Contact SBRL Community Contacts Get answers to your Federal and State broadband questions: New Mexico broadband contacts Federal broadband contacts Contacts for New Mexico broadband questions: Rand Tilton, NM Department of Informatio n Technology (NM DoIT)/Broadband Rand.Tilton@state.nm.us Gar Clarke, NM DoIT Geospatial Program Manager Presented October 2021 webinar: "NM Broadband and What’s Next." Recording: HERE Sli des: HERE NM Broadband Program (NMBBP ): Online Interactive Broadband Map Statewide Broadband Strategic Plan (June 2020) NM Speed Tester New Mexico Contacts for Federal broadband questions: U.S. Senator Ben Ray Lujan: Sen. Lujan wants to know about telehealth or broadband barriers and successes you have experienced. Telehealth barriers and successes: M e lanie_Goodman@lujan.senate.gov Health polic y matters: Calli_Shapiro@lujan.senate.gov Broadband and telecommunications matters: Jeffrey_Lopez@lujan.senate.gov. Senator Ben Ray Lujan's recording about New Mexico telehealth: HERE Federal

Telehealth Waivers Wind Down, Restricting Some Providers From Delivering Care Across State Lines Hailey Mensik August 2021 States allowed medical professionals licensed elsewhere to hold virtual visits with their residents during the pandemic. Some are making the rollbacks permanent, but others are reversing again. State lawmakers temporarily scrapped hundreds of regulations early in the COVID-19 pandemic to help businesses and consumers deal with widespread shutdowns, giving patients greater access to telehealth and helping spur an explosion in use of virtual care. A number of states allowed medical professionals licensed elsewhere to hold telehealth visits with residents of their state during the pandemic, and some already have or are looking to make the rollbacks permanent. Exact numbers are difficult to track because some policies overlap and are organized differently in different states, but as of July 28, 17 states and the District of Columbia still had some type of telehealth waivers in place, according to the Federation of State Medical Boards. Other states like New York, Minnesota, Florida and Alaska are among those that have pulled back emergency waivers. Alaska is going back to its old ways after its governor's emergency order ended. Patients there can only visit telehealth providers licensed in the state now after about a year without that rule. The same goes for Florida after its emergency declaration expired on June 26. Meanwhile, Arizona lawmakers passed sweeping legislation in May making the state's pandemic-related telehealth waivers permanent, including requiring insurers to cover audio-only visits and allowing out-of-state medical professionals to conduct telehealth visits with patients in the state. Advocates for allowing providers to permanently deliver virtual care across state lines say it would help ease staffing shortages, help patients and doctors maintain existing relationships and benefit patients in isolated communities by making faraway specialists more accessible. But as long as medical licensing is regulated at the state level, the broad access to services and providers that existed during the pandemic won’t continue for everyone. Patients in rural areas are often far away from a doctor's office, and in states like Alaska where flexibilities expired, can be even further from providers practicing certain specialties, such as a pediatric intensivist or certain oncologists, said Mei Kwong, executive director for the Center for Connected Health Policy. "Maybe there aren't enough of those cases in those particular states to make it worth a provider's while to go and move there, but there's still a need because they may still have people who need those services," Kwong said. The patchwork of red tape could also pose a challenge for providers who have pivoted to delivering more virtual care over the past year. Mia Finkelston, a family medicine physician in Maryland, made the switch to telehealth nearly a decade ago and has been practicing with Amwell ever since. She's currently licensed in 29 states, and said the process to get her licenses varied widely. "It's not standard as far as fees, it's not standard as far as what documents you need to give them. It really is based on those state medical boards and what they decide is important to them," Finkelston said. As more states' waivers expire and others' rules change, one option for providers who want to continue delivering care across state lines is through the Interstate Medical Licensure Compact, which currently includes 30 states, the District of Columbia and Guam. Similar to the nurse licensure compact, it allows eligible physicians to practice in other compact states. It’s worth noting, however, that the Interstate Medical Licensure Compact does not issue a compact license or a nationally recognized medical license for physicians, but rather streamlines the process for them to receive multiple licenses from individual state medical boards. Physicians pay an initial $700 compact fee, then an additional cost for each license in any compact state they want to practice in. States must pass legislation to join the compacts. "No two states are totally alike in their legal and regulatory framework for the practice of medicine, which of course, affects telehealth, which is just one aspect of the overall US healthcare system," Kyle Zebley, director of public policy at the American Telehealth Association, a coalition with a board that includes representatives from hospitals like HCA and payers like CVS, said. "Therefore a way to be consistent with our federal system, consistent with the way that the practice of medicine has been done in this country for so long, we've come up with this great model of compact, which is a way to be consistent with all that while still allowing for care across state lines," Zebley said. As lawmakers try to facilitate continued access to telemedicine for those who need it most, licensure reforms will be key, the authors of a February article in the New England Journal of Medicine argue. "The growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of health care markets beyond state borders," the authors said. They agree that a federal medical licensing system is the loftiest reform option and strengthening existing compacts is the way to go, suggesting Congress pass legislation to encourage holdout states to join the Interstate Medical Compact. Other options include encouraging states to practice reciprocity, where they automatically recognize an out-of-state license, as the Department of Veterans Affairs does with physicians in its system. Source: https://www.healthcaredive.com/news/telehealth-waivers-wind-down-restricting-some-providers-from-delivering-ca/603169/#:~:text=Healthcare%20Dive-,Telehealth%20waivers%20wind%20down%2C%20restricting%20some%20providers%20from%20delivering%20care,but%20others%20are%20reversing%20again. < Previous News Next News >

