Updated Version of CONNECT for Health Act Introduced in Congress Center for Connected Health Policy May 4, 2021 Last week an updated version of the CONNECT for Health Act was introduced in Congress. Last week an updated version of the CONNECT for Health Act was introduced in Congress. The bill, which was first introduced in 2016 but has been repurposed in this newest version to remove restrictions on telehealth for mental health, stroke care and home dialysis in certain circumstances. It also addresses several of the restrictions in Medicare, including geographic limitations, expanding originating sites to include the home, restrictions on federally qualified health centers (FQHCs) and rural health clinics (RHCs) reimbursement and gives the Secretary of Health and Human Services the ability to waive other telehealth restrictions permanently. For more information, see the press release, or read the bill’s summary published by Senator Schatz office. Stay tuned for a deeper dive and further analysis from CCHP next week. Press Release: https://www.schatz.senate.gov/press-releases/schatz-wicker-lead-bipartisan-group-of-50-senators-in-reintroducing-legislation-to-expand-telehealth-access-make-permanent-telehealth-flexibilities-available-during-covid-19-pandemic Summary: https://www.schatz.senate.gov/imo/media/doc/CONNECT%20for%20Health%20Act%20of%202021_Summary.pdf < Previous News Next News >

Amazon rolls out its telehealth service nationwide Annie Palmer, Bertha Coombs February 8, 2022 Amazon is launching its telehealth program, known as Amazon Care, nationwide and has signed up a handful of new companies to use its services. Amazon is rolling out its telehealth service, known as Amazon Care, nationwide, the company announced Tuesday. Amazon Care launched in 2019 as a pilot program for employees in and around the company's Seattle headquarters. The program provides virtual-care visits, as well as free telehealth consultations and in-home visits for a fee from nurses for testing and vaccinations. It has since expanded into more of a primary care service. To read this full article: https://www-cnbc-com.cdn.ampproject.org/c/s/www.cnbc.com/amp/2022/02/08/amazon-care-telehealth-service-launches-nationwide.html < Previous News Next News >

The changing landscape of telehealth: 4 federal legislative developments Naomi Diaz May 24, 2022 Federal lawmakers have introduced four bills that look to update, continue, renew and expand telehealth access for patients and providers. Below are recent federal developments for policy, regulatory and legal changes related to telehealth during the COVID-19 pandemic, according to JD Supra: HHS' $16.3 million for Title X family planning program: On May 10, HHS announced it will release $16.3 million in grants for family planning groups to expand telehealth services and infrastructure. The funds will be made available through the American Rescue Plan and will be awarded to 31 Title X family planning programs and facilities. Restoring Hope for Mental Health and Well-Being Act: The bill, introduced May 6, would provide grants to schools and emergency departments to scale up or expand pediatric mental health telehealth access. Women's Health Protection Act: Introduced May 4, this bill would protect a provider's ability to provide abortion services via telehealth. Telehealth Extension and Evaluation Act: This bill, introduced April 26, would extend telehealth flexibilities enabled by Medicare for two years following the COVID-19 pandemic. < Previous News Next News >

NM Telehealth Workgroup Hosted by the New Mexico Telehealth Alliance 7/29/2021 New Community Forum for NM Healthcare Peers on Telehealth Topics This is a monthly community forum to discuss telehealth issues with your healthcare peers. The intent is to help New Mexican systems advance remote care. Topics will change monthly and be directed by what the group members ask for. Hosted by the New Mexico Telehealth Alliance, our first session on July 29 is a collaboration with Presbyterian Healthcare Services and the University of New Mexico. We will explore audio only post-pandemic billing using HCPCS code G2252. Register here: https://www.eventbrite.com/e/nm-telehealth-community-forum-registration-163947169397 < Previous News Next News >

