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

The intersection of remote patient monitoring and AI Bill Siwicki October 25, 2022 Robin Farmanfarmaian, a Silicon Valley AI entrepreneur and author, explains how artificial intelligence can boost the efficacy of RPM and help democratize healthcare. Robin Farmanfarmaian is a Silicon Valley-based entrepreneur working in technology and artificial intelligence. She has been involved with more than 20 early-stage biotech and healthcare startups, including ones working on medical devices and digital health. With more than 180 speaking engagements in 15 countries, she has educated audiences on many aspects of technology intersecting healthcare, including artificial intelligence and the shift in healthcare delivery to the patient's home. She has written four books, including "The Patient as CEO: How Technology Empowers the Healthcare Consumer" and, most recently, "How AI Can Democratize Healthcare: The Rise in Digital Care." Healthcare IT News spoke with Farmanfarmaian to discuss where AI is impacting remote patient monitoring today and how AI can democratize healthcare. Q. Where is remote patient monitoring today? Where do you see RPM five and 10 years from now? A. Remote patient monitoring is still in the first five years of adoption and integration into the healthcare system, and the pandemic accelerated this trend by illustrating the need and value of RPM. There are many clinical-grade devices now that patients can buy or use to measure and monitor various vital signs, including EKG, heart rate, heart rate variability, blood pressure and blood oxygen level. The Centers for Medicare and Medicaid Services is one of the organizations that sets the standard of care in the U.S. healthcare system, and CMS launched CPT codes for remote physiological monitoring more than four years ago. CMS has expanded coverage and specificity over the past few years with additional and updated CPT codes. In 2022, CMS launched CPT codes for remote therapeutic monitoring (RTM). These codes cover RTM for respiratory and musculoskeletal (MSK) conditions, such as remote physical therapy and COPD inhaler tracking. Considering that most of healthcare happens in a patient's daily life, not the occasional clinic visit, this is a big step forward toward helping patients use their treatments in the best possible way on a daily basis. Many mainstream corporations have launched their own wearables that have cleared the FDA, blurring the lines between healthcare companies and consumer-facing tech companies. Apple, Amazon, Google and Samsung are some of the giants that can shift consumer habits on a national scale, and they all have launched mainstream wearables. For instance, the Apple Watch has outsold the entire Swiss watch industry multiple years in a row, and the device has an EKG monitor that has cleared the FDA for use with people over the age of 22 and with no history of arrhythmia. This trend is great news because many people may already be tracking something about their health, whether that's blood pressure monitoring, continuous glucose monitoring or even a simple accelerometer for step count. That makes it significantly more likely a patient will continue to use the device if their healthcare professional recommends it and has access to the data. In 10 years, remote patient monitoring will be mainstream, and likely reimbursed by all the major payers. We're already seeing that RPM has the ability to catch hospital readmissions days before they happen. The healthcare industry is experiencing a revolution in vital-sign measurement devices, with many companies innovating on ways to collect vital signs. New innovations include taking vital signs using a smartwatch, using just a smartphone or laptop camera, breathalyzer devices for standard vital signs like BP and Sp02, sensors in clothing, epidermal sensors and subcutaneous sensors. Within 10 years, tracking vital signs will be done in ways that are more seamless and effortless for the patient, such as subcutaneous sensors that last five years. Eversense already has an FDA-cleared implantable sensor for continuous glucose monitoring that passively records glucose levels 24/7. Q. How did artificial intelligence first come into the picture with RPM? What was the connection? A. Some of these new FDA-cleared devices measure vital signs continuously, which means they are collecting thousands of data points a day on each patient. BiolntelliSense has a medical-grade rechargeable sensor that sticks to the chest and passively measures more than 20 vital signs, recording 1,440 measurements a day. Humans don't have the ability to analyze and interpret thousands of data points every day for every patient – which is why these clinical-grade wearables and sensors have an AI software component to manage, monitor, analyze and interpret the thousands of daily data points per patient. The AI software typically flags or alerts the healthcare team and patient when the vital signs are outside predetermined ranges, personalized to the individual. While it is still early in this trend, there are examples of new innovations that only exist because of continuous, personalized data collection. January AI uses the previous three days of data from a continuous glucose monitor, combined with vital-sign data, to predict glucose response in real time to individual foods, educating the patient at the point of the decision-making. This helps manage diabetes in a more personalized and predictive way, instead of the standard reactive way diabetes is currently treated. But January AI isn't just for people with diabetes. They work with athletes, people with pre-diabetes or metabolic syndrome, and people who just want to be as healthy as they can be. This education in real time doesn't just assume the standard diet for diabetes is right for every individual or that there is any one healthy diet that works for everyone. People don't react the same way to food as others, or even to themselves. Everyone has a unique glucose response to food based on many factors, including that day's activity level, sleep, amount of fiber, stress, weight, age and many more data points. AI-based software, combined with RPM, allows personalized care 24/7. Q. Today, how does AI work with RPM to improve patient care and outcomes? A. When RPM is used for serious conditions, it can be the difference between life and death. VitalConnect ran a study on their single-lead EKG VitalPatch and was able to predict hospital readmission for cardiac patients 6.5 days in advance. Alacrity Care is working on RPM for oncology that combines vital signs taken with FDA-cleared devices including the Omron blood pressure watch and the Oxitone pulse-oximeter watch with a daily oncology practitioner check-in and blood labs taken in the home. This is to catch serious, life-threatening problems such as neutropenia, sepsis and cytokine storm days before a patient with cancer is in serious medical trouble. Catching these three conditions early can be the difference between life and death. New AI-based software tools are clearing the FDA, including one earlier this year for TytoCare that analyzes lung sounds for the patient and the remote clinician using a connected stethoscope in the home. There are other companies working on sensors in clothing that are covered by Medicare. SirenCare has socks available by prescription that monitor the temperature on the bottom of the foot. For patients with diabetes, a hotspot on the bottom of the foot could lead to a skin ulcer, which could eventually lead to an amputation if the wound doesn't heal. With access to the continuous data, the software can alert the patient and clinician when there is a problem so it can be treated before the skin breaks. The promise and goal of RPM is to keep patients safely in their homes and catch problems early, before they become serious or emergency issues. Q. You have a new book out with Michael Ferro, "How AI Can Democratize Healthcare." How does that theme fit in with the combination of AI and RPM? A. When dealing with AI, life begins at 1 billion data points. There are some major problems with traditional healthcare datasets that exist today to train software. Most healthcare data is locked into silos, whether that is the EHR, faxes, the payer or in clinical notes. In fact, when I get lab results from my physician through the hospital's patient portal, it is uploaded as a scanned fax and saved as a PDF that is not machine readable, and sometimes, not even human readable. While we are seeing interoperability move forward, there is still a long way to go. The typical healthcare data is collected on people at one point in time, such as their annual physical or if they are hospitalized. Frequently, that means the data doesn't include an individual's baseline, taken in their daily environment. It also means that most of the clinical-grade vital-sign data is on people who are already sick enough to be in a hospital. By shifting the data collection to the patient's daily life, RPM has the ability to collect clinical-grade data when people are in all stages of health and at all ages. When collected continuously in machine-readable databases, once RPM is more fully adopted, those databases have the ability to dwarf EHR data from a hospital or health system. That is the type of training data that can give healthcare a much deeper look and understanding of normal vital signs across ages, genders and genetics. RPM helps democratize healthcare in a way never before possible. Many people don't live within easy access to a doctor or clinic. Trying to get to a clinic during their open hours can be next to impossible for some people due to many factors – from not being able to take off work, school, finding transportation, distance, childcare and other barriers, to traveling to a physical clinic. Even for established patients, specialist doctors are frequently booked out one to three months in advance, which gives a medical problem time to advance and potentially get much worse. That, in turn, lowers the odds of a successful outcome when and if that patient is ever seen and treated by a healthcare professional. Instead of trying to physically get to a clinic, RPM can be used to determine when someone needs to see a healthcare professional and can make a virtual care visit much more effective. The best healthcare is the healthcare that actually gets done. RPM enables passive healthcare in someone's daily environment, 24/7. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/intersection-remote-patient-monitoring-and-ai?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < 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 >

