HHS to maintain COVID-19 public health emergency past January Jakob Emerson November 11, 2022 The U.S. will extend the COVID-19 public health emergency past January 11, 2023, CNBC reported Nov. 11. A 12th extension of the PHE since the first in January 2020 is also likely because of a lack of public statement from HHS warning about a termination. The agency last renewed the PHE Oct. 13 for an additional 90 days to Jan. 11, 2023 — it also told states it would provide a notice 60 days before if it did decide to end it, or Nov. 11. The PHE allows the country to continue operating under pandemic-era policies, which led to a complete overhaul of telehealth and who can use it, fast-tracked approvals of COVID-19 vaccines and treatments, and preserved healthcare coverage for millions of Medicaid beneficiaries nationwide. Eleven states also still have coinciding public health emergency orders in place. As of now, Medicare telehealth flexibilities will end 151 days after the PHE expires. In July, the House passed The Advancing Telehealth Beyond COVID-19 Act, but the legislation must still be approved by the Senate for Medicare patients to continue using telehealth through 2024. "It's not that we necessarily want to continue the PHE for a long period of time," Nancy Foster, AHA's vice president of quality and patient safety, told Becker's in October. "What has not yet happened is fully thinking through how to unwind some of the [telehealth] flexibilities we currently have, and how to perhaps make permanent some of the others." In addition, the end of the PHE will trigger a Medicaid redetermination process that will cause a major disenrollment of beneficiaries. Over the course of about a year, HHS estimates up to 15 million people could lose health coverage. Payers are prepping for the redetermination period, as they expect to lose Medicaid members and hope to switch some to ACA coverage. With the Inflation Reduction Act's extension of ACA premium tax credits through the end of 2025, the nation's largest insurers have all recently announced plans to majorly expand exchange offerings in 2023, including UnitedHealthcare, Elevance, Aetna, Cigna and Centene. The extension of the federal emergency past January may have been unexpected for insurers, as UnitedHealth Group executives told investors Oct. 14 they thought the PHE would end in January. "Our tailwinds will be weighed against one known headwind, and that is the membership attrition and related impacts on our Medicaid business as eligibility redeterminations are conducted over the course of the next year," Elevance Health's CFO John Gallina told investors Oct. 19. The extension also comes amid uncertainty around public health as winter looms. New Omicron strains — dubbed "escape variants" for their immune evasiveness — have become the dominant strains in the U.S., accounting for 40 percent of all cases in the week ending Nov. 12. Daily cases in the country are expected to grow 39 percent from Nov. 3-17. Hospital admissions trends are expected to remain stable or be more uncertain, with 1,300 to 7,300 new admissions likely reported on Nov. 25, according to the CDC. As of Nov. 4, the nation's seven-day average of new hospital admissions was 3,273. See original article: https://www.beckerspayer.com/policy-updates/hhs-to-extend-covid-19-public-health-emergency-through-april.html < Previous News Next News >

Celebrating 2021 National Rural Health Day Southwest Telehealth Resource Center Dec. 1, 2021 Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. This webinar streamed live to a national audience on November 15th and the recording and presentation slides are available at: https://telemedicine.arizona.edu/webinars/previous for on-demand playback. Each year the National Organization of State Offices of Rural Health selects a Community Star from each of the 50 states. The 2021 Community Star report, https://en.calameo.com/read/0045723395dc12ef8ac48, includes stories of how each Community Star is working to improve life in their rural community. Congratulations to all of the 2021 Community Stars! Matthew Probst, PA-C Chief Quality Officer and Medical Director El Centro Family Health Mathew Probst is the Chief Quality Officer and Medical Director for a Federally Qualified Health Center located Northeast of Albuquerque, New Mexico. Under his leadership, Mr. Probst was able to implement initiatives at the start of the pandemic which resulted in his county having one of the lowest fatality rates and one of the highest vaccination rates in the county. Read more about why Mr. Probst was featured in an award-winning documentary named The Providers: https://en.calameo.com/read/0045723395dc12ef8ac48 < Previous News Next News >

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

Telemedicine & Telehealth: For Allied Health Professionals, Too Faith Lane April 20, 2022 With more and more people using telehealth applications since the pandemic, one education expert asked how to expand training to include Physical Therapists and Occupational Therapists According to a recent study, one in five adults polled about health care during the coronavirus pandemic said that they or someone in their household delayed receiving medical care or were unable to get care, due to office closures or shutdowns. Although the pollsters focused questions about doctor or dental appointments, providers across the board experienced disruption in their specialty areas, including Peggy Stein, OTD, OTR/L, CHT, an Occupational Therapist in Oregon. Occupational therapy, or OT, focuses on how people perform activities that are most important to their daily lives, so for people who need it, missing out affects quality of life, according to Stein. “OT is important to assess the ability of people to participate in usual activities. Work is important and many people equate occupation with work. However, life involves more than work. Participating in life includes taking care of ourselves, our family and friends, pets, home, yard, or attending to community. These are all ‘occupations’,” Stein said. “The state did halt therapy for a few weeks, and many providers had upheaval for several months,” she said. And while Stein eventually returned to her practice, the buzz surrounding providing telehealth continued in the medical and therapeutic communities. “Back in March 2020, we hosted a webinar. We had numerous occupational therapists, physical therapists (PTs) and speech language pathologists (SLPs) in attendance; more than we have previously seen attending our telemedicine training programs,” said Melanie Esher-Blair, MAdm, Distance Education & Event Coordinator for the Southwest Telehealth Resource Center (SWTRC) and the Arizona Telemedicine Program (ATP). “They wanted more information on how to put the ‘tele’ into their scope of practice to maintain continuity of care for their clients,” said Esher-Blair. She said she knew the SWTRC and the ATP had the experts for developing a program. Both OT and PT national associations have information regarding how telehealth fits into the scope of practice, so attendees of the March webinar agreed creating a training around telehealth was important. An interdisciplinary team worked together to come up with the Occupational and Physical Therapy Webinar Series. For full post and access to video: https://southwesttrc.org/blog/2022/telemedicine-telehealth-allied-health-professionals-too < Previous News Next News >

States Expand Medicaid Reimbursement of School-Based Telehealth Services Center for Connected Health Policy June 2021 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. The National Academy for State Health Policy released a report last month on how states are increasing Medicaid coverage of school-based telehealth during COVID-19, as well as assessing which services can be effectively delivered via telehealth and how to best support equitable access to services via telehealth for students. The authors found that 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. As far as services, the brief showed that most states cover audiology and speech-language therapy via telehealth, although behavioral health services had the greatest expansion and providing telemental health they found to be a recognized best practice. Half of all states cover individualized education program (IEP) plan services or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as well. The report also suggests that moving forward states should explore federal funding opportunities to expand technology and broadband access for students facing disparities in access to care. < 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 >

