Telehealth QA – Is it all it’s QAcked up to be? Trudy Bearden, PA-C, MPAS February 16, 2022 In hopes of sparking renewed commitment to applying improvement science to telehealth, we offer this Telehealth QI and QA Miniseries. Today is the fourth in the series. Require expertise and excellence in telehealth service delivery. Expertise with telehealth requires deliberate practice which builds on or modifies existing skills, usually with the help and guidance of a coach or teacher with targeted feedback on what to improve and how to improve those skills. Send staff through telehealth training either internally or externally. The California Telehealth Resource Center Telehealth Course Finder is a great place to start for external telehealth trainings. Provide peer review of telehealth sessions by inviting a trusted clinician to join a telehealth visit – with patient permission. Debrief after the session to provide feedback and to discuss what went well, what did not go well and what changes can be made to improve Implement written triage protocols that are easily accessible by all staff to clarify which patients or patient issues are appropriate for telehealth and which need to be seen in person. Make a commitment to exceptional service delivery. Solicit and act on patient and staff feedback. Consider including a patient partner or advisor in these efforts. Below are some sample staff and clinician satisfaction survey questions. Some institutions may already incorporate some of these into their existing patient feedback systems (e.g., Press Ganey) so check to see if they are before duplicating efforts. Sometimes it’s best to collect feedback simply and in real time by asking, “How was your visit? What could have gone better?” Read full article here: https://southwesttrc.org/blog/2022/telehealth-qa-it-all-it-s-qacked-be < Previous News Next News >

Telehealth heavy hitter Dr. Roy Schoenberg on virtual care in 2023 Bill Siwicki December 14, 2022 The Amwell CEO reviews his successful predictions from last year and looks ahead at clinician-initiated telemedicine and virtual care shifting from transactional to transformational. From the distant past of the 1990s up to just a few years ago, many healthcare technologists have predicted that telemedicine would make it into the mainstream of healthcare delivery. Well, today, thanks to many factors surrounding the COVID-19 pandemic, telemedicine has finally made it into the mainstream. And now that it is being so robustly used across the country, the big question is: What's next? We spoke with a heavy hitter in the world of telehealth, Dr. Roy Schoenberg, president and CEO of Amwell, one of the big players in telemedicine technology and services, to get his views on how his predictions from last year turned out and where virtual care is headed in 2023. Q. You predicted last year that in 2022 we'd see exciting advancements in remote patient monitoring and automation powered by the patients who need them most. How did that prediction turn out? A. Not only has the technology for remote patient monitoring and care automation become more advanced, but the use cases they are powering are maturing rapidly. Today, we're seeing applications of automation that go beyond mimicking clinicians and instead are being used to help patients manage the reality they face in the moments in between visits when they are not in front of clinicians. It's this area that I predict will grow more rapidly in the years ahead as it means that technology can actually assist clinicians in being there for their patients more frequently in a cost-effective way. As the industry struggles to keep up with workforce shortages and deal with financial constraints, technology that can serve clinicians and patients, while being financially viable, will become pervasive. Still, we've only just begun to scratch the surface of what RPM and automated care programs can do to drive more patient-centric, value-driven care. We can transform lives and quality of life by extending the reach of clinicians through digital technology and empowering people to live their healthiest life. Q. You also predicted that in 2022 patients will be interacting with healthcare both physically and through technology – hybrid care. How did that turn out? A. 2022 was a year of advancing the understanding that digital care is much more than videoconferencing. People now are coming to terms with the fact digital care is not just about changing where care happens but how care happens. By thinking about it as a true distribution arm, you can see how you can manage patient conditions differently, you can reach customers differently, you can motivate patients to play a more active role in their healthcare – this is a powerful reimagination of traditional care models. Hybrid care models that combine physical and virtual interactions was the first iteration of seeing this understanding play out; and we saw these models accelerate significantly. The next phase is hybrid care models that combine physical, virtual and automated interactions. It's this type of digital care delivery that we are focused on enabling our clients to achieve through an integrated platform approach that allows for a well-coordinated, seamless care experience across all settings. Q. What are two predictions you have for 2023 on technological advances in telemedicine? A. In 2023, we'll continue to see digital health's influence in completely reimagining how care is accessed and delivered. It's a transformation that will be sparked not just by consumer demand for digital care, but also by clinician preference. In fact, clinician-initiated digital care will far outpace patient-initiated virtual interactions going forward, with clinicians becoming the top utilization driver. It's a trend we've already started to see. We've reached a point where physicians and nurses are prescribing virtual care. Within physician practices, medical assistants are triaging patients for virtual encounters when the manner in which they are seen – in person or virtually – is less important than the need for speedy access to care. In an era when patients are surrounded by devices, we'll not only gain greater knowledge of potential use cases for RPM and automated care, but also a wealth of data around which approaches work best in specific circumstances. These findings will further advance digital care from a "nice to have," convenient feature to an integral aspect of the continuum of care. Additionally, I predict digital care will continue to shift from transactional to transformational. Virtual primary care is becoming ubiquitous, however the opportunity for virtual primary care is dramatically extended when it's tightly integrated with escalation paths to create a more comprehensive care experience. Discussions around digital care's trajectory will increasingly examine how to more tightly integrate virtual care and digital health within the complete patient journey. It will be a time of reinvigoration around the power of what is still a relatively new component of care. Some of our best learnings around digital health will take place in this space where the immediate pressures of COVID-19 have passed, and clinicians feel more free to imagine: "What's next?" Q. What's a prediction you have for 2023 regarding telemedicine public policy? A. One of the biggest challenges for the digital care industry continues to be around state licensure. It's clear we need to allow healthcare to be distributed around the country through technology – the internet does not stop at state lines. What's less clear, however, is who on Capitol Hill will be the one to say, "We have to find another way." Change must occur in partnership with medical boards that will continue to play an important role in enabling the safe practice of medicine. It's inevitable this will be the biggest war we'll see play out over the next few years and it will greatly impact the future of care distribution. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telehealth-heavy-hitter-dr-roy-schoenberg-virtual-care-2023 < Previous News Next News >

