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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 >

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

Telehealth and Maternal Mental Health Needs Two recent studies show telehealth can help new and expectant mothers. Psychology Today April 30, 2021 Telehealth measures decreased prenatal distress, pregnancy-related anxiety, and postpartum depression. Telemedicine has skyrocketed since the start of the pandemic. According to The New York Times, just short of May 2020, the Johns Hopkins neurology department was seeing 95 percent of patients virtually. The rise in telemedicine to address maternal mental health has also seen unprecedented growth during the pandemic. Meanwhile, Mental Health America states that the mental health needs of Americans have skyrocketed. Anxiety and depression screenings increased nearly four-fold in 2020, from nearly 2,000 screenings per day to roughly 8,000 per day. Women, and in particular pregnant women, are vulnerable to hormonal fluctuations that make them twice as likely to experience depression during their lifetime compared to men. Research in the past year and a half has shown that telehealth can be substantially as effective as in-person care. (Telehealth, more encompassing than telemedicine but inclusive of it, may include only educational components.) With respect to maternal mental health, there are two studies highlighted herein that demonstrate telehealth's promise when it comes to improving maternal mental health in terms of prenatal distress, pregnancy-related anxiety, and the postpartum period. Of note, one of the studies was conducted prior March 11, 2020, or the official start of the pandemic, which makes it non-COVID-19 related. Maternal mental health, or perinatal mental health, is defined by the Maternal Health Task Force as a woman’s mental health during pregnancy and in the postpartum period. The significance of this period is multifold. It includes increased risk of the following: preterm delivery, low birth weight, impaired postnatal infant growth, insecure infant-mother attachments, and suboptimal breastfeeding practices. The first study published in Midwifery in 2021 supports the use of tele-education in improving prenatal distress and pregnancy-related anxiety. Specifically, the Midwifery study showed that “tele-education offered to the pregnant women on pregnancy and birth planning during COVID-19 decreased their prenatal distress and anxiety levels.” What the pregnant women received were phone calls, text messages, and a digital education pdf file, all of which educated women on a variety of topics, including “general methods of protection from coronavirus, coronavirus prevention methods during pregnancy, coronavirus and delivery process, measures to be taken during the coronavirus pandemic and postpartum process, measures to be taken during the coronavirus pandemic and breastfeeding, and how to manage stress, anxiety, and depression in these processes.” The tele-education included a digital pdf file called the “Booklet for Pregnancy and Birth Planning Education during Coronavirus (COVID-19).” All the of the educational content was developed with suggestions from medical and public health experts. A major takeaway from the above Midwifery study is that tele-education is effective in reducing the fears pregnant women have about giving birth as well as about their babies’ health in the context of a pandemic; in summary, prenatal distress and pregnancy-related anxiety were significantly decreased (p-value <0.05). Significantly lower scores on pregnancy-related anxiety questionnaires developed by van den Bergh (1990) and revised by Huizink et al. (2016) demonstrated the effective role played by tele-education. The second study published in Midwifery in 2021 supports the use of telemedicine interventions in treating postpartum depression symptoms. While the study’s timeframe was not during COVID, the results are helpful in understanding the beneficial role telemedicine has played in the past couple of years. Previous research has shown it can be a challenge for postpartum women to seek care for the “baby blues” or depressive symptoms, either of which could be significant. This may be due to perceived stigma, time, financial constraints, transportation, or childcare concerns. In this study, the telemedicine modalities included: telephone support, mobile applications, social media, and websites. This meta-analysis reviewed at least seven randomized controlled trials that largely used cognitive behavioral therapy (CBT) or psychoeducation to help pregnant women participants. The second Midwifery study concluded that telemedicine interventions “significantly decreased postpartum depression symptoms” and “demonstrated feasibility and acceptability among mothers in the postnatal period.” A major takeaway from the second Midwifery study is that telemedicine appears to be “promising in preventing and improving postpartum depression.” Of note, the study looked at women without a history of mental health conditions. Meanwhile, Hanach et al. highlight the need for larger-scale, future research to figure out the structure, content, and type of providers recommended within future telemedicine interventions. In conclusion, the benefits of telehealth—especially during COVID-19—appear to help women in the prenatal and postpartum phases of pregnancy. While the research is still growing, and quite limited, such positive signs are helpful in understanding the role that technology can play in addressing maternal mental health needs. Future studies that reflect on the benefits of telehealth are vital and will be particularly useful in supporting new and expectant mothers, especially in times of adversity. Source: https://www.psychologytoday.com/ca/blog/healthy-mothers-healthy-families-and-healthier-world/202104/telehealth-and-maternal-mental < Previous News Next News >