Trends in Telehealth Prescription Laws Kirin Goff, Southwest Telehealth Resource Center July 2021 New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. States across the country are proposing or enacting legislation that supports making the increased access to telehealth that occurred during the pandemic permanent. However, many states seem to struggle with how to appropriately regulate remote prescribing requirements as there is wide variation in approaches and priorities emerging in these proposed and new laws. The most common approach is to carve separate requirements for controlled substances, and then clarify if and under what circumstances they can be prescribed via telehealth. Notably, concerns about addiction and access to mental healthcare are becoming increasing prevalent in telehealth legislation. Some states are attempting to address the latter by specifically expanding telehealth to meet these needs, including allowances for remote prescriptions. The Worsening Drug Epidemic As the COVID-19 pandemic took center stage, substance use also increased. Preliminary estimates indicate that in the first eight months of 2020, drug overdose deaths increased by 48.1% in Arizona and 46.8% in Colorado, compared to same period in 2019. In the U.S. as a whole, drug overdoses increased by 27% between September 2019 and August 2020, compared to the previous twelve months (all data are based on Commonwealth Fund examination of provisional data from CDC’s National Vital Statistics System). As more Americans become personally impacted by the opioid epidemic, opinions about drug policy seem to be shifting. In lieu of strict regulatory measures, harm reduction is becoming more mainstream, and approaches seem to increasingly favor policies that improve access to care for substance use disorders. For example, the American Medical Association put out an issue brief supporting policies that employ evidence-based harm reduction policies and “remove existing barriers for patients with pain to obtain necessary medications…[including] arbitrary dose, quantity and refill restrictions on controlled substances.” Controlled Substance Prescription Arizona has addressed this issue most directly and comprehensively by enacting HB 2454. This law allows providers to prescribe Schedule II drugs, which are defined as drugs with high potential for abuse, such as Vicodin, methadone, and OxyContin, via audio-visual examination and delegates review for more detailed requirements to a newly created Telehealth Advisory Committee. The committee will “review national and other standards for telehealth best practices and relevant peer-reviewed literature” and establish best practices for providers to follow. This committee must include several experts in behavioral health and substance use, indicating that optimal ways to regulate prescribing controlled substances are a high priority. In other Southwestern states, the majority of recent bills on the topic focus on cannabis. For example, New Mexico’s medical marijuana law (HB 2) allows providers to determine medical marijuana qualification via telehealth. Likewise, Utah recently passed a bill (SB 170) allowing for medical marijuana renewal via telehealth examination, although it still requires in-person exams for initial recommendations. Research and Access to Care Healthcare access issues are also of primary concern, and telehealth is seen as a potential solution, particularly in rural areas. For example, New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. Likewise, Utah attempted (HB 36) to extend the term of a grant for research about how telehealth can improve access to mental health care, particularly for underserved populations. The range of proposed and enacted laws reflects a lack of evidence as well as differing ideologies among legislators. It is unusual for such substantial changes to the legal framework to occur so quickly – without more incremental steps and without a significant body of experience and precedent to glean from other jurisdictions. Arizona’s HB 2454 provides an innovative approach to remote prescribing by providing both access and data, which will be key to watch as states continue to pass telehealth legislation. < Previous News Next News >

Principal Deputy Inspector General Grimm on Telehealth By Christi A. Grimm, HHS-OIG Principal Deputy Inspector General February 26, 2021 It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. It has been just over a year into the COVID-19 pandemic and we remember the over 500,000 Americans who have lost their lives due to COVID-19. That figure is a stark reminder of the critical mission of the Department of Health and Human Services. Challenges in responding to the pandemic have been many, thorny and unprecedented. Consequential decisions often were made quickly to respond to the emergency and provide relief in the way of funding, supplies, and reductions in regulatory and procedural burden. This quick response and scope of relief make oversight, enforcement, transparency, program integrity, and accountability all the more important. Early in the pandemic, OIG, along with many others, recognized the value of expanding options for accessing health care services. Telehealth is a prime example. Where telehealth and other remote access technologies were once a matter of convenience, the public health emergency made them a matter of safety for many beneficiaries. In some cases, health care providers needed regulatory flexibility to provide safe and effective care remotely during the ongoing pandemic. In March 2020, we issued policy statements and FAQs in support of increased telehealth flexibilities. A year later, there is a robust national conversation about expanding coverage for telehealth services based on the experience providers and patients have had during the pandemic. For most, telehealth expansion is viewed positively, offering opportunities to increase access to services, decrease burdens for both patients and providers, and enable better care, including enhanced mental health care. A 2019 OIG study found that telehealth can be an important tool to improve patient access to behavioral health services. And as we observed in recent rulemaking, OIG recognizes the promise that telehealth and other digital health technologies have for improving care coordination and health outcomes. It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse, or misuse. OIG is conducting significant oversight work assessing telehealth services during the public health emergency. Once complete, these reviews will provide objective findings and recommendations that can further inform policymakers and other stakeholders considering what telehealth flexibilities should be permanent. This work can help ensure the potential benefits of telehealth are realized for patients, providers, and HHS programs. We anticipate the first work products to be published later this year. We are aware of concerns raised regarding enforcement actions related to "telefraud" schemes, and it is important to distinguish those schemes from telehealth fraud. In the last few years, OIG has conducted several large investigations of fraud schemes that inappropriately leveraged the reach of telemarketing schemes in combination with unscrupulous doctors conducting sham remote visits to increase the size and scale of the perpetrator's criminal operations. In many cases, the criminals did not bill for the sham telehealth visit. Instead, the perpetrators billed fraudulently for other items or services, like durable medical equipment or genetic tests. We will continue to vigilantly pursue these "telefraud" schemes and monitor the evolution of scams that may relate to telehealth. As our work and the national conversation continues, OIG believes there is a shared goal: ensuring that telehealth delivers quality, convenient care for patients and is not compromised by fraud. As we continue our COVID-19 oversight and enforcement work, we look forward to providing objective, independent information to stakeholders and policymakers. < Previous News Next News >

