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 >

Study: Teletherapy program reduces OCD symptoms Emily Olsen May 23, 2022 Researchers found a 43.4% mean reduction in patient-rated obsessive-compulsive symptoms. A teletherapy program reduced symptoms of obsessive-compulsive disorder, and most patients maintained improvements up to a year later, according to a study published in JMIR. The treatment, from digital mental health company NOCD, included twice-weekly video appointments that used exposure and response prevention (ERP) therapy for three weeks. Patients then underwent six weeks of weekly half-hour video check-ins. Researchers followed up with the patients three, six, nine and twelve months after the therapy program. The study found a 43.4% mean reduction in patient-rated obsessive-compulsive symptoms as well as a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety and a 37.3% mean reduction in stress symptoms. Of the more than 3,500 patients included in the study, more than 1,600 participated in follow-up surveys. The study's authors were employed by NOCD or reported they had received payments from NOCD while conducting the study. "The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD," researchers wrote. WHY IT MATTERS The study's authors noted the virtual intervention took about 12 weeks and fewer than 11 therapist hours. "Technology assistance likely played an important role in this treatment’s ability to both engage and treat a large number of patients in wide-ranging geographic locations and to achieve a high mean rate of symptom improvement and a high rate of treatment response," they wrote. "Teletherapy using video allows people in remote locations to access treatment and to be able to complete, in-session, in vivo exercises in places and situations that are most relevant to, or triggering of, their symptoms." THE LARGER TREND NOCD announced it had raised $33 million in Series B funding in September last year. That brought its total financing to $50 million, according to Crunchbase. Mental health technology funding increased 139% globally in 2021, compared with 2020, bringing in $5.5 billion, according to a CB Insights report. Meanwhile, mental healthcare makes up a large portion of telehealth utilization in the U.S. Though utilization fell nationally in February, mental health diagnoses still made up more than 64% of telehealth claim lines, according to FAIR Health's tracker. For original article: https://www.mobihealthnews.com/news/study-teletherapy-program-reduces-ocd-symptoms < 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 >

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

Telehealth regulations don't go far enough for some Georgina Gonzalez April 21, 2022 Telehealth protections are fading as pandemic era waivers, which allowed providers to treat patients across state lines, are expiring. Many lobbyists are worried about the future of the industry and believe that the current proposals don't do enough to help secure its future, Politico reported April 20. More than 30 states have signed onto the American Medical Association favored Interstate Medical Licensure Compact, which creates a common application for providers, allowing them to more easily apply for licenses to practice in other states. However, some lobbying groups don't think the compact is enough. "[The compact] streamlines the application process, but it doesn't do a lot to reduce the burdens and costs of maintaining a multistate licensure footprint. That is a source of a lot of frustration for physicians in telemedicine," Nate Lacktman, partner at Foley & Lardner's law firm told Politico. The American Telehealth Association believes states should recognize each other's licenses, but acknowledges that due to the federal nature of the country, more compacts will have to be created to get around the problem. Another advocacy group, the Alliance for Connected Care, has proposed a voluntary national system that would recognize licenses from other states. However, the ATA thinks the federal government could tie federal funding to the proposal to encourage states to sign on. For Full Posting: https://www.beckershospitalreview.com/telehealth/telehealth-regulations-don-t-go-far-enough-for-some.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >

Telehealth May Help Reduce Medicine's Carbon Footprint Kat Jercich, Healthcare IT News July 2021 A wide-ranging study recently found that an increase in telehealth over the past six years corresponded with a decrease in greenhouse gas emissions due to transportation. A large-scale study recently published in The Journal of Climate Change and Health found that an increase in telehealth use in the Pacific Northwest corresponded to a dramatic decrease in transportation-related greenhouse gas emissions. The study – a collaboration among researchers from Northwest Permanente, Brigham and Women's Hospital and Harvard Medical School – examined six years of outpatient care at Kaiser Permanente Northwest, which serves more than 600,000 people in Oregon and Washington. "Prior to the pandemic, despite rising total visit volume, transportation-associated emissions were already declining due to a greater proportion of telehealth visits," observed the researchers. WHY IT MATTERS As the study notes, the healthcare sector is a "significant source" of greenhouse gas emissions. From 2010 to 2018, emissions from the U.S. healthcare industry increased by 6 percent. Although many of those emissions arise directly from facilities or indirectly from the supply chain, researchers note that patient transportation to clinics also plays a role in healthcare's carbon footprint. "To date, there are no large-scale studies of emissions reductions due to telehealth across an entire ambulatory system of a regional healthcare system in the United States, nor any studies showing the impact of COVID-19 on healthcare-associated [greenhouse gas] emissions as a result of rapid telehealth adoption," they explained. Team members looked back at the total number of in-person and telehealth visits from 2015 through 2020. They calculated the average distance between patients' home addresses and their assigned primary care clinics, and used Oregon Department of Transportation data about how individuals run errands to estimate what percentage of in-person trips were taken by car. They also assumed that telehealth visits replaced in-person visits on a 1:1 ratio (which may not be true, as other studies about downstream care have shown). Overall, in-person outpatient visits had increased at 1.5% per year through 2019 – but declined by 46.2% in 2020. Meanwhile, telehealth visits – which had already been increasing – jumped in 2020 by 108.5%. Researchers calculated that greenhouse gas emissions from patient travel due to transportation for primary care, specialty care and mental health visits fell from 19,659 tons CO2-eq in 2019 to 10,537 tons CO2-eq in 2020. "This reduction is primarily due to increased use of telehealth services as opposed to a decline in total annual visits during the pandemic and is evidenced by the total number of visits in 2020 being greater than prior years that had much larger total emissions," said researchers. "Nor is this reduction attributable to changes in fuel efficiency or transportation mode share over time, which are likely minimal on this time scale and were not modeled in this analysis," they added. The researchers argue that reductions in transportation-related greenhouse gas emissions "greatly eclipse" smaller increases associated with the use of computer equipment. The study has limitations: In addition to the 1:1 assumption mentioned above, researchers also pointed out that some visits would not have been conducted at a primary care clinic. In addition, they acknowledge that the Oregon DOT estimates may not represent medical appointment visits accurately. Still, "our study likely underestimates emissions reductions as we did not account for decreased commuting by healthcare providers conducting telehealth visits from home," the researchers wrote. "Furthermore, the environmental benefit of telehealth may not be limited to reductions in transportation-associated emissions if increased virtual care permits healthcare systems to care for more patients without increasing outpatient clinic space," they added. THE LARGER TREND Given the effect of climate change on the environment – and, in turn, on wellness, particularly for already vulnerable communities – many healthcare experts have called for action, with some noting the role that digital tools can play. In addition to preventative measures such as those outlined in the study, digital health tools may also help in the shorter term with regard to the consequences of climate change. When a winter storm tore through the southern United States earlier this year, for example, clinicians were able to keep seeing patients from their own homes. "If there are natural disasters, which we're seeing more and more of, because of global warming, we're hoping we'll be able to continue to provide care [via telehealth] through more weather events – like the freeze, like the hurricanes, and things of that nature," said William Kiefer, CEO of Chambers Health, a community-based system in Texas, in March. ON THE RECORD "If the U.S. healthcare system were to maintain or expand upon current levels of telehealth utilization, additional reductions in [greenhouse gas] emissions would potentially be achieved through impacts on practice design," said researchers in the new study. "Ambulatory visit carbon intensity would be an effective way to measure these changes." < Previous News Next News >

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

Transgender Telemedicine and Telehealth Services: A Tremendous Asset Dr. Maheu, Telehealth.org August 2021 Telehealth services can also be effective in reaching communities not isolated by location but marginalized by identity. One of the most significant arguments for telehealth services is their ability to reach people in underserved communities. Telehealth.org described some of the foundational issues in its article The Future of Telehealth, Teletherapy, and Telemedicine. The article specifically highlighted telehealth as a means of overcoming geographic limitations. However, telehealth services can also be similarly effective in reaching communities not isolated by location but marginalized by identity. In particular, transgender telemedicine & telehealth services provide significant benefits to the trans community. Challenges Facing the Transgender Community Telehealth.org outlined many challenges facing transgender individuals seeking services in its article Transgender Telemedicine: Inequities and Barriers in Health Care Access. In seeking therapy services, one of the most substantial dissuading factors reported by transgender individuals is fear of discrimination. This fear does not come without significant evidence. Last year, the Supreme Court decided to extend trans individuals the same discrimination protections other groups already experience under employment laws. Even after that landmark decision, 38% of Americans still indicate they do not support the rights of trans people. With so-called bathroom bills and legislation that prevents trans girls and women from participating on sports teams for women, the current American legislative landscape continues to be challenging. Location and marginalization often intersect. Trans individuals living in rural areas often face a general lack of available services. Additionally, available clinicians usually do not have a trans-informed perspective. Similar concerns exist in politically conservative areas. How Transgender Telemedicine and Telehealth Services Help the Trans Community As noted above, telehealth services have already been an asset to assist individuals who are geographically isolated. It should be just as effective in reaching trans individuals in those areas as helping others. For those isolated by discrimination and fear of discrimination due to their trans status, telehealth can also help. By allowing people in the trans community to reach beyond their geographic limitations, they immediately have access to a larger pool of supportive clinicians who can provide trans-informed services. Telehealth transgender services also provide increased anonymity to a degree for trans people. In many of rural America’s small towns, people know each other by vehicle. Seeing someone’s vehicle parked in front of a mental health or drug treatment facility can often send the town’s gossip mill into a tailspin. By accessing discrete trans telemedicine or telehealth services to their homes, people avoid this harmful exposure. Can Transgender Telemedicine & Telehealth Services Continue? Trans individuals used telehealth 20 times more in the past 18 months than they ever have before. This new safe therapy avenue, however, may not last. Just two weeks ago, four states either ended many of their telehealth expansion policies or announced their intention to do so. Federally, the waivers introduced by the CARES Act will expire in October unless renewed or made permanent. The system is in transition and it may well end up leaving behind some of the progress it has made. Transgender Telemedicine and Telehealth Advocacy The time is now to reach out to your officials, state and federal, and advocate for more permanent laws that expand telehealth services and reimbursement. Sharing case examples without client identifying information and your passion for the issue could be just the sort of personal advocacy needed. Your voice may persuade elected officials to act quickly and empathetically on behalf of the trans community and everyone else who will benefit from telehealth support. Rural Transgender Report: https://www.lgbtmap.org/file/Rural-Trans-Report-Nov2019.pdf < Previous News Next News >

