Majority of Americans Value the Convenience Associated with Telehealth Mark Melchionna December 07, 2022 New survey results released by AHIP showed that most Americans highly value the simplicity and convenience associated with telehealth and support making pre-deductible telehealth coverage permanent. America's Health Insurance Plans (AHIP) described survey results indicating that Americans value the convenience associated with telehealth, with 69 percent saying they prefer it over in-person care for this reason. As the COVID-19 pandemic became increasingly severe, many patients and providers began to use telehealth at a higher frequency. This was supported by federal and state governments allowing flexibilities that removed barriers to this type of care, leading to improved patient access. The high level of telehealth use has continued during the pandemic, even following the drop in COVID-19 severity as vaccines and treatments became widely available. According to the FAIR Health Monthly Telehealth Regional tracker, telehealth use increased by 10.2 percent in May. A survey released by AHIP aimed to gather information regarding Americans' opinions on telehealth. Conducted by NORC at the University of Chicago and using the AmeriSpeak panel, the survey polled 1,000 Americans, 498 of whom have employer-provided or individual market coverage, regarding telehealth use within one year prior. The survey was fielded in October. Among the portion of survey respondents who were commercially insured, 40 percent claimed to have used telehealth within a year prior, and 53 percent claimed to have used it between two and five times within a year prior. About 69 percent of commercially insured telehealth users said they used telehealth due to the associated high level of convenience compared to in-person care, 78 percent stated that telehealth made the process of seeking out healthcare easier, and 85 percent said there is an adequate number of providers available via telehealth for their subjective needs. Also, 73 percent of commercial telehealth users stated that Congress should make permanent arrangements that allow for the coverage of telehealth services prior to paying their full deductible. Further, female telehealth users were almost four times as likely than men to say they participated in a telehealth appointment because they lacked childcare or eldercare, the survey shows. “Patients and providers accept – and often prefer – digital technologies as an essential part of health care delivery,” said Jeanette Thornton, executive vice president of policy and strategy at AHIP, in a press release. “Telehealth can be just as effective as in-person care for many conditions and allows patients to receive more services ‘where they are.’ That’s why health insurance providers are committed to strengthening and improving both access and use for the millions of Americans who use telehealth for their health care needs.” A report from July found similar patient opinions of telehealth. Released by CVS Health, the 2022 Health Care Insights Study reported survey results from two separate questionnaires. Around 92 percent of respondents stated that convenience is a critical factor when selecting a primary care provider. The surveys also reported that many consumers find virtual appointments more convenient than in-person visits because they didn’t have to leave home (41 percent), they didn't have to pay for transportation (37 percent), and they saved time (37 percent). See original article: https://mhealthintelligence.com/news/majority-of-americans-value-the-convenience-associated-with-telehealth < Previous News Next News >

Billing & Reimbursement Guides Southwest Telehealth Resource Center & ruralMED Revenue Cycle Resources Medicare, Medicaid and private payor: Payor Matrix Allowable, Conditional, Not Allowable 4 virtual visit types E-Visit, Telehealth, Virtual Check-In, T elephone NEW MEXICO RESOURCES 2024 Virtual Visit & Reimbursement Guide for New Mexico (Find a ll SWTRC /ruralMED Regional 2024 Billing Guides a nd Resources: HERE ) NATIONAL RESOURCES American College of Emergen cy Physi cians (ACEP) ED Facility Level Coding Guidelines Center for Connected Health Pol icy (CCHP) 2023 Billing for Telehealth Encounters: An Introductory Guide on [Medicare] Fee-For-Service Final Rule for CY 2024 Physician Fee Schedule Centers for Medicare and Medicaid Services (CMS.gov) 2024 List of Telehealth Services: Medicare Physician Fee Schedule 2024 Medicare Learning Network Telehealth Services Fact Sheet “What’s Changed?” Health and Human Services (Telehealth.HHS.gov) Billing for Telehealth