Telehealth Resources NMTHA's Telehealth Resources provide information on the following topics: New Mexico Organizations New Mexico Broadband Interstate Telemedicine Licensure Telehealth Organizations & Associations Teleheath Training COVID & Telemedicine NM Based Orgs NEW MEXICO ORGANIZATIONS Health Insight New Mexico New Mexico Association for Home & Hospice Care New Mexico Health Resources New Mexico Primary Care Association SYNCRONYS (New Mexico Health Information Exchange) University of New Mexico Center fo r Telehealth UNM Project ECHO NEW MEXICO BROADBAND NM Broadband Program Overview of Broadband Program - Videos Mapping Training Resources Strategic Planning INTERSTATE & TELEMEDICINE LICENSURE Interstate Medical Licensure Compact (NM is not yet a participant) Federation of State Medical Boards New Mexico Physician Licensure Requirements (including telemedicine) New Mexico Physician License Application instructions (see last page for telemedicine) NM Broadband Interstate Licensure TELEMEDICINE ASSOCIATIONS & ORGANIZATIONS American Telemedicine Association (ATA) Center for Connected Health Policy Center for Telehealth & e-Health Law Southwest Telehealth Resource Center National Library of Medicine National Telemedicine Initiative Office for the Advancement of Telehealth (Health Resources and Services Administration, DHHS) Telemed Associations Org. TELEHEALTH TRAINING Telemental Health Training : Providing healthcare organizations and clinicians with ethical, legal, technological, and clinical frameworks for conducting effective telehealth sessions. Telehealth Trainings : The Arizona Telemedicine Training Program and Southwest Telehealth Resource Center offer 1-day training courses on telemedicine and telehealth. National Consortium of Telehealth Resources : Building a telehealth program? Browse through our offerings from Telehealth Resource Centers. If you can’t find what you’re looking for, use our contact form or give us a call. We have an abundance of resources available! Weitzman Institute : Weitzman ECHO (Extension for Community Health Outcomes) provides specialty support for primary care providers seeking to gain expertise in management of certain complex illnesses and conditions, including COVID-19, MAT, Chronic Pain, and more. TH trainings New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. View Statutes Experts in Telehealth: An Interview Series A series of brief interviews from local and regional experts sharing experience, insights, and guidance on telehealth. Access Interviews Get answers from the NM Department of Information Technology (NM DoIT). Contact NM DoIT Broadband Questions? Contact U.S. Senator Ben Ray Lujan to discuss you r telehealth issues, ideas, and goals. Policy & Advocacy Contact Senator Lujan COVID & TELEMEDICINE NEWMEXICO.gov (Guidance for Providing Patient Care by Electronic Means During the COVID-19 Public Health Emergency.) NM Medicaid, COVID-19, and Telehealth Resources NM-HSD April 6, 2020: Special COVID-19 Supplement #3 – Guidance for New Mexico Medicaid Providers NRTRC COVID-19 and Telehealth Resources ATA COVID-19 Response Webinar Series eHealth Initiative COVID-19 News, Resources, and Events Weitzman Institute COVID-19 Resource Page An Analysis of Private Payer Telehealth Coverage During the COVID-19 Pandemic (Center for Connected Health Policy) UNM Resources: COVID-19 briefings COVID-19 practice guidelines COVID-19 therapeutic evidence Covid resources Top of Page NM Based Orgs NM Broadband Interstate Licensure Telemed Associations Org. TH trainings Covid resources

Telehealth Mini-Grants NM BHSD March 16, 2021 BHSD would like to announce the release of funding in the form of telehealth mini-grants. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us To CYFD and BHSD Non-Medicaid Providers: Dear New Mexico Providers: BHSD would like to announce the release of funding in the form of telehealth mini-grants. When the COVID-19 public health emergency ends, BHSD will no longer be able to support behavioral health providers who are delivering behavioral health services through telehealth systems that are not HIPAA compliant. We are now offering funding to help providers come into compliance so that critical behavioral health services will not be disrupted. If your agency is currently delivering services using the telephone and/or another non-HIPAA compliant system, this grant could help you make the transition. BHSD is seeking letters of interest that respond to this question: what is your current telehealth system, and what do you need to become HIPAA compliant? Funding is available in amounts of up to $50,000 per agency, and all work must be completed by the end of 2021, which is when the PHE is currently set to expire. Letters of interest should include: • Specific hardware and/or software and costs • Training for staff and administrators and costs • Anticipated changes to practice model • How many practitioners/staff members do you expect to train • How many clients do you anticipate serving with your new system • Timeframe for making changes BHSD will expect any agency that receives funding to report back on progress made on each of these points. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us < Previous News Next News >