Teletherapy Aimed to Make Mental Health Care More Inclusive. The Data Show a Different Story Jamie Ducharme June 14, 2021 Case studies suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For years, teletherapy has been pitched as the next frontier in mental-health care. Unlike medical disciplines requiring a more hands-on approach—say, physical therapy or surgery—talk therapy has long seemed a natural and effective fit for telehealth. And by taking appointments off the therapist’s couch and into patients’ homes via their devices, advocates argued, telehealth could make counseling more accessible and convenient for everyone, with particular benefits for those who lived in health care deserts or who couldn’t regularly drive back and forth to see a clinician. The hope was that virtual therapy could help democratize a system that allowed almost 20% of white Americans to receive mental-health care in 2019, but fewer than 10% of people identifying as Black/African American, Hispanic/Latino, Asian or Pacific Islander. Then, of course, the pandemic hit, sending the U.S. health care system into a panic and shuttering clinics and private practices nationwide. Telehealth, once psychiatry’s up-and-comer, was suddenly its lifeline. With impressive speed, a system built around face-to-face visits shifted almost exclusively online. By May 2020, 85% of the American Psychiatric Association’s (APA) surveyed clinician members said they were conducting the majority of their sessions virtually, up from just 2% prior to the pandemic. It was the perfect pressure test for the promise of virtual mental-health care. If there was ever a time for teletherapy to shine, it was during the pandemic. But the data aren’t so shiny. Telehealth has indisputably improved mental-health care access—but not to such an extent that it delivers on promises of revolutionizing the mental-health system. The same problems that kept many people—particularly those who are lower-income or of color—from seeking care before the pandemic still exist, even with the expansion of telehealth. As a result, mental-health usage in the U.S. hasn’t changed as drastically as many advocates would have liked. In a series of TIME/Harris Poll national surveys conducted this winter and spring, about half of respondents reported using telehealth since the pandemic began, compared with about 25% who said they had beforehand. Increases in telehealth usage during the pandemic, broken down by demographic groups But only about 5% said they’d gotten mental-health care for the first time during the COVID-19 crisis. That suggests the expansion of telehealth didn’t bring in an influx of new patients to the mental-health system. Government data show a similar picture: about a quarter of U.S. adults received mental-health care in the winter of 2021, according to the U.S. Centers for Disease Control and Prevention (CDC), up from about 19% in 2019. That’s an improvement, but not an enormous one. The number of U.S. adults reporting mental health problems grew significantly during the pandemic, but the number of those getting treatment did not Similarly, a March 2021 study from California’s Kaiser Permanente health system found that telehealth allowed clinicians to conduct 7% more psychiatric visits in spring 2020 than 2019—but most of those were with patients who already had a psychiatric diagnosis. Among people without a pre-existing diagnosis, volume declined by more than 40%, suggesting that virtual appointments were more helpful for people already served by the mental-health system than those outside it. On the opposite U.S. coast, telehealth allowed McLean Hospital, a psychiatric institution near Boston, to increase outpatient volume by about 15%, counting both new and existing patients, but psychiatrist-in-chief Dr. Scott Rauch says there’s “absolutely the recognition that there are some populations,” like certain older adults, “that are having difficulty accessing the technology.” In fact, despite the increased availability of telehealth, the share of American adults with an unmet mental-health need increased from August 2020 to February 2021, from 9% to almost 12%, according to CDC data. That’s understandable, given elevated levels of anxiety, depression and stress during the pandemic, but it also suggests teletherapy is not a panacea. And that means the harder work is still ahead. There are lots of ways to think about access to care. The most obvious—making it easy for a patient to speak directly with a clinician, either in person or via a device—is only one. There are also financial barriers. A single therapy session can easily top $100 (without insurance) in many parts of the country, and telehealth has done little to change that. Rightly so, argues Dr. Joe Kvedar, a former president of the American Telemedicine Association, since there’s no evidence to suggest virtual therapy is lower quality than face-to-face. Be that as it may, high price tags mean both therapy and teletherapy remain unattainable for many. Another limitation: there are simply not enough therapists to go around. More than 125 million people in the U.S. live in an area with a shortage of mental-health practitioners, according to U.S. Health Resources and Services Administration estimates. Whether they’re seeing patients virtually or in the flesh, there are a finite number of mental-health professionals with a finite number of hours in their days. Rauch, from McLean Hospital, says telehealth can increase appointment capacity somewhat, mainly because patients are less likely to cancel or no-show, but “as long as it requires an hour of clinician time to deliver an hour of clinical service, expanded access won’t be drastically enhanced.” To meet demand, the U.S. needs not only more therapists generally, but also more therapists from diverse backgrounds. A 2020 study concluded that just 10% of U.S. psychiatrists identify as Black, Hispanic, American Indian, Alaska Native, Native Hawaiian or Pacific Islander. That means many patients of color can’t find a therapist whom they trust and with whom they can form a close rapport, a barrier that dissuades many people from getting the help they need or prevents them from reaping the full benefits of therapy, says Dr. Amanda Calhoun, a psychiatry resident at Yale and a fellow on the APA’s Council on Minority Mental Health and Health Disparities. “There are many patients who want a Black therapist and they can’t get it,” Calhoun says. “If we truly want to reduce the gap [in mental-health care usage] we need to make it a trustworthy system where people feel they can connect with