City of Hope advances cancer care with hybrid telehealth and in-person visits. Bill Siwicki November 29, 2021 City of Hope envisions expanding the use of telemedicine to include telegenetic consultations, remote chemotherapy support, remote monitoring via wearables and palliative care. City of Hope, based near Los Angeles, is a research and treatment organization for cancer, diabetes and other life-threatening diseases. In 2018, it made strategic moves to more easily meet the needs of its patients and communities by investing in telehealth. Part of that strategic direction was working with technology companies to ensure that City of Hope leveraged telehealth in a high-quality, patient-centric way, while easing the burden of travel times for patients undergoing treatment. With every visit, the organization's team evaluates whether patients are best served by either a virtual or an in-person appointment. THE PROBLEM Then COVID-19 emerged. Suddenly, City of Hope needed to rapidly scale its telehealth infrastructure to meet the needs of patients. In doing so, its work with telemedicine technology and services vendor Amwell helped the healthcare provider organization reimagine the delivery of oncology services. "For example, when a physician delivers a cancer diagnosis to a patient, it can be a lot easier to do so when the patient is at home, in a space that feels comfortable, surrounded by family," noted Dr. Paul Fu, chief medical information officer at City of Hope. "At a time when the American Cancer Society estimates 87% of cancer patients and survivors had their care disrupted due to the coronavirus, City of Hope offered uninterrupted cancer care and used telehealth when appropriate to evaluate patients, manage side effects of treatment, review labs and scans, answer questions, and offer reassurance to patients and their families." Even when patients came in person, City of Hope used telehealth to include family members and other members of a patient's care team seamlessly in the visits. It's an approach that has enabled the organization to more easily and conveniently surround patients with specialized cancer care and eliminate unnecessary travel. "Moving forward, City of Hope envisions expanding our use of telehealth to include services such as telegenetic consultations, remote chemotherapy support, remote monitoring using wearables, expedited condition triage and palliative care," Fu said. "By fully addressing each patient's needs, we're making a deep impact on personalized patient care and satisfaction." PROPOSAL Prior to working with Amwell, City of Hope delivered telehealth services, but the technology it used was not integrated with other systems, leaving room for an improved care journey for patients and providers. "We started with Amwell by launching our patient app to enable virtual connections between our patients and their providers," Fu explained. "Since launching our app, we've been able to rapidly scale up our telehealth program both in terms of patients and providers using it and in terms of use cases and modalities. "We've also been able to integrate the platform with other systems we have in place to improve the patient experience," he continued. "These were key elements – scalability and integration capabilities – that we looked for in selecting our telehealth provider as we knew we would want to grow the program." MARKETPLACE There is a wide variety of telehealth technology and services vendors on the health IT market today. Healthcare IT News published a special report listing these vendors and details about their offerings. Click here to read the special report. MEETING THE CHALLENGE Having a well-integrated telehealth platform enabled City of Hope to develop consistent workflows around telehealth that supported an enhanced patient experience. Further, an integrated platform allows the organization to track telehealth visits within the same quality improvement framework that it uses for in-person visits. "We integrated the Amwell platform with our Epic EHR to provide a more seamless experience for patients and our provider teams," Fu noted. "Now, physicians can simply click a video icon in Epic to get to the telehealth screen and start their session. "Before each visit, nurses or medical assistants initiate the session, talking with patients to gather the information needed to inform the session. When an interpreter is needed, the platform makes it easy to incorporate these services during a live session with the click of a button." City of Hope also uses the Doximity Dialer to facilitate patient telephone calls straight from the Epic Haiku mobile app with a caller ID registered to City of Hope. This gives patients a greater feeling of trust from the start of the call, knowing that the telehealth call is a legitimate service coming from their healthcare institution. "Another crucial technology feature is the ability to easily bring other members of the care team into the video encounter," Fu said. "It's not uncommon for our patients to have a person they want to be involved in the discussion, such as a family member or other caregiver – even interpreters can be added to visits. This feature, which allows the sharing of screens, significantly enhances satisfaction among our patients. "However, what really makes our telehealth service unique is the network of services the patient receives via telehealth," he continued. "City of Hope offers concierge-like specialized healthcare services that help patients navigate their care journey and gain answers to questions about medication management, alternative treatments that can reduce side effects and more." The organization also connects patients with supportive care services that deliver in-person support when needed, such as when patients face mobility issues or when child life specialists can work with the children of adult patients or the siblings of pediatric patients. RESULTS "We looked at several different success metrics and largely chose to focus on process measures, including how likely patients are to recommend our telehealth services," Fu said. "We also looked at the number of successful completions to ensure our process and the use of the technology was easy for patients, as well as satisfaction with the use of telehealth services. "We're now beginning to look at health outcomes achieved via telehealth," he added. "Early data show that similar to many organizations, cancer screening procedures dropped during the pandemic, but we observed that the decrease was uneven across specialties." To measure clinical outcomes, City of Hope is tracking its patients as well as referrals into its system who had delayed screening. Based on the data it receives, City of Hope continually refines and improves its virtual care services to meet patients' needs, Fu said. ADVICE FOR OTHERS "When launching or expanding a telehealth program, ensure patients are kept at the center," Fu advised. "Telehealth services should be deployed in such a way that they cause the least amount of stress for patients, especially those who are dealing with complex conditions. "This can be achieved by mapping out the patient journey for both virtual and in-person care and looking for opportunities to strengthen care coordination and management, the quality of care that patients receive, and more." Even during the madness of the first months of COVID-19, City of Hope's patient-centric approach to cancer care, including use of telemedicine, strengthened its ability to optimize patient outcomes, improve the patient experience and provide uninterrupted cancer care, Fu added. "Our telemedicine use is just one of the ways City of Hope has expanded our reach beyond patients in the Los Angeles area," he concluded. "We reach cancer patients around the globe, including those taking part in clinical trials. In an era of digitally augmented patient care, a continual focus on meeting a patient's holistic care needs will become a competitive differentiator for healthcare providers." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication https://www.healthcareitnews.com/news/city-hope-advances-cancer-care-hybrid-telehealth-and-person-visits < Previous News Next News >