Telehealth Remains Key Modality for Behavioral Healthcare Delivery eVista December 19, 2022 A Michigan-based provider leveraged a telehealth solution to expand critical access to behavioral healthcare as demand for these services skyrocketed during the COVID-19 pandemic. After reaching new heights during the first year of the COVID-19 pandemic, telehealth use is leveling off in several clinical care areas. But there is one prominent exception: behavioral healthcare. Healthcare stakeholders are continuing to flock to telehealth for behavioral health services. An analysis of data from January 2020 to March 2022 shows that mental health conditions were the most common telehealth diagnoses at the national level. In addition, data shows that amid a drop in overall telehealth use since 2020, telemental healthcare has grown. In the first quarter of 2019, 32.4 percent of all telehealth visits were related to behavioral healthcare, according to a market research report. That figure jumped to 59.9 percent by Q1 2022. This data, along with the ongoing mental health crisis in America, signifies the importance of providing virtual care options for behavioral healthcare. At Michigan-based Easterseals MORC, telehealth has been integral to behavioral healthcare delivery since 2019. Then, amid the pandemic, the organization saw its virtual visit volumes skyrocket, and they continue to show no signs of slowing down. "We went from 25 telehealth users before the pandemic to 300," says Clarissa Hulleza, Chief Information Officer of Easterseals MORC. "Those numbers are still going up. We're not seeing any decrease." WHY THE ORGANIZATION IMPLEMENTED TELEHEALTH Easterseals MORC, an affiliate of the national Easterseals organization, serves over 21,000 individuals annually. It provides a wide array of behavioral health services, including therapy, psychiatric care, and substance abuse treatment, as well as long-term care for those with intellectual and developmental disabilities. In 2019, the organization decided to implement a telehealth solution. One of the key goals of the move was to expand access to behavioral healthcare across the state. “The reason we pursued a telehealth solution was so that people who couldn't get to us regularly or at all, could be provided the opportunity to still receive care," says Hulleza. "We serve all of Michigan, and not all of Michigan has access to transportation, or maybe their closest local provider is 20 miles away. So, it was really creating more opportunities for access." Additionally, telemedicine was already becoming popular as a mode of physical healthcare delivery, prompting behavioral healthcare providers to catch up. "It was one of those, 'well, why aren't we doing the same?'" Hulleza says. Easterseals MORC partnered with eVisit to launch a telehealth pilot program in May 2019. A little under a year later, the COVID-19 pandemic hit, compelling providers across the country to rapidly scale up their telehealth programs. According to Hulleza, already having a telehealth solution and vendor partnership in place enabled Easterseals MORC to expand virtual care use seamlessly. "I would say that the absolute benefit was that we never had to close our doors," she adds. "In a time that people needed behavioral healthcare the most, we were able to provide it." IMPLEMENTATION CHALLENGES AND KEY LESSONS LEARNED Easterseals MORC leverages telehealth for nearly all of its services, including case management, one-on-one and group therapy. The organization even provided Applied Behavior Analysis (ABA) therapy virtually, which aims to improve social behaviors using interventions. But implementing a telehealth solution for behavioral healthcare has its challenges. For Easterseals MORC, those challenges ranged from clinician training to technology issues among those receiving services. Clinicians were not only providing care in a new way, they also had to become tech support in helping those they served navigate the new technology. Training is a critical aspect of telehealth technology implementation. If training is not provided proactively, it can result in clinicians avoiding virtual care use as they might find it difficult and overwhelming. “Pilot testing the solution before a full rollout was critical to ensuring that clinicians had adequate training to use the technology and that workflows were not negatively impacted,” Hulleza says. Partnering with the right vendor was a vital aspect of this effort, as the vendor was able to provide clinician training resources as well as suggest new policies and processes required to promote and support the telehealth program. “Ultimately, we selected our vendor because we were looking for a partnership that would improve the overall behavioral healthcare delivery experience. This meant that we needed a tool that offered more than a two-way video solution — one that integrated with, and empowered, the clinical workflow with value-added technology,” Hulleza shares. “There were multiple tools in the marketplace that solved the video connection challenge, but Easterseals MORC was looking to do more than simply move the clinical interaction to a video screen.” Further, choosing the right partner and then piloting the telehealth solution allowed the organization to test the supporting technology infrastructure before a full rollout. Easterseals MORC tested laptop specifications and made sure the solution worked equally well on different devices, including mobile phones and tablets. "We even went as far as making sure our bandwidth at all of our locations was increased so that if we had 20 people doing telehealth at the same time, there wouldn't be any degradation in services," Hulleza says. On the side of those receiving services, Easterseals MORC had to consider the digital divide facing its population. "[The people we serve] don't always have the newest phones, the best bandwidth," she says. "They don't have the luxury of going to a bedroom and closing the door. They might have shared living arrangements. We had to make sure we were accommodating all of those things." To address individuals' technology access needs, the organization applied for various grants and used those to provide iPads and iPhones with built-in data plans. Another essential aspect of closing the digital divide is identifying the viability of an individual to receive services via telehealth. Easterseals MORC uses a checklist tool provided by the telehealth vendor to identify these individuals and the barriers they face. "Do you have a private place? Do you have a microphone? What model phone do you have or mobile device?" Hulleza adds. "The tool goes through all of these questions and allows providers to evaluate if telehealth is an option." Easterseals MORC plans to solidify telehealth as a key behavioral health delivery mechanism within its business. It is unclear if Congress will make the temporary telehealth flexibilities enacted during the pandemic permanent — but for Hulleza, there is no going back. "I absolutely want to grow telehealth here," she says. "The need amplified because of the pandemic, but telehealth was going to exist for our organization even if the pandemic didn’t happen." ____________________________ About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/telehealth-remains-key-modality-for-behavioral-healthcare-delivery < Previous News Next News >