their therapist or psychiatrist.” Patients who do not speak fluent English, or who feel more comfortable using another language, may also struggle to find a therapist with whom they can communicate freely. Increased use of language interpretation could be an essential tool for expanding access, Calhoun says. It seems naive, or at least wildly optimistic, to think telehealth could overcome some of these entrenched structural issues. And in some cases, virtual care actually worsens disparities. Some people don’t have a reliable Internet connection or a smart device, for example. About 7% of American adults don’t use the Internet at all, according to Pew Research Center, and those without advanced education and people of color—i.e., those already often underserved by the mental-health system—are least likely to be “digitally literate,” according to a 2020 Health Affairs article. Further, elderly adults, an estimated 20% of whom have some sort of mental-health condition, may struggle to navigate virtual platforms even if they have quality Internet access. And online platforms aren’t perfect. Some people feel uncomfortable sharing their most intimate thoughts through a screen, and any digital system runs the risk of malfunctioning or being hacked. That recently happened in Finland, when a data breach led thousands of patients’ sensitive appointment notes to land in hackers’ hands. Plus, teletherapy is only convenient if you’re able to step away from work and other responsibilities to conduct the call in a private place. While the pandemic has many white collar workers drowning in time at home, surrounded by devices, that’s far from a universal experience. For essential workers, a disproportionate number of whom are people of color, it may be only slightly easier to steal away for a teletherapy appointment than it would have been to schedule an in-person visit with a clinician. Perversely, teletherapy may be making it easier than ever for people who already had access to mental-health care to get it, while leaving behind the people who arguably need it most. If teletherapy isn’t doing the trick, the question then becomes how to better serve those still not getting the mental-health care they need. Calhoun says any real solution needs to take a step backward and investigate why many people either cannot or choose not to seek help. For people of color, centuries of neglect and mistreatment by the medical institution are not easily forgotten. In the 1700 and 1800s, influential American doctors coined since-discredited diagnoses like “drapetomania” (psychosis or madness causing an enslaved person to run away) and “negritude” (essentially, the “disease” of not being white). Many contemporary providers aren’t aware of those offensive diagnostic frameworks, Calhoun says, but the cultural legacy of that racism is still widely felt in communities of color. Training more clinicians from underserved backgrounds is the single most impactful way to encourage people of color to get help, Calhoun says. But that process takes time. In the interim, she says, all clinicians need to be educated about psychiatry’s problematic past so they can acknowledge and understand why some patients may not feel comfortable seeking help, and then hopefully address those issues in their own practices. Looking beyond telehealth and focusing on community-based programs—like church-run mental-health groups or the Confess Project, a nationwide initiative that trains barbers to be mental-health advocates—may also help build that trust. Case studies also suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For the past decade-plus, Massachusetts has run a program that allows participating primary-care providers to teleconference in a psychiatrist during a child’s checkup, for example. Such programs don’t eliminate mistrust of the medical system, but they can at least make it easier to introduce people to the mental-health system. Mental-health apps—while not appropriate for patients with serious diagnoses, and clearly not an option for those without a smartphone—can also provide a cheap (or even free) stopgap measure for people struggling to find or afford an appointment with a clinician, Rauch says. And in some cases, adds Dr. Adrienne Robertson, a family medicine physician who works with the online medical startup Nurx, through which people can request prescription medicines and diagnostic tests simply by filling out a form, eliminating face-to-face interactions with providers can actually put patients of color at ease, because they can “just [be] a patient like everyone else.” Policy also plays a role. Nordic countries, like Sweden, have among the most robust and widely used telemedicine programs in the world, boosted by affordable, state-sponsored medical networks. Unlike in the U.S., where insurance limitations and out-of-pocket costs are roadblocks for some patients regardless of platform, many people in Nordic countries have a public option for virtual care. Last year, the Centers for Medicare and Medicaid Services made it easier for Medicare holders to use telehealth services, a policy that allowed more than a quarter of Medicare beneficiaries (and more than 30% of Black and Hispanic beneficiaries) to use telehealth during the fall and summer of 2020, but it’s not clear what will happen after the pandemic ends. Permanent federal action for Medicare and Medicaid holders—many of whom are low-income or elderly adults—could open up therapy to millions of people who can’t currently afford it. And changing federal policies that currently limit clinicians to treating patients located in the state where they are licensed could help even out distribution of the mental-health workforce. All of these fixes are considerably more complex than bringing appointments online; they require rebuilding the system, rather than simply shifting it to a new platform. That work needs to happen sooner rather than later, Calhoun says. Already, according to TIME/Harris Poll data, many people are returning to in-person medical appointments, both psychological and physical. In May, more than half of respondents who’d received mental-health care said they’d had an in-person appointment since the start of the pandemic, up from 37% in February. While some patients and clinicians are sure to stick with teletherapy after the pandemic, much of the system will seemingly revert back to how it was—and without concerted effort, the same problems may persist for years to come. This article can be found at https://time.com/6071580/teletheraphy-mental-health/. < Previous News Next News >