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

Audio-Only Telemedicine In Primary Care: Embraced In The NHS, Second Rate In The US Rebecca Fisher, Urmimala Sarkar, Julia Adler-Milstein December 5, 2022 Use of telemedicine in primary care soared in the first wave of the COVID-19 pandemic and remains well above pre-pandemic levels. In the US, a major enabler of this shift is equal reimbursement across video, audio, and in-person visits. Policy makers must now choose whether to extend these COVID-19-era telemedicine policies. A key decision is whether audio-only telemedicine should be covered and if so, whether it should retain parity with video-based telemedicine. The dominance of video over audio in the US suggests that an appropriate policy strategy would be to not reimburse for audio-only telemedicine or reimburse at markedly lower levels. However, US policy makers would be wise to look internationally first—where experience suggests that audio-only can be an effective and more equitable means of delivering primary care. In the National Health Service (NHS) in England, almost one in three consultations in general practice is audio-only; a figure that has been stable since October 2021. This represents a major rise; pre-pandemic around 10 percent of consults were by phone. Despite efforts from UK policy makers such as fast-tracking funding for online consultation tools, the number of video consults remains stubbornly low, at just 0.4 percent of appointments. This is despite the fact that most NHS primary care practices are video-equipped, and the US and UK populations do not differ significantly in their digital literacy. What Explains The Higher Levels Of Audio-Only Telemedicine In The UK Versus US? There is no evidence that directly answers this important question. We therefore leverage circumstantial considerations to develop three possible explanations. National Policy Given the active efforts of policy makers at the start of the pandemic to expand availability of telemedicine, an initial explanation is that the countries implemented different policies regarding telemedicine provision—with the US pursuing policies that favored video while the UK pursued policies that favored audio. However, we are not aware of any such policy differences. In both countries, policy makers acted swiftly to make it easier for providers to consult using either modality. National guidance issued to practices in England encouraged use of phone and video encounters “tailored to the person, the circumstance and their needs,” but there was no directive to prioritize audio-only above video consulting. In the US, emergency legislation removed barriers to telemedicine consulting, including giving parity of reimbursement across audio and video encounters (theoretically an incentive to drive up audio-only rates). Both countries reduced regulatory barriers to video consultation, allowing providers to use non-medical video call applications such as Skype and Facetime. But neither country mandated—or strongly incentivized—provision of one telemedicine modality over the other. Path Dependence A second explanation is one of path dependence. The idea that faced with the need to act fast and little central planning or coordination, health care delivery organizations disproportionately scaled-up the form of telemedicine that made sense given prior circumstances before the pandemic. In the NHS, the use of audio-only for triage and traditional encounters in general practice was common pre-pandemic. In 2019, 10 percent of encounters in English general practice were by phone, compared to fewer than 1 percent across both telemedicine modalities in the US. The public was also used to receiving health advice by phone—the NHS 111 service is a free phoneline to help people in England access non-emergency medical advice and to link them to local NHS services. Thus, when the pandemic hit, it was easier to act quickly to scale the more familiar modality of audio. In contrast, the US did very little of either modality pre-pandemic, and in an effort to more closely replicate face-to-face care at the start of the pandemic when in-person care was not an option, US practices chose to ramp up video-based telemedicine. Provider Perceptions Of Quality While path dependence emphasizes the concept of choice driven by ease, a third potential explanation is that, instead of prior familiarity driving decisions about modality offerings, these decisions were driven by different perceptions of the strengths and limitations of each modality. In the UK, analysis of why general practitioners hadn’t used video consultations found that despite improvements in functionality and reliability of video consultation tools, practitioners viewed video encounters as logistically more challenging and more cognitively demanding than either face-to-face or telephone consulting. Physicians felt that many presenting problems could be sorted safely by telephone, with in-person assessment required for the remainder. Where problems required visual assessment, physicians preferred a combination of photograph plus telephone consultation (SMS technology is widely embedded in general practice [GP] electronic health records). Consensus from UK physicians seems to be that video provides little benefit over audio-only. Differential uptake of video over audio-consulting suggests that US physicians feel differently; surveys of US physicians have highlighted concerns about the diagnostic accuracy of telephone visits, and their suitability for new patients. The acceptability of different telemedicine modalities to patients is another dimension of quality that could have driven what health care delivery organizations offered. Evidence from the UK suggests that telephone appointments are a popular appointment modality in general practice. Indeed, analysis of 7.5 million patient-initiated requests for care across 146 primary care providers found that telephone consultation was the most popular patient preference, requested by 55 percent of people seeking care, with fewer than 1 percent of requests seeking a video consult. In the US, one trial reports similar patient satisfaction with audio and video consults, but it is possible that US physicians felt that patients expected video consultations and made efforts to oblige. Based on circumstantial evidence, we suspect that path dependence and perceptions of quality worked together to push the countries in different directions. While more conclusive evidence is needed, explanation three raises the more critical question of how to move from perceptions of quality differences to robust evidence that can inform choice of modality. What Is Currently Known About Which Modality Is Better From A Quality Perspective? The clearest evidence on differences between modalities is about access, where audio-only has clear advantages over video consults in promoting equity. People with the greatest need for health care may be least enabled to access it digitally—termed the “digital inverse care law.” In both the US and the UK, digital exclusion is socially patterned. Older people, those in lower-income groups, people with disabilities, or who do not have English as a first language are more likely to be digitally excluded. In the telemedicine context, video visits require digital literacy and access to technology and broadband/data that are not ubiquitous. On the health system side, providing video visits requires health centers and staff to overcome barriers including cost, training, and technology. These barriers may be more likely to occur in safety-net settings. In the US, video visits are more common in people earning above $100,000, White people, younger people, and people with private health insurance. In contrast, users of audio-only telemedicine are more likely to be Black people, older adults, and on Medicaid. With telephony already embedded in health centers and 97 percent of Americans owning cell phones, audio-only telemedicine represents an important means of accessing care for underserved populations. Beyond equitable access, we lack evidence on differences in other dimensions of quality between the two consultation modes, either overall or in specific clinical scenarios. Unfortunately, there is a major obstacle to such evidence generation: In the US, we do not routinely capture the specific telemedicine modality in use and therefore cannot readily compare audio-only to video encounters. Ruth Hailu and colleagues describe the range of interventions—including simplifying coding and adapting electronic health records—required to generate data that would support comparative analysis. However, even with such data available, the choice of modality is non-random, and individuals are likely to receive a blended mix of consultation types during episodes of care. Disentangling the impact of each encounter modality on a range of clinical and patient-reported outcomes would be a substantial research undertaking. Large, diverse population observational studies may be required, alongside a range of qualitative studies of patient and physician experience. Some of this evidence will take years to gather, and decisions on extending coverage beyond the pandemic emergency will likely be required before a full picture is clear. Neither health system can claim an “evidence-based” strategy—and it likely that neither the US nor the NHS has it right yet. So Where Does This Leave Policy Makers? In the UK, there is no urgent policy decision to be made around reimbursement, since all forms of telemedicine are covered by the capitated payment system for general practice. Instead, debate has focused on whether access to in-person appointments is now too limited. This is framed by decreasing public satisfaction with access to general practice, in the context of ongoing and severe shortages of primary care physicians. Despite nudges from policy makers, the pandemic has barely shifted the number of video consultations in general practice, and use of telephone consulting has expanded instead. Ongoing studies will monitor outcomes of this change and may require expansion to help the NHS identify an optimal blend of consulting modes. With UK general practitioners unconvinced of quality benefits of video consultations, it is likely that compelling evidence of their benefit would be required for use to increase. US policy makers face more difficult choices about ongoing reimbursement for audio-only telemedicine. The Consolidated Appropriations Act of 2022 extends certain telehealth coverages for 151 days after the official end of the federal public health emergency, thus going some way to preventing a “telehealth cliff.” But with the World Health Organization recently discussing for the first time the possibility of ending their emergency declaration on COVID-19, decisions about funding for audio-only and/or video will need to be made relatively soon. In the absence of robust evidence, decisions are likely to hinge on perceptions of the quality of different consultation modes. Arguments against payment parity between audio-only and video telehealth are likely to focus on early perceptions that audio is a lower-quality modality or prone to overuse. These arguments and their rebuttals have been clearly described already. However, given the clear evidence of the meaningful benefits for reaching underserved people, the US should extend coverage of audio-only telemedicine for a minimum of five years. During this time, perceptions of quality can be informed by empirical evidence, such that we can either phase out audio-only in an equitable way or give providers more flexibility to combine use of modalities. Even with reimbursement parity, policy makers will need to invest in complementary enablers of equitable telemedicine access through state-level action. As Elaine Khoong writes, avoiding a two-tier system where video encounters are disproportionately available to the wealthy requires policy makers to expand video-visit capacity in the safety net, alongside community-based strategies to improve digital literacy. Given that telehealth does not necessitate the same geographical constraints as in-person care—for example, with respect to physician licensing or online prescribing—amending policies to streamline provision across states is also vital. A Role For Payment Reform? The past two years have shown that telephone and video consultation can be combined to deliver high-quality and efficient care. Going forward, patients are likely to receive a blended mix of appointments across modalities, tailored to clinical need and individual circumstance. In the NHS, capitated payments give clinicians and managers the flexibility to offer a mix of appointment modalities, based on the clinical situation without the need to consider differential reimbursement or administrative burden. In fee-for-service models, differentiating payment levels across telemedicine modalities is likely to increase bureaucracy and risks decreasing efficiency and quality. In the longer run, experience from both systems suggests that we should move away from modality-based reimbursement. In recent testimony to the US Senate’s Committee on Finance, Robert Berenson suggested that fee-for-service is a particularly flawed payment model for telemedicine, and that the Centers for Medicare and Medicaid Services should consider paying for telehealth services in a similar model to the UK: via monthly capitated payments for primary care physicians as part of a hybrid payment model. Capitated payment systems enable physicians to use the encounter modality considered most appropriate for the situation without worrying about how they will be paid (or the patient billed). Berenson’s proposal would allow physicians and patients to tailor the type of telemedicine encounter more precisely to individual patient need and might reduce bureaucracy associated with billing, in turn increasing efficiency. As evidence on the benefits and risks of each modality emerges, such a payment model also allows rapid translation of evidence into practice. Authors’ Note Professor Sarkar holds current research funding from the National Cancer Institute, California Healthcare Foundation, the Food and Drug Administration, HopeLab, and the Commonwealth Fund. She has received prior grant funding from the Gordon and Betty Moore Foundation, the Blue Shield of California Foundation, and the Agency for Healthcare Research and Quality. She received gift funding from The Doctors Company Foundation. She holds contract funding from AppliedVR, InquisitHealth, Somnology, and RecoverX. Professor Sarkar serves as a scientific/expert adviser for nonprofit organizations HealthTech 4 Medicaid (volunteer) and for HopeLab (volunteer). She is a member of the American Medical Association’s Equity and Innovation Advisory Group (honoraria). She is an adviser for Waymark (shares) and for Ceteri Capital I GP, LLC (shares). She has been a clinical adviser for Omada Health (honoraria), and an advisory board member for Doximity (honoraria). See original article: https://www.healthaffairs.org/content/forefront/audio-only-telemedicine-primary-care-embraced-nhs-second-rate-us#.Y45MpkrZubQ.twitter < Previous News Next News >