CCHP Releases Factsheet Based on Policies in New FQHC Category of Policy Finder CCHP October 25, 2022 Last week’s latest update to CCHP’s Telehealth Policy Finder included a brand-new feature: a category specifically for federally qualified health centers' (FQHC) Medicaid fee-for-service policies. Funded by the National Association of Community Health Centers (NACHC) through funding from the Health Resources and Services Administration (HRSA), the new section includes the many unique rules that apply to FQHCs that sometimes effect their ability to utilize telehealth. CCHP is now making a factsheet available summarizing the findings from our new FQHC section. CCHP searched statute, state Medicaid manuals, administrative code and fee for service polices between July and early September 2022, for relevant policies. In some categories, the factsheet reports a certain number of states that are reimbursing for a specific modality or the prospective payment system (PPS) rate. Note that CCHP only counts states as providing reimbursement if official and explicit Medicaid documentation was found confirming they are reimbursing FQHCs specifically for a certain modality. A broad statement that all providers are reimbursed or any originating site is eligible without an explicit reference to FQHCs was insufficient. Additionally, a state Medicaid program was counted as reimbursing FQHCs even if they do so in a very limited way, such as only for mental health. KEY FINDINGS INCLUDE: Definition of Encounter/Visit: The majority of Medicaid programs do provide a definition for a FQHC ‘encounter’ or ‘visit’ that stipulates that it is a face-to-face interaction. This does not necessarily preclude use of telehealth as live video can also be considered ‘face-to-face’. Same-Day Visits: CCHP examined each state Medicaid program’s policy on ‘same day encounters/visits’. Many states have limitations around FQHCs claiming more than one encounter in a single day for a single patient. This is thought to be a limitation applicable to telehealth because it is common for a patient to visit a FQHC for a primary care visit, and upon examination require a specialty service (such as mental health). CCHP observed that most state Medicaid programs do indeed have limitations around same day encounters, particularly if the services occur at the same location and are both considered the same type of encounter (for example, a medical encounter). However, there are often allowances for multiple encounters if the service is considered a different type of encounter, for example a mental health encounter. FQHCs as Originating Sites: 36 states and DC explicitly allow FQHCs to serve as originating sites for telehealth-delivered services. If a state does reimburse a facility fee, it is common for FQHCs to be eligible to collect the fee, however not every state Medicaid program reimburses the facility fee. FQHCs as Distant Site: 34 states and DC explicitly allow FQHCs to be distant site providers. This was often stated in Medicaid manuals or regulations as a clarification so that there could be no confusion about their eligibility for reimbursement. FQHCs Collecting the Prospective Payment System (PPS) Rate: In some cases, policy addressed whether or not FQHCs would be eligible for the prospective payment system (PPS) rate. Twenty state Medicaid programs and DC explicitly clarify that FQHCs are eligible for the PPS rate when serving as distant site providers. Store and Forward Reimbursement: The vast majority of states did not specify or excluded store-and-forward from an eligible service FQHCs could be reimbursed for. Only 4 state Medicaid programs explicitly reimburse FQHCs for store-and-forward. Audio-Only Reimbursement: 9 state Medicaid programs explicitly allow reimbursement for audio-only services to FQHCs. In some cases, services are only reimbursed through communication technology-based services (CTBS) codes, or have other restrictions (such as limitations around the service type) limiting its use. Remote Patient Monitoring Reimbursement: While most states did not address whether or not FQHCs would be eligible for remote patient monitoring, in a few instances CCHP noted states that allowed them to be reimbursed through CTBS codes, although separate from their ‘core services’ or encounter rate. Services Outside the Four Walls: FQHCs have sometimes had to adhere to rules restricting services from being rendered outside of the four walls of their facility. This can pose a problem for telehealth encounters when the patient may be at home and connecting to a FQHC provider. CCHP found that Medicaid policies did not always address this situation explicitly, and the policies that were found often did not address a telehealth situation explicitly leaving it ambiguous whether this model of care is allowed. FQHC Limitations on Establishing a Patient Provider Relationship: This was examined as a topic area for each state, but only California was found to have such requirements. For more detailed explanations, examples of each topic area above, and a chart reporting whether each state reimburses FQHCs for the specific modalities or PPS rate, see the Telehealth Policies and FQHCs Factsheet. For each state’s specific FQHC policies, along with links to source materials, see the new FQHC section of CCHP’s Policy Finder. See original article: https://mailchi.mp/cchpca/cchp-releases-factsheet-based-on-policies-in-new-fqhc-category-of-policy-finder < Previous News Next News >

River Valley Counseling Center boosts productivity and experience with telehealth Bill Siwicki June 01, 2022 From putting band-aids on decades-old computers to conducting high-quality telemedicine visits, the mental health organization is making its clinicians and patients happy. River Valley counseling Center's Holyoke Clinic in Holyoke, Massachusetts, always was trying to make ends meet with its technology. THE PROBLEM Its efforts to revamp and improve its technology were merely trial and error. Staff were putting band-aids on their technologies, struggling to figure out what the root of the issues were when disruptions would occur. Was it the computer itself? Network connectivity? A glitch in the signal? To put the extent of the issues in perspective, some hardware was more than a decade old; it could easily take clinicians five minutes just to reach the login screen. "When we thought one thing was addressed, another hurdle would pop up," recalled Chassity Crowell-Miller, LICSW, a clinical social worker at the clinic. "This element of touch and go was particularly challenging for mental healthcare, in which providers may be helping with sensitive, traumatic issues and were unnecessarily disrupted and inhibited by the outdated technology. "Overall, our clinicians' ability to help, as well as our patients' treatment and overall experiences, were negatively impacted," she added. It's important to note that the organization's Holyoke Clinic tends to an underserved population, with many patients being of low socioeconomic status. Across the community, there are high poverty, school dropout, substance abuse and violence rates. "For providers in our community and beyond, the past two years have been like nothing they have ever seen in the field," Crowell-Miller observed. "At the onset of COVID, while many organizations and communities were able to transition seamlessly to virtual learning and working in order to continue their work, River Valley counseling Center's Holyoke Clinic was not set up for this abrupt move to technology. "While telehealth has improved access to many outpatient services, marginalized patients – rural, poor, older and minority patients – may not have benefited equally from telehealth's expansion," she continued. "With all this in mind, River Valley counseling Center needed to receive the equipment, infrastructure and IT counsel necessary to support its people in our Holyoke location – both in person and via telehealth." PROPOSAL The cost of outdated technology often is not discussed, but for providers to do their jobs effectively, sound technology infrastructure is a table-stakes requirement, said Stephen Moss, senior vice president and general manager, connected workforce, at Insight, a health IT and infrastructure company. "The last two years have forced health providers to play IT catchup and significantly accelerate digital transformation," he said. "For many like River Valley counseling Center, it calls for starting with the basics. "They are navigating the impact of legacy infrastructure that is sometimes decades old, not to mention extremely outdated devices that magnify the frustration of resources that should make their work easier actually impeding their ability to care for patients," he continued. River Valley's challenges stood out to Insight. "To help, we focused on how to improve productivity and the client experience, particularly to address the lag and frozen sessions during telehealth consultations," Moss explained. "A simple upgrade to 50 new Intel-powered desktops and laptops has made daily multitasking an afterthought rather than a source of frustration for clinic staff. "To be able to hold a telehealth session without hang-ups not only allows River Valley's medical providers to more effectively address their clients' needs, by eliminating disruptions, they're gaining credibility and the ability to treat more people on a daily basis," he added. The Insight and Intel teams took a hands-on approach to provide and implement the right technology, at the right price, said Jason Kimrey, vice president, U.S. channel and partner programs, at Intel. "The strategy was informed by the mindset that having the best technology was the most effective way to maximize productivity for River Valley and its counselors," he said. "To help guide the process, we collaborated and leveraged our partner ecosystem to understand the unique challenges and pain points for the organization." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE With River Valley's considerations in mind, Intel prioritized implementing more modernized devices and hardware that provided an opportunity to update core infrastructures, Kimrey said. Intel upgraded network switches, physical hard drives, chips and more to accommodate for the increased bandwidth necessary for telehealth usage, he added. "As a team, Insight's counsel helped combine and implement all of this," Moss explained. "Going from barely conducting any services remotely before the pandemic to now doing most of their work via telehealth is a monumental culture change. Coping with new technology shouldn't be a burden on caregivers; it needs to be an intuitive, simplified experience. "When we work with organizations like River Valley, we start with understanding what their unique challenges are, who is impacted and what they need to accomplish in their daily work," he continued. "Then we figure out the right technology based on individual caregiver personas and their needs to optimize their user experience, productivity and ability to help their clients." Insight handles rapid provisioning, configuration and deployment for virtual desktop environments so new devices are ready to go out of the box with minimal setup and networking connection required by the organization's IT team or employees, he added. "Insight also has the ability to provide virtual IT support for day-to-day management of the health of the devices, which frees up organizations with limited internal IT resources, such as River Valley counseling Center, to focus on more meaningful transformative projects," Moss said. "For River Valley, they've gained the ability to quickly provide new devices to their staff that are ready to go with the applications they need," he added. "Their care providers now can work just as effectively from home or at the clinic." RESULTS Technology is critical to making peoples' lives better, and River Valley has really felt that, Crowell-Miller stated. Thus far, highlights for River Valley, she reported, have included: Improved client and clinician experience. There have been tangible benefits for the client experience – both internally and externally. The provider organization has increased its telehealth services from 5% pre-pandemic to 95% during the height of the pandemic, while removing common barriers like lag time and income lost from prior no-show rates. Now, because of the ability to adapt, adjust and shift to telehealth, when necessary, clinicians can meet the patients where they're at. Increased productivity. The technology addressed a loss of productivity and slowness for River Valley counseling Center, which impacted the quality of services it was able to provide. Even just logging onto computers is much faster and happens within seconds. Specifically, the organization has dramatically improved productivity by up to an estimated 25% for clinicians with minimal access to technology at home, making it easier to use the office for virtual or in-person visits when necessary. Providing community resources. River Valley counseling Center now is able to get a better foothold to help and serve the community. This technology isn't just transactional from a healthcare provider standpoint; having this infrastructure in place is mutually beneficial for the clinicians and the patients in ways beyond traditional appointments and hosting telehealth sessions. This technology has helped River Valley counseling Center put the resources in the hands of clients. River Valley works on these computers while seeing a patient in person, and staff are able to help provide resources like databases, printed materials and more for the patients. ADVICE FOR OTHERS "Because every organization is different, it's really important to ensure you're working with a technology partner that understands not only the healthcare sector and how technology plays a vital role in patient care, but also the unique challenges and needs of your operations, clinicians, patients and the community you serve," said Crowell-Miller. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/river-valley-counseling-center-boosts-productivity-and-experience-telehealth < Previous News Next News >