The Punctuated Equilibrium Of Telemedicine: Digital Health Solutions And Government’s Role Richard Schwabacher September 14, 2022 As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. Action was taken at the state and federal levels, as well as by payers and employers, to make telehealth easily accessible. Nearly overnight, swift changes in payment, reimbursement, coverage and licensing policies were made as the pandemic disrupted every facet of life. Telehelth benefits have proven to be popular, so much so that Congress recently voted 416-12 to extend benefits. Simultaneously, investment in the digital health market has soared to a record $29.1 billion in 2021 to transform a healthcare system that could support digital capabilities. Patients, already accustomed to digital services, like banking, quickly adapted to the change. When radical change occurs in a short period of time and then finds a new balance, we call that a punctuated equilibrium. With respect to telemedicine, we don’t expect to return to life as we knew it before Covid-19 or, at the other end of the spectrum, settle in a place where high rates of telemedicine adoption were during the surges. Ultimately, there will be a new equilibrium that nestles between those two polar opposites. Despite overwhelming investment and adoption of virtual care and telehealth options by patients and providers, barriers still exist. There are specific actions government and businesses can take and should, to support healthcare programs born out of the pandemic—but only if the economics and incentives are aligned. Spotlight Moment For Laboratory Diagnostics Laboratory diagnostics has always been a critical component of healthcare—diagnosis, prevention, management, and so forth—but the pandemic put lab testing and access to it squarely in the spotlight. It became an urgent need that nearly everyone had. The value and role of laboratory diagnostics cannot be understated. According to the CDC, 70% of high-quality care depends on diagnostic testing to make medical decisions by equipping providers with the necessary information to properly address patient needs. Diagnostics are most often the healthcare tools providers rely on when diagnosing, managing and treating a variety of diseases and conditions; for instance, 12 of the 15 most clinically and economically significant disease categories in the U.S. dictate using laboratory diagnostics as the standard of care. Lack of access to laboratory diagnostics for patients has wide-ranging effects, including implications for medication nonadherence that will continue to grow as the burden of chronic diseases grows. The Role Of Government Policy The patchwork approach to solving these problems will not suffice in the long run, which is why the role of government in the sustained expansion of virtual care services is so important. Healthcare policy ought to keep pace with the evolution of healthcare technology. It’s encouraging to see the current administration invest in and promote innovation with information technology to better serve community health. The investment not only includes $34 billion initially invested through the HITECH sections of the American Recovery and Reinvestment Act but also many billions of dollars expended by U.S. industries, including laboratories. Three specific policies can help direct and reward innovation leading to better outcomes. • Ensure that all patient data needed by clinicians for individual and population care is available. While the CURES Act and the ONC CURES Act Final Rules aim to prevent data blocking, business practices among providers and payers sometimes serve as effective barriers to serving patients in their communities. ONC and CMS can refine the rules to ensure data is available in all EHRs from all appropriate sources, facilitating timely availability of all patient data wherever it is needed. • CMS should develop companion coding for telemedicine services and home-based specimen collection for lab testing. The value of telehealth is compromised if the patient must travel to a distant site for lab testing in support of the telehealth intervention. • While the government can mandate that providers report specified data, the results from home-administered testing are not available in standardized electronic formats and do not get reported. This has created barriers to public health responses in communities most at risk. What Can Businesses Do? There are ways for businesses and the government to collaborate that can improve the telemedicine landscape that benefits patients and consumers, as the clear, quantifiable health outcomes speak for themselves and can help influence further adoption and integration. For instance, the number of Medicare beneficiary telehealth visits increased 63-fold in 2020 to more than 52.7 million. While at the Mayo Clinic, ambulatory management of Covid-19 showed effective use of remote patient monitoring with a 78.9% engagement rate. These are just two examples that illustrate the increased adoption and success of making telemedicine an integral part of healthcare protocols. Companies that move to a value-based incentive model from a fee-for-service model and move toward reimbursement models that reward quality can be an alternative to the status quo. Telemedicine can be part of the solution when addressing inequities in access to care, including specialty care and at-risk populations. We already know that lack of access to laboratory diagnostics for patients has wide-ranging effects that will continue to grow as the burden of chronic diseases grows. Virtual Care Is Here To Stay Digital healthcare models are changing the landscape of the healthcare system as we know it, and this is good news for patients and providers. The changes empower patients to take more control of their health, give them more options that cater more to their needs, lower costs for “virtual-first” or “hybrid care” healthcare plans and improve access. Our collective experience during the pandemic has shown that people need healthcare and clear access points. The expanded use, adoption and successful integration of digital healthcare solutions have been received positively and have encouraged more participation. We need to continue to expand telehealth and remote options with policy that supports it—to backtrack on the progress we’ve made would be a mistake. See original article: https://www.forbes.com/sites/forbestechcouncil/2022/09/14/the-punctuated-equilibrium-of-telemedicine-digital-health-solutions-and-governments-role/?sh=523fd49e2deb < Previous News Next News >

Telemedicine and diagnosis Adriana Albini September 27, 2022 The adoption of telemedicine and its range of applications grew exponentially in the early days of the Covid-19 pandemic, and the general consensus now is that it is here to stay, albeit perhaps with a more hybrid bias of in-person and remote visits. Telediagnosis, or TeleDx, i.e., the identification of a disease at a site remote from the patient, has expanded to include primary care, revolutionising the way in which patients and doctors communicate with each other and establish rapport. It is still early days to fully evaluate the effect of virtual vs in-person visit on diagnostic error, but there are guidelines for health professionals to conduct effective virtual examinations, and many best practice examples, both in terms of ways to gather information from the patient (from wording of questionnaires to digital records, home environment, and so on) and technological innovations. In cancer care, pathology plays a central role in the final diagnosis upon which clinicians will develop treatment for their patient, and remote pathology can offer many advantages, such as easier access to pathology experts, consultation among specialists, timely and secure availability of images, and so on. Up until the 1990s, pathologists worked almost entirely within the constraints of the analogue world, with physical glass slides and microscopes. Some attempts were made at capturing virtual images of slides through a tiling method, which was time consuming and prone to error, as it required accurate placing and extensive stitching together of images. But at the end of that decade, engineer Dirk G. Soenksen (founder, and CEO of Aperio) devised a much more efficient system based on a linear scanner, the ScanScope, that allowed for tightly focussed and fast slide image capture, opening a new era for the practice of pathology. Whole slide imaging, or WSI, was first employed in education and research but in recent years, with the improvement of its technology, it has received regulatory approval by the FDA and around the world for diagnostic use as well. The potential for feeding AI algorithms to provide diagnostical support is massive, as virtual slides are accumulating fast and standardised databases are being built. “Telemedicine in Cancer Care Continuum: implementation and integration”, was an online conference developed by the SPCC in collaboration with the American Society of Clinical Oncology (ASCO), which took place on 6-7 May 2022. In his presentation, Liron Pantanowitz, Professor of Pathology, and Director of Anatomical Pathology at the University of Michigan, talked about telepathology in both its non-acute and acute settings, focussing more extensively on the latter. The term ‘telepathology’ was coined by Ronald S. Weinstein in 1986, after he organised the first public event of satellite-enabled dynamic-robotic distant pathology, but the very first live telepathology ever performed dates as far back as to 1968. Massachusetts General Hospital set up a two-way television link with Boston’s Logan Airport that enabled doctors at the hospital to remotely study blood smears, urine samples and X-rays for patients at the airport, and even listen to their heartbeat with an electronic stethoscope. However, as in the case of telehealth in general, the adoption of digital pathology had to wait until the Covid-19 pandemic to be widely implemented. To facilitate continuity of healthcare while social distancing, certain restrictions were lifted, such as CLIA in the US, allowing pathologists to work from home and sign out cases. The first use of telepathology Prof. Pantanowitz looked at was for frozen section consultation. There are several challenges when a pathologist is asked to provide an intraoperative consultation. The pathology specimen is fresh, not easy to cut. The frozen section itself is difficult to prepare and is often filled with artifacts. These artifacts not only make it hard to read the glass slides but can compound the problem when using digital images. The turnaround time needs to be rapid. Usually, pathologists strive for less than 20 minutes to provide the surgeon with an answer. And they are under serious diagnostic pressure because if they get it wrong, it is difficult to reverse the surgical decision that has been made based on their diagnosis. Over the past 54 years different modes of practising telepathology have been developed. A pathologist on site can take static images, which is easy but too time-consuming. There is also video microscopy, live streaming from one pathologist to another. If there is no pathologist present on site to read the slides, there are systems such as robotic microscopy, where the pathologist can remotely take control of the functions on a microscope, such as navigation and focus. And there is also Whole Slide Imaging, which is the entire digitization of a slide to be remotely reviewed. Thanks to advancements in technology, hybrid devices are now available from many vendors with robotics and Whole Slide Imaging functions in one scanner. See full article: https://cancerworld.net/telemedicine-and-diagnosis/ < Previous News Next News >