Telehealth integrated into EHR is the way to go for CarDon & Associates Bill Siwicki October 19, 2021 The skilled nursing organization has a 90% treat-in-place rate for all telehealth encounters, and data from its platform has helped identify areas for improvement. Just before the COVID-19 pandemic struck, CarDon & Associates, which operates 20 senior housing/skilled nursing communities in the Midwest, was exploring different ideas to give its staff time back, improve resident outcomes and reduce rehospitalizations. THE PROBLEM The organization wanted an effective telehealth platform with new technologies to streamline the process for contacting physicians and improving documentation in its system of record. It also wanted to give its nurses a sense of confidence with technology that could guide them through assessments to keep residents in-house. "Once the pandemic started, we had to act fast and implement new portable devices and temporary solutions to provide virtual physician and consult visits as well as provide our residents a way to connect with their families and friends," said Brandy Armstrong, RN, director of clinical information at CarDon & Associates. "The swift implementation worked, but we still wanted a better, more secure solution that would assist our staff and provide quality care for our residents. The pandemic made searching for a telehealth platform a higher priority." PROPOSAL CarDon & Associates turned to Third Eye Health for a telehealth solution. The telehealth technology offered fast connectivity with access to board-certified, state-licensed physicians who are trained to provide care in a post-acute setting. Coverage includes nights, weekends and holidays. "The solution includes a care coordination team that facilitates communication between our care team and their physicians," Armstrong explained. "Our care team could communicate with telehealth physicians and the care coordination team through the platform. The system sends alerts to the user's email for new messages, watch lists and new encounters. "The purpose of the platform was to provide an easy-to-use application on a portable device that would give our nurses quick access to physicians to treat our residents in-house, improve documentation and provide reporting and analytics." Brandy Armstrong, RN, CarDon & Associates "They also offer a cloud-based, HIPAA-compliant platform that integrates with our EHR," she continued. "All telehealth-generated documentation includes a wet signature that imports from their platform into our system of record." Lastly, the vendor offers reporting and analytics that measure clinical performance, usage, resident encounters treated in place and chief complaints. "The purpose of the platform was to provide an easy-to-use application on a portable device that would give our nurses quick access to physicians to treat our residents in-house, improve documentation and provide reporting and analytics," she said. MARKETPLACE There are many vendors of telemedicine technologies and services on the health IT market today. Healthcare IT News has published a special report detailing many of the vendors and their offerings. Click here to read the special report. MEETING THE CHALLENGE Before implementing the telehealth solution, CarDon & Associates distributed iPads to all nurses and CNAs, so it was already starting to transition to a more mobile workflow. After it deployed portable devices, the organization started implementing the new telehealth solution with training provided by vendor staff. "Our nurses use the telehealth platform heavily as part of their everyday workflow during the evening and weekend coverage time," Armstrong noted. "The nurses have a portable device to use specifically for telehealth encounters. They sign in at the beginning of their shift and contact the telehealth provider when needed. "The nurses use the platform for new admissions, readmissions, bridging scripts and changes in condition," she added. "They can have video encounters with the touch of a button and interact with a physician within two minutes." The telehealth solution is integrated with the organization's system of record from vendor MatrixCare. The organization collaborates with telehealth vendor staff along with MatrixCare staff to ensure successful integration with each facility at which it implements the technology, she said. RESULTS To date, CarDon & Associates has a 90% treat-in-place rate for all telehealth encounters. Out of 2,090 consults, 1,826 residents were treated in place. Using the data in the telehealth platform, the organization was able to identify areas for improvement. And improved documentation has been integrated with the system of record. ADVICE FOR OTHERS Armstrong has a variety of tips for healthcare organizations considering similar telehealth systems integrated with EHR technology: Identify what problems you are trying to solve, what goals you are trying to meet and how you will evaluate outcomes. Determine who in your organization will develop a policy and procedure, and who will be involved with planning, implementation and evaluation. Involve frontline staff in discussions to get their input, insight and buy-in. Buy-in will be necessary for the implementation phase. Consider appointing a champion to help with ongoing education to ensure the technology is being used the way it was intended. Share your outcomes with staff members within your organization. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication https://www.healthcareitnews.com/news/telehealth-integrated-ehr-way-go-cardon-associates < Previous News Next News >