Physician fee schedule final rule opens up telehealth access Susan Morse, Managing Editor, Healthcare Finance Nov. 5, 2021 AMA wants Congress to avert physician payment cuts it says will amount to 9.75% for 2022. For the first time outside of the COVID-19 public health emergency, Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including audio-only telephone calls. This will expand access for rural and other vulnerable populations. The Centers for Medicare and Medicaid Services announced this and other actions in the 2022 Physician Fee Schedule final rule released late Tuesday. In line with legislation enacted last year, CMS is eliminating geographic barriers and allowing patients at home to access telehealth services for diagnosis, evaluation and treatment of mental health disorders. Certain mental and behavioral health services via audio-only telephone calls that are being covered include counseling and therapy for the treatment of substance use disorders and services provided through opioid treatment programs. WHY THIS MATTERS While expanded telehealth coverage is supported by providers and others who responded to the final rule, the update to the clinical labor rates for 2022 got harsh feedback from the American Medical Association. With the budget neutrality adjustment to account for changes in Relative Value Units, as required by law, and expiration of the 3.75% temporary 2021 payment increase provided by the Consolidated Appropriations Act, the 2022 physician fee schedule conversion factor is $33.59, a decrease of $1.30 from the 2021 rate of $34.89. The AMA wants Congress to intervene to stop the physician payment cuts. "While the American Medical Association will thoroughly analyze the 2,400+ page rule, it is a reminder of the financial peril facing physician practices at the end of the year," said AMA president Dr. Gerald E. Harmon. "The final rule includes a reduction in the 2022 Medicare conversion factor of about 3.85%. "The AMA is strongly advocating for Congress to avert this and other looming cuts to Medicare physician payments that, overall, will produce a combined 9.75% cut for 2022. This comes at a time when physician practices are still recovering the personal and financial impacts of the COVID public health emergency." Other actions in the final rule include: Promoting growth in Medicare diabetes prevention program CMS is expanding the Medicare Diabetes Prevention Program (MDDP) model, in which local suppliers provide structured, coach-led sessions in community and healthcare settings using a Centers for Disease Control and Prevention-approved curriculum to provide training in dietary change, increased physical activity and weight-loss strategies. CMS is waiving the Medicare enrollment fee for all organizations that apply to enroll as an MDPP supplier on or after January 1, 2022. CMS has been waiving this fee during the COVID-19 PHE for new suppliers, and said it has witnessed increased supplier enrollment. The agency is shortening the model services period to one year instead of two years and is restructuring payments so suppliers receive larger payments for participants who reach milestones for attendance. Increased access to medical nutrition therapy services The PFS final rule also streamlines access to Medical Nutrition Therapy, which includes services provided by registered dietitians or nutrition professionals to help people with Medicare better manage their diabetes or renal disease. CMS has removed a requirement that limited who could refer people with Medicare to these services, allowing any physician to do so. This change should particularly benefit people living in rural areas as the services are provided to eligible individuals with no out-of-pocket costs and may be provided via telehealth. Encouraging vaccines to protect against preventable illness CMS will maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends. Effective January 1 of the year following the year in which the PHE ends, the payment rate for COVID-19 vaccine administration will be set at a rate to align with the payment rate for the administration of other Part B preventive vaccines. CMS will also continue to facilitate vaccinations for common diseases such as influenza, pneumonia, and hepatitis B. This year, Medicare reviewed payments for vaccinations to ensure doctors and other health professionals are paid appropriately for providing vaccinations. This final rule will nearly double Medicare Part B payment rates for influenza, pneumococcal and hepatitis B vaccine administration from roughly $17 to $30. Expanded pulmonary rehabilitation coverage As part of CMS' continuing efforts to address the current PHE, the agency finalized expanded coverage of outpatient pulmonary rehabilitation services, paid under Medicare Part B, to individuals who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least four weeks. This goes beyond the physician fee schedule proposed rule, which would have focused the expanded coverage to those hospitalized with COVID-19. CMS also finalized a temporary extension of certain cardiac and intensive cardiac rehabilitation services available via telehealth for people with Medicare until the end of December 2023. Advancing the Quality Payment Program and MIPS Value Pathways The final rule makes several changes to CMS' Quality Payment Program to promote the delivery of high-value care by clinicians through a combination of financial incentives and disincentives. For example, CMS finalized a higher performance threshold that clinicians will be required to exceed in 2022 to be eligible for positive payment incentives. This new threshold was determined in accordance with statutory requirements for the Merit-based Incentive Payment System. CMS has introduced the first seven MIPS Value Pathways in the clinical areas of rheumatology, stroke care and prevention, heart disease, chronic-disease management, lower-extremity joint repair (e.g. knee replacement), emergency medicine, and anesthesia. To incentivize high-quality care for professionals that are often key points of contact for underserved communities with acute healthcare needs, CMS has also revised the current eligible clinician definition to include clinical social workers and certified nurse-midwives among those participating in MIPS. Ensuring accurate payments through clinical labor update For the first time in nearly 20 years, CMS is updating the clinical labor rates that are used to calculate practice expense. As a result, payments to primary care specialists that involve more clinical labor, such as family practice, geriatrics, and internal medicine specialties, are expected to increase. There will be a four-year transition period to implement the clinical labor pricing update, which will help maintain payment stability and mitigate any potential negative effects on healthcare providers by gradually phasing in the changes over time. Increasing access to physician assistants' services Finally, CMS is implementing a recent statutory change that authorizes Medicare to make direct Medicare payments to Physician Assistants for professional services they furnish under Part B. For the first time, beginning January 1, 2022, PAs will be able to bill Medicare directly. THE LARGER TREND The final rule advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes. That will advance its strategic commitment to drive innovation to support health equity and high-quality, person-centered care, CMS said. ON THE RECORD "Promoting health equity, ensuring more people have access to comprehensive care, and providing innovative solutions to address our health system challenges are at the core of what we do at CMS," said CMS Administrator Chiquita Brooks-LaSure. "The Physician Fee Schedule final rule advances all these strategic priorities and helps build a better Medicare program for the future." https://www.healthcarefinancenews.com/news/cms-physician-payment-rule-promotes-greater-access-telehealth-services-diabetes-prevention#.YYK9zyVXS6A.twitter < Previous News Next News >