OCR Clarifies Post-PHE HIPAA Compliance for Audio-Only Telehealth Center for Connected Health Policy June 21, 2022image The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently released guidance on the use of remote communication technologies for audio-only telehealth to assist health care providers and health plans, or covered entities, bound by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules (HIPAA Rules). The goal of the guidance as stated by OCR is to support continued access to audio-only telehealth post-public health emergency (PHE) and make clear that audio-only telehealth is permissible under HIPAA Rules. One of the main federal public health emergency (PHE) flexibilities instituted at the beginning of the pandemic included relaxed enforcement of certain federal privacy laws related to the use of various telehealth technologies (see OCR’s Notification of Enforcement Discretion for Telehealth Remote Communications (Telehealth Notification)). The Telehealth Notification states that OCR will not penalize providers under HIPAA related to their good faith use of audio or video remote communication technologies during the PHE. While it appears likely that the PHE will be further extended one more time until mid-October, this guidance seeks to prepare providers for a return to compliance once the PHE and enforcement relaxations are no longer in effect. HIPAA Allows Audio-Only OCR first and foremost confirms the ability to comply with HIPAA when using remote communications to provide audio-only telehealth services. The guidance states the expectation of privacy of protected health information (PHI) from impermissible uses or disclosures and the importance of providing telehealth services in private settings. If the setting is not fully private, however, it is stressed that other safeguards must be put in place, such as speaking in low voices and not using speakerphone functions. In addition, entities must verify the individual’s identity if they are unknown. While verification can be completed orally or in writing, the HIPAA Rules do not require any specific method of identity verification. The guidance also highlights that this requirement may entail the use of language assistance services with individuals with limited English proficiency. HIPAA Only Applies to Electronic Information via Electronic Media In addressing the need to meet HIPAA Security Rule requirements to use remote communication technologies, OCR clarifies that the Rule only applies to electronic PHI (ePHI) transmitted over electronic media. Therefore, the Rule does not apply to audio-only telehealth services provided over a traditional landline, however it does apply to landlines being replaced with Voice over Internet Protocol (VoIP) and other electronic technologies that involve the internet, cellular, and Wi-Fi, as well as smartphone apps and messaging services that electronically store audio messages. These requirements again only apply to covered entities, noting that patients receiving telehealth services via remote technologies are not obligated by HIPAA and therefore covered entities aren’t responsible for the privacy of information once it has been received by the patient’s device. To ensure compliance with the HIPAA Security Rule the guidance states that all potential risks should be identified and addressed as part of risk analysis and risk management processes required under HIPAA, including the risk for interception of information during transmission, the ability for devices to encrypt transmitted information, and other device security and authentication processes. Business Associate Agreements & Payer Rules A business associate agreement (BAA) with a telecommunication service provider (TSP) is not always necessary to utilize audio-only technologies, as long as the TSP is just a conduit for the PHI being transmitted and does not have the ability to access the information being shared. If, however, the provider wants to use an app that does store information, then a BAA is required with the app developer, including apps that may provide translation services. The guidance states that whether or not audio-only services are covered by the patient’s health insurer does not impact a provider’s ability to provide those services in compliance with HIPAA, as payer rules and requirements are separate from HIPAA Rules. While continuation of PHE telehealth flexibilities remains a policy focus in Congress, it is likely that the flexibilities related to privacy enforcement will not be continued post-PHE making the technologies used to provide telehealth services an area of focus for providers looking to continue providing telehealth access moving forward. Continuing use of audio-only telehealth is also an area of policy focus post-PHE, therefore this guidance is very timely. While the guidance is technically specific to just one telehealth modality, it does speak to audio-only through electronic technologies, generally encapsulating other remote communications using electronic means, such as video and store-and-forward telehealth. For more information on OCR’s guidance related to audio-only communications post-PHE, as well as general telehealth guidance, please view the OCR FAQs and other resources listed in their entirety. For more information: https://mailchi.mp/cchpca/ocr-clarifies-post-phe-hipaa-compliance-for-audio-only-telehealth < Previous News Next News >