State Telehealth Laws and Reimbursement Policies Report, Fall 2021 Center for Connected Health Policy October 2021 Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2021. Our semi-annual report has gone digital Historically, our twice-yearly updates to the “State Telehealth Laws and Reimbursement Policies” report have been published as a PDF document, and included the telehealth policies for all 50 states and the District of Columbia. Earlier this year, we transitioned exclusively to our new and improved online Policy Finder. This online database allows the CCHP team to easily update each state’s information whenever there is a change, instead of waiting for the spring and fall to roll out the report. Now, you can look up (or download a PDF) of the most up-to-date information on each state from that state’s page. We hope this transition will result in more timely policy information that is easier for you to navigate and understand. Read the Executive Summary We will continue to produce bi-annual summary reports of the status of telehealth policies across the United States to provide a snapshot of the progress made in the past six months. The information for this summary report covers updates in state telehealth policy made between June and September 2021. DOWNLOAD SUMMARY This report is for informational purposes only, and is not intended as a comprehensive statement of the law on this topic, nor to be relied upon as authoritative. Always consult with counsel or appropriate program administrators. Introduction The Center for Connected Health Policy’s (CCHP) Fall 2021 analysis and summary of telehealth policies is based on its online Policy Finder database tool. It highlights the changes that have taken place in state telehealth policy between the initial release of CCHP’s Policy Finder in Spring 2021, and Fall 2021. The research for this Fall 2021 executive summary was conducted between June and September 2021. This summary offers policymakers, health advocates, and other interested health care professionals an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder tool which breaks down policy for all 50 states and the District of Columbia. Please note that many states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in this executive summary, although they are listed under each state in the online Policy Finder under the COVID-19 category. In instances where the state has made policies permanent, or extended policies for multiple years, CCHP has incorporated those policies into this report. DOWNLOAD INFOGRAPH WITH KEY FINDINGS Methodology CCHP examined state law, state administrative codes, and Medicaid provider manuals as the primary resources for the online telehealth policy database tool, from which the findings in this summary are taken. Additionally, other potential sources such as releases from a state’s executive office, Medicaid notices, transmittals or Agency newsletters were also examined for relevant information. In some cases, CCHP directly contacted state Medicaid personnel in order to clarify specific policy issues. Most of the information contained in the database tool specifically focuses on fee-for-service; however, information on managed care plans has also been included if available from the utilized sources. Every effort was made to capture the most recent policy language in each state at the time it was reviewed between the months of June and September 2021. In some cases, after a state was reviewed, they passed a significant piece of legislation. In order to incorporate those significant changes, CCHP conducted a scan for these instances in late September and incorporated language from those enacted bills where appropriate. It should be noted that even if a state has enacted telehealth policies in statute, these policies may not have been incorporated into its Medicaid program. For purposes of this summary, CCHP only counts states as reimbursing for a specific modality or removing a restriction if there is documentation to show that the Medicaid program has implemented a statutory requirement for that policy. Requirements in newly passed legislation will be incorporated into the findings section of future editions of CCHP’s summary report once they are implemented in the Medicaid program, and CCHP has located official documentation confirming this. This survey focused on three primary areas for telehealth policy including Medicaid reimbursement, private payer laws and professional requirements. Within each category, information is organized into various topic and subtopic areas. These topic areas include: Medicaid Reimbursement Definition of the term telemedicine/telehealth Reimbursement for live video Reimbursement for store-and-forward Reimbursement for remote patient monitoring (RPM) Reimbursement for email/phone/fax Consent issues Out-of-state providers Private Payer Laws Definitions Requirements Parity (service and payment) Professional