Increased Access to Care Via Telehealth in CHCs: NACHC Survey on Audio-Only Telehealth and Health Centers Center for Connected Health Policy July 2021 The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Temporary telehealth policies during the pandemic, particularly those related to audio-only, highlighted the capacity of community health centers (CHCs) to increase patient access to care in underserved communities. The National Association of Community Health Centers (NACHC) recently released a report on their survey of CHCs to assess their telehealth experiences over the course of the public health emergency and determine what the effects would be upon termination of temporary policies, and how that would impact their providers and patients. The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Overall, the report suggested that losing audio-only coverage would likely exacerbate existing health disparities. Prior to the pandemic, health centers faced numerous federal restrictions that limited their ability to use telehealth. According to the report, previously only around 40% had used telehealth and audio-only modalities. Once allowed during the pandemic, however, nearly all CHCs utilized telehealth and delivered critical health care services to 30 million patients. Urban health centers and those serving low-income populations were also found to have higher rates of providing services via telehealth and audio-only, and 92% of health centers said audio-only improved patient access to care. To continue to provide this expanded access to care post-pandemic via telehealth the report discussed the need for Congressional action to permanently remove restrictions around use of audio-only and originating/distant site limitations, as well as ensuring reimbursement parity. In addition, as many states struggle to determine their post-pandemic policies related to telehealth, it has become apparent that the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) must also clarify whether states can continue to allow audio-only coverage under Medicaid and still receive federal matching funds. The value and necessity of audio-only was stressed throughout the survey. Benefits of audio-only telehealth included: *Reduced no-show rates *Improved patient/provider relationships *Better coordination of care amongst providers and families *Improved chronic care management The report concludes that without continued telehealth coverage for CHCs, all of the stated benefits will disappear, create a barrier to the provision of quality health care, and negate the ability for health centers to bring equity and access to underserved communities that would otherwise likely go without needed services. The authors urge the federal government to act and preserve access to care via telehealth in health centers across the country. Currently, there is active legislation federally and in many states that seeks to expand and extend telehealth and audio-only policies, including those for health centers. The fate of these bills remains unknown, but it is clear that the ideal resolution would need both federal direction and state engagement. A small but limited step was taken with CMS’s newly proposed physician fee schedule (PFS) for 2022. CMS is proposing to expand the definition of a “mental health visit” for CHCs by including mental health services provided through “interactive, real-time telecommunications technology”, including audio-only if the patient is not capable or does not consent to the use of live video. Additionally, the rate paid for eligible services would be at parity. This proposal is still rather narrow, but many of the existing restrictions, as mentioned previously, live in federal statute and must first be addressed by Congress. < Previous News Next News >

Can virtual nursing help ease clinician burnout? Bill Siwicki November 14, 2022 The turnover rate for nurses stands at 27%. Can telemedicine save the day? No hospital or health system is immune from the challenges of the nationwide nursing shortage. As organizations look for ways to reduce the administrative burden on nurses and improve engagement and satisfaction, virtual nursing is one consideration. Many tasks performed by nurses in the inpatient setting are repetitive – a virtual nursing unit allows nurses to manage these tasks remotely. Bedside nurses and staff then are freed up to focus on patient-facing care, while those in the virtual unit can monitor patients, enter data in the medical record and more. To better understand the ins and outs of virtual nursing, we interviewed Dr. Shayan Vyas, senior vice president and medical director for hospitals and health systems at Teladoc Health. Q. What is the national nursing shortage like today? How does it play out in hospitals and health systems? A. Every health system I've spoken with, that we work with, says workforce challenges are among the top three issues keeping them up at night. This is particularly true for nursing staff. In 2021, nurses were leaving the profession at an alarming rate. According to NSI Nursing Solutions, the turnover rate for nurses increased by 8.4% in 2021 and currently stands at 27%. An increase in patient volume and occupancy rates, among other factors, have led to severe emotional and physical exhaustion and, ultimately, job dissatisfaction and burnout. A 2021 McKinsey survey found that 32% of nurses were likely to leave their current position due to insufficient staffing levels, a lack of support and the emotional toll of the job. President Obama once said that "nurses are the heartbeat of the United States healthcare system," and I really believe that to be true. They put their lives on the line to serve and care for others every single day, and we need to give them the tools to more effectively, efficiently and safely care for others and save lives. Virtual care offers new strategies to address these challenges; virtual nursing is an important component that health systems can include in their transformation and care delivery redesign initiatives. Q. What is virtual nursing, and how does it work? A. Virtual nursing, simply put, is the delivery of nursing care and services from a remote location. Virtual nurses are responsible for monitoring multiple patients while collaborating with the nurses, physicians, therapists and other staff who provide care at the patient's bedside. The virtual nursing unit can be centralized (for example, nurses work from a command center in a healthcare facility), distributed (nurses work from home or other remote locations) or hybrid. Adopting virtual nursing provides a way to mitigate potential staffing losses due to short-term injury or other conditions that require nurses to be off their feet. It is also a way to extend nurses' careers, for example, by offering nurses with developing or chronic physical limitations the option of working seated in a command center, instead of providing physically challenging care on a nursing unit. Virtual nursing programs also can help attract nurses by providing different options for shifts and work styles. This model supports organizations by enabling them to have virtual nurses work from anywhere – allowing them to provide much-needed care and services without requiring nurses to relocate so that they live close enough to a hospital to be able to go on-site for their shift. It also helps new nurses with clinical support, medication verifications and overall non-physical patient bedside care assistance. Health systems that have created virtual nursing programs to augment their bedside nurses have found virtual nursing can extend nurses' careers and improve job satisfaction for floor nurses by taking away responsibility for many tasks that do not require physical touch. This allows the bedside nurse to focus on hands-on patient care and contributes to higher patient satisfaction because of the responsiveness and additional attentiveness it enables. Virtual nursing can also allow advanced nurse practitioners like PAs and ARNPs the ability to connect virtually with a virtual intensivist, and the virtual nurse can help with many of the nonphysical contact needs of patient care. Q. How can virtual nursing reduce the administrative burden on nurses and improve engagement and satisfaction? A. While hands-on care will always be needed, many duties can be fulfilled virtually, including coordinating procedures, getting sign-offs from multiple care team members, reconciling medications, providing patient education, answering questions, initiating the discharge process and more. In many successful virtual nursing programs, administrative tasks like discharge paperwork, medication reconciliation, etc., have been shifted from bedside to virtual nurses. Virtual nursing systems enable virtual nurses to monitor patients and communicate with them, their families, and other visitors and care team members in real time, including responding to patient nurse calls. The goal is to provide a new level of support to patients, nurses and the bedside team. Several health systems with virtual nursing programs have reported high job satisfaction for their virtual nurses. Nurses say the virtual role enables them to spend more time with patients overall. The extra time, and the complementary nature of virtual and bedside nursing roles, contributes to improved job satisfaction for both bedside and virtual nurses, and positive experiences for patients. Q. Please talk a bit about one of your hospital clients using virtual nursing and the results they've achieved. A. Overall, the benefits of virtual nursing include staffing flexibility, potential retention and recruitment advantages, the ability to leverage staff resources, and favorable nurse and patient satisfaction. Another major benefit of virtual nursing is a reduced length of stay, resulting in improved throughput, as well as time saved in the discharge process. Some lesser-known benefits of virtual nursing are a differentiated and improved patient experience, with potential associated improvements to patient satisfaction and HCAHPS and NPS scores. Patients also are seeing a significant improvement in satisfaction as they no longer have to pull a bedside staff member to help answer questions or assist with administrative documentation. Our client, Saint Luke's Health System in Kansas City, Missouri, has helped address the nursing shortage by having virtual nurses support bedside nurses. The virtual nurses can assist with non-hands-on care, education, documentation, admission, discharge, answering questions, and reviewing the care plan or physician rounding with the patient and their loved ones, among other tasks. The unit has enhanced Saint Luke's bedside care response rates, increased patient and nurse satisfaction, reduced the burden on bedside nurses, and positively impacted quality and safety for a better work environment. Patients are discharged within two hours of the discharge order, some 20% faster than in other units, and they're also out of the hospital before noon at a 44% faster rate. This has, in turn, reduced the wait time for patients in the ED and reduces the time to treatment. What's more, these benefits have boosted nurse morale, improving workforce engagement, reducing fatigue, even improving Saint Luke's recruitment capabilities. We need to provide nurses, our frontline workers, with technology that improves their work, quality of life, and the level and effectiveness of bedside care. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/can-virtual-nursing-help-ease-clinician-burnout < Previous News Next News >