The challenges of telemental health, and how they can be overcome Bill Siwicki June 14, 2022 Mental healthcare may be among the more intuitive specialties to deliver via telemedicine – but privacy demands, technology difficulties and the need for safe places deter some from taking advantage. Of all the medical specialties impacted by telemedicine during the course of the pandemic, perhaps the one with the most wholesale and lasting effects is behavioral and mental health. Mental health appointments do not typically involve any collection of vitals or specimens, nor do they absolutely require a face-to-face meeting, although therapists can observe physical cues from the whole body in person. Just talking via video, or even just audio, is enough. We talked with Dr. Janice Johnston, chief medical officer and cofounder of Redirect Health, a telehealth technology and services company, to get her expert observations regarding: The biggest ways telehealth is changing America's treatment of mental health. What impact increased telehealth accessibility has had on mental health treatment. The challenges telehealth presents in treating mental health. The improvements that can be made to telehealth for the treatment of mental health. Q. What are the biggest ways telehealth is changing the U.S.'s treatment of mental health issues? A. Before COVID-19 and historically in the U.S., there has been a negative stigma around receiving mental healthcare. While there have been a lot of movements and campaigns attempting to try and stamp out the stigma, many people have been deterred from seeking professional help due to a lack of coverage in healthcare plans, high copays and fear. As telehealth widens, the availability of mental health services continues to grow and is more accessible than ever. Gone are the days of driving to appointments and sitting in a waiting room, with the feeling that all eyes are on you. Social networks also have created a platform for mental health activists and we are seeing, in real time, an increase in people looking for treatment or routine mental care. COVID-19 accelerated the need for more access and new ways of treating mental health, such as telehealth. As a result of the COVID-19 pandemic, we also have seen many major insurance companies offer permanent or temporary plan benefits that include mental health services. Telehealth has made it easier for insurers to include these benefits in their plans with less out-of-pocket costs for patients. In many cases, insurance providers even waived the entire cost for visits when using telehealth. While most people don't want to be thought of or treated differently because they choose to seek mental health treatment, the stigma around it can make them feel judged, and they avoid choosing care. Telehealth has made it possible for people to now access care from the privacy of their homes, making the decision to seek care much easier and more comfortable. Being able to speak with a mental health professional from home has provided patients the ability to choose a setting that provides the most comfort, making the process of opening up and sharing concerns with a new person much easier. Q. What impact has increased telehealth accessibility had on mental health treatment in the U.S.? A. The COVID-19 pandemic forced changes for Americans across the country that have affected mental wellbeing, such as working from home, quarantine enforcements, lack of spending time with friends and family, and feeling isolated. This led to a surge in mental health issues with most non-emergency medical treatments shut down due to safety concerns and quarantine enforcements. Telehealth was a necessity we didn't see coming, and the pandemic accelerated this service due to the timely needs that were arising. With the higher demand for mental healthcare, telehealth has been the answer for many. People living in rural communities or underserved areas, specifically, experience limited access to specialty healthcare services, especially mental health. One of the key impacts of increased telehealth accessibility is that these communities have been able to turn to telehealth as an option when they may not have had an alternative. Different from rural or underserved communities, many urban populations see that finding in-person care isn't the difficult part, but affording it and getting to their appointment can be. Another key impact of increased accessibility is that telehealth tends to be a much more cost-effective option, as in-person care can regularly be more than double the cost. Think of all the money and time wasted having to take off work, which can result in lost wages, needing to hire a babysitter, or paying for gas when commuting to and from appointments. With telehealth, patients are able to afford their scheduled appointment at a time that is convenient and works for them. Additionally, while most offices provide services in standard office hours, many telemental health services provide care before and after work hours as well, so patients have more scheduling flexibility. There also are a lot of cultural barriers and health inequities that many minority communities experience that may deter them from seeking mental healthcare. During the pandemic, these communities experienced a rise in telemental health usage. While there are several reasons why this rise has occurred, we have seen that telehealth has been able to combat some of the barriers these groups have had to overcome. For one, telehealth affordability has made services much more accessible to minority groups or lower income individuals, enabling them to include mental healthcare into their budgets. Additionally, minority groups have experienced higher rates of depression and anxiety, only exacerbated by the pandemic, so the demand from these communities, along with the decrease in negative stigma around mental care through telehealth, has driven them to these options. Lastly, telehealth allows those with language barriers in the U.S. to have access to a broader group of mental health professionals who can provide a better understanding of their cultural backgrounds, partnered with the ability to speak in their preferred language. Q. What are some of the challenges telehealth presents in treating mental health issues, and instances when in-person care must be sought? A. While telehealth has expanded access to mental healthcare for so many across the country, there are still limitations that may lead some to favor in-person care. First, privacy. While many patients prefer telehealth so they can have their appointment in the privacy of their homes, there are situations where people may not have that same privacy in their home. Some people may live in multi-generational homes where others are home and in earshot, or they could share a room with others with privacy not immediately available. This may leave patients taking their calls from their car, which is not always comfortable or preferred. As a result, people in these settings may prefer care in person. Second, safe places. While some people prefer their care virtual for a variety of reasons, others feel that virtual mental healthcare is cold and distant, and favor in-person care in order to feel more engaged with their mental health provider. Sometimes being removed from their normal home setting can help create a safe place for the patient to discuss their mental health concerns. This is especially a factor with live support groups, which can be more engaging and easier in person than virtually. Many times, live support groups are used for people looking to overcoming addictions, and being able to separate them from their traditional setting can be helpful for pulling them out of their environment, even momentarily. And third, technology. Some individuals may not understand the technology behind apps or websites that provide mental health services. They may not know how to access video links or use their phone to connect to a provider, which could result in a sub-par session, where they do not feel comfortable or at ease. Patients also do not want to see time consumed or wasted during their appointment because of technical struggles and may prefer to see their providers in person to avoid the hassle of these situations. Q. What improvements can be made to telehealth specifically for the treatment of mental health issues? A. We can look to the current challenges of the telehealth space to find where to start with improving the telehealth experience for everyone. For starters, creating wider access to the internet allows telehealth to reach more people who may not have any options available to them today. In fact, the Biden administration recently secured commitments from 20 leading internet service providers to either reduce prices or increase speeds to serve low-income households. This is a great step in the right direction. Better cellular and internet speeds allow for more telemental health experiences to be held over video, and not telephonically, where mental health professionals can better assess their patient through both verbal and nonverbal cues. With all the advancements and changes we have seen in technology in just the last few decades, there is a lot for patients and providers to keep up with. Education is key to making sure telehealth sticks around and continues to rise in its availability. Many providers are willing to learn new technology, but need to be trained by the people that thoroughly understand the ins and outs of these systems. As new standards of care are set by technological advancements, providers and patients alike need to be provided the education to keep up with these evolving standards. It is important for those implementing new systems to deliver the proper education providers need to learn the technology, as well as assist their patients. Another thing to consider is how to assist patients with disabilities through telehealth. There are laws in place in the U.S. to ensure equality in care for those with and without disabilities, and therefore considerations need to be made in telehealth situations as well, such as providing additional instructions or scheduling longer appointment times. Sometimes added support or modifications need to be made to technology systems in order to support these patients as well. Telehealth systems should meet accessibility requirements and should provide resources that are available in multiple formats, like audio recordings or large text sizes. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. For more information: https://www.healthcareitnews.com/news/challenges-telemental-health-and-how-they-can-be-improved < Previous News Next News >