Accessibility to Telehealth Andrew Donnellan, Nov 03, 2021 Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Telehealth has many benefits including reduced, or eliminated travel and wait times; decreased exposure to communicative diseases; easier access to healthcare professionals and therapeutic interventions; and greater flexibility. However, for many individuals with disabilities, Telehealth and its associated benefits may be out of reach due to web inaccessibility. Benefits can become barriers because of websites’ inconsistent compatibility with screen readers, closed captions, magnifiers, speech to text software (used by individuals with limited dexterity), easy to understand instructions and hyperlinks (for individuals with cognitive disabilities), and alternative text formats. Although Telehealth companies provide guidance on ensuring accessibility by conforming to guidelines laid out in Section 508 of the 1973 Rehabilitation Act, it is only voluntary because the Act only applies to federal agencies and not private companies. So, while an individual with a disability will be met with a relatively accessible federally funded Telehealth website, that same individual may be greeted by an inaccessible private Telehealth website. But wait! What about the Americans with Disabilities Act (ADA)?! Surely it requires public accommodations like Telehealth websites to be accessible?! While the ADA does require brick-and-mortar private businesses that are labeled as public accommodations to be accessible, there is no such mandate for websites. Because of this, federal courts are split by jurisdiction on how to apply the ADA to websites: some jurisdictions say the ADA applies to all websites; some say it is inapplicable to all websites; and others conclude it applies only if the website has a connection, or "nexus," to the physical, brick-and-mortar place it represents. This lack of consistency can leave a disabled Telehealth user without an accessible Telehealth website simply because they live in a jurisdiction that does not ensure accessibility to websites. What can be done to help solve this problem? Perhaps the most comprehensive solution would be for the Department of Justice (DOJ), the federal Department tasked with enforcing the ADA, to finally answer the repeated calls by private business owners, courts, and other federal agencies for guidance by issuing a concrete rule requiring website accessibility under the ADA. However, because the Department proposed such a rule in 2010 and then withdrew from its proposal in 2017, it appears that those calls for guidance will go unanswered, save for a few amicus briefs and unofficial statements. Another, and perhaps more viable, solution is to lobby state senators to implement legislation requiring accessible Telehealth. It appears the ball has already started rolling because just this year, the New Jersey legislature has proposed a new bill that requires Telehealth to “ include accessible communication to facilitate the use of… Telehealth by individuals with a disability….” Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Since we are all human, we all deserve accessible Telehealth — it is a right. This right will not be realized unless, and until, we stand up and demand mandated accessible websites. https://southwesttrc.org/blog/2021/accessibility-telehealth < 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 >

COVID-19 Policy Playbook Recommends Removal of Telehealth Restrictions for OUD Treatment Center for Connected Health Policy May 2021 Legal recommendations for a safer more equitable future Researchers from the Network for Public Health Law have published a COVID-19 Policy Playbook, that outlines legal recommendations for a safer more equitable future. Chapter 18 of the playbook features access issues to treat individuals with opioid use disorder (OUD). The chapter outlines several of the federal concessions made for telehealth during the PHE, including the ability to utilize non-public facing audio-visual communication technology regardless of their level of HIPAA compliance, and the ability to prescribe controlled substances, particularly buprenorphine via telemedicine. They also note that states have made similar flexibilities available at the state level in many cases. The chapter concludes with a list of recommendations, including the following: *The Secretary of Health and Human Services (HHS) should permit treatment to be initiated via telehealth *Restrictions should be removed on who can receive treatment via telehealth. *States should authorize provision of buprenorphine via telehealth where applicable. COVID-19 Policy Playbook: https://static1.squarespace.com/static/5956e16e6b8f5b8c45f1c216/t/6064ad386b6e756cabb56f96/1617210684660/COVIDPolicyPlaybook-March2021.pdf < Previous News Next News >

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

CMS Warns Providers to Bill Correctly Center for Connected Health Policy May 2021 OIG is currently conducting several audits on telehealth In mid-April, CMS sent out a Medicare Learning Network (MLN) Connects Newsletter with a reminder to providers to bill correctly for telehealth services. In the short section in their newsletter, CMS cites a 2018 Office of Inspector General (OIG) report that found that there was a significant amount of telehealth claims that were improperly paid, and thus not billed correctly. As the OIG is currently conducting several audits on telehealth, it is possible that they may come to a similar conclusion again. The section also refers providers to several resources to ensure they are billing correctly, including the: Telehealth Services MLN booklet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Telehealth Payment Eligibility Analyzer https://data.hrsa.gov/tools/medicare/telehealth List of Covered Telehealth Services https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes For policies specific to the public health emergency (PHE), CCHP also recommends providers review the CMS resources listed in the Federal COVID-19 section in CCHP’s Policy Finder, as there are several telehealth flexibilities currently in place as a result of the PHE. CCHP's Policy Finder: https://www.cchpca.org/federal/?category=covid-19&topic=originating-site < Previous News Next News >