Regulation Definitions Consent Online Prescribing Cross-State Licensing Licensure Compacts Professional Boards Standards Key Findings No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states, noticeable differences exist. The main areas where changes were made over the past six months fall in the three buckets that CCHP uses to categorize information within its policy finder: Medicaid policy, private payer policy, and regulation of health professionals. Changes were also highly influenced by temporary expansions made during the COVID-19 pandemic. Some states took approaches to extend their pandemic policies multiple years into the future, while others made policies (or portions of their COVID policies) permanent. Still others have not adopted their more lenient COVID policies at all. Connecticut, for example, passed a new temporary law (active until June 30, 2023) which not only requires Medicaid to reimburse for synchronous, asynchronous store-and-forward transfers, remote patient monitoring and audio-only modalities if the provider is in-network, but also places similar requirements on private payers as well. In Medicaid, it was common for states to make slight adjustments to their telehealth policies to add or clarify the services that can be delivered via telehealth, types of professionals that can deliver care through telehealth or the types of settings a patient could be in during a telehealth interaction. For example, Iowa clarified that an intern psychologist can provide telehealth services to Medicaid members. Mississippi clarified federally qualified health centers (FQHC) and rural health clinics (RHC) could be distant site providers, and added the home as an originating site. And, Arkansas now specifies that both the home is an eligible patient site and that group meetings may be performed via telemedicine. Although reimbursement for audio-only telephone has become pretty standard during the COVID-19 public health emergency (PHE), less than half of state Medicaid programs explicitly are reimbursing for the modality permanently, and many that are have placed restrictive parameters around its reimbursement. It was also common for states to make modifications to their telehealth private payer reimbursement law language to alter the definition of telehealth/ telemedicine. This typically included an expansion of the definition to be broader in scope so that it entails more than just live video, although often with some caveats. For example, Arkansas’ private payer law now stipulates that telemedicine does not include audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan. Iowa revised their law to include ‘real-time interactive electronic media’, but still excludes audio-only telephone from the definition of telehealth. Requirements around payment parity were also a common change, with eight states passing a law requiring the reimbursement amount is the same whether a service is provided via telehealth or in-person since Spring 2021. Illinois, for example, now requires reimbursement parity for in-network or tiered network health care professionals or facilities, including services provided via audio-only. Iowa is another example of a state requiring reimbursement of covered services is made on the same basis and same rate as in-person mental health services. Finally, there is a noticeable shift in telehealth policy towards tightening of professional requirements around the use of telehealth by providers. For example, Michigan passed new consent requirements for social work, athletic trainers, massage therapists, acupuncturists and veterinary medicine. Texas is another state that added practice standards (including a consent requirement and prescribing rules) for teledentistry specifically. West Virginia adopted emergency telehealth practice standard regulations to implement a previous law that passed (W. VA Code 30-1-26(b)) for five professions, including dentistry, nursing, osteopathic medicine, social work and medicine. While many states have had these types of standards for several years, the rate at which new telehealth standards are being adopted has increased significantly within the last six months. Additional findings include: Fifty states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service. Twenty-two state Medicaid programs reimburse for store-and-forward. However, three states (NC, OH, VT) solely reimburse store-and-forward as a part of CTBS, which is limited to specific codes and reimbursement amounts. Michigan is the only state to add reimbursement for store-and-forward since Spring 2021. Additionally, three jurisdictions (MS, NH, and NJ) have laws requiring Medicaid reimburse for store-and-forward but as of the creation of this edition, don’t have any official Medicaid policy indicating this is occurring. Twenty-nine state Medicaid programs provide reimbursement for RPM. States that added RPM since Spring 2021 included Washington, Michigan and California. As is the case for store-and-forward, three Medicaid programs (NH, HI and NJ) have laws requiring Medicaid reimburse for RPM but at the time this report was written, did not have any official Medicaid policy. Additionally, two of the states (OH and CA) only reimburse the remote physiologic monitoring codes CMS does. Twenty-two states reimburse for audio-only telephone in some capacity (often limitations apply); however, Michigan only reimburses for it when used for provider to- provider electronic consultations. Eleven state Medicaid programs including Arizona, California, Maine, Michigan, Minnesota, North Carolina, Ohio, Oregon, South Carolina, Texas, Washington, reimburse for all four modalities, although certain limitations apply. While this Executive Summary provides an overview of findings, it must be stressed that there are nuances in many of the telehealth policies. To fully understand a specific policy and all its intricacies, the full language of it must be read utilizing CCHP’s telehealth Policy Finder. Below are summarized key findings in each category area contained in the Policy Finder as of September 2021. Read more: https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2021/ < Previous News Next News >