Legislators Throughout the Southwest are Moving Towards Institutionalizing Telehealth Services Kirin Goff, Southwest Telehealth Resource Center July 2021 Legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services As the COVID-19 pandemic becomes increasingly under control and more states are ending their public health emergency declarations, legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services. At the forefront of this new legislation is Arizona’s HB 2454 that Governor Doug Ducey signed into law on March 5, 2021 to provide comprehensive amendments to the state's laws governing telehealth. In Arizona and other southwest states’ new telehealth laws, entities are generally prohibited from denying coverage for telehealth services and are required to cover remotely provided services at the same rate as equivalent in-person services. Exceptions to these requirements may be developed by an advisory committee of government officials, practitioners, and other stakeholders, who will determine, among other things, circumstances in which telehealth services are inappropriate. Even in the absence of a rule prohibiting telehealth services, healthcare providers must use good faith in determining whether telehealth services are appropriate, and if so, which communication modalities are appropriate. Communication Modalities Prior to the public health emergency response to the pandemic, audio-only services were generally permissible only if the healthcare provider had an existing relationship with the patient and audio-visual communication was not reasonably available. Voicemail was specifically excluded. Going forward, telehealth services in Arizona may be provided, when appropriate, through interactive audio/video, asynchronous store-and-forward technology (i.e., digitally stored medical imaging, multimedia files, other information that can be reviewed remotely), and remote patient monitoring technology. Legislation in other states throughout the southwest also includes measures that govern the types of communications by which telehealth services can be provided. In many cases, telehealth can be provided by means other than real-time, audio-visual communication. Nevada SB 5, for example, amends an existing definition of telehealth to include audio-only interactions. Utah's SB 161, which was enacted, allows providers to use HIPAA-compliant asynchronous audiovisual technology for certain treatments. Amendments to New Mexico's Cannabis Regulation Act (HB 2, also enacted) provide a patient to be diagnosed as a qualified patient via telemedicine, which includes store-and-forward and remote patient monitoring technologies as options. Collection and Reporting of Telehealth Data to Form Policy Decisions Legislators in Nevada, like those in Arizona, seek to collect and use data on telehealth services to aid in forming policy. Nevada SB 5 requires the state's Department of Health and Human Services to establish (if funding permits) a data dashboard allowing analysis of access to telehealth by different groups and populations. The bill goes further to include behavioral health boards, the Patient Protection Commission, and the Legislative Committee on Health Care to use the dashboard in formulating policy. Another Nevada bill (ACR 5) establishes a legislative committee to address the shortage of behavioral health professionals in the state. This committee will study the provision of behavioral health services through telehealth and consider ways to expand the use of telehealth to provide such services. Expansion of Services Various bills explicitly expand telehealth services in particular fields such as dentistry (Colorado SB 21-139, New Mexico SB 200), audiology and speech pathology (Colorado SB 21-021, New Mexico HB 210), occupational therapy (Colorado HB 21-1279), and dietetics and nutrition (New Mexico HB 147). Other measures are aimed at expanding broadband access:(Nevada AB 388; Colorado HB 21-1109), including efforts specifically directed at underserved communities (Arizona HB 2885, Nevada AB 388), seniors (Colorado SB 21-210, New Mexico SM 6), and children (New Mexico SM 15). In-Person Medical Examination Requirements In-person requirements have long been a contentious topic in the provision of initial telehealth services in certain contexts. For example, Arizona’s HB 2454 prohibits providers from prescribing Schedule II drugs after an audio-only communication with the patient, but generally allows other drugs to be prescribed after audio-only telehealth communications. In another context, Nevada’s SB 266 provides for in-person medical examinations for workers' compensation claims, but only if initial examinations were performed through telehealth services and only if a party requests an in-person examination. Interestingly, some bills seek to relax restrictions. For example, New Mexico’s HB 12 seeks to eliminate a previous requirement that a practitioner could only certify a patient for medical cannabis use if the practitioner had previously examined the patient in-person. Overall, the surge of bills moves us towards institutionalizing telehealth. Importantly, the latest round of legislation also exposes how much more there is to learn about optimizing telehealth and identifying best practices as uptake continues to increase across the southwest. New Mexico HB 147: https://track.govhawk.com/public/bills/1414538 New Mexico SM 6: https://track.govhawk.com/public/bills/1425880 New Mexico SM 15: https://track.govhawk.com/public/bills/1443803 New Mexico’s HB 12: https://track.govhawk.com/public/bills/1428580 Source: https://southwesttrc.org/blog/2021/legislators-throughout-southwest-are-moving-towards-institutionalizing-telehealth < Previous News Next News >