US Reps Push for Extension of Telehealth Flexibilities for HDHP Members Mark Melchionna December 15, 2022 Three US Representatives led a bipartisan group of lawmakers in submitting a request to Congress to extend telehealth flexibilities for some high-deductible health plan members. In anticipation of critical telehealth flexibilities expiring on Dec. 31, US Representatives Michelle Steel (CA-48), Brad Schneider (IL-10), and Susie Lee (NV-3), along with a bipartisan group of 30 Congress members, sent a letter requesting that House leadership include two pieces of legislation that extend some flexibilities in a year-end package. When the COVID-19 pandemic began, patients and providers turned to telehealth in droves to maintain care. According to the Centers for Disease Control and Prevention (CDC), there was a 154 percent increase in telehealth visits when comparing data from the last week of March 2020 with that of March 2019. This uptake of telehealth was likely associated with the withdrawal of regulatory restrictions in response to the limitations placed on in-person care during the public health emergency. As part of the CARES Act of 2020, Congress passed reforms that expanded access to telehealth services. For instance, prior to the CARES Act, Americans with high-deductible health plans (HDHPs) coupled with health savings accounts (HSAs) had to reach the minimum deductible before they qualified for telehealth coverage. However, Section 3701 of the CARES Act eliminated this requirement initially through Dec. 31, 2021. The provision was later extended through the Consolidated Appropriations Act, 2022. This led to wider coverage of telehealth services as health plans and employers were able to expand access to virtual care services for individuals with HDHP-HSAs pre-deductible. According to the representatives, increased access has led to many benefits for patients, particularly those without access to transportation services and those who reside far away from clinical locations. “Access to telehealth has also provided a significant portion of the U.S. workforce relief at a time when household costs are rising. Telehealth has allowed families to avoid taking time off from work to travel to and from appointments, and timely care has helped prevent costly visits to urgent care or the emergency room. Unfortunately, those with a high deductible may decide to skip critical preventative services – including primary care and behavioral health services – if the deductible is not waived, often leading to poor health outcomes and more costly care down the line,” the letter states. Due to the increasingly apparent benefits of telehealth, the US representatives are requesting that House leadership include the Primary and Virtual Care Affordability Act and the Telehealth Expansion Act in the end-of-the-year package. The Telehealth Expansion Act would make the telehealth flexibility permanent for people with HDHP-HSAs. The Primary and Virtual Care Affordability Act would both extend the flexibility and allow insurance providers to cover primary care services pre-deductible. This letter is part of a larger effort among healthcare stakeholders to ensure that expanded access to telehealth is solidified. Another letter written by the Connected Health Initiative (CHI) requested that Congress extend the safe harbor for telehealth coverage by HDHPs. In the letter, CHI noted its support for removing restrictions impeding telehealth access among Medicare beneficiaries. It also emphasized the upcoming telehealth deadline Americans with HDHPs will face at the end of 2022. Due to this, CHI requested that Congress extend the safe harbor for HDHPs to cover telehealth with first-dollar coverage. This would also allow them to maintain HDHP status. See original article: https://mhealthintelligence.com/news/us-reps-push-for-extension-of-telehealth-flexibilities-for-hdhp-members < Previous News Next News >

Once a Temporary Convenience, Telehealth is Here to Stay Beth Wood August 2021 Multifaceted networks supporting virtual medical visits hailed as a positive legacy of pandemic Whether you call it telehealth, telemedicine, e-health, virtual or video visits, the electronic delivery of health care services is coming into its own. The coronavirus pandemic spurred federal, state and private insurance programs to offer more coverage of telehealth to encourage people to follow the stay-at-home rules established in mid-March 2020. “After this last year and the benefits we’ve seen, telehealth is definitely here to stay,” said Kiran Savage-Sangwan, speaking from Sacramento. She is the executive director of the California Pan-Ethnic Health Network, a statewide health-advocacy organization. “The way we pay for healthcare has not robustly supported telehealth in the past,” Savage-Sangwan said. “The state has taken some interim steps before making permanent policy changes. The state will be extending the flexibilities for the Medi-Cal program through the end of next year, I believe, to continue to work out some of the policy issues.” According to the Centers for Disease Control and Prevention, the number of telehealth visits increased in the first quarter of 2020 by 50 percent, compared with the same period the year before. A single week in March 2020 showed a 154 percent increase, compared with the same period in 2019. Behind those numbers was a massive effort among health providers to accommodate this change. Even for UC San Diego Health, a pioneer in telehealth, the quick transition required an all-hands-on-deck approach. “We knew the shutdown would happen, but we didn’t know when,” recalled Marlene Millen, M.D., UC San Diego Health’s chief medical information officer for ambulatory care. “But our operational leads were already prepared for increasing video visits. Over the course of one weekend in March, we trained 1,000 doctors and staff. “We converted appointments and sent patients instructions. That very Monday, when everyone was supposed to be locking down, we were able to convert a couple of thousand appointments into video visits. That’s because we had a really good structure in place.” Millen spent the entire weekend at her home desk with multiple screens open, setting up online patient visits. An internal medicine physician, she has played a role in UC San Diego Health’s development of video visits for 10 years. About two or three years ago, she said, an app-based program was launched, which made it more accessible. But it wasn’t until the insurance coverage changed that telehealth’s potential could be tested. Until the shutdown, video visits were used for patients who had extreme obstacles to making in-person appointments. “Patients we targeted for these visits were ones with medical conditions who couldn’t come into the clinic,” Millen said. “They really embraced it. I had a patient in a wheelchair that had to be carried out of the house and another with a condition that made her use the bathroom all the time. Others had immune conditions. Then there were people who had to get on three buses to get to us. “Some of those patients were in danger of getting kicked out of insurance because of their number of no-shows. Video visits improved those situations. But it wasn’t a general-use case at that time.” Support for telehealth Now that pandemic restrictions have eased, the percentage of telehealth appointments versus in-person consultations has decreased in most of California. At UC San Diego Health, Millen noted, video visits rose to 30 percent during the early 2021 surge in COVID-19 cases. Video visits now account for between 15 and 20 percent of all appointments, a figure higher than prepandemic rates. As headlines attested, the pandemic put socioeconomic disparities in access to health care in stark relief. Some believe telehealth could provide a way to distribute health access more equitably. But there are hurdles. Many low-income people live in Wi-Fi deserts. Some have limited minutes on their smartphones, and others are unfamiliar with the technology. For some, finding a quiet private place in a multiperson home can be a challenge. “California has significant disparities — particularly by race, language and region — when it comes to health care access and health care outcomes,” Savage-Sangwan said. “Certainly, telehealth was helpful during the pandemic. “When people go into a medical office, various medical professionals assist them. Someone checks you in, someone takes your weight. People support you through the process. But when you’re accessing virtual care from home, you’re going to need to get that support a different way. “What we’ve seen to be successful is for the providers’ offices to build that into their workflow. Maybe someone calls you about your doctor’s appointment and would say: `'Hey, are you set up? Do you know how to use the platform? Let me walk you through it.’ We need to support people, so they are truly engaged in their health.” What’s telehealth friendly? Colonoscopies, mammograms and MRIs are obviously not possible through telehealth (at least not yet). But a lot can get done through a video visit, including assessing a medical problem and prescribing remedies for it. Millen, of UC San Diego Health, said her telehealth patients usually followed through on her instructions. She also noted that caregivers and family members became more engaged in video visits, particularly when she asked them to help with the exam. From monitoring diabetes and diagnosing a sinus infection to doing preliminary neurological tests and conducting speech therapy sessions, the use of telehealth has been wide ranging. “Before the pandemic, I would have definitely said: `'Yeah, there are some specialties that won’t be able to do video visits at all,’ ” Millen observed. “I was surprised how well our doctors and staff figured out how to get patient history and information.” Both Millen and Savage-Sangwan of the California Pan-Ethnic Health Network think that behavioral health and counseling services are extremely telehealth friendly. Savage-Sangwan pointed out that the network’s community clinics had been experiencing a high rate of no-shows for these services before the pandemic. With telehealth, the number of no-shows dropped to almost zero. In general, telehealth has proved itself worthy of coming out of the prepandemic shadows and becoming a vital component of equitable healthcare. “I’m happy by how many video visits are still going on,” Millen said. “I was thinking it would fall off rather quickly. But there are certain doctors who really love it and certain patients who really love it. “I see it getting a little more mature. What’s happened in the last few months is that we’ve created more of a system for it that makes sense. On both sides, I think we all know when to hold it and when to fold it.” She laughed. “I mean, when to see them and when to video.” Source: https://www.sandiegouniontribune.com/news/health/story/2021-08-03/once-a-temporary-convenience-telehealth-is-here-to-stay < Previous News Next News >