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

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

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

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 >

Audio-Only Telemedicine In Primary Care: Embraced In The NHS, Second Rate In The US Rebecca Fisher, Urmimala Sarkar, Julia Adler-Milstein December 5, 2022 Use of telemedicine in primary care soared in the first wave of the COVID-19 pandemic and remains well above pre-pandemic levels. In the US, a major enabler of this shift is equal reimbursement across video, audio, and in-person visits. Policy makers must now choose whether to extend these COVID-19-era telemedicine policies. A key decision is whether audio-only telemedicine should be covered and if so, whether it should retain parity with video-based telemedicine. The dominance of video over audio in the US suggests that an appropriate policy strategy would be to not reimburse for audio-only telemedicine or reimburse at markedly lower levels. However, US policy makers would be wise to look internationally first—where experience suggests that audio-only can be an effective and more equitable means of delivering primary care. In the National Health Service (NHS) in England, almost one in three consultations in general practice is audio-only; a figure that has been stable since October 2021. This represents a major rise; pre-pandemic around 10 percent of consults were by phone. Despite efforts from UK policy makers such as fast-tracking funding for online consultation tools, the number of video consults remains stubbornly low, at just 0.4 percent of appointments. This is despite the fact that most NHS primary care practices are video-equipped, and the US and UK populations do not differ significantly in their digital literacy. What Explains The Higher Levels Of Audio-Only Telemedicine In The UK Versus US? There is no evidence that directly answers this important question. We therefore leverage circumstantial considerations to develop three possible explanations. National Policy Given the active efforts of policy makers at the start of the pandemic to expand availability of telemedicine, an initial explanation is that the countries implemented different policies regarding telemedicine provision—with the US pursuing policies that favored video while the UK pursued policies that favored audio. However, we are not aware of any such policy differences. In both countries, policy makers acted swiftly to make it easier for providers to consult using either modality. National guidance issued to practices in England encouraged use of phone and video encounters “tailored to the person, the circumstance and their needs,” but there was no directive to prioritize audio-only above video consulting. In the US, emergency legislation removed barriers to telemedicine consulting, including giving parity of reimbursement across audio and video encounters (theoretically an incentive to drive up audio-only rates). Both countries reduced regulatory barriers to video consultation, allowing providers to use non-medical video call applications such as Skype and Facetime. But neither country mandated—or strongly incentivized—provision of one telemedicine modality over the other. Path Dependence A second explanation is one of path dependence. The idea that faced with the need to act fast and little central planning or coordination, health care delivery organizations disproportionately scaled-up the form of telemedicine that made sense given prior circumstances before the pandemic. In the NHS, the use of audio-only for triage and traditional encounters in general practice was common pre-pandemic. In 2019, 10 percent of encounters in English general practice were by phone, compared to fewer than 1 percent across both telemedicine modalities in the US. The public was also used to receiving health advice by phone—the NHS 111 service is a free phoneline to help people in England access non-emergency medical advice and to link them to local NHS services. Thus, when the pandemic hit, it was easier to act quickly to scale the more familiar modality of audio. In contrast, the US did very little of either modality pre-pandemic, and in an effort to more closely replicate face-to-face care at the start of the pandemic when in-person care was not an option, US practices chose to ramp up video-based telemedicine. Provider Perceptions Of Quality While path dependence emphasizes the concept of choice driven by ease, a third potential explanation is that, instead of prior familiarity driving decisions about modality offerings, these decisions were driven by different perceptions of the strengths and limitations