Advances in telemedicine are on the way in 2022 Bill Siwicki Dec. 20, 2021 A physician expert in virtual care talks technological advances, reimbursement legislation and the continued evolution of remote patient monitoring. 2020 and 2021 saw the mainstreaming of telehealth and the rise of remote patient monitoring. These changes to the healthcare landscape were helped partly by requirements of the COVID-19 pandemic and partly by the subsequent loosening of telemedicine reimbursement and licensure regulations by the government. But what's to happen in 2022? Will the government and commercial payers continue to reimburse for telemedicine? Will new virtual-care legislation pass? Will there be technological advances that push the care paradigm further forward? And what of the future of remote patient monitoring? Healthcare IT News sat down with Dr. Ian Tong, chief medical officer at Included Health, a telehealth technology and services company, to get his read on these questions and his predictions for telehealth in 2022 and beyond. Q. What do you see in the realm of technological advances in telemedicine in 2022? A. While 2021 saw many healthcare technology mergers and acquisitions in response to the pandemic, and growing virtual-care adoption among payers, providers and consumers, much of the technology of these combined entities remains fractured. Though promoted as one offering, consumers still are having to navigate two or more platforms and work to connect the dots themselves. The technology needs to become invisible – so good that you don't even realize it's there. The technology for virtual-care appointments also will continue to advance beyond 1:1 doctor-patient video conferencing. For example, in response to the rising behavioral health provider shortage, we can expect to see technology that can enable group sessions with multiple patients receiving counsel and support at once. Whether it's behavioral, acute or chronic care, the most important role that technology will play is enabling all physicians to have the same window into a patient's medical history and care plan so they can provide integrated, longitudinal care. The technology is what will enable this industry to realize the full potential of virtual care beyond transactional, one-time interactions. Q. All the temporary reimbursement moves by government and payers for the sake of the pandemic really pushed telehealth into the mainstream. What do you foresee happening with reimbursement for virtual care in 2022? Will it become permanent? Will it be expanded? A. With usage rates 38 times higher than pre-pandemic, and the inarguable value for the people who need it most – seniors and the immunocompromised who can't afford in-person exposure – I believe the government will and should expand virtual-care access. Pre-pandemic virtual care was used for urgent, low-complexity issues – cough, cold, rashes. But today, the real value is for integrated chronic-disease management or ongoing behavioral-health therapy, where people need not be burdened by the constant travel in and out of doctors' offices. The more care that shifts to virtual, the less burden of disease the patients will have, which will lead to better outcomes. This is an opportunity that should be afforded to everyone, especially our most vulnerable and historically underserved communities. Q. Remote patient monitoring is a form of telehealth that is of growing interest to healthcare provider organizations. What do you see happening with RPM in 2022? A. Adoption of remote patient monitoring devices continues to rise, and we don't see it slowing down any time soon. Today, one third of consumers are more likely to choose a provider that allows them to share data from a connected health device, which only promotes more positive outcomes. The more real-time data that we can collect in the comfort of people's homes, the more personalized, data-driven virtual care we can provide. However, to really launch adoption in this sector, the costs of these devices need to come down. As costs come down, health plans can more easily find an ROI [return on investment] to subsidize the use of these devices. https://www.healthcareitnews.com/news/advances-telemedicine-are-way-2022 < Previous News Next News >

Senate panel seeks to expand telehealth for Medicare mental health services Jeff Lagasse, Editor May 27, 2022 The draft suggests removing Medicare's in-person visit requirement, protecting audio-only telehealth and supporting provider use. Senate panel seeks to expand telehealth for Medicare mental health servicesThe draft suggests removing Medicare's in-person visit requirement, protecting audio-only telehealth and supporting provider use. Jeff Lagasse, Editor Photo: Kilito Chan/Getty Images The Senate Finance Committee, led by Chair Ron Wyden (D.Ore.), is seeking to make permanent some of the telehealth flexibilities enacted during the COVID-19 pandemic that pertain to mental health services. In what the committee calls a mental health "bill of rights," Wyden and ranking committee member Mike Crapo (R-Idaho), along with Senator John Thune (R-S.D.) and Senator Ben Cardin (D-Md.), released a discussion draft for telehealth policies that suggests, among other things, removing Medicare's in-person visit requirement and codifying audio-only mental health coverage. Wyden said via statement that the policies outlined in the draft "will help strengthen access, awareness and support for telehealth." Aside from nixing Medicare's in-person visit requirement, the committee's proposed policies include establishing benefit transparency for mental health services delivered via telehealth, to inform Americans with Medicare how and when they can access such services. The committee also recommended directing Medicare and Medicaid to promote and support provider use of telehealth; and incentivizing states to use their CHIP programs to establish local solutions to serve behavioral health needs in schools, including through telehealth. The telehealth discussion draft is the first legislative draft released by the committee since it began its larger mental healthcare initiative. Other discussion drafts may be released prior to a committee markup. The committee said it's committed to fully paying for any mental health package with bipartisan, consensus-driven offsets. Earlier this year, the committee announced five areas of focus for addressing shortfalls in mental healthcare: workforce, care integration, mental health parity, telehealth and youth. WHAT'S THE IMPACT? When the pandemic first began, the Centers for Medicare and Medicaid Services waived barriers to telehealth reimbursement, but those flexibilities only last for 151 days after the end of the COVID-19 public health emergency. The current PHE expires in mid-July. If again extended as expected and for another 90 days, the PHE would end in mid-October, just prior to the midterm elections. Most experts have said they expect the PHE to be extended through the end of the year. To make telehealth flexibilities permanent, CMS needs authority from Congress. Wyden says that the committee's goal is ultimately to craft a behavioral telehealth bill by this summer. Other proposed policies in the draft include requiring fee-for-service and Medicare Advantage plans to publicly post information on Medicare beneficiaries' rights to receive telehealth services for mental healthcare, plus information on approximate cost-sharing obligations for virtual mental health services. The committee also recommended: mandating that the federal government collect information on trends and care quality and give regular reports to lawmakers. requiring that Medicare give providers guidance on improving access to virtual mental healthcare for those with language barriers and hearing or vision impairments. "Telehealth, particularly for behavioral health services, has become an essential component of care, and I am pleased that we have this opportunity to improve access to telemental health care, particularly for underserved communities," said Cardin. THE LARGER TREND The draft comes at a time when mental health concerns are rising for many Americans. Earlier this month a CVS Health/Morning Consult poll showed Americans of all backgrounds, but especially those who are Black, young adults, older than 65 or who identify as LGBTQIA+, are increasingly concerned about mental health and how to access care. Results show that a majority of respondents, 59%, have experienced concerns about either their own mental health or that of family and friends. That's a 9% increase since April 2020. Another majority, 53%, agree that hearing about other people's challenges makes them more comfortable seeking out resources and care for themselves. A 2021 study showed that mental health services accounted for the most common use of telehealth during the early days of the pandemic. In the midst of skyrocketing depression rates, the findings show that more patients used telehealth for behavioral, rather than physical conditions. A report from health insurer Cigna, also released last year, made it clear that businesses have taken notice of this shift to behavioral telehealth: Some 44% of human resources decision-makers and 27% of health plan leaders said that increased access to mental health services will become a long-term solution for their organization. Some 57% of health plan leaders said they had seen the value of mental health services increase more than for most other services and benefits as a result of the coronavirus. For more information: https://www.healthcarefinancenews.com/news/senate-panel-seeks-expand-telehealth-medicare-mental-health-services < Previous News Next News >

New FAIR Health White Papers Shows Large Telehealth Utilization Increases Before COVID-19 Center for Connected Health Policy April 2021 Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. In its fourth edition of the Healthcare Indicators and Medical Price Index White Paper, FAIR Health found that the fastest area of healthcare utilization growth from 2018 to 2019 occurred for telehealth services. FAIR Health conducted the annual analysis using its data repository of 32 billion claims for patients in commercial insurance plans. Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. FAIR Health also noted that the most common claim type for telehealth was for mental health services, bolstering other recent evidence that telehealth utilization continues to grow for behavioral and mental health services. The findings are an important contribution to ongoing policy discussions about where telehealth is going after the pandemic. While most telehealth experts have been paying close attention to telehealth utilization during the pandemic, these findings suggest that the story of telehealth’s rapid growth likely begins in 2019, one year prior to the public health emergency. FAIR Health is a national nonprofit organization that maintains a large database of privately insured healthcare claims data. The organization performs healthcare utilization and cost analyses on market trends for use by researchers, consumers, and industry stakeholders. For more information about FAIR Health's data, view their website. FAIR Health Consumer: https://www.fairhealthconsumer.org/#about FH Healthcare Indicators and FH Medical Price Index 2021: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/FH%20Healthcare%20Indicators%20and%20FH%20Medical%20Price%20Index%202021--A%20FAIR%20Health%20White%20Paper--FINAL.pdf < Previous News Next News >