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 >

Membership Benefits Welcome to the New Mexico Telehealth Alliance! This members section contains exclusive content and is available to subscribed members. For information on membership benefits, please select an option below. If you're already a member, please log-in to access your exclusive content. Click here to download NMTHA virtual backgrounds (ZOOM and Google Meets compatible). Membership Benefits Learn more New Member Log-in Guide Download Add/Change Member Guide Download

Federal Broadband Funding Negotiations Continue Center for Connected Health Policy June 2021 As the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. President Biden’s American Jobs Plan originally totaled $2.3 trillion, $100 billion of which was designated to broadband. As noted in recent CNBC articles, as the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. While Senate Republicans then put forward a $928 billion counteroffer, there appears to be agreement on both sides with the piece of the proposal designating $65 billion to broadband. Nevertheless, discussions on other issues remain far apart and it is possible to pass the bill without Republican support in the evenly split Senate, therefore Senate Majority Leader Chuck Schumer recently expressed his desire to continue the process with or without Republicans to get comprehensive jobs and infrastructure legislation done this summer. For more information read the American Jobs Plan in its entirety - https://www.whitehouse.gov/american-jobs-plan/. < Previous News Next News >

22 States Changed Telemedicine Laws During the Pandemic Kat Jercich June 2021 Most pursued changes via administrative action, according to a new Commonwealth Fund report, which may not be a permanent solution after the COVID-19 public health emergency ends. The Commonwealth Fund released an issue brief this week reviewing state actions to expand individual and group health insurance coverage of telemedicine between March 2020 and March 2021. It found that 22 states changed laws or policies during that time period to require more robust insurance coverage of telemedicine. "If telemedicine proves to be a less costly way to deliver care, payers and consumers may benefit from expanding coverage of telemedicine after the pandemic," wrote report authors. WHY IT MATTERS In March 2020, federal regulators temporarily relaxed restrictions for telemedicine visits for Medicare patients, raising payments to the same level as in-person visits and reducing cost-sharing, among other changes. Officials encouraged states and insurers to provide similar flexibility under private insurance – and many took that encouragement to heart. Of the 22 states that expanded access to telemedicine during the pandemic, the report found that most pursued changes via administrative action. "Use of executive authority allowed states to move relatively quickly during the crisis, though it has meant that the new telemedicine coverage requirements are temporary," wrote the researchers. They noted, for example, that seven governors included specific telemedicine coverage requirements in executive orders, which will expire after the public health emergency. Some states used bulletins, notices, or executive orders from the department of insurance or a similar agency to enhance coverage. New legislation, which takes more time, but is necessary for permanent changes, passed in eight states. Utah, Illinois, West Virginia, New Hampshire and Massachusetts – which had not previously required coverage – changed their policies during the pandemic. At this point, 40 states require coverage. These policies do not all carry equal impact. Eighteen states required coverage of audio-only services for the first time during the pandemic, bringing the total number up to 21. Four states eliminated cost-sharing for telemedicine services, and three added a requirement that cost sharing not exceed in-person identical services. And 10 states newly required insurers to pay providers the same for telemedicine and in-person visits. Report authors noted that insurers were cooperative with these changes, but longer-term adoption of policies like reimbursement parity "would likely be contentious." They pointed out the states will need data to inform debates on how best to regulate telemedicine. In 2021, at least 30 states have weighed legislation that would revise telemedicine coverage standards, found the Commonwealth Fund. Despite the known benefits of telemedicine, researchers also cautioned that it has not been equally beneficial to all patients. "Research shows telemedicine use is lower in communities with higher rates of poverty and among patients with limited English proficiency, potentially undermining goals of expanding access to underserved communities and exacerbating health inequities," read the report. THE LARGER TREND As the report notes, multiple states have implemented pro-telehealth policies to enable access during and beyond the COVID-19 public health emergency. But a major question remains regarding federal legislation, which could fill in many state-by-state gaps and prevent a so-called "telehealth cliff." "If Congress does not act before the public health emergency ends, regulatory flexibilities that now ensure all Medicare beneficiaries maintain access to telehealth will go away," said Kyle Zebley, director of public policy at the American Telemedicine Association, during a conference panel earlier this month. ON THE RECORD "Whether telemedicine reduces overall healthcare costs depends on how services are reimbursed and if virtual visits reduce other services or simply add to utilization," said Commonwealth researchers. "Having access to data can help stakeholders understand how longer-term expansion of telemedicine affects access, cost, and quality of care." Source: https://www.healthcareitnews.com/news/22-states-changed-telemedicine-laws-during-pandemic < Previous News Next News >

2021 National Telemedicine Summit World Conference Forum, LLC Sept. 13, 2021 Key Strategies to Revolutionize & Transform Healthcare Delivery, Optimize Quality Patient Care & Outcomes, Increase Accessibility, Enhance Data Analytics, and Reduce Costs! September 13 – 14, 2021 • The Ritz-Carlton, South Beach • Miami, FL Today, telemedicine is one of the fastest growing sectors in healthcare. Specifically, COVID-19 has enhanced and accelerated the role that telemedicine plays within our healthcare system. It is reshaping the landscape of healthcare delivery in the United States, and is being recognized as the future of global healthcare. Telehealth addresses and achieves the basic tenants of Healthcare Reform: providing the population with access to improved and convenient, high quality patient centric care, enhancing outcomes, while reducing per capita expenditures. Today, more than 70 percent of hospitals throughout the United States are engaged in telehealth programs. Studies have shown that the benefits of telehealth include significantly improved outcomes, efficient care delivery as well as reduction in mortality rates, hospitalizations, length of stay, readmissions and healthcare costs. Telehealth has greatly enhanced access to quality care in rural areas and patient satisfaction has increased due to its convenience and patient centric approach. We have created an exciting, high level forum featuring knowledgeable leaders and executives from the nation's leading Hospitals and Health Systems who will share their perspectives, valuable insights and expertise on how to be best equipped for the rapidly evolving and exciting landscape of telehealth. This exclusive event targets senior level executives in order to maximize educational and networking opportunities. By attending the 2021 National Telemedicine Summit, you will learn what highly regarded Hospitals and Health Systems are doing to be prepared for the challenges that lie ahead in 2021 and beyond! We look forward to greeting you in Miami! Link: https://www.wcforum.com/conferences/telemedicine < Previous News Next News >

Join Pivotal NM & The Grant Plant for an Overview of FCC's COVID-19 Telehealth Program Application Joohee Rand April 23, 2021 Pivotal NM is hosting an urgent info session this Friday April 23rd, 10am to provide an overview so that more providers will be ready for application from New Mexico. Anchorum St. Vincent has partnered with PIVOTAL NM to provide technical assistance in applying for the FCC’s Covid-19 Telehealth Program in 2021. $250M in total funding is available through this program this year, and FCC just announced that the application will be open from April 29 – May 6th, for just one week. Pivotal NM is hosting an urgent info session this Friday April 23rd, 10am to provide an overview so that more providers will be ready for application from New Mexico. Pivotal New Mexico will be also hosting additional office hours in the following week and can be available for further support in applications. Registration: https://mailchi.mp/pivotalnm.org/join-us-to-learn-about-fccs-telehealth-grant-app?e=95bb6af734 < Previous News Next News >

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

Grants & Funding The Federal government has numerous funding sources for telehelath support: USDA Community Connect Grants USDA Distance Learning and Telemedicine Grants Other Telemedicine Grants FCC Rural Health Care - Healthcare Connect Fund USDA COMMUNITY CONNECT GRANTS This federal program funds broadband deployment into rural communities where it is not yet economically viable for private sector provi ders to deliver service. For more information, please visit USDA Community Connect Grants . USDA DISTANCE LEARNING AND TELEMEDICINE GRA NTS Th is federal program helps rural communities use telecommunications' unique connectivity capabilities to overcome effects of remoteness and low population density. Grant funds may be used for a cquisition of eligible capital assets, such as: Technical assistance and instruction for using eligible equipment Inside wiring and similar infrastructu re that further DLT services Acquisition of instructional programming as a capital asset Computer hardware, network components, and software Audio, video, and interactive vid eo equipment Terminal and data terminal equipment For more information , please visit USDA Distance Learning and Telemedicine Grants . OTHER TELEMEDICINE GRANT OPPORTUNITES The Health and Human Services Division for telehealth and broadband related programs posts funding opp ortunities HE RE . HEALTHCARE CONNECT FUND The New Mexico Telehealth Alliance (N MTHA) manages the Southwest Telehealth Access Grid (SWTAG), a Federal Communications Commission (FCC) approved consortium for funding through the Healthcare Connect Fund (HCF). If you manage one or more healthcare provider sites serving clients in New Mexico, contact NMTHA to discuss joining SWTAG. Advantages to applying to SWTAG via NMTHA include: Lower application and administrative costs. Access to expert funding advice for a mix of rural and urban sites. Professional assistance with proven track record of funding success. Additional information on eligibility and application procedures can be found HERE . Community Connect Distance Learning Other Healthcare Connect

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