Mental Health vs. Primary Care: How Americans Are Using Telehealth Robin Gelburd, J.D. April 19. 2022 Social workers and psychiatrists are among the providers Americans are frequently visiting via telehealth, highlighting the pandemic’s continued mental health impact. Ever since the COVID-19 pandemic began, many Americans have been receiving health care via telehealth. The question arises: Who are the health care professionals on the other end of all these video links and phone calls? According to new evidence from private insurance claims data, the top specialty providing telehealth services nationally this past January was social worker. Because the most common telehealth service social workers provide is psychotherapy, this is just one sign of how prevalent the provision of mental health services through telehealth has been, as our country continues to grapple with the pandemic and its impact on many fronts. Tracking Telehealth Month by Month FAIR Health has been tracking telehealth trends on a monthly basis since January 2020 with the Monthly Telehealth Regional Tracker. Drawing on our repository of billions of private health care claims, the Telehealth Tracker documented the rapid rise in telehealth usage in the early months of the pandemic and has followed the evolution of telehealth since then. The Telehealth Tracker is a free, interactive, online map of the four U.S. census regions (Midwest, Northeast, South and West) that allows the user to view an infographic on telehealth for a specific month in the nation as a whole or in individual regions. The Telehealth Tracker itself evolved as the pandemic continued. In the first year, to study the impact of the COVID-19 pandemic on telehealth, each month in the pandemic year of 2020 was compared to the corresponding month in the pre-pandemic year of 2019. In 2021, the focus turned to month-over-month rather than year-over-year changes. In 2022, we’ve added new features: the top five telehealth provider specialties rendering telehealth services and the Telehealth Cost Corner, which presents a specific telehealth procedure code and its median costs. Continuing from previous years are the percent change in telehealth’s share of medical claim lines, the top five telehealth procedure codes and the top five telehealth diagnoses. (A claim line is an individual service or procedure listed on an insurance claim.) Provider Specialties In January 2022, social worker was the provider specialty rendering the most telehealth services nationally and in every region but the West. In the West, primary care physician was the leading provider specialty, ahead of social worker by just a tenth of a percentage point in terms of each specialty’s share of telehealth claim lines. In every other region and nationally, primary care physician was in second place behind social worker. Nationally, psychiatrist, psychologist and primary care nonphysician were in third, fourth and fifth place, respectively. Though the regions varied in the order of provider specialty, in all of them – as in the nation as a whole – three of the five top specialties were related to mental health: social worker, psychiatrist and psychologist. The share of telehealth services provided by social workers varied by region. Nationally, social workers accounted for 28.7% of telehealth claim lines. In the Midwest, where their share was greatest, they accounted for 32.2%; in the West, where it was least, they made up 22.4%. Diagnoses Throughout 2021 and into January 2022, mental health conditions constituted the top telehealth diagnostic category nationally and in every region. In January, mental health conditions accounted for 58.9% of telehealth claim lines nationally – up from 55% in December 2021. By comparison, mental health conditions also were No. 1 among telehealth diagnoses in 2020, but accounted for only 44% of telehealth claim lines nationally. Throughout 2021, generalized anxiety disorder was the top telehealth mental health diagnosis nationally and in most regions, though major depressive disorder was No. 1 in the West. From May to July 2021, and again from September to October, substance use disorders emerged as one of the top five telehealth diagnoses nationally. Procedure Codes Throughout 2021, the telehealth procedure code used most often nationally was the code designating one hour of psychotherapy. This remained the nation’s top telehealth procedure code in January 2022, when it accounted for 23.1% of telehealth claim lines. The nation’s top five codes contained two other psychotherapy codes that month: one in fourth place designating 45 minutes of psychotherapy and another in fifth place marking a 30-minute psychotherapy visit with evaluation and management. In three of the four census regions, all three of these codes were in the top five, with one hour of psychotherapy in first place. In the South, however, the top five telehealth codes contained one hour of psychotherapy in first place and 45 minutes of psychotherapy in fifth place, but did not include the code for a 30-minute visit. Services Besides Mental Health Despite the dominant position of mental health services, telehealth also offers a gateway to services and treatments for many other conditions. In January, along with mental health conditions, the top five telehealth diagnostic categories nationally also included acute respiratory diseases and infections, COVID-19, developmental disorders and joint/soft tissue diseases and issues. The Telehealth Cost Corner was created to spotlight the costs of a different telehealth procedure code each month. For January, the spotlight was on the code designating treatment for a speech, language, voice, communication and/or hearing processing disorder. This code is most commonly used by speech-language pathologists to help correct specific speech or language disorders – typically in young children with developmental language delays and/or autism, though sometimes also in older adults after stroke or other debilitating incidents. Provider Specialties In January 2022, social worker was the provider specialty rendering the most telehealth services nationally and in every region but the West. In the West, primary care physician was the leading provider specialty, ahead of social worker by just a tenth of a percentage point in terms of each specialty’s share of telehealth claim lines. In every other region and nationally, primary care physician was in second place behind social worker. Nationally, psychiatrist, psychologist and primary care nonphysician were in third, fourth and fifth place, respectively. Though the regions varied in the order of provider specialty, in all of them – as in the nation as a whole – three of the five top specialties were related to mental health: social worker, psychiatrist and psychologist. The share of telehealth services provided by social workers varied by region. Nationally, social workers accounted for 28.7% of telehealth claim lines. In the Midwest, where their share was greatest, they accounted for 32.2%; in the West, where it was least, they made up 22.4%. Diagnoses Throughout 2021 and into January 2022, mental health conditions constituted the top telehealth diagnostic category nationally and in every region. In January, mental health conditions accounted for 58.9% of telehealth claim lines nationally – up from 55% in December 2021. By comparison, mental health conditions also were No. 1 among telehealth diagnoses in 2020, but accounted for only 44% of telehealth claim lines nationally. Throughout 2021, generalized anxiety disorder was the top telehealth mental health diagnosis nationally and in most regions, though major depressive disorder was No. 1 in the West. From May to July 2021, and again from September to October, substance use disorders emerged as one of the top five telehealth diagnoses nationally. Procedure Codes Throughout 2021, the telehealth procedure code used most often nationally was the code designating one hour of psychotherapy. This remained the nation’s top telehealth procedure code in January 2022, when it accounted for 23.1% of telehealth claim lines. The nation’s top five codes contained two other psychotherapy codes that month: one in fourth place designating 45 minutes of psychotherapy and another in fifth place marking a 30-minute psychotherapy visit with evaluation and management. In three of the four census regions, all three of these codes were in the top five, with one hour of psychotherapy in first place. In the South, however, the top five telehealth codes contained one hour of psychotherapy in first place and 45 minutes of psychotherapy in fifth place, but did not include the code for a 30-minute visit. Services Besides Mental Health Despite the dominant position of mental health services, telehealth also offers a gateway to services and treatments for many other conditions. In January, along with mental health conditions, the top five telehealth diagnostic categories nationally also included acute respiratory diseases and infections, COVID-19, developmental disorders and joint/soft tissue diseases and issues. The Telehealth Cost Corner was created to spotlight the costs of a different telehealth procedure code each month. For January, the spotlight was on the code designating treatment for a speech, language, voice, communication and/or hearing processing disorder. This code is most commonly used by speech-language pathologists to help correct specific speech or language disorders – typically in young children with developmental language delays and/or autism, though sometimes also in older adults after stroke or other debilitating incidents. < Previous News Next News >