UCHealth slashes code blues up to 70% with telehealth technologies Bill Siwicki December 20, 2022 The academic medical center uses tele-sitter and virtual ICU platforms for a program it calls Virtual Deterioration. UCHealth is a non-profit healthcare organization based in Colorado made up of 12 hospitals across the state. THE PROBLEM The organization had a new use case for virtual care, a program called Virtual Deterioration. Essentially, it was trying to find patients who were deteriorating in the hospital sooner in order to provide rescue and treatment faster to give them the best outcome. "What we were seeing prior to this program was a lot of variability as we tried to detect deterioration, and then once we were detecting it, reaching out to the bedside caregivers as to what happened next," said Dr. Diana Breyer, chief medical officer of the Northern Region at UCHealth. "And so, this was very much a part of our plan to decrease that variability for patients that were staying in place for us to be able to monitor them consistently with more frequent vital signs to make sure we really had rescued them and utilized technology to keep an extra set of eyes on them," she added. PROPOSAL UCHealth already had implemented vendor AvaSure's TeleSitter platform for patient safety and the vendor's Verify for virtual ICU. It expanded use of these technologies to Virtual Deterioration. Prior to implementing the technology, the process for virtual deterioration involved staff in a remote clinical command center working in tandem with frontline staff. "And we did try a process before we employed the technology, where it was a lot of secure chat through our EHR, similar to texting, in addition to a lot of phone calls and not really being able to visualize our patients," said Amy Hassell, RN, senior director for the Virtual Health Center at UCHealth. "This approach created a lot of friction and interruption to the bedside staff who were trying to do hands-on tasks with the patient," she continued. "So we decided to bring in an audio-visual connection. We have mobile carts, and some of our hospitals have cameras in the ceiling so we can just turn on that camera when a deterioration event is occurring." With the camera in the room, physicians and nurses in the command center now can see and interact with the patient as well as the care team. "They're able to see what's occurring so that it's just like we're in the room with that care team member," Hassell explained. "When we do this, it helps us cut down on phone calls and interruptions at the bedside, allowing us to still participate and do our part of the program. "The program provides support and makes sure milestones of care are being met throughout that deterioration event, and help triage if needed," she continued. Because it's a clinical command center that operates a lot of equipment and different platforms, staff have a weekly operational meeting with the IT team that supports the area. "They were part of our planning phases; further, we did our own IT technical dress rehearsals ahead of implementation with the clinical folks each time we went live," Hassell explained. "IT is in lockstep with us and have been very helpful to getting this deployed by helping support us, navigate us through the bumps, as we push the envelope. They're great partners to us and have been since the very beginning." MARKETPLACE There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report. MEETING THE CHALLENGE Today, the Virtual Deterioration technology is a separate platform. There's going to be context-aware linking soon, and that will help because then staff can go right in from the patient's chart through that portal. Clinicians at the bedside use this technology. Nursing staff and physician staff are the ones pulling the monitoring equipment into the room and using it at the bedside. On the reciprocal end, it's the remote clinical command staff who are accessing that camera to participate with the team and interact with them. UCHealth is in the midst of developing a new role called the "patient technology technician." "The patient technology technician is a staff member who brings the mobile device into the room so that nurses and physicians don't have to be responsible for setting it up, and they can remain focused on the patient," Hassell said. "That's been successful. We're really trying to get all of our folks operating at the top of their license. "This role will be very helpful as we continue to scale it, so the nursing staff aren't the ones having to bring monitoring equipment to that rapid response," she added. RESULTS When UCHealth started looking at this project, it looked for deterioration in particular, such as what are the metrics being sought. One of them that is well-established in the literature is around decreasing code events in the acute care setting, Breyer noted. "Those patients ideally are brought to the ICU and if they're going to code, code there, or if they're rescued," she said. "So we have seen improvement throughout the work that we've been doing around deterioration in this space both in the northern and southern region of UCHealth where we've implemented the solution. "And that's probably our biggest metric that we're able to measure," she continued. "I'll add that in the space of deterioration, it is sometimes difficult to measure what you're doing because you're trying to show that you're now doing something that you were previously not doing. And measuring that omission can be a challenge." The other thing staff are measuring as a process metric is for those patients who stay in place and are not being moved to a higher level of care at the time of their rapid response event. "We are measuring a consistent post-RRT intervention that we previously did not have," Breyer said. "That's another area that we're monitoring. Ultimately, we would like to see this improve mortality, but that's more of a lagging indicator, and that one is a little more variable in the literature as to how much they affect these deterioration events." Hassell stresses the organization is going to have to continue to trend this and the lagging indicator of mortality within the patient population being touched. "But we have early data where we've seen our rapid response rates increase anywhere from 26% up to about an 86% increase, depending on what location you're looking at as we've done this across our system," she reported. "And then, in early data again, we've seen our code blue events in our acute care areas go down by 25% to 70%. "We've seen our code blue events drop, which helps us know we're going in the right direction, we're detecting deterioration earlier, thus reducing a bad outcome from a code blue," she continued. To Breyer's point, UCHealth has seen the post-monitoring period, because it's leaving that camera in place for six hours and virtual staff are helping oversee and watch that patient in conjunction with the frontline staff who are very busy. "And so we've seen an increase in post-rapid response vitals anywhere from a 39% increase up to 152% increase of vitals being ordered, and then working on getting them completed," Hassell explained. "It's been a large range that we've seen, but a lot of intentionality because resources are tied up in that rapid response call. "Once the patient is stabilized, and they're staying on the floor, the nurses then go see other patients that they've not seen for a while," she continued. "And so we've got to make sure that we're taking time to watch over the patient in that kind of fragile window when they still could continue to deteriorate and need a higher level of care. That's where we put a lot of focus and energy, and those are some of our early metrics." ADVICE FOR OTHERS The piece Hassell likes about the technology currently in use is that staff have been able to flex it for a different use case that's been highly valuable. "We're still working on making it an improved platform with the company, but I also think that it's been instrumental and opened up pathways for us that we wouldn't have previously had," she noted. "We weren't seeing the success that we're seeing now until we introduced the camera piece because it solved those issues we mentioned. "And so if you are considering any sort of hybrid approach from, for example, a clinical command center or nursing workflows, you want to have a great platform that you feel your staff can use and interact with seamlessly and with ease," she advised. From a technology standpoint, having it be easy and seamless for the bedside team is key, Breyer said. "While there are now great technology solutions to some of these problems, the heavy lift is the change management with your bedside team, the non-technology piece," she concluded. "And so that's where a lot of the energy for a successful project must be." Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/uchealth-slashes-code-blues-70-telehealth-technologies?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