Endocrine Society Provides Guidance for Appropriate Use of Telehealth Mark Melchionna October 07, 2022 The Endocrine Society published a policy perspective covering various factors, such as clinical and patient factors, which could help determine subjective care needs and whether telehealth use is appropriate. October 07, 2022 - Aiming to enhance personalized care, the Endocrine Society created a policy perspective containing five aspects of care that can help clinicians decide when using telehealth is appropriate. With 18,000 members spread across 122 countries, the Endocrine Society is focused on promoting efforts to treat all hormone-related conditions, including diabetes, obesity, and hormone-related cancers. Amid the rapid growth of telehealth that resulted from the COVID-19 pandemic, healthcare stakeholders anticipate that telehealth will continue to pave its way into various aspects of clinical care. Published in The Journal of Clinical Endocrinology & Metabolism, the Endocrine Society policy perspective describes five aspects of care that can assist the process of determining when telehealth is appropriate. “Clinicians will need to draw upon their own knowledge of each patient and their clinical goals to decide when to incorporate telehealth into their care,” said the policy perspective's first author Varsha G. Vimalananda, MD, a physician-scientist at the VA Bedford Healthcare System and an associate professor of medicine at Boston University School of Medicine, in a press release. “Telehealth visits can be considered as an option each time we schedule an appointment. Patient preference should be elicited, and decisions guided by weighing the factors we describe in the perspective piece.” The five aspects of care to be considered when deciding whether telehealth is appropriate for a patient are clinical factors including whether an in-person exam is necessary, patient factors such as access to transportation and comfort level with technology, the patient-clinician relationship, the physical surroundings of the clinician, and the availability of infrastructure needed for telehealth visits. Telehealth is playing an increasingly valuable role in a personalized healthcare, but physicians and patients need to discuss how it fits into the care plan they are deciding on, according to the policy perspective. "Moving forward, endocrine care is likely to involve a hybrid of in-person and telehealth visits, and thus the decision to use telehealth for any given patient will not be made at a single time point but rather considered in a longitudinal context," the perspective states. Previous studies have indicated that various benefits that arose from telehealth expansion. For example, a study published in September found that increased telehealth use during the pandemic led to a drop in opioid overdose risk. Researchers studied data from before and during the pandemic, which indicated that the likelihood of receiving opioid use disorder services and medications was higher in the mid-pandemic patient group that had increased access to telehealth. Further, telehealth continues to be used widely across the country. Recent data from FAIR Health shows that telehealth use rose 1.9 percent nationally from June to July and that it increased in three of the four US census regions: the Midwest, the South, and the West. See original article: https://mhealthintelligence.com/news/endocrine-society-provides-guidance-for-appropriate-use-of-telehealth < Previous News Next News >

Telehealth's ‘great opportunity’ at community health centers Emily Olsen June 14, 2022 ​ Ray Lowe, senior vice president and CIO at AltaMed Health Services, discusses his organization's move to virtual care at the start of the COVID-19 pandemic and how such care can evolve. See original video: https://www.healthcareitnews.com/video/telehealths-great-opportunity-community-health-centers < Previous News Next News >

Joint Commission Updates Telemedicine Accreditation Rules Center for Connected Health Policy April 2021 Before a practitioner may provide services in a hospital, he or she must have their qualifications evaluated and verified. According to an article in The National Law Review, The Joint Commission recently announced slightly revised ‘credentialing by proxy rules’. Before a practitioner may provide services in a hospital, he or she must have their qualifications evaluated and verified. This process, known as credentialing, ensures an individual possesses the necessary qualifications to provide medical services to patients. ‘Credentialing by proxy’ allows a hospital receiving services to accept the distant site hospital’s credentialing and privileging decisions. Certain criteria must be met in order for a hospital to qualify to utilize credentialing by proxy. Previously, this included requiring both the originating site hospital and distant site hospital to be accredited with the Joint Commission. The new change allows the distant site telemedicine entity to be accredited with The Joint Commission or, alternatively, enrolled in the Medicare program. The affected standard is MS.13.01.01, EP 1, and is reflected in the Joint Commission’s 2021 update to their Comprehensive Accreditation Manuals. Comprehensive Accreditation Manuals: https://store.jcrinc.com/2021-comprehensive-accreditation-manuals/ < Previous News Next News >

Patients Prefer Telehealth for Primary Care, Mental Health Needs Mark Melchionna October 31, 2022 A recent report shows that amid a return to in-person care, telehealth use has dropped among some populations, but it is still a popular modality for accessing primary and mental healthcare. October 31, 2022 - A recent report shows that although in-person care is the preferred channel of care, telehealth use remains highly used among young adults and those engaging in primary care and mental health services. Published by Stericycle Communication Solutions, the report was created in collaboration with Ipsos. It is based on a survey of 1,004 adults, 18 and older, from the continental US, Alaska, and Hawaii, conducted between July 5 and 8. In May 2022, over two years after the start of the pandemic, the FAIR Health Monthly Telehealth Regional Tracker reported an overall 10.2 percent increase in telehealth use. But while evaluating patient preferences related to healthcare access, the 2022 Stericycle Communication Solutions US Consumer Trends in Patient Engagement Survey shows that telehealth use has dropped amid a return to in-person healthcare. Within the year preceding the survey, 45 percent of adults claimed to have used telehealth on at least one occasion, while 25 percent only used it one to two times. This represents a drop from a previous survey, which showed that 39 percent of respondents used telehealth one or two times in the year prior. The report also noted that only 26 percent of older adults accessed telehealth one or more times within the past year. But the share of young adults between 18 and 34 that used telehealth remained high, reaching 61 percent. Further, the report showed that in-person care is popular among healthcare consumers. In total, 44 percent of survey respondents indicated that they prefer in-person visits. However, of those who are open to telehealth, patients prefer virtual visits for certain types of care, including primary care (55 percent) and mental healthcare (45 percent). On the other hand, patients do not prefer virtual visits for specialties such as dermatology, pediatrics, ENT, cardiology, urology, gynecology, orthopedics, and pulmonology. Patient satisfaction with telehealth is high. Among survey respondents, 90 percent indicated that their telehealth experience was either good or excellent. The top reasons for a patient choosing telehealth were convenience (58 percent) or safety (43 percent). Also, 24 percent said that telehealth helped them access a better provider. The report concluded that more evaluation is necessary to continue to optimize telehealth. For instance, since some patients requested in-person care for certain conditions, providers must consider the types of appointments that may be preferred via telehealth and invest accordingly, the report states. Several reports have provided further insight into patient satisfaction with telehealth. A study from the Journal of the American Geriatrics Society in October found that although patients over 65 preferred in-person care, they were also highly satisfied with telehealth. Using a seven-point scale, researchers evaluated the extent to which patients of this age felt satisfied with virtual care. They found that the median patient satisfaction score was six. More research from September found that telehealth continues to play a significant role in healthcare due to the satisfaction it provides patients. Following a survey, researchers found that 67 percent of patients claimed to have used telehealth within the preceding year. Of this population, 94 percent stated their intention to use telehealth again. See original article: https://mhealthintelligence.com/news/patients-prefer-telehealth-for-primary-care-mental-health-needs < Previous News Next News >

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

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 >

Building Lasting Tele-Behavioral Health Programs to Address Patient Needs Kat Jercich, Healthcare IT News. August 2021 In a HIMSS21 Global Conference Digital session, two experts discuss what it's taken for the University of Rochester to spin up a virtual behavioral health program over the past nine years. Telehealth during the COVID-19 pandemic has allowed many patients – especially those in under-resourced areas – unprecedented access to behavioral healthcare. But as Michael Hasselberg, senior director of digital health at the University of Rochester, discussed with Cleveland Clinic Director of Design and Best Practices Julie Rish during a HIMSS21 Global Conference Digital session, such programs have required being nimble and adaptable in the face of changing needs. Hasselberg outlined the results of a tele-behavioral health model in effect at the University of Rochester, explaining that it grew from a pilot program aimed at primary care doctors to a full-scale initiative in nearly a decade. But the pandemic, he says, ramped up demand – and the supply had to change in response. "Like every health system in the entire country, overnight you had to flip the switch on, and essentially totally pivot to telemedicine," he said. Having the infrastructure and years of experience allowed the team to shift within about a week to providing behavioral health services nearly entirely virtually. Even as vaccines have become more readily available, Hasselberg estimates that about 60% of the team's ambulatory services are being provided via telemedicine. Interestingly, considering reports from other parts of the country, Hasselberg said the team has not encountered patient difficulties with broadband access, even in rural areas – thanks in part to state government efforts to ensure connectivity throughout the region. But one challenge, he said, has been gaining community trust and support. "Learning to build those community partnerships, identify how the stakeholders are, doing focus groups … has allowed us to be successful," he said. For other organizations looking to replicate the university's success, he said, start by reaching out to providers already in place. "Build that partnership there. Find out where their struggles may be, where the gaps may be, how you can join forces to fill those gaps and truly partner," he advised. He also suggests approaching the programs as iterative – being agile and flexible, and not allowing perfect to be the enemy of good. "Just get something out there: See what works and what doesn't work, and continue to build off of that," he said. It's also vital to remember that not every service can be done via telehealth, he said. Having a support network to assist patients with technology is enormously helpful. Rish noted that it's not just about access alone. It's also about comfort and about trust. "Having somebody from your team who can get to the community, who can be onsite – that's really important," said Hasselberg. Hasselberg said it's been useful to examine who can most benefit from telehealth because of transportation hurdles or other barriers to in-person care. "Finding parking at an academic medical center is not an easy thing to do!" he laughed. By merging that information with electronic health record data, he said, the team can get specific about how best to target services. As far as care delivery predictions, Hasselberg said he saw telemedicine as the "tip of the iceberg." "I think the future of behavioral health will be an a la carte array of options," he said. < Previous News Next News >