2022 Proposed Physician Fee Schedule Center for Connected Health Policy July 2021 ...I want my MTV (Mental Telehealth Visits)! On July 13, 2021, the Center for Medicare and Medicaid Services (CMS) released their proposed CY 2022 Physician Fee Schedule (PFS). The PFS is historically where CMS will make administrative changes to telehealth policy in the Medicare program. As the pandemic begins to stabilize and restrictions begin to lift, there has been great concern as to what will happen with the temporary telehealth changes on the federal level. The CY 2022 proposed PFS is one step towards addressing those questions. Telehealth Services & Communications Technology Based Services (CTBS) The PFS is traditionally where CMS will add additional telehealth services to the eligible telehealth services list for Medicare. No new services were added in the CY 2022 proposal. Instead, CMS made permanent adoption of G2252, virtual check-in service of 11-20 minutes, which was introduced in last year’s PFS and noted that the temporary services they had placed in Category 3, also in last year’s PFS, will remain active until the end of CY 2023 and not the end of the year that the public health emergency (PHE) is declared over. Mental Health & Audio-Only The most significant proposals involve the provision of mental health services via telehealth and utilization of audio-only to deliver those services. In December 2020, Congress passed the Consolidated Appropriations Act (CAA) which included a change to federal telehealth policy. That change allowed for the provision of mental health services in the home and without the geographic limitation, if the patient had an in-person visit with the telehealth provider within six months prior to the telehealth service taking place. CMS is implementing that policy and outlined details in the PFS noting that the in-person visit would need to have taken place before each telehealth encounter. Therefore, if you had an in-person visit with your telehealth provider a month before you received services via telehealth, that visit would qualify. But if you wanted a follow-up visit eight months later via telehealth, you would need to have another in-person visit with that provider. Additionally, CMS stated that because of the likelihood that mental health services provided via technology will continue post-pandemic, the concern about cutting off people who receive such services, and the efficacy of utilizing audio-only to provide mental health services, the agency is revisiting its stance on how it defines “interactive telecommunications system.” In federal statute, telehealth is provided through a “telecommunications system.” There is no federal definition for “telecommunications system.” In regulations, CMS added the word “interactive” before “telecommunications system.” CCHP has always maintained and provided comments to CMS over the years that given the lack of a federal statutory definition for “telecommunication system,” it is within CMS’ power to change the definition to be more expansive. In comments to last year’s PFS and at the end of the year when the public was solicited for comments regarding the temporary waivers, CCHP reiterated this position. In their response to comments in last year’s PFS, CMS noted that they “continue to believe that our longstanding regulatory definition of “telecommunications system” reflected the intent of statute and that the term should continue to be defined as including two way, real-time, audio/video communications technology.” In the proposed CY 2022 PFS, CMS has reassessed their position. Based on data from COVID-19 and other factors, CMS is proposing to allow the use of audio-only to provide mental health services in the Medicare program if: It is for an established patient; The originating site is the patient’s home; The provider has the technical capability to use live video but, The patient cannot or does not want to use live video and There must be an in-person visit within six months of the telehealth service. Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs) CCHP has maintained that additional flexibilities may be given to FQHCs and RHCs without Congressional action by redefining what constitutes as a “visit” for these entities. CMS is proposing to expand the definition of a “mental health visit” for FQHCs and RHCs by including that definition mental health services provided through “interactive, real-time telecommunications technology” including audio-only. For the latter, the patient must not be capable or not consent to the use of live video. Additionally, the rate paid to FQHCs and RHCs will be their prospective payment system (PPS) rate or all-inclusive rate (AIR). It should be noted that FQHCs and RHCs will still be not be considered distant providers providing telehealth services. This is a definition change to what constitutes a “mental health visit” for these entities. Therefore, that would also mean that the statutory limitations on the use of telehealth, such as geographic limits, would presumably not apply if CMS is not viewing this as “telehealth” but simply as a visit for these entities. Other items were proposed in the CY 2022 PFS. To read about those proposals and a more in-depth look at the aforementioned ones, download CCHP’s fact sheet (below). Public comments on the PFS are due September 13, 2021. CCHP’s fact sheet - https://www.cchpca.org/2021/07/Proposed-CY-2022-Physician-Fee-Schedulefinal.pdf < Previous News Next News >

Remote Patient Monitoring: Benefits, Barriers, and Billing Center for Connected Health Policy August 2021 Remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. Last month, the California Health Care Foundation (CHCF) released a new report, Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know, which looks at remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. The CHCF report focuses on RPM’s use specific to safety-net providers given system constraints particularly limiting chronic illness management to those patient populations. They note that in California, avoidable hospitalizations are highest for Medicaid beneficiaries and that almost 700 hospitalizations per 100,000 people could be prevented through better access to care and more effective chronic care management. In addition, they discuss that providers have seen how telehealth can improve treatment of diabetes, hypertension, and heart disease, as well as mortality and quality of life. RPM specifically has shown benefits for older patients and those facing barriers such as lack of transportation to care. Nevertheless, as discussed in the report, technological issues and strict reimbursement policies remain barriers to RPM utilization. The report also offers potential best practices for providers considering RPM adoption. RPM Basics and Benefits As noted on CCHP’s state and federal RPM policy tracking page, RPM is considered to be the collection of a wide range of health data from the point of care, such as vital signs, weight, and blood pressure measurements. The data is then transmitted to health professionals in facilities such as monitoring centers in primary care settings, hospitals and intensive care units, as well as skilled nursing facilities. The CHCF report gets into various RPM benefits found within the authors’ research across all settings, including how RPM maximizes use of the entire care team and enhances quality of care and outcomes, as well as how it can improve costs of care. Focus group information gathered for the report also showed that patients feel empowered when able to track trends related to their health information through RPM, becoming more engaged and also more willing to change treatment plans when related to the monitoring information. Other research cited found benefits specific to vulnerable populations, including high adherence and successful self-management education to high-risk and low-income populations. Examples were also provided showing that RPM can give patients, especially those that are Spanish-speaking, an overall sense of support. RPM Barriers Despite the evidence on its benefits, as mentioned previously, RPM is not widely used as a modality of care in the safety net, largely related to a number of technological and reimbursement policy barriers. For instance, ensuring that devices can integrate into electronic health records (EHRs) and that data is seamlessly shared and uploaded is crucial, but often costly. Some technological options also don’t offer an ability to be alerted to new and concerning information in a timely manner. Instead, the report discusses how often lower cost options include devices that are not directly connected to EHR systems and involve patients manually reporting measurements through a patient portal or by text message. The study also cites how many patient groups within the safety net population struggle with lack of broadband connectivity as well as digital literacy issues, which also highlights the need to cover phone and text communication modalities. As the authors note, without additional certainty around RPM reimbursement, providers are limited in properly assessing associated costs and savings to be able to provide RPM related services, especially within the safety net. State Medicaid RPM Reimbursement CCHP’s recent state telehealth policy tracking shows that twenty-seven states now have some form of reimbursement for RPM in their Medicaid programs. Many of the states that offer RPM reimbursement also have a multitude of restrictions associated with its use. The most common of these restrictions include only offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected. One state (Ohio) has reimbursement only for specific remote physiologic monitoring codes modeled after Medicare reimbursement. In California under newly enacted legislation AB 133, the Department of Health Care Services (DHCS) may authorize the use of RPM as an allowable telehealth modality under its Medicaid program. However, the language states that DHCS will establish a new undetermined fee schedule for it and likely limit covered services and providers eligible for RPM reimbursement. More details on AB 133 can be found in CCHP’s newly released fact sheet on California health budget agreement and all of its telehealth components. Medicare Remote Physiological Monitoring (and proposed RTP) Reimbursement As far as Medicare RPM reimbursement in the Centers for Medicare & Medicaid Services (CMS) proposed 2022 PFS they are suggesting the addition of five new CPT codes for remote therapeutic monitoring (RTM): *989X1: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment *989X2: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days *989X3: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days *989X4: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes *989X5: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes According to CMS, the RTM codes are similar to the seven Remote Physiological Monitoring (RPM) codes they have included over the past few years with a couple of differences which are primarily related to the particular equipment being used and data collected, and which providers can directly bill for these codes. For instance, RTM codes are proposed to monitor health conditions and allow non-physiologic data to be collected, including self-reported and digitally uploaded information, though devices for both RTM and RPM must meet the same Federal Drug Administration (FDA) definition of medical device. CMS is soliciting comments on the types and costs of devices that may be used for RTM services under the proposal. In addition, RPM services have been considered to be evaluation and management (E/M) codes which cannot be billed by certain providers, while RTM codes are considered to be general medicine codes. Additional details are still to be determined and questions remain related to billing and code construction that stakeholder comments can hopefully lead them to clarify after the comment period on the proposed PFS closes on September 13, 2021. Details on the other items in the proposed 2022 PFS can be found in CCHP’s fact sheet, explainer video, and slide deck. RPM Adoption Guidance Barriers in mind, the CHCF report suggests providers look to incorporate RPM into programs and workflows prior to considering the use of a specific technology, highlighting a number of considerations and ways providers can assess how to utilize RPM and adopt it consistent with best practices and existing policies. The guidance recommends to those considering starting an RPM program includes: Use RPM as a tool within a wider program, such as on top of an existing chronic disease management or diabetes educational program Invest in organization-wide adoption and management to ensure deployed at scale Identify key performance indicators to prioritize specific populations and results, such as no-show rates and clinical outcomes Estimate enrollment and overall costs, potential partnerships with other health centers Incorporate cultural responsiveness and solutions designed for patients with physical limitations Looking Forward As best practices continue to emerge and interest and understanding increases around use of telehealth modalities, including RPM, hopefully coverage consistency, and clarity, can increase as we move forward. Given existing variance amongst the states and the use of two different terms by the federal government for just this one type of modality – which they consider separate from telehealth – it will remain important moving forward to continue to highlight the benefits of telehealth and how they can outweigh any concerns necessitating the need for such strict and confusing policies that vary by each telehealth modality. For more details on the report’s RPM findings, please download it here - https://www.chcf.org/wp-content/uploads/2021/07/RemotePatientMonitoringSafetyNetNeedKnow.pdf. To track the ever-evolving telehealth landscape, please utilize CCHP’s policy finder - https://www.cchpca.org/new-mexico/ < Previous News Next News >