Telemental Health Collaborative Care Medication Management: Implementation and Outcomes Smita Das, Jane Wang, Shih-Yin Chen, and Connie E. Chen Dec. 22, 2021 Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Abstract Introduction: Access to quality mental health medication management (MM) in the United States is limited, even among those with employment-based health insurance. This implementation, feasibility, and outcome study sought to design and evaluate an evidence-based telemental health MM service using a collaborative care model (CoCM). Materials and Methods: CoCM MM was available to adult employees/dependents through their employer benefits, in addition to therapy. Outcomes included Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) collected at baseline and throughout participation. This analysis was not deemed to be human subjects research by the Western Institutional Review Board. Results: Over 17 months, 212 people enrolled and completed >2 assessments; the enrollees were 58.96% female with average age of 32.00 years (standard deviation [SD] = 7.38). In people with moderate to severe depression or anxiety, PHQ-9 and GAD-7 scores reduced by an average of 7.27 (SD = 4.80) and 6.71 (SD = 5.18) points after at least 12 ± 4 weeks in the program. At 24 ± 4 weeks, the PHQ-9 and GAD-7 reductions were on average 7.17 (SD = 5.00) and 6.03 (SD = 5.37), respectively. Approximately 65.88% of participants with either baseline depression or anxiety had a response on either the PHQ-9 or GAD-7 at 12 ± 4 weeks and 44.71% of participants experienced remission; at 24 ± 4 weeks, 56.41% had response and 41.03% experienced remission. Conclusions: An evidence-based CoCM telemedicine service within an employee behavioral health benefit is feasible and effective in reducing anxiety and depression symptoms when using measurement-based care. Widespread implementation of a benefit like this could expand access to evidence-based mental health MM. Read more here: https://www.liebertpub.com/doi/full/10.1089/tmj.2021.0401 < Previous News Next News >

Expansion of Telehealth Services Must Be Sustained Gerald E. Harmon, MD American Medical Association President July 2021 Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. The rapid growth and large-scale adoption of telehealth services over the past 18 months has allowed physicians to deliver a broad range of badly needed services to patients nationwide in an innovative, cost-effective manner. Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. Congress can brighten this picture by passing legislation already introduced into the current session that enjoys bipartisan support. Among other steps that need to be taken, the pending legislation—CONNECT for Health Act of 2021 (S 1512) and the Telehealth Modernization Act (HR 1332)—would strip away all geographic restrictions placed on telehealth services and allow Medicare recipients to receive this care in their own homes, rather than being forced to travel to an authorized health care center to receive it. Although this provision has been waived for the duration of the public health emergency trigged by the COVID-19 pandemic, the ability to provide telehealth services directly to patients regardless of their location will be lost unless Congress acts. Physicians and their patients who have witnessed firsthand the immense benefits and value of telehealth services must not be forced to stop using these widely available tools for better health simply because the pandemic is over. Telehealth has improved health care The benefits of telehealth are obvious. Telehealth enables physicians to strengthen continuity of care, extend access outside of normal clinic hours, and ease the impact of clinician shortages in rural areas and among underserved populations. By increasing the quantity and quality of communication between patients and physicians, telehealth has strengthened the trust that lies at the center of this relationship. Telehealth can slice overall health care costs by helping physician practices and health care systems better manage diabetes, heart disease and other chronic illnesses while increasing the overall quality of care and patient satisfaction. This technology can also prevent patients from delaying care for conditions that, if undetected and untreated, can trigger emergency department visits or lengthy hospital stays. Wide-ranging case-study examples of the comprehensive value that virtual care can provide are featured in the AMA’s Return on Health research issued in May. And let’s not forget the value of telehealth services to patients with impaired mobility, the immunocompromised, frail or elderly individuals who require the aid of a caregiver to travel, and those who cannot arrange the transportation or child care they need to receive care. The enhanced opportunities telehealth affords to assess the impact of patients’ social determinants of health lays the groundwork for better treatment and improved health outcomes for historically marginalized and minoritized communities. The widespread expansion of telehealth services we have witnessed serves all of these patient populations and others in an efficient and cost-effective manner that must be sustained. While the Centers for Medicare & Medicaid Services has expanded its coverage for telehealth services during the pandemic, only action by Congress will ensure that Medicare beneficiaries will enjoy full access to those services once the pandemic is behind us. The expansion of telehealth covered by Medicare at payment parity with in-person services during the COVID-19 public health emergency includes more than 150 services, including emergency department visits, hospital admissions and discharges, critical care and home care, to name just a few. Offering this equivalency remains a critical factor in ensuring that physician practices can cover the additional costs tied to virtual care provision. How we support greater telehealth adoption Our AMA’s commitment to telehealth technologies grows stronger each day. For example, our Telehealth Immersion Program helps individual physicians, physician practices and health systems expand and optimize telehealth services through interactive peer-to-peer training sessions, curated webinars, clinical best practices, virtual care boot camps and other assets. Additional resources, including a Telehealth Quick Guide, Telehealth Playbook, and STEPS Forward™ telehealth training module, are just three more examples among many available on our website. The Digital Medicine Payment Advisory Group is a collaborative initiative convened by the AMA to help integrate digital medicine technologies into clinical practice by knocking down barriers to widespread adoption while zeroing in on comprehensive solutions for issues with coding, reimbursement, coverage and related factors. The mission of this diverse cross section of nationally recognized digital medicine experts includes: Reviewing existing code sets—particularly CPT® and HCPCS—to ensure they accurately reflect current digital medicine services and technologies. Assessing factors that affect the fair and accurate valuation of services delivered in this manner. Providing information and clinical expertise that promotes widespread coverage of telehealth, remote patient monitoring and all other digital medicine services, including increased transparency of services covered by payers and improved enforcement of parity coverage laws. The expansion of physician-based telehealth services in 2020 ranks as one of the most important advances in health care delivery in many years. Allowing this progress to slip from our hands because of outdated and arbitrary restrictions will result in higher costs and poorer health outcomes for patients everywhere. The decisions made and the policies adopted in the near future will shape the direction of telehealth services for many years to come. We urge Congress and the Biden administration to take the steps necessary to build on the progress in virtual care we’ve made thus far while laying the foundation for greater innovation going forward. < Previous News Next News >

