standing administrative burdens and the aftermath of burnout from COVID-19 in their hospitals, health systems and doctor's offices. With too many clinicians continuing to stress that they've lost passion in their careers and considering quitting their jobs altogether, experts say change is needed. The healthcare industry can't afford to lose these highly skilled clinical workers to other industries. On this note, Healthcare IT News interviewed Dr. Pooja Aysola, a practicing emergency department clinician in Boston and senior director of clinical operations at Wheel, a virtual care company. She talks about physicians' newfound familiarity with telehealth and what it means for the future, the possibility of physicians working full time in telemedicine, and how virtual care can help with staffing shortages in healthcare. Q. With the massive uptake in telemedicine during the past two years of the pandemic, clinicians have grown accustomed to delivering care virtually. What do you think this familiarity means for clinicians moving forward? A. I hadn't ever considered a career in virtual care until a few months into the pandemic. I was working in an emergency room in Boston when my shifts were cut after the hospital rolled back elective procedures. I started working in telemedicine as a temporary solution, but I ended up loving the flexibility to see patients at home and on my own schedule. I also quickly realized I didn't have to be in the same room as my patients to deliver great care. I can treat conditions such as UTIs through a screen and provide immediate value to my patients. I'm not alone in my sudden pivot from virtual-care skeptic to virtual-care advocate. Two in three clinicians now say treating patients in virtual only or hybrid care settings best fits their lifestyle, despite a significant lack of interest in telehealth before the pandemic. I'm hopeful this new trend will allow more clinicians to create career paths that work for them, rather than against them. Clinicians should have the flexibility to decide when they want to work, where they want to work, and how they want to work. If we're moving toward a hybrid care model, then we should enable clinicians to adopt hybrid careers, if that's what works best for them. In medical school, we're taught there's only one track you can follow: in-person care. But that's not the case anymore. I want every doctor and nurse to feel empowered to follow the career path that works best for them. Q. You seem to suggest that physicians looking for a change, perhaps due to burnout, can switch to telehealth full time. What would a move to virtual care look like for a physician? A. The past few years have been incredibly tough for clinicians. Burnout, frustration and fatigue are some of the many challenges facing clinicians today. Recent data shows more than half of clinicians have lost passion for their careers because of stress – and close to half believe burnout is the biggest threat to patient care today. Working in virtual care was a less-than-traditional career path before the pandemic. But now, many clinicians are considering working in virtual care to help combat burnout and increase flexibility. A move to virtual care will look different for everyone. For example, some clinicians enjoy having a set schedule each week to see patients. Others enjoy having more flexibility, where they can easily sign on after dropping their kids off at school, sign off before running an errand, or even split their time between virtual and in-person care. At Wheel, more than half of clinicians still work in a brick-and-mortar setting. One of our clinicians currently is driving around the country with her partner in an RV. She customizes her schedule based on her travel plans that day. She can see patients in the morning and go for a hike in the afternoon, or spend a few hours on the road before pulling over and seeing patients in the afternoon. Clinicians interested in telehealth should look for opportunities that prioritize and personalize their experience as clinicians. Some specific factors to consider include: What kind of electronic health record does the company use? And was the EHR created with your experience in mind? Do they offer ongoing training? And provide resources on important topics, such as "webside" manner and guidance on managing state licenses? Do they have a robust clinical quality program in place? How do they provide feedback on quality of care? Q. How can telehealth help with the staffing shortage in healthcare? A. Our current clinician staffing shortage is a national crisis. And it's only expected to get worse. According to an Elsevier study, almost half of U.S. clinicians plan to leave their jobs within the next few years. I've seen firsthand the impact shortages are having on clinician burnout and patient care. And I firmly believe this is a crisis that the entire industry must address. Ensuring clinicians feel encouraged to explore careers in virtual care, if that's what works best for them, is one of many steps to take. Another way for telehealth to help address staffing shortages is by powering the transition to what we call "virtual-first care." With virtual-first care, patients can start their care journey with telemedicine. By leaning on technology, healthcare organizations can more easily triage the patient's care needs and determine the best care setting – virtual, in-person or hybrid care. This is a more efficient way to approach care delivery while simultaneously increasing access to care. While telehealth alone is not the only solution, it is one of many steps we can take to help address staffing shortages and help ensure timely patient access to care. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telemedicine-answer-physician-burnout-and-staffing-shortages < Previous News Next News >