82% of Americans Want Telehealth Flexibilities Extended Mark Melchionna November 30, 2022 A recent survey indicates that 82 percent of respondents with employer-provided coverage believe that the government should extend telehealth flexibilities. A recent survey conducted by America's Health Insurance Plans (AHIP) found that a majority of respondents are requesting that the government sustain the telehealth flexibilities enacted during the COVID-19 pandemic. In 2020, the number of people using telehealth increased dramatically, largely due to the withdrawal of various regulatory restrictions as well as the new barriers imposed on in-person care. According to data from market research firm Trilliant Health, telehealth use peaked in the second quarter of 2020. Though telehealth use has waned since 2020, it remains popular among patients and providers. As a result, Congress is faced with deciding whether to continue or terminate telehealth flexibilities. A survey from the Morning Consult on behalf of AHIP’s Coverage@Work campaign collected data on patient preferences regarding telehealth and how they feel about its future. The survey polled 818 voters with employer health insurance between Nov. 11 and 13. The main survey findings related to whether patients would consider seeing a doctor through telehealth, reasons for using telehealth, and their opinions on the government extending telehealth flexibilities. The survey shows that 65 percent of those with employer-provided coverage reported being likely to consider seeing a doctor or receiving treatment through telehealth. This finding was consistent across age, income, and ethnicity groups. Also, 49 percent claimed that interest in telehealth is mainly backed by convenience, and 35 percent stated that it saves time as it eliminates the need for travel. Among all respondents, 82 percent believe that the federal government extending telehealth flexibilities is important. This included a bipartisan majority of Democratic voters (95 percent), independent voters (77 percent), and Republican voters (70 percent). Considering the survey results, AHIP concluded that respondents would advocate for the government to continue telehealth flexibilities. This is not the first indication of healthcare stakeholders seeking this end goal. In September, a letter to the US Senate composed by the American Telemedicine Association (ATA) and its advocacy arm known as ATA Action asked for a continuation of expanded telehealth access. Specifically, the letter urged the US Senate to sustain telehealth flexibilities for two years through 2024. These flexibilities included waivers put into place during the pandemic, including removing initial in-person requirements for telemental health and eliminating restrictions on the location of providers and patients engaging in telehealth. Signed by 375 stakeholders, such as Amazon, the American Nurses Association, and Bicycle Health, the letter also detailed concerns about a forced return to in-person care. Also, in March, Senators Tom Carper (D-Delaware) and Tim Scott (R-South Carolina) introduced a bill known as the Hospital Inpatient Services Act, which allowed for a two-year extension of the federal acute hospital-at-home waiver. Introduced in November 2020 by the Centers for Medicare and Medicaid Services, the waiver enables treatment for common acute conditions in home settings. This waiver was highly used throughout the COVID-19 pandemic, with 92 health systems, comprising 203 hospitals across 34 states, using it as of March 4. See original article: https://mhealthintelligence.com/news/82-of-americans-want-telehealth-flexibilities-extended < Previous News Next News >

Sparrow Health System uses pandemic lessons to expand its virtual care strategic plan Bill Siwicki September 28, 2022 Today, the Michigan health system is seeing more than 1,000 e-visits per month, making greater use of its patient portal and successfully addressing the behavioral health caregiver shortage. Sparrow Health System in Lansing, Michigan, began developing a virtual care strategy in October 2019 – well before COVID-19 struck – with the hope of leveraging the technology as a tool to support patient care and the organizational strategy, rather than as a stand-alone strategy in and of itself. Sparrow's initial goal was to launch on-demand, virtual urgent care to increase access and provide another front door into the health system. It intended to go live in July 2020, using Amwell as the technology and services vendor for virtual urgent care for an estimated 1,500 visits in the first year. Telehealth plans quickly changed But then, COVID-19 hit, and plans quickly changed. "With most of our practices closed in late March of 2020, we needed an immediate solution that couldn't wait until July," said Patrick Sustrich, director of retail healthcare at Sparrow Health System. "What we thought would take months took us days, and we leveraged the capability of our Epic EHR to stand up on-demand and scheduled video visits using Zoom for Healthcare and our own providers. "In the first month, we surpassed our one-year goal of 1,500 virtual visits – telephone and video," he continued. "The benefit of staffing this ourselves was that it allowed our providers to access the patient's medical record, document directly into the chart and accept all the same insurance we do for in-person visits." Once the practices reopened, most thought they would resume normal operations and transition all their visits back to in-person. But this did not happen. Patients enjoyed virtual care "Not only was COVID not over, but patients enjoyed the convenience of virtual visits, and providers saw the value of this tool," Sustrich said. "Through August 2022, we have successfully completed more than 144,000 virtual visits. "Additionally, our health system has embarked on a strategy to tend to a situation that has plagued providers since the inception of the patient portal – the overwhelming number of medical advice requests," he continued. In fact, more than 16,000 medical advice requests are received each month. This uncompensated care takes hours out of a provider's day, and a solution was badly needed. Sparrow took a multi-tiered approach to resolve this issue. "The first approach was to leverage Epic to triage medical advice requests to the correct location – one direction for billing/finance, another for medication refills and another for scheduling questions/issues," he explained. "This significantly reduced the number of medical advice requests to the provider. "Next, we launched both patient- and caregiver-initiated e-visits in an effort to convert messages requiring medical decision-making into billable visits," he said. "Monthly reports were generated to providers showing them precisely the opportunity to convert medical advice requests into e-visits." More than 1,000 e-visits per month Although caregiver-initiated e-visits have only been available since Q2 of this year, Sparrow is averaging more than 1,000 e-visits per month. Additionally, a pilot is being conducted to evaluate the impact of using a centralized nurse triage process to resolve minor patient issues, freeing up providers' time to increase access. "Our main hospital campus struggled with LOS and a lack of beds, as most hospitals did during COVID," Sustrich recalled. "We needed to leverage the bed capacity of our community hospitals. We quickly looked for a telehealth solution to prevent unnecessary transfers and keep care local. "iPads with a Zoom video link provided patient-to-provider and provider-to-provider connections," he continued. "FCC funding we received has enabled us to purchase five telemedicine carts from Amwell, allowing an offsite provider to control the camera's pan/tilt/zoom features and access a digital stethoscope." Sparrow intends to place these carts at all five offsite ED locations. In the future, it plans on expanding specialist resources to provide care across the health system. Specialists such as those focused on pulmonology, behavioral health and infectious disease could never be supported at one community hospital, but collectively, and with the help of virtual care, these specialists can serve the entire health system, he stated. Staffing a 24/7 platform "Our current 24/7 on-demand platform's wait time is under 19 minutes, with an average completion rate of more than 80%," Sustrich reported. "It is rare to find a health system staffing its own 24/7 platform while having access to the patient's medical record and the ability to document within the EHR. "Many others have contracted this service out to a third-party vendor, which I believe sacrifices patient care quality and safety," he added. Additionally, Sparrow providers staffing this platform respond to e-visits from patients without a primary care provider, conduct COVID follow-up calls, and perform QR validation in the MySparrow Portal for patients who have received the COVID vaccination outside of the health system. After-hours coverage (8 p.m. – 8 a.m.) is conducted by three ED locations offsite from the main campus. "Another metric I am very proud of is our MySparrow Portal activation rates," Sustrich noted. "Early in the pandemic, it became apparent that patient success with our virtual health services was high in patients who already had a portal account. "In response, a campaign across Sparrow's entire medical group was launched to increase MySparrow Portal activation rates," he continued. "Patient tutorials were created, and the campaign began within ambulatory practices; each practice was given a goal, implemented best practices and shared a monthly scorecard." Caregivers hitting their goals Caregivers were rewarded with gift cards when their practice hit their goal, and the hospital's foundation funded the gift cards. Within two years (April 2020 to March 2022), Sparrow saw a 152% increase in its active MySparrow Portal users (146,768 to 369,916) and increased the percentage of patients with a portal account from 55.2% to 78.8%. The challenges Sparrow faced were similar to those of most other health systems, and this caused Sparrow to build the plane while in flight and struggle with training and experience gaps, Sustrich said. "Our assets included an engaged leadership team that supported our virtual health strategy and was willing to invest in it," he said. "We also leverage Epic and its ongoing development of virtual health tools. And I would be remiss if I didn't mention the resilience of our caregivers." Sustrich points to various signs of success: • More than 70,000 successfully completed video visits in the first two years. • More than $8 million in video visit revenue. • 40,000 hours of patient drive-time saved. • A 10% increase in the SUS Score. • Patient satisfaction went from 80% to 89%. • A 20% shift from telephone to video visits. A major FCC telehealth grant "Sparrow had the top FCC grant application in Michigan and was among 62 healthcare facilities nationwide that received funding from the FCC in Round 2 of its COVID-19 telehealth grant program," Sustrich reported. "The $586,000 was used for ambulatory virtual health hardware deployment, a virtual behavioral health program to expand access and cart technology to increase communication and improve care to our community hospitals out in the region. "Hardware purchased included 115 docking stations, 140 Bluetooth digital scales, 350 headsets, 230 monitors, 115 and keyboards with mouse," he continued. "This standardized virtual health equipment across our health system makes video visits accessible to a larger number of providers, thereby positively impacting patients and increasing access to care." Because of the nationwide shortage of psychiatrists and behavioral therapists, patients find it more difficult to access mental health services. "A portion of the FCC money purchased 40 iPads housed in five emergency rooms and throughout each inpatient floor at the main hospital to access virtual behavioral health services," Sustrich said. "Additionally, psychiatrists at Sparrow's St. Lawrence campus can virtually connect with patients in the adult psychiatric, geriatric psychiatric and outpatient units through an audio/video connection. "This will decrease wait time and increase access to behavioral health services," he concluded. "Additionally, bed capacity will increase from 60% to 85% occupancy." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/sparrow-health-system-uses-pandemic-lessons-expand-its-virtual-care-strategic-plan < Previous News Next News >