Packard Foundation COVID-19 Policy Flexibilities Report – Impacts and Recommendations Related to Children and Youth with Special Health Care Needs Center for Connected Health Policy July 2021 Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Last month the Lucile Packard Foundation released a report on COVID-19 policy flexibilities that focused on impacts and recommendations related to children and youth with special health care needs (CYSHCN). In addition to analyzing emergency policies, they looked to clinicians, family advocates, and other stakeholders to identify both challenges and opportunities based on their experiences. The number one policy change highlighted by all interviewees was how greater use of telehealth expanded access to care and had significant advantages, particularly for CYSHCN and their families. Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Stakeholders also spoke to how telehealth addresses transportation and logistical barriers, mitigating challenges such as traveling long distances, missing work, and bringing other family members along as well as cumbersome medical equipment. The report also noted that the greatest challenges were identified as systemic infrastructure issues affecting broadband access, digital literacy, and lack of interpretation services. Based on their analysis and interviews, the report recommended CMS and state Medicaid programs extend emergency flexibilities on payment parity, audio-only and synchronous reimbursement, as well as remove geographic or rural/urban site restrictions and ease cross-state licensing laws. They also suggested the use of targeted federal funding to reduce disparities and providing grants for telehealth infrastructure and training, as well as increasing flexibility of privacy rules. For state Medicaid programs in particular, they recommended piloting additional modalities for future use such as texting, expanding school-based reimbursement and guidance, and considering reimbursement in childcare settings. The authors heard universally from stakeholders that reimbursement and payment parity requirements were essential to the availability of telehealth. According to their review, 38 states plus DC provided Medicaid payment parity by the end of April 2020, and by September, 17 states enacted laws requiring payment parity from private insurers. In addition, some clinicians reported that telehealth reduced emergency room and inpatient utilization, but because the costs saved were not shared with hospitals, the hospital shut down the program and they are now seeing increased emergency room use and negative health outcomes. For more information, please access the full report at https://www.lpfch.org/sites/default/files/field/publications/covid-19-hma-report_1.pdf. < Previous News Next News >

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

Legislation Legislation New Mexico Legislation S.B. 93 - Broadband Access and Expansion Act H.B. 141 - ED Infrastructure Technology Definition S.B. 24 - Parity of Regulation of Telecommunication Federal Telehealth Legislatio n H.R. 7992 - Telehealth Act (2019-2020) H.R.3228 - VA Mission Telehealth Clarification Act (2019-2020) H.R.4900 - Telehealth Across State Lines Act (2019) H.R.5473 - EASE Behavioral Health Services Act (2019-2020) H.R.7233 - Knowing the Efficiency and Efficacy of Permanent Telehealth Options Act (2020) H.R.7338 - Advancing Telehealth Beyond COVID–19 Act (2020) S.2408 - Telehealth Across State Lines Act (2019) S.3988 - Enhancing Preparedness through Telehealth Act (2019-2020) S.4039 - TELEHEALTH HSA Act (2020) S.4216 - KEEP Telehealth Options Act (2020) Federal Broadband Legislation H .R.205 - To accelerate rural broadband deployment. H.R.4229 - Broadband Deployment Accuracy and Technological Availability Act S.4021 - Accelerating Broadband Connectivity Act of 2020

Telehealth Legislation Re-Introduced National Council for Behavioral Health March 12, 2021 This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. < Previous News Next News >