Board of Directors BOARD A message from the Chair: Stetson Berg Thanks to our work at the Alliance and a terrific Legislature, New Mexico enjoys one of the most progressive telehealth statutes in the country. That doesn’t mean our work is done. The New Mexico Telehealth Alliance exists to support New Mexico telehealth capabilities by continuing to advocate for needed policy changes, providing useful resources in a variety of formats, and creating mechanisms for convening and sharing. We offer educational webinars, online forums, links to resources, and networking opportunities. Connect with us and participate in strengthening New Mexico's access and capacity to provide care across our vast State by bringing a telehealth-related problem you need help solving, joining a committee, participating in our webinars, or sharing your expertise as a speaker. Stetson Berg, MHA UNITED HEALTHCARE COMMUNITY AND STATE Chair Executive Committee Member Alex Carter, DMS, PA-C OCHSNER HEALTH Vice Chair Executive Committee Member Jennifer Sandoval, MHA MOLINA HEALTHCARE NEW MEXICO Secretary Executive Committee Member Maggie McCowen, LISW, MBA BEHAVIORAL HEALTH PROVIDERS ASSOCIATION OF NEW MEXICO Treasurer Executive Committee Member Jerry Harrison, PhD NEW MEXICO HEALTH RESOURCES Executive Committee Member Beth Landon, MBA, MHA LANDON & ASSOCIATES Immediate Past Chair Executive Committee Member Robert Longstreet NEW MEXICO PRIMARY CARE ASSOCIATION Executive Committee Member Richard Draper, JD COMAGINE HEALTH Advisory Council Chair Dale Alverson, MD UNM, PROFESSOR EMERITUS TOUCH-TSC, LLC Gisela Bartolome, MBA SYNCRONYS Kate Berg, RN UNM PROJECT ACCESS Christine David, MBA PRESBYTERIAN HEALTHCARE SERVICES Anneke Frankel, MPH UNITED HEALTHCARE COMMUNITY AND STATE Maggie Gunter, PhD SYNCRONYS TOUCH-TSC, LLC Annie Jung, MD NEW MEXICO MEDICAL SOCIETY Monica Marthell, DHA BLUE CROSS / BLUE SHIELD OF NEW MEXICO Niles McCall, MLS, CHCP NEW MEXICO MEDICAL SOCIETY Joy Thompson ALLIANCE FOR NAVAJO BROADBAND SPECTRUM SOLUTIONS, LLC