TELEHEALTH: THE JOURNEY FROM VIDEO VISITS TO STRATEGIC BUSINESS TOOL By Mandy Roth at HealthLeaders April 6, 2021 New approaches to telehealth can help organizations meet their key objectives. KEY TAKEAWAYS: *Asynchronous communication increases provider efficiency and provides a way to address physician shortages. *Virtual hospitals reduce healthcare costs and support the transition to value-based care. *A cloud-based platform enables 24/7 personalized care, moving care upstream to improve outcomes and reduce the cost of care. 2020 was a remarkable year for healthcare innovation, and telehealth finally achieved scale across the industry. Driven by a need to deliver healthcare at a distance, hospitals and health systems stood up new services seemingly overnight, fanned the flames under languishing programs, or found new uses for thriving virtual care initiatives. Now that telehealth has become a fixture in the healthcare delivery firmament, it's time to examine what comes next. While current use predominantly focuses on televisits between providers and patients, and mysteries remain about reimbursement and licensure issues after COVID-19, forward-thinking healthcare executives are using the technology to enable new models of care. Health systems are employing telehealth to transform healthcare delivery in ways that address strategic business objectives: improve outcomes, reduce provider burden, enhance patient experience, improve access, and ameliorate workforce labor issues. HealthLeaders spoke to visionary leaders and digital healthcare experts who shared their insights and perspectives about what organizations should focus on now, next, and in the future to unlock the potential of telehealth. Coverage includes case studies about asynchronous care, remote monitoring, and a futuristic cloud-based platform fueled by artificial intelligence. Health systems shared details about how these initiatives work and how they evaluated the return on investment. These new approaches to telehealth can help organizations meet their strategic objectives and provide information to inspire other organizations on their own telehealth journeys. WHAT'S NOW: PRESBYTERIAN HEALTHCARE SERVICES ENHANCES EFFICIENCY WITH ASYNCHRONOUS COMMUNICATION Strategic Objectives: *Increase provider efficiency and address physician shortages *Reduce costs per patient encounter *Reduce ER and urgent care utilization 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, their reputation 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 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. 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. 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." WHAT'S NEXT: ATRIUM HEALTH LAUNCHES A VIRTUAL HOSPITAL Strategic Objectives: *Increase bed capacity, limit staff and patient exposure to COVID-19, and conserve PPE *Reduce costs and support the transition to value-based care *Improve patient satisfaction and experience "Remote patient management is widening the aperture from the episodic-based healthcare reality that we've known for decades towards a 24/7, always-on ubiquitous reality," says Rasu Shrestha, MD, MBA, executive vice president and chief strategy and transformation officer at Atrium Health. Long before COVID-19 hit American shores, health systems began launching remote monitoring programs, particularly to manage chronic diseases. Hospital at home initiatives, or virtual hospitals, are a robust manifestation of this endeavor. While these models have demonstrated cost savings, adoption has been slow due to reimbursement issues. The pandemic offered a trifecta of motivating factors to accelerate adoption of the virtual hospital model: bed capacity issues, a need to limit staff and patient exposure, and dwindling supplies of personal protective equipment (PPE). With these issues in mind, during March 2020 a handful of clinicians approached Atrium Health administrators, suggesting that the 42-hospital Charlotte, North Carolina–based nonprofit health system consider launching a hospital at home initiative. Two weeks later it was operational, says Scott Rissmiller, MD, executive vice president and chief physician executive. In the first 10 months, the virtual hospital admitted 51,000 patients. "We are able to keep patients in their homes, protect our teammates from infection, and also protect patients," Rissmiller says. "It freed up a good bit of capacity in our acute facility," enabling the health system to reserve that space for its more acute COVID-19 patients. The virtual hospital maintains two "floors." The first floor functions as an observation unit; the second floor is reserved for patients requiring more intensive care, says Rissmiller. Any COVID-19-positive patient is admitted to the first floor of the virtual hospital and receives digital tools to monitor temperature, blood pressure, pulse, and oxygen levels. These devices deliver data via Bluetooth® to a smartphone app developed by the health system's IT department. That data feeds into the patient's EMR, fully integrating into the patient's continuum of care, Rissmiller explains. In a bunker back at Atrium Health's call center, a team of clinicians monitors data and checks in with first-floor patients daily. Second-floor virtual patients have the same home monitoring tools, but receive "much more intensive management" and frequent check-ins, he says. In addition, community-based paramedics visit homes to administer IV fluids, IV antibiotics, breathing treatments, EKGs, and other interventions. This arrangement created additional opportunities to reduce hospital bed capacity. "We were one of the first in the nation to get in-home remdesivir, one of the COVID treatments," says Rissmiller. "To receive remdesivir, you have to be on oxygen therapy, so these patients are sick." In a 10-month period, Atrium Health administered about 150 therapeutic rounds of the drug, he says, which saved about 500 hospital days that would have been required if those patients had been hospitalized. "From a quality standpoint, we do not view this any differently than if these patients were within the walls of our hospital," says Rissmiller. All measures, including length of stay as well as readmission, transfer, and mortality rates, have been almost identical to inpatient stats, and patient satisfaction has been "extremely high," he says. "Patients really would rather be in their home surrounded by their loved ones and support system." The hospital at home initiative has been a "costly endeavor," says Rissmiller. "When we realized this pandemic was going to be significant, our CEO [and President Eugene Woods, MBA, MHA, FACHE] called me and said, 'Scott, whatever you need to care for our patients and communities—do it. We'll figure out the costs later.' It freed us up to be able to do things like this." As it turned out, costs have been offset by funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which enable Atrium Health to bill for many of the services provided. The organization also is one of a handful of healthcare systems that are doing a pilot with the Centers for Medicare & Medicaid Services, which views virtual beds as real hospital beds. "The reimbursement is similar because of the level of service we're providing," says Rissmiller. Initially, though, "it was all upfront costs for us, but the return was in bed days." A focus on reimbursement continues "as we are now maturing the program," he says. "Our concern is that the reimbursement will go away once those [pandemic] emergency orders expire. We're working with the state, our payers, Medicare, and others to make sure that this continues to be reimbursed at a level that allows us to continue to grow it and cover our costs." "Out of necessity, COVID ultimately accelerated health systems' desire to think through their digital strategies and determine how digital fits into their overall care and business models," says Brian Kalis, MBA, managing director of digital health and innovation in consulting firm Accenture's health practice. "New models are starting to pop up, and care is shifting to the home." Strategic goals include producing outcomes that equal or exceed inpatient care, while also improving labor productivity, Kalis says. "A majority of health systems coming out of COVID are putting care at home as a key strategic focus. That requires a collection of new models to deliver care, putting different care team compositions in place, and [utilizing] technology to help a broad range of conditions for pre-acute, acute, and post-acute care." Atrium's virtual hospital has already expanded beyond COVID-19 patients. Once the surge diminished in July, Rissmiller "challenged the team to look at [the initiative] through the lens of a non-COVID world. Can this become a new way of caring for patients that makes sense to the patient and to us as a healthcare system?" There is now a list of 10 diagnoses to be considered for hospital at home care, and congestive heart failure patients have already been admitted into the virtual facility. "We're starting to branch out," he says. "We're also starting to focus on different communities to make sure that we're doing this in a way that helps with our underserved populations and gives them the resources they need to manage care at home rather than coming through the emergency department." While Atrium Health rolled out its program in two weeks, Rissmiller says, "this is something that would be incredibly hard to start up on your own if you hadn't had the 10 years of virtual experience that we've had building these capabilities, but also the confidence to be able to deliver these kinds of services at home. It takes a while for clinicians to understand that care can be delivered safely virtually. We also have a culture at Atrium Health that really enables our clinical leaders to lead and their voices to be heard. That, more than anything, is the secret sauce that's allowed for innovations like hospital at home." WHAT'S IN THE FUTURE: HIGHMARK HEALTH DEVELOPS PLATFORM TO DRIVE 24/7 CARE Strategic Objectives: *Move care upstream to improve outcomes *Reduce cost of care, patient traffic, and volume *Enable 24/7 personalized care Unleashing the potential of virtual care requires strategic innovation fueled by imagination. Highmark Health is one organization traveling along this path. To understand the power of an initiative now underway at the Pittsburgh-based payer-provider system, one must imagine the potential to do something that is currently not possible. For example, take the hypothetical case of an individual living independently at home with six medical conditions. What if real-time data alerts her care team that her health status has subtly changed? What if this alert takes the complexity of her medical history into account and offers decision-support tools to accelerate clinical action before her health deteriorates? The Living Health Model, fueled by the Living Health Dynamic Platform—a Google Cloud–based technology infused with artificial intelligence and advanced analytics—could be the missing link that will enable care to move upstream. The concept revolutionizes the current perception of telehealth and enables 24/7 care. It aims to connect the provider, patient, and payer in novel ways to improve health outcomes, reduce clinician administrative burdens, enhance patient engagement, and reduce costs, says Karen Hanlon, executive vice president and chief operating officer at Highmark Health. "We believe that we have the capabilities and resources to pull it together," says Tony Farah, MD, FACC, FSCAI, Highmark Health's executive vice president and chief medical and clinical transformation officer, who is also a practicing cardiologist. The platform will amplify the impact of remote monitoring tools, which many health systems already use for chronic disease management. By adding sophisticated data analytics, machine learning, decision support, and patient education tools, the system will support comprehensive care rather than managing diseases in silos, Farah says. "Our partnership with Google Cloud is going to not only accelerate our strategy, but also help us scale it." Data will be constantly mined to determine the "next best action" required to proactively care for a patient and formulate a personalized care plan that delivers a "curated" experience based on the patient's personal needs, says Hanlon. For patients with no apparent health conditions, the system may focus on wellness. While full realization of this concept may be years down the road, Hanlon says the first iteration of the platform will be functional at the end of 2021. Accenture cloud expert Geoff Schmidt, managing director, global lead—life sciences technology, says Highmark Health's plans align with what he's seeing in the life sciences sector. Health leaders should not think of the cloud as a capability or an IT initiative, he says; "think of it as a business transformation enabler." Cloud technology is accelerating companies' three- to five-year strategic plans, compressing those timelines down to 12 to 18 months. "We're seeing dramatic transformations and acceleration of CEO agendas because of the capability that the cloud can provide." Partnering with an outside player is a smart move for health systems that want to expedite their transformation initiatives, says Schmidt. "Major technology partners are innovating at a scale that is, just frankly, hard for payers or providers to keep up with." Prior to its partnership with Google Cloud, Highmark Health piloted "analog" proofs of concept, according to Farah. These pilots involved addressing healthcare for several patient populations, including high-risk patients with multiple comorbidities as well as individual chronic conditions like COPD, heart failure, diabetes, and hypertension. Physicians were asked to improve health outcomes in 12 months. "The patient experience went through the roof, and in almost every case—with the exception of diabetes—the total cost of care came down," says Farah. "I would say physician engagement was our secret sauce." "Consumer engagement is also a key component," says Hanlon. "There are a lot of solutions out there. They're very siloed and they're not integrated. We can have the best solutions in the world, but if the consumer and the clinician are not using them, they will have no impact." While Highmark Health does not disclose the company's investment in this platform, "you can guess that it is a fair amount," says Hanlon. In addition to activating the initiative at Allegheny Health Network, a nonprofit health system that Highmark owns and operates, "at the same time we're a health plan serving 5.6 million members," she says. "The ability to interact with all of those members is incredibly important to us. When you look across our book of business, we're probably managing somewhere in the neighborhood of $26 billion in healthcare costs a year. When we look at the investments that are needed to support that base of membership and that level of healthcare spend, we feel it's appropriate and we can justify the investment." Being both a payer and a provider imbues Highmark Health with the motivation and influence to transform healthcare delivery in this way, Hanlon says. The company is a Blue Cross Blue Shield–affiliated payer operating in three states, and also functions as a provider through the Allegheny Health Network. "By having both of those assets in the portfolio," says Hanlon, "it's easier for us to align on the path forward and the economic model." But to characterize this venture merely as a mechanism to save money misses the point, she says. The model is designed to improve patient outcomes by moving care upstream, explains Farah. "Conditions that exist today will be prevented from deteriorating, and conditions that haven't developed will be prevented—or, at a minimum, be delayed in development. That's the primary goal, and it results in a reduction in total cost of care. It flips the equation from focusing on finances to focusing on health." In addition, for the Living Health Model to be effective, it must work with entities outside of the facilities owned by the Highmark Health system, which provides health plans in Pennsylvania, Delaware, and West Virginia. Allegheny Health Network operates facilities in 29 Pennsylvania counties and portions of New York, Ohio, and West Virginia. "We're looking to have impact across all of the markets that we serve as our insurance company, not just where we own a provider asset," says Hanlon. "The progression of value-based care has been a slow march. I think this platform will be a tool to enable providers to continue down that path. Part of our focus is developing other tools we believe will be necessary for the providers to succeed in a value-based environment. We recognize that we're going to have to be a leader in helping others to move down that path." A FRAMEWORK FOR MOVING FORWARD Planning for the future of telehealth requires rethinking the present. "If the only way that you look at telehealth is as a way to replace one-to-one physical visits with a telehealth visit, you're not changing the world; you're just creating a little bit more convenience," says Roy Schoenberg, MD, MPH, president and CEO of Amwell, a Boston-based technology company that provides telehealth technology to health systems. "If you look at telehealth as a product, you're going to end up behind the competitive landscape curve. If you look at telehealth as an operating system, [it becomes a] mechanism for the digital distribution of care." Transforming the way healthcare is delivered requires changing, from the ground up, the way health systems think about their relationships with patients, Schoenberg says. Telehealth can alter dynamics related to patient traffic and volume, patient flow, transitions of care, and assumption of risk. "When you equip yourself with telehealth capabilities," Schoenberg says, "you should ask yourself, 'Does the system that I buy allow me to create new applications for telehealth that the vendor didn't think about?' [You] should imagine plans for patients that incorporate and take advantage of telehealth. The result of that is a completely different beast." This article appears in the March/April 2021 edition of HealthLeaders magazine. - https://www.healthleadersmedia.com/telehealth/telehealth-journey-video-visits-strategic-business-tool < Previous News Next News >