HHS to put $35M toward telehealth for family planning Kat Jercich November 29, 2021 The agency plans to use the funds to award about 60 one-time grants to Title X family planning providers, who must apply by February of next year. The U.S. Department of Health and Human Services announced that it would make $35 million in American Rescue Plan funding available for Title X family planning providers to strengthen their telehealth infrastructure and capacity. Title X family planning clinics help to insure access to a broad range of reproductive health services for low-income or uninsured individuals. "I’ve seen first-hand the critical role that telehealth plays in serving communities, particularly to protect so many families from COVID-19," said HHS Secretary Xavier Becerra in a statement about the grant availability. "As providers transitioned from providing in-person primary care to offering telehealth services, we were able to test, vaccinate, and act as lifelines to communities disproportionately hit by the pandemic," he said. "Increasing our investment and access to telehealth services remains critical." WHY IT MATTERS The Office of Population Affairs funds 71 Title X family planning service grantees and supports hundreds of subrecipients and thousands of service sites around the country. Family planning includes a broad range of services related to reproductive health, including contraception, sexually transmitted infections and pregnancy testing. Although abortion care can be co-located with family planning services, Title X funds cannot be used to pay for it. Although some services require in-person treatment and exams, others can be carried out via telehealth – as evidenced by grantees' use of virtual care to help their patients during the COVID-19 crisis. Still, facilities may not have adequate technology available. "During the global COVID-19 pandemic, family planning programs have accelerated the use of telehealth," said Dr. Rachel Levine, assistant secretary for health, in a statement. "These ARP funds will facilitate the delivery of quality family planning services and reduce access barriers for people living in America who rely on the health care safety net for services," she added. HHS plans to use the funds to award about 60 one-time grants to active Title X grantees. Organizations must apply by February 3, 2022, and notices of awards will be announced before the project start date of May 1, 2022. THE LARGER TREND Even as the government has moved to shore up telehealth infrastructure via funding, the question of virtual care's future continues to hang over Congress. Despite requests from hundreds of advocacy organizations, legislators have so far failed to take action to permanently safeguard telehealth after the end of the COVID-19 public health emergency – what some activists have referred to as "the telehealth cliff." "We recognize there are many unknowns related to the trajectory of the COVID-19 pandemic over the next 12 to 24 months," said American Telemedicine Association CEO Ann Mond Johnson in October. "However, we implore Secretary Becerra to provide as much predictability and certainty as possible to ensure adequate warning before patients are pushed over this looming cliff." ON THE RECORD "The pandemic has laid bare the important role that telehealth can play in our nation’s healthcare service delivery, and we are profoundly grateful for the opportunity to support continued investments in telehealth for the nation’s family planning safety net," said Jessica Swafford Marcella, HHS deputy assistant secretary for population affairs, in a statement. < Previous News Next News >

San Juan Regional Medical Center gets CARES Act funding to expand telehealth services By Hannah Grover, Farmington Daily Times February 15, 2021 AZTEC — Before COVID-19, San Juan Regional Medical Center used telehealth in a limited fashion to support providers and to do provider consultations, according to Chief Information Officer Matt Miliffe. AZTEC — Before COVID-19, San Juan Regional Medical Center used telehealth in a limited fashion to support providers and to do provider consultations, according to Chief Information Officer Matt Miliffe. The pandemic changed things. San Juan Regional Medical Center and San Juan Health Partners worked quickly to expand telehealth offerings. Now the hospital is receiving CARES Act funding to help improve its technology and better provide that service. "Demand (for telehealth) was immediate and has continued to grow," Miliffe said. San Juan Regional Medical Center will receive $1.25 million in CARES Act funding to supply emergency generators as well as to make upgrades in the IT network, according to a press release from the office of Sen. Martin Heinrich, D-NM. IT upgrades, new generators on the way These technology upgrades will support telehealth and field hospital operation projects that have been implemented in an effort to bolster the hospital's response to COVID-19. The grant funding will be matched with $617,000 in local funds. All locations except for San Juan Health Partners Urgent Care began offering a mixture of telephone and video visits in an effort to comply with public health orders, sustain the services offered and prevent the spread of the coronavirus, according to Barbara Charles, administrative director for San Juan Health Partners. The medical center's network infrastructure wasn't designed to service the high demands of video consultations and Miliffe said the IT team has had to push the current capabilities. "However, significant upgrades to the wired and wireless infrastructure is needed to sustain and improve the existing experience, and allow for the continued growth in telehealth demands driven by the pandemic," he said. "This funding will make a fundamental difference in our ability to serve our community’s needs." Your stories live here. Fuel your hometown passion and plug into the stories that define it. Create Account COVID: State health department closes Home Depot over COVID-19 cases One of the barriers that the center has seen is the remote nature of the community. Many patients can only connect through phone due to limited internet connectivity or cell service that can't support video. "The inability to consistently connect by audio and video is an ongoing barrier," Charles said. This funding is part of more than $2.24 million of CARES Act money that will be coming to northwest New Mexico to address healthcare and economic needs. In addition to San Juan Regional Medical Center, the Northwest New Mexico Council of Governments, which is based in Gallup, has been awarded $990,000 to address economic development needs of small businesses and entrepreneurs that have been harmed by the COVID-19 pandemic. The Northwest New Mexico Council of Governments serves Cibola, McKinley and San Juan counties. According to the press release, the council of governments hopes to create 100 jobs and retain 100 jobs through a revolving loan fund that this funding will assist in creating. Legislative session:New Mexico lawmakers work to address economic impact of COVID-19 U.S. Sen. Martin Heinrich Heinrich said in a press release that he has been "moved by the resiliency and grit" of rural New Mexico communities as they have faced a variety of public health and economic challenges related to the pandemic. "That is why I fought so hard to include funding in the CARES Act to help New Mexico’s rural health care systems, small businesses, and entrepreneurs to weather this storm," he said. "This funding is long-overdue and I will continue working for federal resources that New Mexico’s rural communities need to take on the COVID-19 pandemic and rebuild our economy in a way that supports everyone." Heinrich as well as Sen. Ben Ray Luján, D-NM, and Rep. Teresa Leger Fernandez, D-NM, announced $2.24 million of CARES Act funding for northwest New Mexico on Feb. 12. San Juan Regional Medical Center President and CEO Jeff Bourgeois Hospital: Telehealth is here to stay San Juan Regional Medical Center President and CEO Jeff Bourgeois thanked the lawmakers for the funding in the press release and emphasized that the hospital provides essential healthcare services for the Four Corners area. "This funding will ensure that we can meet the diverse needs of our patients and community and improve care for those we are privileged to serve," he said. While the pandemic jump started the demand for telehealth in the community, Miliffe said the San Juan Regional Medical Center does not anticipate it fading away. "Looking ahead to post-pandemic times, we see a long term and stable need for these services in our community as patients look to receive their healthcare in more of a consumer fashion, with services and offerings tailored around them as the individual," Charles, of San Juan Health Partners, said. "It is expected that the need or demand for telemedicine will continue long term. Many patients with health needs that may not require an in-person or face-to-face visit may find this option more flexible and convenient. Additionally, given the unknowns of the pandemic – this remains a safe alternative to in-person visits for patient to seek as needed or routine healthcare needs." Charles said telehealth also plays a key role in the COVID to Home program, which allows COVID-19 patients to receive close monitoring while in self-isolation at their own houses. "Because of this program’s close monitoring through telehealth visits, many patients have been able to stay out of the hospital and manage their care at home through the telephone or video calls. In other cases, caregivers have been able to intervene to coordinate a higher level of care for patients who needed it," she said. "To date, the COVID to Home program has helped more than 1,200 patients manage their care at home, something that would not have been possible without telehealth." Hannah Grover covers government for The Daily Times. She can be reached at 505-564-4652 or via email at hgrover@daily-times.com . This story has been modified to correct the attribution on some quotes. < Previous News Next News >