CMS-Supported Telehealth Will Continue To Be A Driving Force – But Watch for Greater OIG Enforcement The National Law Review March 3, 2022 As mindsets pivoted to a post-pandemic life, telehealth advocates petitioned CMS to embrace telehealth as a permanent care option, and CMS responded with regulatory action at the end of 2021. During the Covid-19 Pandemic, telehealth usage surged as patients and providers turned to it as a safer care alternative. McKinsey estimated telehealth claim volumes reached 80 times pre-pandemic levels at its peak, ultimately stabilizing at 38 times pre-pandemic levels by early 2021.1 This increase was mostly driven by CMS’ waivers and relaxation of regulatory constraints for telehealth reimbursement. But, the temporary nature of both left questions regarding telehealth’s future. In December 2021, CMS issued new regulations which, collectively, steer telehealth toward becoming a part of the telebehavioral health toolkit accepted by Medicare post-pandemic. In the CY2021 Physician Fee Schedule Final Rule2 , further discussed here, CMS broadly expanded access to telebehavioral health services. Specifically, Medicare permanently authorized payment for telehealth services furnished “for purposes of diagnosis, evaluation or treatment of a mental health disorder” under the following relaxed criteria:3. Read full article here: https://www.natlawreview.com/article/cms-supported-telehealth-will-continue-to-be-driving-force-watch-greater-oig < Previous News Next News >

Commentary: Rethinking the Impact of Audio-Only Visits on Health Equity by Lori Uscher-Pines and Lucy Schulson December 17, 2021 New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. Prior to the outbreak of the COVID-19 pandemic in 2020, audio-only visits were rarely included in definitions of telehealth and seldom reimbursed. As clinicians were granted numerous flexibilities to deliver various care modalities at the onset of the pandemic, telephone calls were elevated to the status of reimbursable audio-only visits. Although audio-only visits were used across the health care system, federally qualified health centers (FQHCs) that provide primary care and behavioral health services to millions of Medicaid and uninsured patients were particularly likely to deliver audio-only visits in the spring of 2020. They were also more likely to rely on them as the pandemic progressed (PDF) because of patient and clinic barriers to video telehealth and a supportive policy environment. Almost two years into the pandemic, FQHCs in multiple states are reimbursed at the same Prospective Payment System (PPS) (PDF) rate for in-person, video, and audio-only visits. The new flexibility to deliver audio-only visits was a welcome change. It was widely recognized that, due to the digital divide, audio-only visits would play an essential role in maintaining access to care for many populations. An audio-only visit was far better than the alternative at the time: no visit at all. Currently, experts who call for the permanent reimbursement of audio-only visits cite concerns for the underserved. They argue that given the widespread lack of broadband, limited digital literacy, and reduced access to devices, requiring video visits may leave certain patients behind and exacerbate inequities in health care. While this argument had merit in the first year of the pandemic, the risk benefit calculation of audio-only visits has changed, and it is increasingly important to protect patients from potentially lower-quality audio-only visits. We discuss how ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. At the same time, the reliance on audio-only visits may be preventing innovation that could improve video and in-person health care visits for all populations. Ongoing delivery of audio-only visits can reduce the quality of care among low-income populations and contribute to health disparities. Share on Twitter In the spring of 2020, audio-only visits were a lifeline at a time of uncertainty and helped address a critical need when the delivery system was desperate for quick solutions. Numerous data sources showed high use of audio-only visits in this period (11–48 percent of visits), particularly among low-income and older adults. Even though estimates of audio-only use from claims data were high, they were likely underestimates of the total number of visits being delivered. This is the case because of challenges and inconsistencies with coding telehealth visits and the tendency for scheduled video visits to become audio-only visits when technical difficulties arise. For example, using claims data, Medicare estimated that one in three telehealth visits in the spring of 2020 were audio-only visits. However, data from the Medicare Current Beneficiary Survey showed that the majority of beneficiaries (56 percent) who had telehealth visits reported that they were exclusively audio-only. The Variation in Use Across Settings As the COVID-19 pandemic continued, audio-only visits retreated in some settings but remained dominant in others. Studies of the commercially insured demonstrated that as in-person visits rebounded in 2021, telehealth visits in general, and audio-only visits in particular, declined and play an increasingly minor role. In contrast, in the summer of 2021, 32 percent of FQHCs (PDF) across the United States reported that the majority of their total visits continued to be audio-only. A study of 43 large FQHC networks in California demonstrated ongoing, high-volume delivery (PDF) of audio-only visits in primary care despite receiving technical assistance and funding to grow their telehealth programs. Quality Concerns with Audio-Only Visits Audio-only visits can increase access to care, but this key advantage may come at the expense of quality. Evidence of the quality of audio-only visits in primary care is scant but concerning. First, clinicians report that audio-only visits are not as effective. Challenges range from the relatively minor (for example, not being able to assess facial expressions) to major issues (for example, not being able to verify the patient's identity). Studies have shown that clinicians can miss visual cues and struggle with establishing rapport with patients, and visits are shorter. Additionally, patients report lower satisfaction and comprehension rates. Even as new data emerge about the quality of audio-only visits, it is clear that some patients, including many commercially insured patients, are largely getting more evidence-based, tested services (in-person and video visits) while low-income patients are getting an untested service. Furthermore, cervical cancer screening rates, child weight assessment and counseling, and depression screening and follow-up at FQHCs declined with telehealth (predominantly audio-only) use. Drivers of Audio-Only Visits The variation in audio-only use across different populations is likely not fully explained by differences in which conditions are clinically appropriate for audio-only visits or by patient readiness for video visits. Rather, reimbursement, provider preferences, and organizational priorities are playing a significant role in determining how many in-person visit slots there are, and by extension, which patients get audio-only, video, or in-person visits. In October 2021, 33 percent of FQHC visits in California and 24 percent in Arizona, two states that reimburse FQHCs the full PPS for audio-only visits, were conducted virtually. Contrast that with South Dakota (a state that stopped reimbursing for audio-only visits in its Medicaid program as of July 2021 (PDF)), which only saw 5 percent of visits conducted virtually in the same time period. Although the digital divide is a significant problem in the United States that requires focused attention, it cannot fully explain the variation. A recent paper in Medical Care showed that provider behavior and organizational factors, as opposed to patient digital barriers, are playing the largest role in audio-only visits. Sixty-six percent of Medicare beneficiaries who were exclusively offered audio-only visits during the pandemic had access to telehealth-compatible devices and to the internet. Creating Conditions for High-Quality Telehealth Care At present, 22 state Medicaid programs allow for reimbursement for audio-only visits, with nine states adding reimbursement to permanent policy since the spring of 2021. The trend is to increase access to audio-only visits in the interest of health equity. However, telehealth experts have pointed out that failing to rein in audio-only visits risks escalating costs and creating a two-tiered system (PDF) in which affluent patients get video and in-person visits and low-income patients get telephone calls. It may be that this two-tiered system is already coming to fruition and is now harder to justify in the name of emergency response than it was in the spring of 2020. In March 2021, we argued that reimbursement of audio-only visits should continue for several years beyond the public health emergency to avoid exacerbating disparities in access. However, given emerging data about the prominence of audio-only visits in low-income communities, we now have concerns about this approach. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. It also may be stifling innovation that could be occurring in the delivery of video and in-person visits. Generous parity reimbursement for audio-only visits may be creating perverse incentives to deliver substandard care to the most underserved. Share on Twitter The patients who have challenges accessing video visits are the same patients who face barriers accessing in-person care. Instead of offering scheduled audio-only visits, health systems could be incentivized to address the social determinants of health that create barriers to higher-quality visits. For example, they could partner with community groups to provide transportation to appointments, provide access to low-cost electronic devices, invest in accessible telehealth platforms, create telehealth access points in the community, and train telehealth navigators. Audio-only visits are a powerful tool for emergency response, and over time researchers and clinicians will identify situations in which audio-only visits alone, or as a component of hybrid care models, can support comparable care. But in the coming months, it may be time to consider limiting audio-only visits in the pursuit of health equity. Lori Uscher-Pines is a senior policy researcher and Lucy Schulson is an associate physician policy researcher at the nonprofit, nonpartisan RAND Corporation. This commentary was first published on December 17, 2012 on Health Affairs Blog. Copyright ©2021 Health Affairs by Project HOPE—The People-to-People Health Foundation, Inc. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis. < Previous News Next News >

Now is the time for doctors to shape what’s next on telehealth Tanya Albert Henry, Contributing News Writer, American Medical Assoc. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. Telehealth, which a minority of patients and physicians used prior to COVID-19’s emergence, is now a household word. And survey after survey shows that patients like the convenience, believe they are getting quality care and still feel connected to their physicians. Most physicians, too, have found telehealth to be a great way to connect with patients when appropriate. “There is no question at this point in time, when you think back on the past 18 months, it’s our opportunity to change completely how we deliver care,” according to Joseph C. Kvedar, MD, professor of dermatology at Harvard Medical School and the American Telemedicine Association’s board chair. Dr. Kvedar made that point during a virtual gathering as part of the AMA Telehealth Immersion Program. The boot camp event featured experts and stakeholders from around the country, who discussed the potential for long-term telehealth programs, raised the questions that need to be considered as telemedicine evolves, and examined the challenges that physicians and patients face moving forward. “I would urge you not to think of virtual video visits as the sky or the ceiling or the vision, but as the floor and the beginning, and the first step into what I would call a real hybrid world with digital-first, with digital tools for our patients where patients instinctively turn to a digital device when they need health care and go from there,” Dr. Kvedar said. The boot camp also included a panel discussion about health-at-home models and strategies, as well as breakout sessions on creating telehealth value in obstetrics and gynecology, and renal medicine. The Telehealth Immersion Program is part of the AMA STEPS Forward™ Innovation Academy , which enables physicians to learn from peers and experts and discover ways to implement time-saving practice innovation strategies. Many questions to answer Data may show that the percentage of telehealth visits as a whole are down compared with the beginning of the pandemic, but Dr. Kvedar said there’s another story to be told. Data from one large payer shows that telehealth is shifting from local physicians and health care organizations to national care providers. In April 2020, 96% of all telehealth claims were local, while national providers accounted for just 4%. One year later, the share of national-provider claims rose to 11%. One big question going forward, he asked, is who is going to deliver telehealth services? “Do we want our own doctors to be providing these telehealth services or do we want to go through a third party,” said Dr. Kvedar, co-chair of the AMA Digital Medicine Payment Advisory Group. “The good news is you will have access either way. But … we have to ponder how we want that to go, and I think we have a role to play in making those decisions or at least in influencing them.” Among the other questions that need to be answered going forward: How do you plan while facing payment uncertainty? What will it cost a practice to offer telehealth and what will make the most financial sense for each practice? How do you rethink calculations of overhead? What are the workforce implications? For example, what new roles will be needed to accommodate telehealth properly? How do you define when it will be best to see a patient via telehealth versus coming into the office? Advocate, advocate, advocate Dr. Kvedar asked the boot-camp attendees to send their elected officials a letter describing what has worked in telemedicine and what is needed. He also recommended talking to your human resource professional and health plan contact to let them know what you and your patients need to create a health system that works best. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. https://www.ama-assn.org/practice-management/digital/now-time-doctors-shape-what-s-next-telehealth?smclient=9a5368e1-1650-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

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

How Telemedicine and Digital Therapeutics can Improve Orthopedic Care and PT Bill Siwicki October 11, 2022 A physical therapist and telehealth expert shows how the technologies can help patients, especially in disadvantaged populations, access the care they need and stick to a care plan. Minority and lower-income populations are less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do. Untreated musculoskeletal conditions can result in sedentary behavior that leads to or worsens co-morbidities, including diabetes, obesity, depression and opioid misuse. Access challenges are partly to blame. Disadvantaged populations face many barriers to care, including low referral rates, lack of Medicaid acceptance and transportation difficulties. Telehealth experts say that offering remote education and physical therapy to patients can improve access for vulnerable populations, including: ● Patients in rural communities who live far away from brick-and-mortar care facilities. ● Patients who cannot afford copays for doctor or outpatient PT appointments. ● Patients in urban communities whose mobility issues make leaving home difficult. ● Patients whose inability to take time off work or secure childcare limits in-person visits. ● Patients who speak English as a second language. Healthcare IT News interviewed physical therapist Bronwyn Spira, founder and CEO of Force Therapeutics, to discuss the challenges and opportunities surrounding this area of virtual care. Q. Why are minority and lower-income populations less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do? A. Musculoskeletal disorders are extremely common in our country. At least 60% of American adults are affected by a musculoskeletal disorder, and more than 75% of those 65 and older are living with at least one musculoskeletal condition, which ranges from tendonitis to arthritis, degenerative disc disease, and chronic lower back pain. Lower-income and minority populations face multiple barriers to accessing the right healthcare and are typically less likely to utilize orthopedic care, which can result in significant functional impairment. Untreated musculoskeletal conditions also can result in sedentary behaviors that lead to or worsen comorbidities such as diabetes, obesity and depression. In one study of more than 7,000 individuals with arthritis, the incidence rates of developing disabilities in activities of daily living (ADL) over a six-year period were significantly higher for Blacks (28%) and Spanish-speaking Hispanics (28.5%) as compared to whites (16.2%). As I mentioned, disadvantaged populations often lack sufficient access to care, which can manifest in a few different ways. Many cannot afford the financial burden of co-pays, childcare, transportation, time off work or the out-of-pocket cost of receiving care when uninsured. The Commonwealth Fund found that 50% of low-income adults in the U.S. skipped at least one medical visit, test, treatment or prescription per year due to its cost. Patients with state-funded Medicaid and federally funded Medicare plans also encounter logistical barriers to securing musculoskeletal care, including lower referral rates to orthopedic surgeons. Orthopedic specialists are 13% less likely to accept new Medicaid patients than they are Medicare patients or those with commercial insurance plans. Lastly, more than a third of Americans (36%) have low health literacy, which can be defined as the degree to which individuals can obtain, process and understand health information. Older age, minority membership and low socioeconomic status are disproportionately correlated with poor functional health literacy in both urban and rural populations. Language barriers also impact care utilization and success rates, as individuals who cannot fully understand the directions they are given will not be able to adhere to a care plan. One study on healthcare utilization among Hispanic adults found that limited English proficiency contributes to the underuse of medical services. For all of these reasons, members of disadvantaged populations are far less likely to have orthopedic surgery to correct their musculoskeletal conditions. The data also indicates stark disparities in orthopedic care utilization among racial and ethnic minority groups. Researchers have found that even after adjustments are made for age, sex and income, Black patients are 30% less likely to receive a total hip or knee replacement than white patients. A systematic review of the literature reveals that members of minority populations who do have joint replacement surgery also are at a higher risk for early complications within the first 90 days, leading to higher hospital readmission rates. While there is no consensus as to the cause of these disparities, research suggests that multiple comorbidities, lower income, poor health literacy, provider bias and insufficient interventions are contributing factors. Q. How does offering remote education and remote physical therapy to patients improve access for vulnerable populations? A. First and foremost, remote education and physical therapy platforms reduce the need for patients to attend appointments in person. When hospitals, health systems and ambulatory surgical centers (ASCs) implement care management and remote monitoring tools, they set the stage for achieving greater health equity by removing some of the physical barriers to care. At the start of a surgical episode, for example, replacing preoperative in-person appointments with virtual education classes means that patients can get all the information they need to prepare for surgery without leaving the house. Educating patients about what they can expect for their surgery – including what outcomes are typical, and how long their healing will take – helps them set appropriate goals for their recovery. All remote education content must be tailored to the patient and their condition, and ideally should reflect their comorbidities, medication and social determinants of health, as these factors influence how a patient is likely to respond to treatment. Content should be delivered in the patient's native language, and should feature clear and easily understood directions. Engaging a care partner who can support the patient's recovery journey also can be extremely beneficial. Many patients find it helpful to return to valuable content as questions arise, and care partners can assist by reinforcing the care team's instructions along the way. Content also should be easily digestible and should arrive at the appropriate point in the patient's journey, so as not to overwhelm patients with too much information. For example, before surgery, patients need information about how long they will be out of commission and how to prepare their space for moving around with an assistive device. A few days after surgery, they need information on how to manage their swelling and control their pain. Many hospitals and ASCs also are offering patients the option of virtual PT to supplement or replace traditional outpatient PT, as remote therapy delivers similar results at a much lower opportunity cost for the patient. Randomized trials have shown that virtual PT produces similar outcomes to outpatient PT after total knee and hip arthroplasty procedures, as long as the virtual program is prescribed by the treating clinical team. In addition to the time savings involved, replacing traditional PT with remote PT can save patients hundreds of dollars in copays and convenience, as patients can complete the rehab in their own home at a convenient time. Q. How does telehealth technology serve as a digital bridge to, for example, patients who cannot afford copays for doctor or outpatient PT appointments, patients in urban communities whose mobility issues make leaving home difficult, patients whose inability to take time off work or secure childcare limits in-person visits, and patients who speak English as a second language? A. Digital therapeutics can help orthopedic teams build stronger relationships with their patients, especially those who are members of disadvantaged populations and who are likely to need additional support. Standardizing patient access to preoperative and postoperative education through remote technology can help practices correct against implicit bias and ensure consistent communication with all patient populations, including the 13% of Americans who speak Spanish at home. For patients living in rural communities, telehealth tools can close the access gap imposed by geography. For patients in urban areas, who may struggle to use public transportation or navigate the stairs in a fifth-floor walk-up, telehealth tools can mean the difference between skipping necessary appointments and following their care plan. Ideally, telehealth technology can serve as a digital bridge to connect vulnerable patients to their care teams. However, the infrastructure of any such tool must support all patient populations, including the 43% of lower-income adults without broadband services at home. In many low-income communities, insufficient access to a computer also hinders the use of digital care management and remote monitoring solutions. Applications must compensate for the digital divide in their system design to ensure content does not require internet access, which can be poor or non-existent in certain areas. Patients should be able to access their care plans via mobile device with a secure login. According to the Pew Research Center, 27% of adults living in households earning less than $30,000 a year are smartphone-only internet users. As disadvantaged populations are far less likely to own a tablet, laptop or desktop computer, telehealth tools must be mobile-friendly and SMS-enabled. Two-way text messaging between patients and clinicians is a proven health intervention tool, as patients are much more likely to read and respond to a text than an email. Direct messaging via telehealth platforms also can improve outcomes for disadvantaged populations. When postoperative patients have a question about their pain levels, they can text their care team for answers instead of making an unnecessary trip to urgent care or the ER – or simply ignoring the problem until later, when interventions are less likely to be successful. Research shows that providing a care management platform with direct messaging decreases readmission rates across musculoskeletal procedures. Q. On a personal note, how does telehealth help you, the provider, with all these challenges? A. Early on in my career as a physical therapist, I managed and founded a number of orthopedics and sports medicine clinics in New York. My colleagues and I were constantly frustrated by how basic patient challenges – from inadequate healthcare access to poor health literacy and a lack of motivation – impacted our patients' outcomes. Similarly, we had very little or no visibility into how patients were managing at home, and whether the patients were achieving the outcomes that mattered to them. There wasn't a reliable closed-loop connection that provided the data we needed to make the right care decisions. Many patients would drop out of a treatment regimen due to access or cost challenges. There often were protracted gaps in care, and by the time the patient returned for treatment, they had often regressed or developed complications. That period led me to believe that evidence-based remote therapy and education could play a pivotal role in helping disadvantaged populations follow their postoperative care plan. In the traditional system, clinicians spend much of their valuable time in preoperative education visits, repeating the same things over and over to patients who are not likely to retain the bulk of this information. After surgery, nurses and care coordinators then work overtime to return patients' phone calls and fill in the knowledge gaps for patients. Digital care management systems allow orthopedic practices to scale valuable in-person time by automating low-touch interactions, while identifying the patients who need targeted one-to-one intervention. With the benefit of technology, practices can create high-value, repeatable workflows to fully prepare patients for surgery by giving patients what they need to know as they need to know it. This phased, segmented approach to education has been proven to correct for the retention gap of in-person education. The addition of patient messaging and remote monitoring tools enables the delivery of patient-reported outcomes data and care plan progression feedback to be returned in real time to the care team, who then can intervene as necessary. Orthopedic practices are much less likely to miss a patient who has stalled in their recovery and is at a high risk of developing complications. When digital therapeutics are designed to be inclusive of all patient populations, they can transform the way we practice orthopedics to improve health equity. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/how-telemedicine-and-digital-therapeutics-can-improve-orthopedic-care-and-pt < Previous News Next News >

KFF Report on Telehealth - Medicare Use Offers Future Policy Implications Center for Connected Health Policy June 2021 Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. More work will need to be done to further education around telehealth and ensure its availability to all communities. A Kaiser Family Foundation brief presents new information and analysis of Medicare beneficiaries’ utilization of telehealth using Centers for Medicare & Medicaid Services (CMS) survey data from between summer and fall of 2020 while CMS emergency telehealth expansions were in effect. Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. For instance, while 64% of beneficiaries said their provider currently offers telehealth appointments, only 18% said their provider offered telehealth prior to the pandemic. However, nearly a quarter of beneficiaries said they don’t know if their provider offers telehealth appointments, with the percentage even larger among rural beneficiaries. Therefore, while expanded policies appear to have increased access to services via telehealth, more work will need to be done to further education around telehealth and ensure its availability to all communities. Additional findings from the study include: -Over 1 in 4 (27% or 15 million) of Medicare beneficiaries had a telehealth visit between the summer and fall of 2020 -The majority of Medicare beneficiaries (56%) used telephone only *Video was 28% *Both video and telephone was 16% -The share of Medicare beneficiaries who had a telehealth visit using telephone only was higher among: *Those age 75 and older (65%) *Hispanic beneficiaries (61%) *Those living in rural areas (65%) *Those enrolled in both Medicare and Medicaid (67%) The report also found that rural Medicare beneficiaries were less likely than urban beneficiaries to have a telehealth visit with a doctor or other health professional (21% vs. 28%, respectively). However, among Medicare beneficiaries with a usual source of care and whose usual provider offers telehealth, they found no significant difference between the share of rural and urban Medicare beneficiaries who had a telehealth visit (43% and 45%, respectively). They note this difference is likely driven by the fact that rural Medicare beneficiaries were more likely than urban Medicare beneficiaries to say they do not know if their usual provider offers telehealth (30% vs. 21%, respectively). Similarly, among Medicare beneficiaries with a usual source of care whose usual provider offers telehealth, they found that a larger share of Black and Hispanic beneficiaries had a telehealth visit compared to White beneficiaries (52%, 52%, and 43%). However, among the total Medicare population, the difference in the share of Black and White beneficiaries who reported having a telehealth visit was not statistically significant (30% vs. 26%), while a larger share of Hispanic beneficiaries than White beneficiaries had a telehealth visit (33% vs. 26%). They note that for Black Medicare beneficiaries, this result is likely related to the fact that nearly a quarter of Black beneficiaries overall (23%) say their usual provider does not offer telehealth appointments, compared to 12% of White beneficiaries and 15% of Hispanic beneficiaries. Looking forward, the authors suggest that since they found greater usage of telehealth amongst those with disabilities, low incomes, and in communities of color, the temporary expansions of coverage may be helping more disadvantaged populations access care. In addition, since most services are being provided via audio-only, they state going back to requiring two-way video could be a barrier for many subgroups of the Medicare population. As policymakers continue to request data on telehealth and consider making certain emergency policies permanent, many are looking to Medicare to lead the way, and this information further confirms the importance of maintaining access to all telehealth modalities in all communities, or risk potentially exacerbating existing disparities even further post-pandemic. Additional expansion and education of telehealth availability will continue to remain necessary as well. More information on the survey and analysis can be found in the full issue brief - https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/. < Previous News Next News >

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

CONNECT for Health Act Recently Reintroduced Center for Connected Health Policy May 2021 CCHP Breaks Down Key Elements in New Fact Sheet * < Previous News Next News >

Access and Equity in Medicaid Telehealth Policy Webinar Center for Connected Health Policy April 30, 2021 Access and Equity in Medicaid Telehealth Policy Webinar April 30 Telehealth has demonstrated that it has the potential to make healthcare more accessible for hard-to-reach patient populations in medically underserved communities. However, some lessons from telehealth utilization during the COVID-19 pandemic have raised concerns about access gaps for these patients. Join the Center for Connected Health Policy (CCHP) and leading Medicaid experts on Friday, April 30, 2021 for the first webinar in our Spring webinar series, Access and Equity in Medicaid Telehealth Policy. This webinar will feature presentations from Medicaid administrators and policy staff on trends in telehealth access and equity and strategies to address these gaps. Stay tuned for more information on confirmed speakers for this webinar. This event is free and open to the public. Register: https://us02web.zoom.us/webinar/register/WN_B-EIOkBkQW-QvcxUcqHxKA < Previous News Next News >

New Study Finds Telehealth Outperforms In-Person Care in HEDIS Measures Eric Wicklund October 06, 2022 Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit. KEY TAKEAWAYS A recent study of more than 526,000 patients receiveing care at Wellspan Health sites in 2020 and 2021 found that telehealth outperformed in-person care in 11 of 16 HEDIS quality improvement measures for primary care. The research indicated in-person care was better in medication-based measures, while telehealth scored higher in testing and counseling measures. Researchers stressed that the results show a need for health systems to integrate telehealth with in-person care, enabling patients and providers to select the venue that most suits them and the treatment. New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care. The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements. The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care. The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings. "Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer." "Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care." Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person, and perhaps shifted to virtual platforms for follow-up. "Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models." Eric Wicklund is the Innovation and Technology Editor for HealthLeaders. See original article: https://www.healthleadersmedia.com/telehealth/new-study-finds-telehealth-outperforms-person-care-hedis-measures < Previous News Next News >