The value of telehealth and the move to digitally enabled care — 3 insights Becker's Hospital Review In Collaboration with American Medical Association Nov. 1, 2021 During the pandemic, healthcare organizations embraced telehealth to ensure they could provide access and high quality care to their patients. Now, nearly two years later, organizations are contemplating how best to move forward, including how to safeguard and optimize opportunities to move towards digitally enabled care. During the pandemic, healthcare organizations embraced telehealth to ensure they could provide access and high quality care to their patients. Now, nearly two years later, organizations are contemplating how best to move forward, including how to safeguard and optimize opportunities to move towards digitally enabled care. During Becker's 6th Annual Health IT + Revenue Cycle Virtual Conference, the American Medical Association sponsored a roundtable discussion on this topic. The AMA's Lori Prestesater, Vice President of Health Solutions, and Meg Barron, Vice President of Digital Health Innovations, talked with healthcare executives from around the country about their digital health successes and challenges. Three insights: 1. Providers want virtual care to continue as long as their key concerns are addressed. "Physicians are enthusiastic about digital health technologies," Ms. Barron said. "However, that enthusiasm is directly tied to a solution's ability to help them take better care of patients or reduce their administrative burdens." Four key concerns consistently expressed by physicians when evaluating digital solutions are whether a solution works and has an evidence base, how providers will be compensated, what liability and privacy issues exist, and how implementation and change management will occur. 2. One of the major advantages of telehealth is improved access. Access can be widely defined; virtual technology has made significant inroads in improving access in multiple ways: COVID-19 access. The department chair of a hospital in the Northeast noted that telehealth helped them provide quick access and treatment to patients during the pandemic. "It worked extremely well in this emergency situation," he said. "Patients would call in and report symptoms, and we could make decisions about their care. We provided pulse oximeters and followed up via telehealth." Specialty access. A CMO from a Midwestern health network — who is the father of a daughter with a chronic illness — shared his personal experience with specialty care from multiple systems. "I can't imagine how my daughter could receive specialty care without telehealth. Care that was previously siloed can now be accessed nationally, if not internationally." Behavioral health access. A chief population health officer from a health system in the Midwest said telehealth access to mental health services was a big success. "Patients found the pandemic very rough, and many needed some behavioral health services, but they didn't necessarily want to try to see somebody because of the stigma associated with it," she said. "Being able to offer telebehavioral health services to our patients, and frankly, even to our employees, was a great success." 3. Challenges such as patient hesitancy, bandwidth issues and measurement of value remain. Although patients are generally positive about telehealth, some have found it difficult to onboard to telehealth platforms. One provider in the Northeast said younger patients love the ability to text and connect virtually, but elderly patients often prefer in-person visits for the human connection. Also, many healthcare organizations have faced connection issues. A West Coast CMO explained, "We have 24 hospitals, and many of them are in rural areas. We really struggled with bandwidth." Finally, measuring the value of these technologies remains a challenge. Ms. Prestesater pointed out that it can be a "many-year equation to evaluate the value for a chronically ill patient." AMA has a recently released Return on Health value framework that can help an organization quantify the comprehensive value of virtual care. Although some participants warned that virtual care may not be less expensive, it can be hard to quantify savings from things like avoiding emergency care. A Midwest hospital executive said, "Home-based care has led to a substantial reduction in visits to the emergency room and days in the hospital for us. The problem in the whole equation is it's hard to measure something that doesn't happen." < Previous News Next News >