Prescribing via Telehealth Post-Pandemic Center for Connected Health Policy July 2021 Another result of telehealth policies being in flux is uncertainty around the long-term landscape in terms of prescribing controlled substances post-pandemic. Another result of telehealth policies being in flux is uncertainty around the long-term landscape in terms of prescribing controlled substances post-pandemic. Existing federal law, mainly the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, restricts the prescribing of controlled substances via telemedicine except in very specific and limiting circumstances. Given these federal restrictions, this may be a telehealth policy barrier states have trouble tackling completely on their own. There is a potential pathway for the prescribing of certain controlled substances without an in-person exam post-PHE, which is if the U.S. Drug Enforcement Administration (DEA) creates the telemedicine special registry they were mandated to establish rules for by October 2019 but never did. Thus, the specific medications and the criteria to qualify for the registry is yet to be seen. In the first official mention of the long awaited regulations since December 2019, last month the DEA said in response to comments on a recently proposed (yet unrelated) rule about narcotics: “Although these comments regarding telemedicine special registration are beyond the scope of this rule, DEA understands commenters' frustration with the delay. DEA intends to promulgate regulations for the telemedicine special registration in the near future.” In addition, a few of the current federal bills CCHP is tracking that would alter the Ryan Haight Act include: * S. 445/HR 1384 – Makes exceptions for narcotic drugs in schedules II, IV, or V for community health aides or community health practitioners prescribing to an individual for treatment or detoxification * S. 340 – Allows for a telehealth evaluation for schedule III or IV drugs under certain circumstance * S 1457 – Similar language to S. 340 is in Sec. 205 of bill. CCHP will continue to track this issue and provide updates as they occur. Existing federal laws around prescribing can be found on CCHP’s website through both the policy finder tool and the pending federal legislation page at https://www.cchpca.org/federal/pending-legislation/. < Previous News Next News >

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

Supreme Court Limits Medication Abortion via Telehealth Center for Connected Health Policy April 2021 Last month the U.S. Supreme Court reinstated a U.S. Food and Drug Administration (FDA) rule that requires in-person visits for patients seeking medication abortion, eliminating patient access to the abortion pill mifepristone via telehealth. Last month the U.S. Supreme Court reinstated a U.S. Food and Drug Administration (FDA) rule that requires in-person visits for patients seeking medication abortion, eliminating patient access to the abortion pill mifepristone via telehealth. Last summer, a federal district court decision suspended the FDA rule during the pandemic, allowing providers to mail the pill to patients after a telehealth visit. While a recent study showed no difference in safety and efficacy, the ruling reignited political controversy around the subject of abortion and medication abortion in particular, leading the Trump Administration to request the reversal. The lower court ruled that the in-person requirement “imposed a ‘substantial obstacle’ to abortion care that is likely unconstitutional” however, in his concurrence, Chief Justice John Roberts stated that the issue was not related to constitutionality, but whether the lower court had the authority to remove the restriction due to their own determinations related to the risks of COVID-19, when they should defer to entities with the appropriate “background, competence, and expertise to assess public health.” Justice Sonia Sotomayor and Justice Elena Kagan dissented the decision, stating that it places patients at risk, particularly minority and low-income populations, and puts “an unnecessary and undue burden on their right to abortion.” Advocacy groups, providers, and policymakers are now requesting that the Biden Administration remove the previous Administration’s policy and FDA restriction. Meanwhile, even if the federal in-person requirement is removed, 19 states have their own in-person requirements, which will continue to prohibit the ability to provide medication abortion via telehealth. < Previous News Next News >

Geisinger's journey to greatly expanded telehealth Bill Siwicki April 19, 2022 The prolific health system is now able to offer telemedicine appointments to patients for primary care, urgent care and more than 70 specialties. More than 8% of total outpatient visits now are conducted virtually. Rural Pennsylvania is bigger than the states of New Jersey, Massachusetts, New Hampshire and Vermont combined. Some 75%, or 33,394 square miles, of Pennsylvania are considered rural. The geography is diverse, from rugged mountainous terrain to large stretches of farmland. High-profile health system Geisinger and its affiliated entities serve 45 predominantly rural counties throughout central and northeastern Pennsylvania, 31 of which are a part of Appalachia, a unique region of the Appalachian Mountains that cuts through the western part of the state. THE PROBLEM "Access to specialty care for many of our communities is scarce; these communities already are faced with primary care shortages, and for those who need to seek specialists and sub-specialists, long travels often are a costly and time-consuming reality," said Tejal A. Raichura, director of the center for telehealth at Geisinger. "Surveys show that rural Pennsylvanians are not taking care of themselves as well as their urban counterparts," she continued. "Fewer rural residents than their urban counterparts get the recommended exercise. Rural residents have higher rates of obesity, with almost two-thirds at risk for chronic diseases based on their sedentary lifestyle." Rural residents are in poorer physical condition, have more health risks and are more likely to lack health insurance, she added. The wage gap between urban and rural Pennsylvanians is getting wider. In fact, it has doubled in the last 30 years. Improving the quality of healthcare while lowering costs and increasing access in rural Pennsylvania counties is challenging, she said. "In 2018, Geisinger leadership committed to expanding our telehealth program and invested in a platform that could cover various elements of virtual care, including video visits to the home and our clinics, tele-stroke visits at our various inpatient units and emergency rooms, and video visits to non-Geisinger organizations, including other hospitals, skilled nursing facilities, correctional facilities, et cetera," Raichura recalled. PROPOSAL The business plan requested support for an expanded telemedicine program, one that would connect distantly located expert physicians trained in several specialties – including neurology, stroke/intensive care, pediatrics, primary care, geriatrics, psychiatry, endocrinology, rheumatology, podiatry and several others – with rural and underserved communities, allowing residents to access specialty care where they live and work. For Full Article: https://www.healthcareitnews.com/news/geisingers-journey-greatly-expanded-telehealth < 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 >

Medicare Telehealth Services for 2023 – CMS Proposes Substantial Changes The National Law Review August 6, 2022 - Volume XII, Number 218 On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2023 Medicare Physician Fee Schedule (PFS) rule. The rule, if enacted as proposed, will: 1. Create three new permanent telehealth codes for prolonged E/M services; 2. Discontinue reimbursement of telephone (audio-only) E/M services; 3. Discontinue the use of virtual direct supervision; 4. Postpone the effective date of the telemental health six-month rule until 151 days after the PHE ends; 5. Extend coverage of the temporary telehealth codes until 151 days after the PHE ends; and 6. Add 54 codes to the Category 3 telehealth list. Reading between the lines, the nature of CMS’ comments and the changes it proposed (and refused to propose) suggest that CMS rulemakers anticipate the Public Health Emergency (PHE), and associated PHE waivers, will expire no later than the first half of 2023. Three New Telehealth Codes for Prolonged E/M Services: This year, CMS rejected all stakeholder requests to permanently add codes to the Medicare Telehealth Services List. Following its standard evaluation process for such requests, CMS considered whether they met appropriate categories. Category 1 services must be “similar to professional consultations, office visits, and/or office psychiatry services that are currently on the Medicare Telehealth Services List.” Category 2 services require “evidence of clinical benefit if provided as telehealth” and all necessary elements of the service must be able to be performed remotely. CMS rejected this year’s requests because none of the proposed services (e.g., therapy, electronic analysis of implanted neurostimulator pulse generator/transmitter, adaptive behavior treatment and behavior identification assessment codes) met the requirements of Category 1 or 2 services. Interested stakeholders can collect and submit better evidence to persuade CMS to add these codes on a Category 1 or 2 basis next year (submissions are due by February 10, 2023). Although it rejected stakeholder-submitted codes, CMS itself proposed three new codes to be added to the Medicare Telehealth Services list on a permanent basis: • GXXX1 (Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). • GXXX2 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99306, 99310 for nursing facility evaluation and management services). • GXXX3 (Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99345, 99350 for home or residence evaluation and management services). CMS added these codes because they are similar to current CPT codes 99356 and CPT 99357 and HCPCS code G2212, all listed on a permanent basis. Discontinue Reimbursement of Telephone (Audio-Only) E/M Services Under PHE waivers, CMS allowed separate reimbursement of telephone (audio-only) E/M services (CPT codes 99441-99443), something that was embraced by a sizeable cohort of practitioners and patients, particularly in rural areas or patients without suitable broadband access for audio-video. CMS rejected requests to permanently add these services to the Medicare Telehealth Services List. With the exception of certain telemental health services, CMS stated two-way interactive audio-video telecommunications technology will continue to be the Medicare requirement for telehealth services following the PHE. This is because Section 1834(m)(2)(A) of the Social Security Act requires telehealth services be analogous to in-person care by being capable of serving as a substitute for the face-to-face encounter. In CMS’ own language, “We believe that the statute requires that telehealth services be so analogous to in-person care such that the telehealth service is essentially a substitute for a face-to-face encounter.” As audio-only telephone is inherently non-face-to-face, CMS determined, that modality fails to meet the statutory standard. Therefore, 151 days after the PHE expires, audio-only telephone E/M services will revert to their pre-PHE “bundled” status under Medicare (i.e., covered but not separately payable). Practitioners will no longer receive separate reimbursement for these services. Discontinue the Use of Virtual Direct Supervision Under Medicare Part B, certain types of services (e.g., many diagnostic tests, services incident to physicians’ or practitioners’ professional services) must be furnished under the direct supervision of a physician or practitioner. For Medicare purposes, direct supervision requires the supervising professional to be physically present in the same office suite as the supervisee, and immediately available to furnish assistance and direction throughout the performance of the procedure. The supervising professional need not be present in the same room during the service, but the “immediate availability” requirement means in-person, physical - not virtual - availability. In connection with PHE waivers, CMS temporarily changed the direct supervision rules to allow the supervising professional to be remote and use real-time, interactive audio-video technology. That change did not require the professional’s real-time presence at, or live observation of, the service via interactive audio-video technology throughout the performance of the procedure. This change was temporary because CMS was concerned widespread direct supervision through virtual presence may not be safe for some clinical situations. In its proposed PFS rule, CMS rejected requests to make virtual direct supervision a permanent feature in Medicare. CMS is considering whether or not it should make virtual direct supervision a permanent feature of Medicare at some point in the future. Interested stakeholders with data are invited to submit comments and information to CMS on this topic. If the proposed rule is finalized, virtual direct supervision will expire at the end of the calendar year in which the PHE ends. If the PHE ends in October 2022, the supervision waiver will end December 31, 2022. If the PHE ends in January 2023, the supervision waiver will end December 31, 2023. Postpone the Effective Date of the Telemental Health Six-Month Rule Until 151 Days After PHE Ends In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person exam requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met: The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service; The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service. For a full understanding of the rule, read the frequently asked questions and what it means for practitioners at Medicare Telehealth Mental Health FAQs. This rule was originally scheduled to take effect the day after the PHE expires. Following an amendment to the rule, it is now set to take effect 151 days after the PHE expires. Extend Coverage of the Temporary Telehealth Codes Until 151 Days After the PHE Ends Temporary telehealth codes are those services added to the Medicare Telehealth Services List during the PHE on a temporary basis, but which were not placed into Category 1, 2, or 3. Coverage of those temporary telehealth codes had been scheduled to end when the PHE expires. In its proposed PFS rule, CMS states it will extend coverage of those temporary telehealth codes until 151 days after the PHE ends. CMS is doing so for consistency with the Consolidated Appropriations Act, 2022 (CAA). CMS stated this extension may simplify the post-PHE transition by applying the same coverage end date to all the various waiver-related telehealth codes in a hope to reduce billing errors. Note, the Category 3 codes are set to expire December 31, 2023, while the other temporary telehealth codes are set to expire 151 days after the PHE ends. This means, under the proposed rule, if the PHE ends after August 2023, the Category 3 codes would expire before the temporary telehealth codes. If finalized, health care providers would need to keep a careful eye on the calendar to ensure billing practices keep up with the various sunset dates. Add 54 Codes to the Category 3 Telehealth List CMS’ Category 3 list contains services that likely have a clinical benefit when furnished via telehealth, but lack sufficient evidence to justify permanent coverage. CMS proposed adding 54 codes to that Category 3 list. The services fall into nine categories: (1) therapy; (2) electronic analysis of implanted neurostimulator pulse generator/transmitter; (3) adaptive behavior treatment and behavior identification assessment; (4) behavioral health; (5) ophthalmologic; (6) cognition; (7) ventilator management; (8) speech therapy; and (9) audiologic. The complete list can be found at this link. Keep in mind, these codes will expire December 31, 2023.Category 3 codes were originally slated to expire at the end of the year in which the PHE ends, but CMS extended coverage of those codes through December 31, 2023. In this year’s proposed PFS rule, CMS declined any further extension, so all Category 3 codes will expire at the end of 2023. In the event the PHE extends well into 2023, CMS said it will consider a further extension of the Category 3 codes at that time. What to Do Next? Providers, facilities, technology companies, and virtual care entrepreneurs interested in changes to the telehealth codes for 2023 should consider providing comments to the proposed rule. CMS is soliciting comments on the proposed rule until 5:00 p.m. ET on September 6, 2022. Anyone may submit comments – anonymously or otherwise – via electronic submission at this link. Alternatively, commenters may submit comments by mail to: Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, P.O. Box 8016, Baltimore, MD 21244-8016. Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 If submitting via mail, please be sure to allow time for comments to be received before the closing date. For original article: https://www.natlawreview.com/article/medicare-telehealth-services-2023-cms-proposes-substantial-changes < Previous News Next News >