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 >

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 >

New HHS-OIG Reports on Telehealth Challenges and Oversight in State Medicaid Programs Center for Connected Health Policy September 2021 Last week the Department of Health and Human Services Office of Inspector General (HHS-OIG) released two new telehealth reports, both related to the use of telehealth to deliver behavioral health services to Medicaid beneficiaries. HHS-OIG breaks up their study into two reports. Last week the Department of Health and Human Services Office of Inspector General (HHS-OIG) released two new telehealth reports, both related to the use of telehealth to deliver behavioral health services to Medicaid beneficiaries. HHS-OIG breaks up their study into two reports: *States Reported Multiple Challenges with Using Telehealth to Provide Behavioral Health Services to Medicaid Enrollees (Challenges Report) which focuses on state care delivery issues, and *Opportunities Exist to Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid (Evaluation Report), which looks closer at state data collection and evaluation efforts. The reports are both based on surveys HHS-OIG conducted with Medicaid directors from 37 states as well as various stakeholders in early 2020. The surveys were particularly focused around telemental health delivery through managed care organizations, however most stakeholders focused on general telehealth issues in their responses. While the information was gathered pre-pandemic, HHS-OIG applies the findings to support understanding and recommendations to the Centers for Medicare and Medicaid Services (CMS) around post-pandemic telehealth policy. Key Challenges: Lack of Telehealth Training and Limited Broadband In terms of challenges related to care delivery via telehealth, the number one issue reported by 32 out of 37 surveyed states, was a lack of provider and enrollee training. In HHS-OIG’s interviews, stakeholders described not only provider issues related to use of telehealth technology, but also lack of education around telehealth coverage and reimbursement policies. Lack of internet access came in as the second highest challenge, reported by 31 out of 37 states. Broadband issues raised included not only enrollees having insufficient broadband speeds, but some clinics in rural areas having no broadband access at all. Other challenges provided by state Medicaid programs included: -Concerns around how providers protect patient privacy and personal information. -Lack of interoperability between provider electronic health record systems and how to increase provider sharing of patient information. -The high costs of telehealth infrastructure, such as initial equipment costs as well as maintenance and repair costs. -A lack of licensure reciprocity across states. -A lack of understanding around telehealth consent policies. Citing how CMS has given states broad flexibility in how they structure their telehealth policies, the recommendations from the report to CMS focus on increasing creation and dissemination of additional informational and educational resources, such as best practices amongst states, funding options related to broadband and interoperability, and creating a state plan amendment template that could additionally assist states in covering some ancillary infrastructure costs. Evaluation: Telehealth Data and Oversight Within the Evaluation Report which focused more on data collection and analysis, HHS-OIG found that only 3 out of 37 states are unable to track which services are provided via telehealth, however only 2 out of 37 states have evaluated that data specific to impacts on access to behavioral health services and only one state has evaluated telehealth impacts on cost. The report notes that though other states didn’t directly evaluate telehealth data however, they did provide information on observational telehealth impacts based on their experiences with telehealth. For instance, 17 out of 37 states reported that telehealth increases access to providers and a few states also noted potential cost savings, while 6 out of 37 said the impact of telehealth on cost is largely uncertain. The final focus of the Evaluation report was related to telehealth quality assessments and oversight by Medicaid agencies. While 10 out of 37 states noted concerns around quality, one state mentioned quality as more of a clinical practice issue, and two states believed provider training could address such concerns. In regard to oversight, only 11 states were said to conduct monitoring specific to telehealth, while other states noted they oversee all services the same. HHS-OIG made much stronger and more specific recommendations when it comes to state oversight and evaluation, suggesting the need for additional telehealth specific measures by CMS, states, and managed care organizations. Looking Ahead The HHS-OIG reports highlight many of the broad issues and questions related to telehealth that have become forefront in policymakers’ minds over the past year and half, such as challenges around addressing the digital divide and how to best evaluate telehealth impacts. The recommendations point toward a few different potential post-pandemic pathways for CMS mainly around increasing education and oversight. As we’ve seen confusion grow around what state Medicaid agencies believe CMS allows them to do as permanent telehealth policy, such as around federally qualified health centers (FQHCs), perhaps the most essential recommendation made by HHS-OIG comes back to increasing coordination amongst state Medicaid agencies with CMS. The reports’ limited scope to behavioral health services through managed care organizations is also notable in terms of policy application even though state and stakeholder responses may have been more general. For instance, many states and policymakers seem to be focused around Medicaid fee-for-service policies more so than managed care, as well as reimbursement challenges, such as payment parity and similar fee schedule considerations. In addition, the HHS-OIG study did not break down any differences or feedback by telehealth modality, while many states and stakeholders have been focused on the future of audio-only availability – especially as a way to address the challenge of limited broadband access. In terms of evaluating data, while many states may have not had a data evaluation plan in place at the time of HHS-OIG survey, many now do as a result of recently enacted legislation predicated on the surge of use and attention to telehealth during the pandemic. Therefore, it may be interesting for HHS-OIG to consider conducting a similar more broad survey in a year or two after states have had more time to collect and wrap their heads around the data. Challenges Report: https://oig.hhs.gov/oei/reports/OEI-02-19-00400.pdf Evaluation Report: https://oig.hhs.gov/oei/reports/OEI-02-19-00401.pdf < Previous News Next News >

NCQA Report: 3 Strategies to Close Telehealth Access Gaps Mark Melchionna May 16, 2022 The National Committee for Quality Assurance released a telehealth report that highlighted care disparities and strategies for improvement. May 16, 2022 - Prioritizing individual preferences and patient needs, breaking down regulatory barriers, and leveraging technology in an equitable manner can go a long way toward addressing the growing disparities in telehealth use, according to a white paper released by the National Committee for Quality Assurance (NCQA). The white paper, titled The Future of Telehealth Roundtable, discusses ways to close gaps in telehealth use and access. The NCQA is a nonprofit organization that focuses on improving the quality of care and certifying various healthcare groups. Dig Deeper Pressure on Congress to Solidify Telehealth Access Builds GOP, Independent Senators Co-Sponsor Medicare Telehealth Access Bill Lawmakers Ask Congress to Create a Rural Telehealth Access Task Force As virtual care grows amid the COVID-19 pandemic, The Future of Telehealth Roundtable highlighted various areas that could be enhanced. The white paper derives from an October 2021 conference consisting of telehealth and technology experts from several prominent healthcare organizations, including MedStar Health. The experts noted that despite the expected benefits associated with telehealth, such as convenience and lower costs, disparities still exist within specific communities. According to the white paper, three strategies could help close care gaps as telehealth is further implemented. The first is creating telehealth services that cater to personal patient preferences and needs, as some individuals may face struggles due to their primary language and socioeconomic status. The second is addressing regulatory barriers to access and changing regulations to allow expanded clinician eligibility for licensure. The final strategy is ensuring that digital technology can be leveraged efficiently. For example, considering patient access levels to technology is critical because it determines how patients can be reached and how to best care for them. “Even prior to the pandemic, a change in healthcare delivery was on the horizon with ever-evolving advancements in technology,” said NCQA President Margaret E. O’Kane, in an accompanying press release. “As virtually based care expands, unique patient needs and preferences must be identified and prioritized so that telehealth can help us close the gaps in healthcare and not widen existing disparities.” The Future of Telehealth Roundtable also emphasized the continuing popularity of telehealth and that it will hold a place in the new normal. But as the implementation process continues with new technology, avoiding the digital divide is necessary to eliminate disparities. Throughout the COVID-19 pandemic, various studies have emphasized pinpointing the potential barriers to telehealth access. One study published in February revealed that Black patients with cardiovascular disease (CVD) prefer recording and sharing blood pressure (BP) via a text-based program rather than an online patient portal. This is likely because the patient portal has higher technical requirements than text-based communication. Further, research published last November shows that patients with limited English proficiency were less likely to use video when accessing virtual services during the pandemic than adults who could speak English comfortably. For full article: https://mhealthintelligence.com/news/ncqa-report-3-strategies-to-close-telehealth-access-gaps < Previous News Next News >