The future of telemedicine: purpose-built, integrated platforms Zoll Data Systems March 1, 2022 Integrated telemedicine solutions can address current pain points. By: Businessperson with tablet pointing to AI and data graphics Maximizing provider returns with big data Stethoscope and calculator on graphs How Emergency Medicine Physicians Can Increase Revenue in 2021 with Medicare PFS Cuts Looming person holding an insurance card. Billing Medicare and Private Payers for Telehealth Visits: What to Expect Post-Public Health Emergency Doctor talking to mother and daughter at reception desk Insurance Verification Technology Prevents Errors that Cause Costly Denials SPONSORED Global Edition Telehealth The future of telemedicine: purpose-built, integrated platforms Integrated telemedicine solutions can address current pain points. By: March 01, 2022 10:27 AM Photo Credit: adamkaz/Getty Images Propelled into mainstream use by the COVID-19 pandemic, telemedicine is becoming standard practice for many healthcare providers. According to David Ernst, MD, president of telemedicine innovator EPOWERdoc, these solutions will transform access to care and continue to drive more cost-effective delivery models, particularly at the EMS and emergency medicine level. Telemedicine’s technological pain points While telemedicine has undoubtedly come a long way, it still has significant limitations. One of the biggest limitations is provider usability. Often, telemedicine “platforms” are actually several disparate solutions cobbled together. These may include a video conferencing app, patient registration portal for demographic and insurance information, EMR, e-prescription app and discharge system. Consequently, providers must toggle between separate software programs to review and enter patient data for a single encounter. This inefficient approach can introduce errors, create frustration for patients and providers, and jeopardize the continuity of care. There is hope, however: Telemedicine technology is making rapid advancements through purpose-built platforms. Read full article here: https://www.healthcareitnews.com/news/future-telemedicine-purpose-built-integrated-platforms < Previous News Next News >

Telehealth 2.0: How Providence is taking its platform to the next level Laura Dyrda June 13, 2022 Telehealth became the prevailing mode for medical providers to see patients during the early days of the pandemic, and while use has leveled off in many areas, virtual care has become a permanent part of the healthcare ecosystem. Hospitals and health systems across the U.S. are now building telehealth, remote patient monitoring and hospital-at-home programs as part of their growth strategies. Patients also prefer telehealth as a convenient way to see their clinicians when an in-person visit isn't necessary. Most health systems have built a functioning telehealth program, but what opportunities are there to refine these programs for a better patient and clinician experience? Todd Czartoski, MD, chief medical technology officer at Renton, Wash.-based Providence, joined the Becker's "Digital Health + Health IT" podcast to talk about where the health system's virtual care program is headed. Click here to subscribe to the podcast and keep an eye out for Dr. Czartoski's episode. Note: Response below is edited lightly for clarity. Question: Where do you see telehealth becoming a better tool for clinicians and patients? How is virtual care at Providence evolving? Dr. Todd Czartoski: Over the last two years, our organization has done just over 4 million [telehealth] visits. For perspective, in 2019 we did 67,000 visits, and in one year we were doing 70,000 visits a week in April and May of 2020. That was a huge shift. Now, turning the lights on and being able to walk into the room is one thing, moving furniture around and optimizing the flow is another. A lot of our focus in the last couple years has been improving the experience for the provider, clinic staff and for the patient. We have really gotten it down to where the basic technical components of [telehealth] work pretty darn well, and we don't have a lot of issues with the connectivity piece. We've added interpreter services, and we've added in the ability to talk to more than one person at a time so you can have a family member in a different part of the country join the visit. Those types of things have been important add-ons, in addition to waiting room functionalities where you can add a survey or information tailored to the patient while they're waiting to see their provider in the virtual waiting room. Those are the things you're going to see continuing to evolve and emerge as additional capabilities. The support staff for the physician or provider's clinic also see their function and role evolving. If you think about a traditional clinic, a lot of those roles require putting patients in the room, checking their vitals, ordering labs or getting patients a follow-up appointment. Some of these things still exist, and some are going to be automated or done as part of a telehealth visit. That's where some of the opportunities are arising to continue to optimize the experience for the patients, staff and provider. You're going to see big trends overall here. Telehealth as a video visit, as a functionality, is somewhat limited. What we've learned is that whether you're a behavioral health specialist, a primary care provider or a subspecialty surgeon … all of those specialist visits can be done safely and effectively with telehealth. It's opened the door for looking at what else could we do beyond just a face-to-face visit. Specifically, the door has been opened for home monitoring. We have a remote patient monitoring solution that we built for COVID-19 home monitoring specifically, and because of the success of that, we've monitored over 30,000 patients up to two weeks who either confirmed or were under suspicion of having COVID-19. That opens the door for what we could do in terms of other types of home monitoring for COPD, diabetes, hypertension or whatever the case may be. That's a big area for growth and development. Finally, moving services outside the hospital, hospital-at-home, is a big initiative for us. We've been working on it for a long time and we're seeing some success. We're rapidly deploying that across our ecosystem and a lot of other health systems are as well. It really checks a lot of the boxes for patient experience; our patients absolutely love it. It's bending the cost curve, improving access and helping improve capacity so we don't have to build more super expensive towers and hospitals. Some of the outcomes with hospital-at-home have been shown to be better than traditional hospitalization when it comes to delirium, falls, length of stay and complications. People actually heal better on their own in a comfortable home environment. Those are a few examples of areas that we're going to see growth in our ecosystem. See original article: https://www.beckershospitalreview.com/telehealth/telehealth-2-0-how-providence-is-taking-its-platform-to-the-next-level.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >