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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 >

GAO Reports on Telehealth and COVID-19 Flexibility Findings Center for Connected Health Policy June 2021 While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed. The United States Government Accountability Office (GAO) released testimony May 19th regarding their ongoing assessment of COVID-19 flexibilities within the Medicare and Medicaid programs, as required under federal pandemic response oversight provisions included the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Provided before the U.S. Senate Committee on Finance, the GAO focused its summarized findings around the effects of program flexibilities and preliminary observations related to telehealth waivers of certain federal requirements, as well as considerations regarding ongoing use. Telehealth waivers included allowing services to be provided remotely in all areas and settings, as well as expanding the types of providers and technologies that could be used, such as audio-only modalities. While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed. GAO testimony highlighted Centers for Medicare and Medicaid Services (CMS) data on recent telehealth utilization: -Medicare telehealth services increased from 325,000 services in mid-March to 1.9 million in late-April; then decreased to 1.3 million by June as it continued to steadily drop -Nearly 40% of beneficiaries received office visits through telehealth; nearly 60% received mental health services via telehealth -Internists and family practitioners were the primary provider specialties using telehealth, through which they delivered one-quarter of their services -89 of the 146 newly available types of telehealth services could be furnished via landline phones -More beneficiaries under age 65 received services via telehealth than those over age 65 -More beneficiaries in urban areas received services via telehealth than those in rural areas -Similar proportions of beneficiaries across all racial and ethnic groups received services via telehealth When highlighting potential considerations moving forward, the GAO added that preliminary observations show that due to lack of broadband and digital literacy, access to services via live video telehealth continues to be limited among those with low socioeconomic status, those over age 85, and those in communities of color. Given that CMS information indicated that telehealth services have continued as in-person visits have been able to increase, the GAO also suggested considering the potential for increased spending if payment parity requirements related to telehealth are maintained post-pandemic. In relation to fraud and program integrity, the GAO discussed the inability of CMS to determine many aspects of telehealth services, such as type of modality and specific location data, as well as the suspension of security rules that raise potential medical information privacy issues. In regard to quality of care via telehealth considerations, the GAO cited a study specific to Direct-to-Consumer telehealth companies potentially overprescribing antibiotics as their primary example, adding that CMS is still exploring how to measure quality related to services provided via telehealth. GAO information was based upon interviews of federal and state officials and provider and patient groups regarding their telehealth experiences, in addition to reviews of federal laws and CMS guidance. Additional GAO data and reports can be found on their website. < Previous News Next News >

Maximizing Telemedicine Benefits Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. In many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. Further, the use of telemedicine was facilitated at the state and federal levels but widespread waivers and measures being put into place to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements. Those of us in the field for a long time are hopeful that many of these measures will stay in place, but there are clearly some that will or already have expired. We are additionally hopeful that even though in-person practices are clearly coming back full-tilt, that everyone has seen and/or experienced the benefits of telemedicine and will continue to use it to some degree as feasible and appropriate with their patients. As this occurs, however, providers will be faced with new challenges as they take their initial telemedicine set-ups and transition to this new hybrid world of services. As noted, some things will still be allowed (e.g., certain billing codes) but others will likely return to pre-COVID status (e.g., not being able to use non-HIPAA-compliant devices and software platforms). In addition to finding the best software for future telemedicine applications, there are other things to consider when trying to maximize telemedicine benefits. From my perspective, although the technology is critical, telemedicine success has very little to do with the technology and everything to do with the people and the environment within which they practice. Thus, in order to maximize telemedicine these are the elements one should consider and focus on in addition to carefully selecting the most appropriate technology for your practice and providers. First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The use cases need to be clearly defined and must match an identified need. Then the who, what, where, why and when must be carefully delineated. Who needs to be involved (e.g., providers, billing, scheduling, IT, legal, administration), what clinical tasks can be accomplished via telemedicine, where will the technology and/or providers be located (e.g., clinic, home) and where will the patients be (e.g., primary care provider office, home, work, school), why will telemedicine be offered as an option (e.g., lack of sub-specialty providers, patients need to travel long distances, no show rates are too high) and when will telemedicine be offered (e.g., certain days/times, any opening in the schedule)? All of this can be accomplished by plotting out in a workflow diagram what the current practice is and how it needs to be adjusted in order to integrate telemedicine into that workflow. Again, the expectation is that although some practices might remain essentially virtual, the majority are going to evolve into a hybrid practice – but such a hybrid will not happen overnight or automatically. Workflow integration is going to be just as critical as integrating telemedicine technologies into a practice – it really is all about the people, setting expectations and establishing standard operating procedures and protocols for everyone that is going to be involved. Another thing that can be done to maximize a telemedicine practice is to properly train everyone on standard operating procedures and protocols, especially the providers who will be interacting with the patients. To date there are very few training programs that incorporate formally telemedicine as part of the curriculum. A number of programs are increasingly exposing trainees to telemedicine if offered at their institution, but typically as an elective or chance encounter in the clinic. There are however a number of organizations that are working on developing and promoting telemedicine competencies and the Association of American Medical Colleges (AAMC) recently developed a set of Core Competencies. Although specific to medical college trainees, they are comprehensive enough to cover nearly every other specialty/profession in many respects. Very briefly, the AAMC Telehealth Competencies consist of three domains, each with a set of explicit skills that increase in complexity and responsibility across three stages of practice: entering residency, entering practice and experienced faculty physician. The skills from each prior stage of training should carry over to the next phase as the provider becomes more expert and acquires additional skill sets. The six domains are: patient safety and appropriate use of telehealth; access and equity in telehealth; communication via telehealth; data collection and assessment via telehealth; technology for telehealth; and ethical practices and legal requirements for telehealth. Patient safety and appropriate use of telehealth includes 4 skill sets ranging from being able to explain to patients are caregivers the benefits and limitations of telemedicine to knowing when a patient is at risk and how/when to escalate care (e.g., convert to in-person) during an encounter. Access and equity in telehealth has 3 skill sets including knowing your biases and implications when considering healthcare, how telehealth can mitigate or amplify access to care gaps, and taking into account all potential cultural, social, physical and other factors when considering telemedicine. Communication via telehealth has 3 skills covering establishing rapport with patients, creating the right environment (e.g., lighting, sound) and knowing how to incorporate a patient’s social support into an encounter. Data collection and assessment via telehealth covers how to obtain a patient history, how to conduct an appropriate remote exam, and how to deal with patient-generated data. Technology for telehealth does not expect everyone to be an engineer or IT expert, but they should be able to explain equipment requirements for a visit, explain limitations and minimum requirements, and explain risks of technology failure and how to respond to them. Similarly, ethical practices and legal requirements for telehealth does not expect everyone to be a lawyer but should be able to describe local legal and privacy regulations, define components of informed consent, understand ethical challenges and professional requirements, and assess potential conflicts of interest (e.g., interest in commercial products/services). Many of these skills can be acquired by those already in practice by attending the wide variety of courses and webinars available for telemedicine skill building. It is also highly recommended that before engaging with patients for the first time via telemedicine to engage in some simulated practice sessions – from start to finish practicing each skill and developing your “style” for interacting with patients via this virtual medium. Finally, in order to maximize benefits you need to assess your program. This does not require a degree in statistics or setting up a complex experimental study. It really requires just two things – a set of metrics and a process. There are lots of metrics available and most have been studied in a wide variety of clinical applications so a good lit review will always help get you started. It is important to keep in mind that the things you measure need to reflect your goals/mission for using telemedicine and the bottom line of making a profit is not always the most appropriate metric to use. There are lots of relevant metrics and as a good starting place the article by Shore et al. “A lexicon of assessment and outcome measures for telemental health” is a great place to get some ideas. Although developed for the telemental health community the metrics provided apply quite well to nearly any specialty or practice. The metrics include such things as patient/provider satisfaction, no shows, symptom outcomes, completion of treatment, wait times, number of services, cultural access, cost avoidance and patient safety. Once you decide on metrics that are appropriate for your practice (recommend starting with 2-3 then add more as your practice grows) there is a very easy, straight-forward process for getting to outcomes. First, consider a given measure an indicator – these are concrete activities, products etc. that can be measured readily (e.g., from the patient record). For example, you could measure A1C levels in patients as a function of being enrolled in a telenutrition program. The next step is to set performance targets – these are concrete goals that are time limited and based on the indicator metrics. For example, you would like to see a 25% reduction in A1C levels in at least 50% of patients enrolled in the telenutrition course at 6 months post-baseline. Finally, you will have quantifiable outcomes (without fancy statistics) at the end of your set time period – if you meet your 25% reduction goal in 50% of patients great. If not, then maybe reassess the program or whether your goals were realistic. In any case, you now have concrete outcomes of your program demonstrating its benefits that you can provide to funders, administration, your care team and even patients and the community. In order to maximize telemedicine benefits you need to get the word out about its availability and its effectiveness! < Previous News Next News >

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

Health Care Disparities and Access to Video Visits Before and After the COVID-19 Pandemic: Findings from a Patient Survey in Primary Care Emily C. Webber, Brock D. McMillen, and Deanna R. Willis May 11, 2022 Abstract Background:In 2020, the Centers for Medicare & Medicaid Services reimbursement structure was relaxed to aid in the rapid adoption nationally of telemedicine during the COVID-19 pandemic. Due to limited access to internet service, cellular phone data, and appropriate devices, many patients may be excluded from telemedicine services. Methods:In this study, we present the findings of a survey of patients at an urban primary care clinic regarding their access to the tools needed for telemedicine before and after the COVID-19 pandemic. Patients provided information about their access to internet services, phone and data plans, and their perceived access to and interest in telemedicine. The survey was conducted in 2019 and then again in September of 2020 after expansion of telemedicine services. Results:In 2019, 168 patients were surveyed; and in 2020, 99 patients participated. In both surveys, 30% of respondents had limited phone data, no data, or no phone at all. In 2019, the patient responses showed a statistically significant difference in phone plan types between patients with different insurance plans (p < 0.10), with a higher proportion (39%) of patients with Medicaid or Medicaid waiver having a prepaid phone or no phone at all compared with patients with commercial insurance (26%). The overall awareness rate increased from 17% to 43% in the 2020 survey. Conclusions:This survey illustrated that not all patients had access to devices, cellular data, and internet service, which are all needed to conduct telemedicine. In this survey, patients with Medicaid or Medicaid waiver insurance were less likely to have these tools than those with a commercial payor. Finally, patients' access to these telemedicine tools correlated with their interest in using telemedicine visits. Providing equitable telemedicine care requires attention to and mitigation strategies for these gaps in access. Introduction Telemedicine and virtual care expanded rapidly during the COVID-19 pandemic of 2020. Fueled by necessity among health care providers and systems to deliver patient care, adoption was also driven by removal of barriers and expanded Centers for Medicare & Medicaid Services (CMS) reimbursement models. In March 2020, CMS authorized Medicare beneficiaries to receive telehealth at any location, including their homes.1 Subsequent waivers increased the scope of Medicare telehealth services, including a wider array of practitioners. Finally, the Department of Health and Human Services Office for Civil Rights announced that it would waive penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers who were using everyday communication technologies to provide telehealth services.2 These combined changes resulted in millions of additional telehealth visits. CMS data from March and June of 2020 showed an increase from 13,000 beneficiaries using telehealth before the public health emergency to 1.7 million in the last week of April 2020.3 These CMS expansions were made permanent in January 2021.4 Despite these expansions, not all patients are positioned to take advantage of the adoption of telemedicine and virtual care. The digital divide or lack of access to reliable high-speed internet is a well-described gap, made worse in 2020, as many entities turned to virtual solutions to work, study, and conduct business as usual. Nearly 42 million people in the United States may not have the ability to purchase broadband internet as of February 2020,5 disproportionately impacting communities of color as well as low socioeconomic status.6 Finally, according to BroadbandNow, an estimated 1.35 million (20%) residents in Indiana are unserved by broadband internet providers at their home address.7 At the height of the COVID-19 pandemic, precautions such as stay-at-home orders and business, municipal, and school shutdowns eliminated public options for internet access. Addressing these gaps is a critical step in preventing worsening inequities in access to care.8 In this study, we surveyed patients in an urban primary care clinic to determine their access to internet and devices, readiness, and barriers to utilizing telemedicine and virtual health care. Methods In August 2019, patients from a primary care clinic located in central Indianapolis, Indiana, participated in a 10-question quality improvement survey. The Institutional Review Board reviewed and determined the survey to be exempt. Each patient arriving at the clinic over a 2-day period was given the chance to participate. The paper survey included questions about home internet and device access, phone plan and phone data adequacy, and interest in virtual visits (see Supplementary Data for full survey). The patient's insurance coverage information was captured on the paper survey form by the staff before handing the form to the patient. The results were assessed using chi-square tests to determine differences between payor groups. A linear regression model was utilized to analyze the association of phone plan data adequacy with interest in video visits. Following the results of the first survey, efforts to improve adoption of virtual visits were undertaken, including office signage promoting virtual visits, offering a virtual visit follow-up at checkout, visual cues to prompt providers to schedule virtual follow-ups, and scripting for appointment schedulers to include offering virtual visits at the time of scheduling. In September 2020, the same quality improvement survey was repeated from the same clinic during an active time period of COVID-19 to see if additional quality improvement efforts were warranted. One additional question was added to the 2020 survey: “How has your ability to do a video visit changed since the onset of COVID-19?” The results were assessed using chi-square tests between payor groups. A linear regression model was utilized to analyze the association of phone plan data adequacy with interest in video visits. Scheduled appointments were tracked weekly by type and audited for completion throughout the study period. Video visits that could not be completed using video were converted to telephone visits and counted as telephone visits. For FULL article: https://www.liebertpub.com/doi/10.1089/tmj.2021.0126 Published Online:11 May 2022https://doi.org/10.1089/tmj.2021.0126 < Previous News Next News >

The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Centers for Medicare and Medicaid Services Nov. 10, 2021 CY 2022 Physician Fee Schedule (PFS) policies for Medicare The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Unless otherwise noted, the policies will take effect on January 1, 2022. Much of the proposals published in July 2021 for public commentary remain intact, but CMS did make several modifications and clarifications. https://public-inspection.federalregister.gov/2021-23972.pdf < Previous News Next News >

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

Are Amazon, Walmart, CVS & Dollar Store Taking Over Healthcare? Dr. Maheu, Telehealth.org August 2021 Amazon, Walmart, CVS, and Dollar General are making notable strides toward increasing their healthcare footprints, positioning themselves to create a seismic shift in healthcare. Telehealth.org has been reporting such efforts for the last several years, and this week offers you an update on the latest developments on amazon care, Walmart care clinic, CVS health, and Dollar General. Amazon Care Introduced in 2019, Amazon Care launched a pilot study for employees in Seattle, quickly followed by an expansion into Washington State. Amazon Care is now expanding nationwide. In addition to developing connections with other companies, the service appears most focused on expanding into underserved rural areas. The pivotal issue to consider as Amazon grows its healthcare footprint is that Amazon currently dominates two digital areas lacking in the industry: optimizing the delivery of digital customer experiences and excelling at the automation of services. Walmart Care Clinic In 2019, Walmart announced the first of its many health centers, called Walmart Care Clinic, with these offerings: primary care, labs, X-ray and EKG, counseling, dental, optical, hearing, community health (nutritional services, fitness), and health insurance education as well as enrollment, in a growing number of their facilities. Walmart has since been keeping itself involved in telehealth developments through mergers and acquisitions. Walmart, the largest in-person retail company in the United States, recently purchased MeMD, described as an “on-demand, multispecialty telehealth provider.” As a complementary addition to the already existing Walmart health centers, MeMD will enable Walmart to provide digital behavioral, primary, and urgent care services. Walmart has also begun a collaboration with Ro, a pharmacy services telehealth app. The relationship will also Ro to sell its health and wellness products in Walmart locations while further increasing Walmart’s digital service offerings. CVS Health Although CVS and Walmart had previously worked together to deliver care through Walmart’s pharmacies, CVS Health announced in January 2019 that Walmart opted to leave the CVS Caremark pharmacy benefit management commercial and Managed Medicaid retail pharmacy networks. That same year, CVS purchased Aetna for $69 billion in cash and stock. The merger brought one of the largest providers of pharmacy services together with the third-largest US-based health insurer. The successful merger formed a healthcare giant with more than $245 billion in annual revenue. Since then, CVS Health has steadily grown its healthcare footprint and, just last week launched a new health care benefit called Aetna Virtual Primary Care. The announcement reads: Offered through the CVS Health Aetna medical insurance subsidiary, Aetna Virtual Primary Care offers members access to a diverse panel of board-certified physicians and coordinated care from a consistent team of specialists based on their health needs. Members will have a continuous relationship with a virtual care physician, beginning from their first 30-45 minute comprehensive primary care visit and extending to every visit thereafter. Existing Aetna virtual care offerings include mental health counseling, dermatology services, and 24/7 urgent care. Dan Finke, executive VP, CVS Health, and President, Aetna, explained, “The future of digital health solutions is rapidly unfolding.” He added, “Aetna Virtual Primary Care is a first-of-its-kind health care solution that provides a simple, affordable, convenient way for eligible members to receive quality primary care from a physician-led care team that knows them and is accessible from virtually anywhere.” As described in his profile, Mr. Finke “is passionate about addressing mental health stigma. He is also deeply committed to attaining health equity for all Americans by engaging public and private stakeholders to address social determinants of health through analytics-based approaches that offer new insight and opportunities into health care disparities.” Dollar General Dollar General is a smaller company, but it has an enviable foothold in rural America. Their stores are well known and trusted. Therefore, they can offer care to patients who live in areas where primary care, behavioral and other specialists are difficult to access. While analysts doubt that Dollar General would follow Walmart’s lead and build primary-care clinics, telehealth solutions are easily within their reach. Dollar General differs from Amazon due to limited floor space, small parking lots, leased rather than owned retail space, and a lack of infrastructure for filling prescriptions. However, these limited abilities did not prevent Dollar General from serving as a site for COVID-19 testing in some states. Dollar General has already partnered with Higi, a blood-pressure machine company that can be seen in some Dollar general stores. Babylon Health is a telehealth provider that has invested in Higi. Given its rural presence, Dollar General may be positioning itself for acquisition by one of the larger publicly traded telehealth companies. In July 2021, the company issued a press released stating: With 75% of the U.S. population living within approximately five miles of one of Dollar General’s 17,000+ stores, the Company recognizes the unique access it provides to rural communities often underserved by other retailers as well as the existing healthcare ecosystem. The Company’s commitment to expanding its health offerings is underpinned by its existing infrastructure, robust supply chain, and current complementary health and nutrition assortment. < Previous News Next News >

A Decade of Telehealth Policy: A New Report From CCHP Mei Kwong- Center for Connected Health Policy August 2022 Ten years ago, in the early months of 2012, the Center for Connected Health Policy (CCHP) faced a decision of potentially great significance. The U.S. Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORPH) Office for the Advancement of Telehealth (OAT) had released a Funding Opportunity Announcement for their Telehealth Resource Center Grant Program and the incumbent contractor for the National Telehealth Resource Center for Policy (NTRC-P) contract would not be reapplying. After weighing the pros and cons of acting as the NTRC-P, CCHP decided to take the plunge and applied. On September 1, 2012, CCHP officially started its work as the federally designated National Telehealth Policy Resource Center and have been serving that role for the past decade. To mark CCHP’s ten-year anniversary as the NTRC-P, we are releasing a look back on telehealth policy in the United States. For the past decade, CCHP has tracked and followed policy development for all 51 jurisdictions in the United States (District of Columbia included) as well as at the federal level providing us with the unique opportunity to observe and study the development of telehealth policy in the United States on both the state and federal levels. This past decade also happens to be the period that encompasses some of the most significant telehealth policy developments seen thus far in the United States. The report is not intended to be an in-depth study on telehealth policy development and history as that could easily be an entire novel given the complexities and nuances that would need to be considered. The National Telehealth Resource Center for Policy Ten-Year Anniversary Report is intended to capture some of the highlights, significant changes, and environmental factors that have had an impact on telehealth policy development in the nation. Considering the increased interest in telehealth policy, CCHP believes this report also will be useful to provide context on how telehealth policy came to be where it is today, particularly for those who may be newer to the field. Additionally, the report is meant to be a celebration of the time CCHP has spent as the NTRC-P including the contributions the organization has made to the telehealth field. This report is dedicated to the memory of Mario Gutierrez, CCHP Executive Director from 2011-2017. Mario was the original visionary who decided in 2012 that CCHP should apply for the project. A special thank you must also be extended to CCHP staff, both past and present, who have truly been the engine that continues to drive the work of the organization forward. Special acknowledgment must be made of Laura Stanworth, Deputy Director, and Christine Calouro, Senior Policy Associate, both who have been with CCHP from the beginning of its role as the NTRC-P and who, along with myself, have seen this past decade of telehealth policy development, including producing all information and navigating CCHP through those first few months of the COVID-19 pandemic. We hope you will enjoy this report and find the information useful. CCHP looks forward to continuing on the ever evolving telehealth policy journey with all of you. See full report: https://mailchi.mp/cchpca/a-decade-of-telehealth-policy-our-10-year-anniversary-report < Previous News Next News >

CCHP Releases Updated Telehealth Billing Guide Center for Connected Health Policy March 16, 2021 The Center for Connected Health Policy (CCHP) has released a new updated telehealth billing guide as a follow up to its 2020 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services. The Center for Connected Health Policy (CCHP) has released a new updated telehealth billing guide as a follow up to its 2020 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services. Policy changes during the COVID-19 Public Health Emergency (PHE) have only made telehealth billing rules more nuanced. The updated billing guide addresses whether or not there is reimbursement for telehealth both generally and/or during the PHE, as well as how to correctly bill for a telehealth encounter, which is one of the most common policy questions CCHP receives as the National Telehealth Policy Resource Center (NTRC – P). Further complicating the billing process is the need to understand whether current rules are only applicable during the pandemic as well as the fact that payer policies continue to vary from payer to payer. For example, policies that apply to a Medicare beneficiary remain different than those that apply to a state Medicaid enrollee or to patients that have private insurance. DOwnload the guide here: https://www.cchpca.org/sites/default/files/2021-03/2021BillingGuideFINAL.pdf Please note, this resource is only provided as a guide and should not be considered legal advice. < Previous News Next News >

Studies Show How Telehealth Can Increase Equitable Access to Care Center for Connected Health Policy May 24, 2022 Focus on the relationship between telehealth and disparities in access to care continues to result in new research examining pandemic era data and the use of telehealth among disadvantaged populations. While policymakers and studies often try to put findings into two groups, whether telehealth increases or decreases inequities, recent research shows that the study framework used and considerations made may impact outcomes more so than telehealth itself. For instance, this month a new study published in Health Affairs found that as a result of emergency federal telemedicine coverage expansions access increased for all Medicare populations, including those in the most disadvantaged areas. The study was framed to examine the impact of expanded telehealth coverage policies on different populations, rather than looking at access generally where inequities have unfortunately always existed. Comparing pre-COVID temporary waiver data with post-waiver implementation data, the authors discovered that the highest odds of utilization were among those in disadvantaged and metropolitan areas. As reported in a Managed Healthcare Executive article on the study, the Johns Hopkins researchers concluded that the results suggest that increased Medicare telemedicine coverage policies improve access to underserved populations without worsening disparities. An additional study just published in Telemedicine Journal and e-Health and covered in a healthleaders article showed that a virtual care program at Penn Medicine is reducing barriers to access specifically for Black patients and eliminating historic disparities. The authors looked at approximately one million appointments per year in both 2019 and 2020 for Philadelphia area patients and found that Black patients used telehealth more than non-Black patients and that appointment completion gaps between Black and non-Black patients closed. Also recently released, the National Committee for Quality Assurance (NCQA) produced a white paper titled The Future of Telehealth Roundtable: The Potential Impact of Emerging Technologies on Health Equity, which focuses on how to ensure telehealth increases equitable access to care. Following up on its previous pandemic telehealth work, in late 2021 NCQA pulled together a multidisciplinary panel of equity and technology experts for a discussion on equitable access and virtual health care delivery. Reviewing hypothetical case studies and responding to various questions, participants highlighted potential challenges and identified three primary ways to ensure equitable access in telehealth delivery: Tailoring Telehealth Use and Access to Individual Preferences and Needs Addressing Regulatory, Policy and Infrastructure Barriers to Fair Telehealth Access Leveraging Telehealth and Digital Technologies to Promote Equitable Care Delivery The white paper suggests the need to prioritize language and cultural humility, address digital literacy, and optimize telehealth for people with disabilities. In addition, in terms of barriers, the authors stress the need to address broadband infrastructure and licensure limitations, while also updating laws and regulations that restrict telehealth use, including payment policies. Another Health Affairs article published this month, Policy Considerations to Ensure Telemedicine Equity, also looked at various factors that must be taken into account to allow telehealth to increase equitable access to care. The author clarifies that equity is a matter beyond telehealth and is related to patient-level barriers that include family, community, and general health care delivery level factors, such as issues related to the digital divide. In addition, the article cautions against policies focusing on increased utilization concerns, stating that increased use may mean that patients are finally attaining the care they need, in addition to the fact that increased access may reduce overall health care costs. Therefore, policies seeking to reduce reimbursement or limit audio-only modalities to address utilization and cost concerns may instead primarily reduce clinicians’ willingness to offer telehealth and modalities that mitigate access barriers for historically excluded groups. The article also highlights how varying payer policies, such as those that allow reimbursement for telehealth visits with new patients versus those that do not, creates inequities, and that differing medical licensing and/or prescribing regulations by state can create inequitable access issues on top of differing coverage policies. These policy considerations are key to ensuring telemedicine mitigates inequities rather than exacerbates them. While the pandemic generally has highlighted and exacerbated existing inequities, it has also provided the information necessary to show telehealth’s ability to address disparities and increase equitable access to care. It is important that policymakers take such findings and opportunities from studies on telehealth equity into account when looking to potentially make pandemic policies permanent in order to properly preserve telehealth’s positive impacts. It is also important that the framework used in the study be placed in context to help explain why some research speaks to telehealth disparities, or health care disparities, versus how telehealth is decreasing health care disparities. As shown in the aforementioned studies and articles, the difference in framing showcases that telehealth in and of itself does not create or exacerbate disparities, rather it is a tool that can be utilized to decrease disparities in access to care. The tool has to be allowed to be effective, however, and that is where the role of public policy comes in. Policies must support broadband and telehealth infrastructure and promote the use of technology to deliver care equal to the delivery of in-person care. For instance, Medicaid policies that limit when telehealth can be used and/or certain allowable modalities can create inequities in comparison to more expansive commercial policies that guarantee better telehealth access to non-Medicaid patients. Therefore, policymakers must recognize that regulatory restrictions around telehealth cannot prevent already existing general access disparities, rather it is often the regulatory restrictions around telehealth that lead to exacerbating disparities. It becomes vital that research be put into context so that subsequent policies are implemented that allow telehealth to reach its full potential to reduce disparities. For full article: https://mailchi.mp/cchpca/the-latest-telehealth-research-studies-show-how-telehealth-can-increase-equitable-access-to-care < Previous News Next News >

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Memorial Hermann to provide school-based pediatric telehealth Naomi Diaz October 18, 2022 Houston-based Children's Memorial Hermann has partnered with telehealth company Hazel Health to provide outpatient pediatric care to K-12 students in Houston. Under the partnership, schools that have agreements with Hazel will be able to offer their students access to health services via virtual telehealth sessions, according to an Oct. 17 press release. Children's Memorial Hermann pediatricians or specialists will connect with the students through the program for follow-up or long-term care management. The aim of the partnership is to increase access to pediatric care in schools across 12 counties in southeast Texas. See original article: https://www.beckershospitalreview.com/telehealth/memorial-hermann-to-provide-school-based-pediatric-telehealth.html < Previous News Next News >

Apply Now: $250 M in Telehealth Grants National Council for Behavioral Health April 30, 2021 Telehealth Grants - Apply Now Yesterday, the Federal Communications Commission (FCC) opened its second phase of the COVID-19 Telehealth Program with an additional $250 million available to eligible providers, including community mental health and substance use organizations. Organizations are strongly encouraged to apply for the grants that may be used to fund technology and equipment to bolster service delivery via telehealth. The application will close at 12:00pm ET on May 6, 2021. Read more and reach out here with any specific questions on the application process. COVID-19 Telehealth Program Application Resources: https://www.usac.org/about/covid-19-telehealth-program/covid-19-telehealth-program-application-resources/?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjbshy_rZnI19Utm_szbXLRtL_Em1obbBZMPGjL8UcKptxsAQkufy8_qpLAJ8F7YLbidFX_B4uUKtfjz1Xqfb00kuVsv-2qjkBEx3 COVID-19 Telehealth Program (Invoices & Reimbursements): https://www.fcc.gov/covid-19-telehealth-program-invoices-reimbursements?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjeRoIRGRmJOwVOAO8DxtchsnKpit1UbNY_hCbZZVDnK6jxX-VTendryRdaw0BeLxWnFcR90xotZs6ikzMrcjjvHZgcWX3tpv1reh Questions: Round2TelehealthApplicationSupport@usac.org < 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 >

How Telemedicine Requirements and Policies Will Change Post-Pandemic Jordan Scott, HealthTech July 2021 The public health emergency led to a loosening of telemedicine requirements and an uptick in virtual care use, but are these changes here to stay? Telehealth was instrumental in providing care throughout the COVID-19 pandemic as people avoided in-person interactions. While many people are now comfortable returning to in-person appointments, Americans are more open to using telehealth services than they were prior to the pandemic, and telehealth use is expected to remain above pre-pandemic levels. Some telehealth restrictions were lifted at the beginning of the pandemic out of necessity, a major factor in the rapid expansion of virtual care services. However, many providers are wondering if those changes are here to stay or if a tightening of telemedicine requirements will lead to a “telehealth cliff.” The CARES Act: How the Pandemic Changed Telehealth Policy Former U.S. Secretary of Health and Human Services Alex Azar declared a public health emergency on Jan. 31, 2020, in response to growing concerns over the spread of COVID-19. And on March 13, 2020, by Proclamation 9994, President Donald Trump declared a national emergency. As a result of authority granted under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Centers for Medicare & Medicaid Services (CMS) provided flexibility for Medicare telehealth services. It did this by broadening the waiver authority under section 1135 of the Social Security Act. Before the declarations, providers were subject to CMS’ geographic and originating site requirements for telehealth reimbursement under Medicare. According to the requirements, the originating site is the patient’s location at the time telehealth services are received. Under Section 1834(m) of the Social Security Act, the originating site must be a physician’s office, skilled nursing facility or hospital. The patient must also be located within a Health Professional Shortage Area or in a county outside of any Metropolitan Statistical Area as defined by the U.S. Census Bureau. “That meant an extremely small proportion of Medicare reimbursement was going toward telehealth, well under 1 percent,” says Kyle Zebley, vice president of public policy for the American Telemedicine Association (ATA). Dr. Ezequiel Silva III, a radiologist with the South Texas Radiology Imaging Centers and a member of the American Medical Association’s Digital Medicine Payment Advisory Group, explains that the waivers also impacted licensure. Physicians enrolled in the Medicare program licensed in any state can provide telehealth services to people anywhere in the U.S. if the state allows it. Each state has its own telehealth policies. The waivers also allowed physicians to practice from home since many offices were closed at the beginning of the pandemic, says Silva. He adds that CMS’ Interim Final Rule expanded coverage of audio-only health services, which helped those without access to two-way audiovisual technology and those who weren’t comfortable using video telehealth. Telehealth policies were put into place in 1997. While there’s been incremental expansion, the regulations haven’t kept up with changes in technology and what’s now possible in virtual care, says Zebley, who adds that if the pandemic hadn’t happened, the pace of telehealth adoption would have remained slow. However, he explains that the Medicare waivers had an extraordinary impact and led to an uptick in telehealth utilization. “During the first quarter of 2020, the number of telehealth visits increased by 50 percent, compared with the same period in 2019, with a 154 percent increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019,” reads a CDC report released in October 2020. “Laws hadn’t kept up with the way providers wanted to deliver care, so it was a game-changing moment,” says Zebley. “Ninety percent of Medicare beneficiaries are satisfied with their care, and two-thirds are very satisfied.” HIPAA-Compliant Telehealth Requirements Likely to Return The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) enforces HIPAA requirements. It announced on March 17, 2020, that “OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” Telehealth creates a unique challenge for HIPAA because a physician is no longer interfacing with a patient behind a closed clinic door, says Silva. Instead, information is transferred digitally, which requires different security precautions. Silva explains that while security requirements were reduced, OCR loosely defined which communication technologies could be used for telehealth. It also encouraged healthcare organizations to notify patients of privacy risks. AMA found this guidance to be appropriate, says Silva. However, it’s likely that HIPAA requirements will be reinstated once the public health emergency ends. “The reinstatement of HIPAA requirements is inevitable, and healthcare organizations need to prepare accordingly. They need to have their regulatory and legal offices getting ready to follow the spirit and letter of the law,” says Zebley. “It’s very clear what HIPAA requires. If an organization is operating a telehealth platform or technology that’s not HIPAA compliant, I expect that it would need to be compliant perhaps in a few months’ time.” The ATA supports the reinstatement of HIPAA requirements because it’s important to protect patient data, explains Zebley. Will Telehealth Restrictions Return Post-Pandemic? The public health emergency and telehealth waivers are still in place, but if the declaration ends before Congress or CMS acts, healthcare providers could hit a “telehealth cliff.” “If that happens it’s going to be regressive,” says Zebley. “However, I’m extremely optimistic that Congress will act before the emergency ends.” The public health emergency has been renewed approximately every 90 days since it was first declared, with the most recent renewal on July 20, 2021, by U.S. Secretary of Health and Human Services Xavier Becerra. Silva says there’s been speculation that the public health emergency will last through the end of the calendar year. If it doesn’t, the previous Medicare telehealth requirements could go back into effect until CMS rule-making addresses the issue. CMS released its 2022 Medicare Physician Fee Schedule Proposed Rule on July 19, 2021, which would extend the waivers on some telehealth services, especially those that address mental health, through the end of 2023. Comments are due on Sept. 17, 2021 “As CMS continues to evaluate the temporary expansion of telehealth services that were added to the telehealth list during the COVID-19 PHE, CMS is proposing to allow certain services added to the Medicare telehealth list to remain on the list to the end of Dec. 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE,” reads the CMS fact sheet. The CONNECT for Health Act of 2021, introduced in the U.S. Senate on April 29, 2021, aims to expand the use of telehealth by removing geographic requirements for telehealth services and expanding originating sites permanently. It’s one of several bills that could address the long-term expansion of telemedicine. Organizations such as the ATA and AMA have been advocating for a permanent expansion of telehealth services on federal and state levels. AMA published a telehealth implementation playbook for those looking to implement telehealth. Silva says the healthcare industry needs to look at the data around patient experience and the value of telehealth to determine how to proceed with virtual care policy going forward. Zebley encourages those who are concerned about the possible loss of telehealth flexibility to reach out to their elected officials. Source: https://healthtechmagazine.net/article/2021/07/how-telemedicine-requirements-and-policies-will-change-post-pandemic-perfcon < Previous News Next News >

Consumer Survey Data Supports Use of Virtual Visits Center for Connected Health Policy July 2021 The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. The Deloitte Center for Technology, Media & Telecommunications released the second edition of their Connectivity and & Mobile Trends 2021 survey, which gathered information from consumers about their relevant experiences during the pandemic. Using an online methodology of over two thousand consumers surveyed in March 2021, the report looks broadly at how the pandemic has influenced innovation and the “digital home,” including the increase in virtual doctor visits and patient telehealth preferences. In regard to telehealth, they found that over half of Americans had a virtual visit, 80% of those patients were satisfied with their experiences, and 62% were likely to schedule future telehealth visits post-pandemic. Almost 30% of consumers reported assisting someone else in their household with a telehealth visit. The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. While 30% of consumers reported no challenges, others did report they found the lack of human connection challenging, as well as the inability to have their vitals collected which was indicated more frequently among older patients. The report also looked at individual use of “wearables” to advance health and wellness, presuming their ability to support health care providers will continue to grow along with telehealth – although the authors also stated both will likely require the evolution of the regulatory landscape. Interestingly enough, use of wearables was actually found to be mixed during the pandemic and 39% said cost is the primary reason they haven’t bought one. Also, of note for those that had used wearables was that 60% claimed not to be concerned about privacy of their wearable-generated data, which is often raised as one of the main regulatory concerns related to increased innovation in health care. To review additional details about the information gathered, please view the findings in their entirety - https://www2.deloitte.com/content/dam/insights/articles/6978_TMT-Connectivity-and-mobile-trends/DI_TMT-Connectivity-and-mobile-trends.pdf#page=8. < Previous News Next News >

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Policy & Legislation New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. New Mexico Legislation Federal Resources NEW MEXICO LEGISLATION Telehealth NMSA § 13-7-14 "Healthcare Purchasing Act" NMSA § 59A-22-49.3 "Health Insurance Contracts " NMSA § 59A-23-7.12 "Group and Blanket Health Insurance Contracts " NMSA § 59A-46-50.3 "Health Maintenance Organizations " NMSA § 59A-47-45.3 "Nonprofit Healthcare Plans " (see also S.B.354 (2019) "Coverage for Telemedicine Services" ) Broadband NMSA § 63-9J-1 thru 63-9J-4 "The Broadband Access and Expansion Act" ( see also S.B.93 (2021) "Broadband Access and Expansion Act" ) New Mexico Federal FEDERAL RESOURCES Center for Connected Health Policy (CCHP) Find up-to-date information for Medicare, Medicaid, Federal Employee Plans, and more... CCHP, a nonprofit, nonpartisan organization, has been the federally designated National Telehealth Policy Resource Center since 2012. CCHP provides technical assistance to twelve regional Telehealth Resource Centers (TRCs), state and federal policy makers, national organizations, health systems, providers, and the public. CCHP - Federa l CCHP - New Mexico

AHA Statement Stresses Importance of Telehealth in CVD Care Yael L. Maxwell November 16, 2022 With ongoing challenges related to reimbursement, access, and acceptance, the writing committee offers potential solutions. Stressing the importance of telehealth in cardiovascular care, especially given its increased prevalence during the COVID-19 pandemic, a new scientific statement from the American Heart Association (AHA) outlines the current barriers to this type of care and offers some strategies for continued access. As in-person visits were shut down in the spring of 2020, many clinicians and patients turned to telehealth, with subsequent studies and surveys showing related gains in heart failure and nonemergent cardiovascular care. Other research showed that patients who were more likely to use telehealth tended to be younger and privately insured, have more comorbidities, and be from underrepresented racial/ethnic groups. As the pandemic has waned, however, reimbursement for telephone and video visits has been a larger concern. Earlier this month, the US Centers for Medicare & Medicaid Services (CMS) released its 2023 Physician Fee Schedule, which includes continued coverage for telehealth, but only for 5 months following the end of the public health emergency, which some say is not long enough for clinicians to make long-term plans and invest in necessary infrastructure. “This paper in a way summarizes the importance of telehealth and the benefits of telehealth in patient care,” writing committee chair Edwin A. Takahashi, MD (Mayo Clinic, Rochester, MN), told TCTMD. “Payment parity is so important in sustaining telehealth. So I hope that CMS and insurance companies will see the importance highlighted in this paper and reconsider their reimbursement plans with it.” What Is Telehealth? The statement, published online this week in Circulation, begins by defining the concept of telehealth, breaking it down into clinician-to-patient visits and clinician-to-clinician consults. The former includes real-time virtual visits, either video or audio, as well as digital communication, called eVisits, initiated by either the physician or patient. The latter includes both real-time virtual consults, which may also include the patient, as well as digital exchange of low-complexity medical information between clinicians, called eConsults, or second opinions on more-complex concerns. A final hybrid category includes remote monitoring for patients and predictive analysis for clinicians—both machine initiated. Takahashi and colleagues point out some commonly used telehealth tools for cardiovascular home monitoring, including machines for monitoring risk factors like blood pressure, weight, smoking, and diet; medication tracking apps and smart pillboxes for managing medication adherence; and tools like home EGC, pulse oximeter, and pulmonary artery pressure monitoring devices. While there are an undefined number of ways in which telehealth can be useful within cardiovascular care, Takahashi said it’s most effective in tracking disease progression for heart failure and CAD, improving stroke outcomes by decreasing time to diagnosis, and monitoring PAD progression, as well as preventing ulcers and tracking patients postoperatively. The paper outlines advances in telestroke, teleradiology, and telehealth in PAD management. Challenges and Potential Solutions Many challenges remain in order for telehealth to flourish in a nonpandemic era. In his experience, Takahashi said, the biggest barrier to using telehealth relates to “having patients accept it as a replacement for inpatient visits.” But overall, challenges like infrastructure—including broadband internet and hardware for patients—to complete telehealth visits as well as reimbursement stand in the way of telehealth use more generally, he said. “In order for people to adopt and use telehealth, people need to be able to bill for using it. Otherwise, it just is not sustainable.” The statement also stresses the importance that clinician attitude, biases, and acceptance play in the success of telehealth. Difficult to use technological platforms hindered by HIPAA-compliant encryption can also make it more difficult for clinicians to access telehealth appointments. Beyond increases in reimbursement for telehealth, the authors propose a few strategies for continued success. They advocate for government programs to improve broadband internet access across the country, more research to elucidate the specific benefits telehealth can have across the spectrum of cardiovascular disease care, and increased standardization for methods in assessing telehealth quality. “The COVID-19 pandemic improved the telehealth infrastructure through necessity but also uncovered systemic weakness, limitations, and inequities,” they conclude. “Further research into barriers for telehealth implementation and equitable execution are important to ensure the delivery of high-quality care for patients.” Yael L. Maxwell by Yael L. Maxwell Editor, Fellows Forum Yael L. Maxwell is Senior Medical Journalist for TCTMD and Section Editor of TCTMD's Fellows Forum. She served as the inaugural… Read Full Bio See original article: https://www.tctmd.com/news/aha-statement-stresses-importance-telehealth-cvd-care < Previous News Next News >