Final CY 2023 PHYSICIAN FEE SCHEDULE FACT SHEET CCHP November 1, 2022 On November 1, 2022, the Center for Medicare and Medicaid Services (CMS) released their final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS had previously released their proposed version on July 7, 2022. After receiving submitted feedback from the public during the comment period, CMS published the final version that, unless otherwise stated, will have policies going into effect January 1, 2023. Much of what was proposed in July remains in this final version. End of the Public Health Emergency (PHE) CMS is going forward with the policies required of the Medicare program that were in the 2022 Budget Act. These policies included allowing some of the temporary telehealth COVID policies to continue through a 151-day grace period after the end of the PHE and delaying other permanent policies: • Federally qualified health centers (FQHCs), rural health clinics (RHCs), physical therapists, occupational therapists, audiologists and speech-language pathologists remain eligible providers to be reimbursed by Medicare if they provide certain services via telehealth during this grace period. • The patient may be in the home when receiving these services and the geographic limitation would also not apply during the 151 day grace period. • Policies around the provision of mental health via telehealth that were put into law by the Consolidated Appropriations Act (CAA) passed in December 2020 and administrative policies from the 2022 PFS are also delayed during this 151 day grace period. • The temporary telehealth eligible services COVID-19 list will remain fully available during this 151-day grace period. See full fact sheet: https://www.cchpca.org/2022/11/FINAL-2023-MEDICARE-PHYSICIAN-FEE-SCHEDULE.pdf < Previous News Next News >

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

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 >

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