Common Wealth Fund Analyzes State COVID-19 Telehealth Changes Center for Connected Health Policy July 2021 Recommending Longer Term Expansion Data to Determine Permanent Policies The Commonwealth Fund recently released an issue brief titled, States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations, to help inform future policy considerations for telehealth post-pandemic. Focusing on private insurance coverage, the authors reviewed pre-pandemic state telehealth statutes as well as state emergency actions related to telehealth between March 2020 and March 2021. The study found that 22 states made telehealth policy changes, mostly in regard to audio-only coverage, cost-sharing requirements, and reimbursement parity. Audio-only coverage and reimbursement parity were the most popular changes made to ensure expanded access to telehealth. Notable pre-pandemic findings include: -35 states required private insurance telehealth coverage -25 states required insurers to limit cost-sharing -15 states required private payer reimbursement parity -3 states explicitly required audio-only coverage Notable policy expansions during the pandemic included: -5 additional states required telehealth coverage -4 new states eliminated cost-sharing for services via telehealth -10 states added a requirement for private payer reimbursement parity -18 states moved to require audio-only coverage The report also looked at methods of emergency telehealth expansion by states, finding that policy changes came in a combination of legislation, executive orders, and other agency actions such as bulletins and notices. The study found 8 states passed legislation, but that the primary method was administrative action, given its ability to be made quickly. Administrative changes also appeared to often hinge on existing statutory authority or executive orders creating such authority. As part of the study’s methodology, the authors additionally interviewed insurance regulators in 10 states that had made telehealth expansions. Regulators highlighted the importance of audio-only coverage, both for older patients and their ease of use, as well as patients with behavioral health conditions that find it more comfortable. While some regulators expressed concerns related to increased costs with audio-only coverage, others highlighted billing parameters and how insurers have the ability to determine which audio-only visits qualify for reimbursement. The regulators also noted that almost all insurers were supportive of the temporary expansions, but that they’d likely oppose long-term payment parity requirements, even though one regulator commented how the work may be the same for a visit via telehealth as in-person. Interviews also revealed an insurer desire to pay lower rates for their third-party corporate telehealth providers, which regulators said may be less costly but also may fragment care, which can result in lower quality care and higher health care costs. The report also covers existing research around the benefits of telehealth and suggests the need to address insurance and audio-only coverage long-term to reduce access issues and stabilize the coverage landscape for providers to continue investing in telehealth use. The study concludes with the recommendation that maintaining telehealth expansions may benefit payers and consumers if telehealth can be shown to reduce health care costs. This will require access to longer-term information to monitor its use, including stakeholder workgroups and formal data collection mechanisms. Of course, longer-term data requires longer-term expansions, which could trend states toward temporary extensions in the short-term, such as those recently enacted in Connecticut and proposed in California. As policymakers continue the call for telehealth data, the primary response from researchers seems to be the same call. In addition to telehealth expansion impacts on health care costs, the issue of improved access to care must remain a primary focus of data collection and evaluation as well to truly result in equitable policy adoption. For more information on the actions states took to expand telehealth during COVID-19, read the Commonwealth Fund’s issue brief in its entirety - https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/states-actions-expand-telemedicine-access-covid-19. CCHP’s Policy Finder tool can also be used to look up COVID telehealth policy documents by state. New Mexico policy finder - https://www.cchpca.org/new-mexico/. < Previous News Next News >

Medicare Physicians Fee Schedule 2023 draft and the Impact on Rural Health Arizona Telemedicine Program August 16, 2022 Request a copy of the full report by navigating to the original article link. For original article: https://telemedicine.arizona.edu//event/webinar/2022-08-16-medicare-physicians-fee-schedule-2023-draft-and-impact-rural-health < Previous News Next News >