Workers Report Burnout Due to Healthcare Cybersecurity Concerns Jill McKeon Oct. 6, 2021 Three-quarters of industry professionals reported having healthcare cybersecurity concerns about protected health information being communicated via unsecured communication devices. Physician burnout was a growing problem prior to the pandemic, but other healthcare professionals are reporting significant levels of burnout as well, according to a survey conducted by Spok. Over 50 percent of IT staff and contact center staff reported feeling a considerable level of burnout. Meanwhile, over 60 percent of clinical executives reported feeling “a great deal” of burnout since the pandemic. Healthcare professionals overwhelmingly agreed that the risk of clinician burnout is a public health crisis “that demands action by healthcare institutions, governing bodies, and regulatory authorities.” Many credited complicated technologies and poor technological integration as some of the leading factors in clinician burnout. The research suggested that improved communication tools could lessen the risk of clinician burnout. “Survey respondents seem to agree that improving communication technology could help address the risk of burnout through increasing efficiency of workflows, improving exchange of data between care members, and adopting mobile technologies,” the study explained. COVID-19 reshaped many aspects of care delivery, and also highlighted the need for secure communication technologies that can simultaneously comply with HIPAA and seamlessly integrate into an organization’s operations. Just over 80 percent of surveyed healthcare workers reported believing that COVID-19 played a role in protected health information (PHI) being communicated via unsecured or personal communication tools. Researchers surveyed over 200 healthcare executives, physicians, IT personnel, nurses, and contact center representatives about the state of communication in their organizations. Results revealed that the COVID-19 pandemic not only caused significant healthcare worker burnout, but also shifted resources away from valuable cybersecurity initiatives. “With security and privacy issues on the rise in 2021, perhaps it’s not unexpected that survey respondents are concerned,” the survey report stated. “Looking ahead, hospitals and health systems may need to bolster initiatives to meet HIPAA standards for PHI protection and to avoid noncompliance, reputational harm, and serious financial penalties. It could also signify the need for health systems to have in place an advanced, HIPAA-compliant critical communication solution.” All industries have become increasingly reliant on communication technologies, especially during the pandemic when mobile communication devices became the primary method of communication for many workplaces. Smartphones have remained the number one most supported device in healthcare since 2012, as in-house pager use continues to decrease. However, pagers still play a key role in care team communications. Most respondents reported that their organization’s budget constraints continue to prevent them from updating their outdated communication devices. In addition, the complexity of meeting HIPAA requirements and insufficient leadership support are major obstacles in advancing a healthcare organization’s internal communication tactics. Implementing new communication tools also presents new cybersecurity risks and calls for enterprise-wide training programs. Just under half of respondents reported that their teams paused outstanding IT communication projects during the pandemic. While 43 percent of respondents expected to resume these projects within the next six months, the rising prevalence of the Delta variant may alter that timeline. < Previous News Next News >

Frequently Asked Questions Regarding Licensure & Telehealth Mei Wa Kwong, JD September 12, 2022 This video addresses the most frequently asked questions CCHP receives regarding licensure and telehealth for example: (1) What does the law says if your patient is going on vacation to another state, but still needs your services? (2) Do you really need a license in another state if you’re just consulting with a provider who is already licensed in that state? (3) ….and many more! View the PPT for this video here. See original video: https://www.cchpca.org/resources/frequently-asked-questions-regarding-licensure-telehealth/ < Previous News Next News >

Audio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny Scott Mace October 03, 2022 The federal oversight agency recommends CMS adopt new coding procedures to compare care quality to in-person visits. With pandemic-fueled temporary waivers on telehealth leading to a surge in telehealth visits in 2020, especially on audio-only platforms, the practice is overdue for its own exam for effectiveness and privacy, according to a new Government Accounting Office (GAO) report. The use of telehealth services topped 53 million visits in the period between April and December 2020. During the same period in 2019, only 5 million such visits occurred. Many of those were conducted by phone or non-video telehealth, which was rarely allowed prior to the pandemic. [See also: CMS Proposes to Cut Audio_only Telehealth Coverage.] The Centers for Medicare & Medicaid Services has monitored some risks to program integrity related to these telehealth waivers, but the GAO report found that CMS "lacks complete data on the use of audio-only technology and telehealth visits furnished in beneficiaries' homes," in part because no billing mechanism exists to identify all these telehealth visits. "Providers are not required to use available codes to identify all instances of audio-only visits," the GAO reported. "Moreover, providers are not required to use available codes to identify visits furnished in beneficiaries' homes." The GAO said this coding is important to monitor the quality of these telehealth services as compared to equivalent in-person services. "CMS has not comprehensively assessed the quality of telehealth services delivered under the waivers and has no plans to do so, which is inconsistent with CMS' quality strategy," the GAO said. "Without an assessment of the quality of telehealth services, CMS may not be able to fully ensure that services lead to improved health outcomes." The GAO offered three recommendations for CMS going forward: 1. Develop a new billing modifier or make clearer how to bill audio-only office visits for better tracking; 2. Require providers to use existing site of service codes when beneficiaries receive Medicare telehealth services at home; and 3. Assess the quality of telehealth services delivered during the public health emergency. Finally, the GAO urged the Health and Human Services Department's Office of Civil Rights to offer additional education, outreach, and other resources to providers to help them explain risks to privacy and security that patients may face during telehealth visits. Scott Mace is a contributing writer for HealthLeaders. See original article: https://www.healthleadersmedia.com/technology/audio-only-telehealth-visits-during-pandemic-draw-gao-scrutiny < Previous News Next News >

Patients prefer telehealth for common illnesses, study shows Bill Siwicki November 23, 2022 But more than half are concerned about the quality of care they're receiving, according to the Software Advice survey. One of the firm's analysts dives into the results. Telemedicine has, at long last, become very popular. But lingering concerns remain on its effectiveness for certain diagnoses and treatments. Software Advice's 2022 State of Telemedicine Survey finds that while a majority of people prefer virtual appointments for common illnesses, more than half of patients still are concerned about the quality of care they're receiving. Software Advice, a Gartner company, polled more than 1,000 patients on telemedicine usage after the worst of the pandemic – regarding whether they intend to keep using it and improvements that can be made. We interviewed Lisa Hedges, associate principal analyst at Software Advice, to discuss the findings of the study and talk about the future of telemedicine. Q. What is the overarching message healthcare CIOs and other health IT leaders should take from your study? A. That failure to invest in telemedicine is downright foolish at this point. It's been around for a long time and fully took off during the pandemic. It isn't going anywhere now that so many patients have experienced the convenience it offers. This also means if you are one of the healthcare organizations that adopted telehealth during the pandemic and plan to eliminate those tools in the near future, you're making a mistake. The bottom line here is that telemedicine is a valuable tool for patients, and providers who offer remote care services for certain conditions and symptoms are going to have the edge over providers who don't. Q. About 86% of patients rate their telemedicine experience as positive; 91% are more likely to choose a provider that offers telemedicine. Why do you think this is, and what does it mean for healthcare provider organizations? A. Convenience and ease of use are top reasons patients like telemedicine, and that certainly makes sense when you consider the time it saves. Patients don't have to drive to a physical office, find parking, spend time in a waiting room (where they may be exposed to other contagions), and then drive back home once the appointment is over. All of that is hassle enough even without considering the fact that most people going to see doctors don't feel great, so their baseline before doing any of that is discomfort. What this means for providers is they're looking at a great opportunity. We're all well aware of the current shortage of qualified healthcare workers, and we know that the working conditions for healthcare staff have been particularly brutal during the pandemic. With so many employees quitting, it's left a lot of extra work behind for those who have stayed on, which leads to more burnout and even more turnover. If practices can find a way to alleviate that burden, though, they're going to make life better for their employees. Telemedicine can do this by shortening the average exam time, nearly eliminating patient wait times, reducing the average number of no-shows, and saving money by cutting down on operational costs. All of these things can directly or indirectly impact the quality of life for healthcare workers and for patients. Q. Only 49% prefer telemedicine visits for mental health treatment, despite it being one of the more remote-ready specialties. What does this finding say for the future of telepsychiatry? A. This is a great question that a lot of people are puzzling over. Mental healthcare does seem to be an ideal match for telemedicine, specifically the use of video conferencing to conduct therapy sessions. So, I was a little surprised that more patients in our survey didn't indicate a preference for telemedicine. But there are a couple of things to consider here. First, we didn't collect data on patient history, so not every participant in our survey has experience seeking mental health treatment. That could be a factor in this dataset. Second, 19% indicated no preference between telehealth and in-person appointments for mental health treatment when we asked this question, which means only 32% prefer in-person mental health appointments. So, it's still the majority of patients saying telehealth is their favorite option for mental healthcare. As far as what this means for the future of teletherapy, I don't think it's any huge concern. It could simply be that some patients are still warming up to the idea of having intimate conversations with a therapist through a computer screen. It could be an age thing. It could be something else. Regardless, I suspect that if we were to run this survey annually for the next few years, that 49% would increase every time. Q. One-third of patients worry that an in-person exam, lab work or other testing is critical to properly diagnose and treat patients. How can telemedicine jump this hurdle? A. I'm not convinced telemedicine needs to jump this hurdle to prove itself valuable. Sure, there are incredible advancements being made in remote patient monitoring tools and other wearable devices that can help diagnose patients from a distance, but I think it's equally worth noting that telemedicine is a tool to be used in the right circumstances – it's not a one-size-fits-all approach to medicine. Yes, for a lot of medical conditions, doctors actually have to see the patient to perform physical tests. Those situations aren't ideal for telemedicine, and we shouldn't be thinking of them as hurdles – or even failures. If, instead, we reframe our thinking so that we recognize the situations that are ideal for telemedicine appointments – those that don't require physical tests for diagnosis, such as mental healthcare or common ailments like upper respiratory infection – we can see that telemedicine is a deeply valuable tool as it stands. So, to answer your question, the real hurdle for telemedicine here is teaching patients when it is best used instead of needing to find ways to provide lab work or physical exams remotely. In essence: It's a messaging problem instead of a technology problem. The good news is patients seem to be recognizing this on their own. If you look at patient preferences for in-person appointments versus telemedicine appointments broken down by symptom in our report, you see that patients intuitively understand which symptoms are best treated remotely and which are more likely to need physical exams. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/patients-prefer-telehealth-common-illnesses-study-shows < Previous News Next News >

Telehealth Industry Expected to Grow from $26.4 Billion in 2020 to $70.19 Billion by 2026, at a CAGR of 17.7% DUBLIN--(BUSINESS WIRE) August 5, 2020 The present situation of COVID-19 has a great impact on the Telehealth market, where home care services are increasing through the modes of telehealth services. Information is passed through telecommunication where a patient can access the treatment from the clinician and can take advice without approaching to the doctor and without going out for the hospital. This situation gives immense opportunity for the telehealth market players. Market Highlights The Telehealth Market is estimated to reach USD 70.19 billion by 2026, from USD 26.4 billion in 2020 and registering a CAGR of ~17.7% during the forecast period. The growing technologies in the telecommunications sector to reach the patients in time play a major role in the telehealth services, which raise the growth in the Telehealth market. Based on the application of Telehealth - Telehealth services market is segmented into three segments, including Teleradiology, Tele-consultation, Tele-ICU, Tele-stroke, Tele-psychiatry, and Tele-dermatology. Teleradiology had achieved a major share in the telehealth market in the last year due to increasing mental health issues among people. The insufficient health services providers give the scope of opportunities in the telehealth industry to fulfill the demand of the end-users. The market components cover the segments of Software & Services and Hardware. The segment of software & services accounted for the larger share of the global telehealth market in 2019. Telehealth market based on the end-user segment classified into Providers, Payers, and Patients. The end-users, such as providers segment accounted for the largest share in 2019. Telehealth segmentation is based on geography includes North America, Europe, APAC, and RoW. North America accounts for the largest share in the telehealth market in the entire world. The Telehealth market is growing enormously in the region of North American countries, which is very advanced in the technological perspective and in the advanced medical facilities. The increase of chronic diseases like cancer, asthma, and other diseases driving the adoption of the home healthcare services to avoid the expensive costs charged by hospitals, these are some aspects which increased the growth in the telehealth market in this region. In the last recent years, Europe is also another region in the telehealth market region where market players experienced tremendous growth due to knowing the awareness of remote monitoring and healthcare from home. The telehealth market is expanding globally during the forecasting period. The factors which give opportunities for this market are lack of physicians, increasing chronic diseases that need immediate attention from the physicians. However, the reimbursement or coverage of the fee, illiteracy of some people who cannot adopt the current advanced telecommunication are the challenges faced by the telehealth market. Key Players in the Telehealth Market The key players in the market are Teladoc, Doctor on Demand, GE Healthcare, SnapMD, Encounter Telehealth, GlobalMed, HelloMD, MDLIVE Inc, InTouch Technologies, Dictum Health, Inc., LLC, and American Well. Globally, advancements in the technologies and growing awareness of remote services increased the demand for telehealth services. In the coming future, emerging countries/regions play an important role in the telehealth services market. This study will help the market players to understand the key market trends, market dynamics, and end-users pain-points. The qualitative and quantitative analysis of the study will enhance the user experience of the study. The competitive analysis of the major players enables users to understand the dynamic strategies such as technology innovation, partnerships, merger & acquisitions and joint ventures of the key players This report also provides the portfolio analysis and capability analysis of the leading players. Quantitative analysis of the market enables users to understand the actual facts of the market across four major regions. Companies Mentioned AMC Health American Well Asahi Kasei Corporation Cerner Corporation Chiron Health Cisco Systems E Healthcare Imediplus Iron Bow Technologies Koninklijke Philips Medtronic Medvivo Group Medweb Siemens Healthineers AG Teladoc Health Telespecialists Vsee Zipnosis For more information about this report visit https://www.researchandmarkets.com/r/kyppo0 Contacts ResearchAndMarkets.com Laura Wood, Senior Press Manager press@researchandmarkets.com For E.S.T Office Hours Call 1-917-300-0470 For U.S./CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900 < Previous News Next News >

Amazon's telehealth arm quietly expands to 21 more states By Katherine Khashimova Long March 8, 2021 An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector. An Amazon telehealth outfit that started as a pilot service for Seattle-area employees and their families has quietly filed paperwork to operate in 21 more states, a signal of Amazon's expanding ambitions for the $3.8 trillion medical sector.The service, Amazon Care, launched a year ago as an app providing on-demand chat and video consultations with medical professionals for Amazon's then-54,000 Puget Sound employees. Users can also book in-person visits at their home or office with clinicians. Payment for the service routes through Amazon.com. In recent weeks Amazon Care has incorporated in Alaska, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Maine, Maryland, Montana, New Hampshire, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont and Wyoming, according to records filed with state agencies. The online health magazine Stat was first to report Amazon Care's expansion. Amazon did not respond to questions about whether access to the newly expanded service will continue to be limited to Amazon employees. But there are indications that Amazon may begin offering the service to a broader audience. In December, Business Insider reported that Amazon had pitched other companies, including Seattle-based Zillow, on the health care app. Amazon has been hiring health care practitioners, research scientists and product managers for the app around the country—including in California, Georgia and Texas, according to Stat. And with a nationwide group of home health care providers, Amazon Care on Wednesday announced it would begin lobbying lawmakers to ease regulations on what kind of health services can be performed outside of a doctor's office—potentially widening the services Amazon Care can provide. Amazon has not yet received professional licenses that would allow it to operate facilities like medical testing labs in the 21 states it has filed to do business. However, that paperwork may be coming down the line: In its Georgia business registration, Amazon indicated it planned to start doing business in the state this July. Amazon began nosing around the lucrative field of health care in 2017, when it made several high-profile hires from the sector. Former One Medical Vice President Christine Henningsgaard joined Amazon, as did Missy Krasner, from the digital health-records management company Box.Henningsgaard, who left Amazon in 2019 to start the maternity-focused health care venture Quilted Health, refers to herself on her LinkedIn profile as part of the "founding team" of Amazon Care, which she described as "bringing customer obsession, advanced technology, and last mile logistics to health care." Around the same time, the company formed an ill-starred health care consortium with Berkshire Hathaway and JPMorgan Chase. The organization, later dubbed Haven, had a stated goal of offering better service and rates from health care providers on behalf of the triumvirate's nearly 1.2 million employees; Haven dissolved last month. Amazon purchased online drugstore Pillpack for $753 million in mid-2018; the next year, the company won landmark approval allowing its voice-activated artificial intelligence, Alexa, to transmit private patient information. When the coronavirus began infecting Amazon's hundreds of thousands of warehouse workers last summer, the company built hundreds of its own on-site laboratories to test employees. In November, Amazon launched an online pharmaceutical delivery service, sending drugstore share prices tumbling. Just weeks later, Amazon's cloud-computing division unveiled a health data management service for doctors and hospitals that complies with patient confidentiality regulations. Amazon Care has likely been in the works since at least early 2018, when Amazon hired Seattle geriatrician Dr. Martin Levine. Amazon Care clinicians are employed by Care Medical, formerly Oasis Medical, a company Levine founded shortly after he joined Amazon, according to business records. Amazon replaced Levine early last year with Dr. Sunita Mishra, a former executive at Providence St. Joseph, where she led the development of the health system's mobile app for on-demand medical care. Levine is now chief medical officer at The Polyclinic health system, which operates 14 sites around the Puget Sound region. Weeks after Mishra joined Amazon, the company expanded access to Amazon Care to all of its now-80,000 Washington state workers. < Previous News Next News >

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

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 >

The Future of Telehealth: Informatics, Scalability and Interoperability Bill Siwicki, Healthcare IT News July 2021 A Philips executive describes what's happening now with virtual care – and what needs to happen to ensure a solid future for telemedicine and remote patient monitoring. The COVID-19 pandemic pushed telehealth into the spotlight with exponential adoption, helping to prove its value. The healthcare industry learned that, with the right solutions, care can extend outside hospital walls and be conducted anywhere. Further, CIOs and other health IT leaders reinvented systems and processes, and clinicians gained an improved understanding of the invaluable impact of integrated informatics on digital transformations and the quality and efficiency of care. Even while the pandemic continues, healthcare provider organizations have begun to stabilize these infrastructures and revisit the technologies and workflows deployed earlier in the crisis and turn them into standard practices. On this note, Karsten Russell-Wood, portfolio leader for post-acute and home at Philips, shares his viewpoints with Healthcare IT News on the biggest priorities to ensure telehealth is sustained long term. Q. How can telehealth and remote patient monitoring technologies help support chronic and acute care anywhere? A. With the right tools, extending care outside the hospital is not only feasible, but in many cases preferred. The Philips Future Health Index 2021 Report, which surveyed nearly 3,000 healthcare leaders across 14 countries, found that healthcare leaders expect an average of 23% of routine care to take place outside of the hospital walls within three years. This new frontier will undoubtedly include extending real-time care to those with both acute needs and chronic conditions who benefit from consistent communication with doctors. For these patient populations in particular, COVID-19 spurred an interest in becoming a more active participant in care plans, bringing them new levels of convenience and personalization. To meet these needs, providers must continuously work to tailor care toward the consumer, just as we're seeing happen in the banking and retail industries, and [to] advance care models from brick and mortar to "clicks and mortar." Even if the home can't be the hospital, community spaces and retail locations can fill in as connected care stations for underserved communities or patients [who] don't have an ideal setup at home. This is only possible through the use of data-driven, connected care solutions that feed into cloud-based software and allow clinicians to maintain visibility into their patients' conditions from afar. Beyond wellness checks, remote patient monitoring enables doctors to view critical patient data on a consistent basis, helping them cater care to a patient's unique needs, as well as activate timely interventions before health deteriorates. Traditionally, acute patients need an inpatient admission to the hospital and require continuous rounding by a physician. Approaching this patient population with a 360-degree model – monitoring them at home from pre-admission through post-discharge – could help track the different phases of acute care from outside the hospital. The benefits here include freeing clinicians from the bedside, helping them better allocate hospital resources according to risk, and, above all, keeping patients in a more convenient, lower-cost setting. Hospital-grade wearables equipped with secure data integration, for example, can help guide relevant, timely decisions from care teams regarding whether a patient needs to be hospitalized immediately, or can receive treatment elsewhere and remain outside the hospital for the time being. Care teams can view daily and weekly trends via continuous biometric devices, showing everything from skin temperature, respiratory rate at rest and coughing frequency, and be notified if symptoms are worsening. There are similar advantages of using connected devices when managing patients with chronic conditions. In the comfort of their own home, patients can remain connected to their providers in a convenient, passive manner, which can motivate them to adhere to their treatments. Until recently, patients have traveled to their doctors to receive care. However, that doesn't mean hospitals have always been the most accessible means of delivering that care, people just didn't have a choice. The industry now has the means to deliver that same level of care in a much more accessible way, bringing it to patients wherever they may be. For example, those with diabetes or congestive heart failure who may wish to avoid in-person visits can potentially avoid an unnecessary hospitalization if their doctors detect a change in their condition in time. Patients with cardiac arrhythmias can remain home while being continuously monitored. Doctors can detect arrhythmias such as atrial fibrillation as they occur and intervene if necessary. Telehealth solutions can also help clinicians monitor whether a chronic condition is becoming acute. Q. With telehealth and remote patient monitoring comes the need for interoperability and security. How does a healthcare provider organization ensure data can be accessed and shared seamlessly across settings, and that solutions are interoperable? A. As hospitals evolve to extend care beyond their walls, telehealth and remote patient monitoring enable a hybrid continuum of care that brings an increased amount of health data. This requires secure, robust data-sharing infrastructures and a standard for technologies to work together across platforms and locations. The Future Health Index 2021 report found that two of the biggest barriers to the adoption of digital health technologies were difficulties with data management (44%) and lack of interoperability and data standards across technology platforms (37%). Providers need to rely on a longitudinal health record to activate the right care anytime and anywhere. For example, for remote care for patients in ICU settings, known as tele-ICUs, where integrated systems are particularly important: Without a strong backbone for smooth data integration, intensivists can only see what is happening in front of them, instead of making informed decisions based on a holistic view of a patient's health. To ensure data can be accessed and that solutions are interoperable, secure flows of data must be activated. Solutions that are designed to work in tandem are better organized and more secure from malicious attacks. By safeguarding technologies to make sure they're interoperable across platforms and geographic locations, health systems can better protect the data that flows throughout their system and provide increased security. Using a cloud-based platform approach will help achieve this, as well as standardize the current disparate IT landscape and allow data to be accessed anywhere. Leveraging open APIs and approved standards like IHE-HL7 can help facilitate data exchange across multiple sources and vendors across the continuum of care with minimal friction. With the rise in cloud-based applications, software-as-a-service and virtual care solutions enabling data sharing, organizations must work to ensure systems and processes mature at the rate they are evolving. Providers should assess their current infrastructure and their performance metrics such as ROI, quality, scalability and satisfaction, which will help them develop IT models accordingly that support these emerging care pathways. New types of executive roles will also grow in necessity to support building beyond hospital walls, such as chief digital officer and virtual health leadership supporting the informatics department. Further, to ensure confidentiality, integrity and availability of critical data and the systems that house that data, security plans should span across organizations and industries. While updating IT systems all at once may not be realistic, health systems can start by rigorously assessing third-party vendor capabilities, only using 510k cleared medical devices and implementing policies for data protection. Hospitals should prioritize partnerships with organizations that take a proactive approach to protecting health information across devices, systems and settings, so administrators, healthcare providers and patients have confidence about how care is delivered. By connecting devices, unlocking data and fostering collaboration, we will empower new forms of engagement, actionable insights and better health outcomes. Q. You have said that virtual care strategies cannot be a bandage on top of existing or new piecemeal solutions that work in silos, that a much-needed technology infrastructure must be established that not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. Please elaborate. A. Implementing telehealth solutions during the pandemic to supplement in-person care was like building a plane while flying it. Now healthcare organizations can be strategic, stabilize these infrastructures and revisit the technologies deployed in times of crisis and transform them into standard practices. Our world moving forward is one that embraces the best solutions available, leveraging both traditional care models as well as virtualization to provide quality care. This change isn't one that any one organization can do alone, and relies on partnerships with technology companies that enable and foster clinical creativity through co-creation and embrace the subscription economy. Healthcare organizations are increasingly partnering with those with proven track records in implementing foundational technology infrastructures and who can serve as consultants to drive their digital transformation. The ability to co-create has never been more important in driving outcomes. Working side by side with partners in the technology sector will help hospitals and health systems develop solutions from the ground up. There is value in disintermediated partners in this case, as they allow providers, vendors and patients to take collaboration to the next level. And health systems should be given flexibility when it comes to implementing and exploring virtual tools that are right for them. Rather than making a big capital investment upfront, they should be able to adopt solutions in a stepwise fashion, and scale up or down in real time. Today's healthcare organizations care more about access than they do about ownership. They want customized experiences and flexible payment options. That's why healthcare organizations are increasingly turning to subscription services, with a shift from buying a physical product to leveraging a holistic solution that provides ongoing value and engagement. By adopting these new business models, it not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. We've seen success with software-as-a-service models as a predictive, usage-based model that allows for faster innovation, but also reduces the demand for IT maintenance, standardizes service levels and usage, and helps providers quickly scale according to need. < Previous News Next News >

My Story: A Patient’s Perspective Tara Barry January 27, 2022 The pandemic has created a lot of new realities throughout the world, telemedicine being one of them. As someone with thyroid disease and other ailments, I have to get regular check-ups (sometimes every month when it’s really flaring up). With my health issues, I see multiple different doctors (primary, cardiologist, endocrinologist, allergist), and it’s often very hard for me to find time to fit them all in to my already jam-packed schedule. Telemedicine has been such a welcome adaption for me, as it has truly taken a lot of the usual “appointment” stress, like commute time, completely out of the equation. During the pandemic, I’ve been particularly cautious about in-person appointments. Since I am someone with a weakened immune system, it makes me nervous going into such a historically germ-filled location such as a doctors’ office. Telemedicine appointments truly put me at ease. I have had experience with ‘televisits’ for both primary care and specialty care. I’ve been able to have a quick appointment on my lunch break and sometimes even during a short 15-minute break. When I made my first appointment I was a little nervous about how it would be. I didn’t know if I’d feel more rushed and like they were just squeezing me into their busy day or not. It was a relief to find that wasn’t the case at all. I find these appointments to actually be much more conversational than in-person visits, and also feel like they really get down to the issues faster. You can learn about treatment options in mere minutes and have your prescriptions sent in while you’re still on the call! I am someone who is technologically savvy so I wasn’t too worried about being able to successfully hop on to a telemedicine call. I think the various systems different doctor’s offices use make all the difference. In my experience, I have always been given the telehealth links ahead of time and the instructions have been very clear and concise. Typically, the medical assistant will call prior to the appointment to go over your medical history, insurance information, what your appointment will be focused on, and the instructions to get on the call. Sure, there’s been a few times we’ve had some connection issues, but they always seem to resolve themselves quickly and don’t take away from the appointment itself. To read full article: https://telemedicine.arizona.edu/blog/my-story-patient-s-perspective < 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 >

For next steps on telehealth, look to the states By Kat Jercich January 26, 2021 Lawmakers in legislatures nationwide have introduced about 300 bills aimed at expanding access to telemedicine – but not every bill is equally helpful. As the United States approaches its one-year anniversary of the COVID-19 pandemic beginning to disrupt normal healthcare operations, a question continues to endure: What's next for telehealth? The answer remains unclear on a federal level, with U.S. lawmakers recently reintroducing legislation that would take at least a few steps toward safeguarding virtual care. In the meantime, though, state legislatures have taken action – and experts say their movement in this regard is unprecedented. "I've been doing this a long time, and I've never seen anything like this," said Claudia Tucker, senior vice president of government affairs at Teladoc, during the third installment of the American Telemedicine Association's EDGE policy conference on Tuesday. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >> As Tucker described it, lawmakers in nearly every state have introduced about 300 bills in the last few months aimed at expanding access to telemedicine. But, she said, not every one of those bills has equal merit. Some, for instance, require providers to see a patient in-person before allowing audio-only appointments – a move that legislators may not realize will have a chilling effect on care. "State policy matters. When you put clinically unnecessary barriers to care [into place] through state policy … they can be a big deal," noted Quinn Shean, managing director at Tusk Ventures/Tusk Strategies. Shean also noted that many of the hundreds of bills being introduced engage with the "who, what, where and when" of telehealth: what types of providers can provide it, and which modality they can use. "We're seeing states catch up based on their experience in the pandemic," she said. Panelists throughout the day pointed to the double-edged sword of telehealth: It can enable patient access, but it can also deepen the digital divide. "The idea that someone living in Appalachia can have access to one of the best oncologists in the country through telehealth is life changing," said Tucker. As Evan Hoffman, director of state and local government relations, pointed out, virtual care can be instrumental in helping keep struggling rural hospitals open. Telehealth tools, he said, "can beam [provider input] in to support rural hospitals and their efforts to engage patients. The flurry of bill volume cannot be understated in telehealth." At the same time, said Shean, "It's going to be on industry and stakeholders to make sure we do use telehealth as a great equalizer." One potential make-or-break issue when it comes to equity is broadband access – whether patients are able to connect with providers at all. "We have seen, especially in our lower-income areas … the disparity in accessibility widen," said New York State Assembly member Pamela Hunter, D-Syracuse. "We need to make sure that those who need accessibility in care – the most vulnerable – are able to utilize this up-and-coming ... technological health-delivery system," continued Hunter. At this point, she said, "it really is not for everyone." Experts also pointed to coverage and reimbursement as pivotal issues for broader access after the COVID-19 pandemic. "We're going to have to talk about parity," said Minnesota Senator Michelle Benson, R-Anoka. "There is some concern that providers are going to have to be held accountable" for potentially inappropriately charging for services. "I don't know how that looks in statute," Benson admitted. "I hate it when legislators are overly prescriptive," she continued, but maintained that some regulation would undoubtedly be necessary. When it comes to policy progress over the next 100 days, Tucker advised, "follow the money." "There's a huge focus on money, reimbursement, health plans," she said. "It's all about: 'Where does the money go?'" Telehealth, she argued, begets access, quality of care, and savings. "Let's not forget that third one," she emphasized. "The flurry of bill volume cannot be understated in telehealth," noted Hoffman. "It speaks to the tremendous opportunity before us." Shean added that the industry is, for the most part, past the need to simply prove the merits of telehealth. Instead, she said, "We should be using this time of telehealth advancement to be rethinking … to really think bigger." Kat Jercich is senior editor of Healthcare IT News. Twitter: @kjercich Email: kjercich@himss.org Healthcare IT News is a HIMSS Media publication. < Previous News Next News >