HHS-OIG Reports on Pandemic Medicare Telehealth Trends to Inform Permanent Policies Center for Connected Health Policy Nov. 2, 2021 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. Interestingly, it was found that though pre-pandemic requirements limiting telehealth visits to established patients were waived, 84% of visits still occurred within those parameters. In addition, as policymakers consider making some telehealth pandemic policies permanent, some stakeholders have suggested a need to require an in-person visit within a certain period of time in order to be eligible for a telehealth visit. However, the data collected by HHS-OIG shows such requirements may not be necessary, as Medicare patients were found to already have had an in-person visit on average within four months prior to the telehealth visit without such a requirement. Additional findings included: Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management services via telehealth from providers with whom they had an established relationship Beneficiaries received about 45.5 million office visits delivered via telehealth, which accounted for nearly half of all telehealth services 86% of traditional Medicare beneficiaries received a telehealth service from providers with whom they had an established relationship, compared to 81% of Medicare Advantage Beneficiaries who received home visits via telehealth, which represented only 1% of all services provided via telehealth, were the least likely to have an established relationship with their providers The average amount of time between beneficiaries’ in-person visits and their first telehealth services varied by type of service Beneficiaries who received home visits via telehealth had an in-person visit with their providers at an average of around 9 months prior to first telehealth service Beneficiaries who received nursing home visits and assisted living visits via telehealth had an in-person visit at an average of 2 months prior to their first telehealth service HHS-OIG notes that the provision of this data seeks to inform policymakers looking at long-term telehealth policy and making certain pandemic expansions permanent, especially in light of concerns around telehealth fraud and abuse. For instance, it could help in examining the necessity of one of the most controversial, and confusing, permanent federal changes made thus far as part of the Consolidated Appropriations Act, which post-PHE will require an initial in-person visit within 6-months of a tele-behavioral health visit for purposes of Medicare reimbursement. However, the requirement only applies if the service is not provided in a geographically rural area and at a qualifying medical facility. There is also an exception for treatment of substance use disorder and co-occurring mental health treatment. In addition, CMS is proposing to make the 6-month in-person visit a requirement for subsequent visits in the proposed calendar year 2022 physician fee schedule. For non-behavioral health visits, the 6-month requirement wouldn’t apply, however patients would need to be located in a rural area and eligible facility type to qualify for Medicare reimbursement. Some Medicaid programs are considering limiting telehealth use to established patients, occasionally also applying restrictions to specific modalities and services. However, the HHS-OIG findings may suggest that it is unnecessary to limit telehealth to certain patients and services to prevent fraud and abuse as standard practice may already be providing sufficient guardrails in those respects. In addition, the study findings could indicate that the issue may be more related to general standard of care concerns that apply across all services, not just those delivered via telehealth. The balance may then include looking at how to manage health care fraud generally, which elsewhere HHS-OIG has clarified that most fraud is not telehealth specific. The issue could then boil down to how much autonomy to provide clinicians when making medical determinations, including when a telehealth visit is appropriate. Typically oversight in that respect has been under the purview of clinical licensing boards, not governed by general laws, but as we shift outside of the pandemic it is possible we may see additional shifts in terms of these policy approaches. As policymakers balance these multiple findings, perspectives and concerns, it remains to be seen how such data will be applied or used to justify permanent policies. It will also be important to continue to weigh these factors against general access to care issues so as to not inadvertently limit telehealth as a means of ensuring patients can receive necessary medical services. Additional information on the HHS-OIG study can be found by viewing the brief and complete report. < Previous News Next News >

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