Opportunity Knocking — Empanelment, COVID-19 and Telehealth By Trudy Bearden, PA-C, MPAS February 17, 2021 Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment. Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment is a foundational component of primary care and is essential in population health management. In 2019, the People-Centered Integrated Care collaborative, participants from 10 countries developed an overview of empanelment and a comprehensive definition: Empanelment is a continuous, iterative set of processes that identify and assign populations to facilities, care teams, or providers who have a responsibility to know their assigned population and to proactively deliver coordinated primary health care. That definition is accurate and comprehensive, but we must appreciate the recent, succinct statement by my Empanelment Learning Exchange colleague Elizabeth Wala, Global Advisor, Health and Nutrition at Aga Khan Foundation: “Empanelment is grouping patients under providers.” Opportunity. As a primary care clinician and health care consultant, I have been thinking hard since April 2020 about the importance of empanelment, telehealth and the COVID-19 pandemic. Just to be clear, I’m using the term telehealth as defined by the discrete set of services described by the Centers for Medicare & Medicaid Services (CMS) List of Telehealth Services. Similarly, there are amazing opportunities for other remote services, including chronic and principal care management, remote patient monitoring, virtual check-ins and more that lend themselves to applying empanelment to improve health and well-being. Maybe for another blog … Most clinicians use electronic health records (EHRs) these days and can run or request reports on their patient panels to identify which patients may need health care services. Empanelment provides each clinician with a list of names of their patients along with additional information such as age, date last seen, diagnoses, preventive and chronic care that is due and more. Here are some of the ways we can leverage empanelment and telehealth to keep people safe, expand access and capture revenue. Check in on the unseen and unknown. Empanelment is not just about those who seek health care services from us, although that’s often how it starts. The beauty of empanelment is that there should be no people on a clinician’s panel who are “unseen and unknown.” However, the Centers for Disease Control and Prevention (CDC) estimates that 41% of U.S. adults have delayed or avoided medical care during the pandemic because of concerns about COVID-19, which presents us with an opportunity. Identify who hasn’t been seen in the past 6-12 months for each clinician’s panel. Have clinicians go through the list and identify who should receive a check-in call and who should be scheduled for a telehealth visit. There may not be reimbursement for those check-in calls; although there are service codes and reimbursement for virtual check-ins, those check-ins are technically supposed to be initiated by the patient. Conduct advance care planning. If ever there was a time! And it can be accomplished by telehealth — using codes 99497 (~$85) and 99498 (~$74) — with decent reimbursement. Start with all individuals 65 and older in your panel. Ensure high-risk patients know about telehealth. Now more than ever, know who your top 5-10% highest risk patients are, including those at highest risk for adverse COVID-19 outcomes. These patients will benefit from having telehealth as an option perhaps more than any other population in your practice. Conduct targeted outreach to the top 5-10% high-risk patients to schedule a telehealth visit, if needed or to let them know about telehealth as an option. Address chronic and preventive gaps in care. As people delay care and as team-based care and pre-visit planning workflows seem to fall by the wayside, I am concerned that missed and delayed diagnoses will soar, which is both terrible for individuals and families, but is also one of the most common reasons for malpractice claims. Use panel data to identify who’s due for what: Chronic conditions, e.g., office visits, tests, vaccines, prescription renewals Preventive services, e.g., well-child visits, colorectal cancer screening (CRC), vaccinations Advise patients about the services that are due by phone, text or letter and schedule those for telehealth visits, if needed. Consider this a call to action for primary care practices! If you’re not already leveraging empanelment to optimize telehealth, expand access, make sure people are doing okay and keep people safe, what can you do by next Tuesday to up your game? < Previous News Next News >

USDA Invests in Four New Mexico Projects for Distance Learning and Telemedicine Infrastructure to Improve Education and Health Outcomes By Amy Mund February 25, 2021 The United States Department of Agriculture (USDA) today announced it is investing $42.3 million to help rural residents gain access to health care and educational opportunities. Rural areas are seeing higher infection and death rates related to COVID-19 due to several factors, including a much higher percentage of underlying conditions, difficulty accessing medical care, and lack of health insurance. The $42.3 million in awards includes $24 million provided through the CARES Act. In total, these investments will benefit 5 million rural residents. “The coronavirus pandemic is a national emergency that requires an historic federal response. These investments by the Biden Administration will help millions of people living in rural places access health care and education opportunities that could change and save lives,” said Agriculture Secretary Tom Vilsack. “USDA is helping rural America build back better using technology as a cornerstone to create more equitable communities. With health care and education increasingly moving to online platforms, the time is now to make historic investments in rural America to improve quality of life for decades to come.” USDA is funding 86 projects through the Distance Learning and Telemedicine (DLT) grant program. The program helps rural education and health care entities remotely reach students, patients and outside expertise. These capabilities make world-class education and health care opportunities accessible in rural communities. The ability to use telehealth resources is critical, especially now during a global pandemic. “The funding will provide new technology to expand learning beyond the classroom, healthcare beyond the doctor’s office and extend the reach of services to the respective regions,” said Acting New Mexico Rural Development State Director Eric Vigil. Fort Lewis College (FLC) in Durango, CO will use a $950,060 grant to strategically align technology that facilitates distance learning, improving access for roughly 3,270 students in the communities where they live. This HyFlex course design will be provided at four rural connectivity centers in La Plata and Conejos Counties in Colorado, Apache County in Arizona, and San Juan County in New Mexico. A HyFlex course design allows students to attend face-to-face classes, through synchronous sessions, fully online, allowing FLC to continue innovative delivering of quality education and support to students despite the continuing challenges presented by COVID-19. The rural connectivity centers will help mitigate the digital divide for the learning communities that are most affected by digital inequities by providing rural students with the internet and technology necessary to fully engage in courses from afar. They will also allow students from each community to access their professors as well as fully engage with the services that students on-campus are able to access including the student health center, faculty office hours, academic support such as tutoring and library services, and student-run organizations. Tanya V. Marin PC will utilize a $263,640 DLT Grant to purchase telemedicine equipment to help Santa Teresa Children's Day and Night Clinic implement a comprehensive health care and wellness programs. Six fully-equipped and upgraded telemedicine carts will be provided to five hub/end-user sites. These sites include three elementary schools and two community clinics. Each site will have the capacity to receive primary care services for children and adults, women's health, and mental health and behavior services, including substance misuse prevention and treatment. The sites are expected to serve approximately 14,000 people in Dona Ana, Socorro, Sierra and Union counties. Ben Archer Health Center Inc. was awarded a $153,963 DLT Grant to provide remote medical, dental and behavioral health care services for underserved and uninsured patients, and distance learning education for health care professionals in Dona Ana, Luna, Otero and Sierra counties. An interactive system involving telemedicine carts with accessories will enable live audio-video interactions between health care professionals and patients. Teleconference equipment for conference rooms will facilitate distance learning and group sessions, and laptops for medical, dental and behavioral providers will be used to provide services to patients in rural communities. New Mexico Highlands University received a $510,363 DLT Grant to create a distance learning hub/end-user site at the main campus in Las Vegas, and at a second end-user site in Mora, N.M. The system will eliminate barriers to higher education for residents of remote communities in San Miguel and Mora counties. This funding will enable New Mexico Highlands University to offer remote courses and to implement remote student support programs (especially for STEM students). In addition to equipping the remote site, the project will fund the purchase of computers configured specifically for distance learning. These computers will be loaned to students. The Mora site also be made available to community members for activities such as workforce development. A recent report by the Rural Policy Research Institute’s Center for Rural Health Policy Analysis found infection and death rates in rural America due to COVID-19 are 13.4 percent higher than in urban areas. A recent report from USDA’s Economic Research Service, USDA ERS - Rural Residents Appear to be More Vulnerable to Serious Infection or Death From Coronavirus COVID-19, underscored the challenges facing rural Americans amidst the COVID-19 pandemic with even greater detail. Due to a confluence of factors, including higher percentages of underlying conditions, lack of health insurance, and lower access to medical facilities/care than urban counterparts, ERS analysts found rural Americans are suffering more severe illness or death due to COVID-19. Rural Residents Appear to be More Vulnerable to Serious Infection or Death from Coronavirus COVID-19 Underlying health conditions (ages 20 to 84) Rural Percent, 23.7 Urban Percent, 3.0 Older adult population scale Rural Percent, 15.9 Urban Percent, 4.0 Lacking health insurance (ages 25 to 64) Rural Percent, 20.2 Urban Percent, 10.5 Distance to county with an intensive care hospital Rural Percent, 11.3 Urban Percent, 0.3 The table above is from the USDA ERS January 2021 report: Rural Residents Appear to be More Vulnerable to Serious Infection or Death from Coronavirus COVID-19 In January, President Biden requested all parts of the federal government to contribute resources to contain the coronavirus pandemic. USDA is responding to the President’s call to action. To date, more than 350 USDA personnel have deployed to assist with standing up vaccination sites, for example. In addition to personnel, USDA is offering its facilities, cold chain infrastructure, public health experts, disaster response specialists, and footprint in rural and Tribal communities across the country. USDA’s commitment to control the pandemic extends to our own staff and facilities, with masking and physical distancing requirements across USDA, a commitment to provide PPE to our front-line workers, and working with states to prioritize vaccinations for our workforce. For more information, visit www.usda.gov/coronavirus. USDA also encourages people seeking health insurance to go to HealthCare.gov now through May 15th due to a special enrollment period. If you are recently uninsured due to a job loss or between jobs, find a plan at HealthCare.gov and keep it for as long as you need it. USDA Rural Development provides loans and grants to help expand economic opportunities and create jobs in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural areas. For more information, visit www.rd.usda.gov/nm. USDA touches the lives of all Americans each day in so many positive ways. In the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, ensuring access to healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate-smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov . < Previous News Next News >

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

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 >