of each modality. In the UK, analysis of why general practitioners hadn’t used video consultations found that despite improvements in functionality and reliability of video consultation tools, practitioners viewed video encounters as logistically more challenging and more cognitively demanding than either face-to-face or telephone consulting. Physicians felt that many presenting problems could be sorted safely by telephone, with in-person assessment required for the remainder. Where problems required visual assessment, physicians preferred a combination of photograph plus telephone consultation (SMS technology is widely embedded in general practice [GP] electronic health records). Consensus from UK physicians seems to be that video provides little benefit over audio-only. Differential uptake of video over audio-consulting suggests that US physicians feel differently; surveys of US physicians have highlighted concerns about the diagnostic accuracy of telephone visits, and their suitability for new patients. The acceptability of different telemedicine modalities to patients is another dimension of quality that could have driven what health care delivery organizations offered. Evidence from the UK suggests that telephone appointments are a popular appointment modality in general practice. Indeed, analysis of 7.5 million patient-initiated requests for care across 146 primary care providers found that telephone consultation was the most popular patient preference, requested by 55 percent of people seeking care, with fewer than 1 percent of requests seeking a video consult. In the US, one trial reports similar patient satisfaction with audio and video consults, but it is possible that US physicians felt that patients expected video consultations and made efforts to oblige. Based on circumstantial evidence, we suspect that path dependence and perceptions of quality worked together to push the countries in different directions. While more conclusive evidence is needed, explanation three raises the more critical question of how to move from perceptions of quality differences to robust evidence that can inform choice of modality. What Is Currently Known About Which Modality Is Better From A Quality Perspective? The clearest evidence on differences between modalities is about access, where audio-only has clear advantages over video consults in promoting equity. People with the greatest need for health care may be least enabled to access it digitally—termed the “digital inverse care law.” In both the US and the UK, digital exclusion is socially patterned. Older people, those in lower-income groups, people with disabilities, or who do not have English as a first language are more likely to be digitally excluded. In the telemedicine context, video visits require digital literacy and access to technology and broadband/data that are not ubiquitous. On the health system side, providing video visits requires health centers and staff to overcome barriers including cost, training, and technology. These barriers may be more likely to occur in safety-net settings. In the US, video visits are more common in people earning above $100,000, White people, younger people, and people with private health insurance. In contrast, users of audio-only telemedicine are more likely to be Black people, older adults, and on Medicaid. With telephony already embedded in health centers and 97 percent of Americans owning cell phones, audio-only telemedicine represents an important means of accessing care for underserved populations. Beyond equitable access, we lack evidence on differences in other dimensions of quality between the two consultation modes, either overall or in specific clinical scenarios. Unfortunately, there is a major obstacle to such evidence generation: In the US, we do not routinely capture the specific telemedicine modality in use and therefore cannot readily compare audio-only to video encounters. Ruth Hailu and colleagues describe the range of interventions—including simplifying coding and adapting electronic health records—required to generate data that would support comparative analysis. However, even with such data available, the choice of modality is non-random, and individuals are likely to receive a blended mix of consultation types during episodes of care. Disentangling the impact of each encounter modality on a range of clinical and patient-reported outcomes would be a substantial research undertaking. Large, diverse population observational studies may be required, alongside a range of qualitative studies of patient and physician experience. Some of this evidence will take years to gather, and decisions on extending coverage beyond the pandemic emergency will likely be required before a full picture is clear. Neither health system can claim an “evidence-based” strategy—and it likely that neither the US nor the NHS has it right yet. So Where Does This Leave Policy Makers? In the UK, there is no urgent policy decision to be made around reimbursement, since all forms of telemedicine are covered by the capitated payment system for general practice. Instead, debate has focused on whether access to in-person appointments is now too limited. This is framed by decreasing public satisfaction with access to general practice, in the context of ongoing and severe shortages of primary care physicians. Despite nudges from policy makers, the pandemic has barely shifted the number of video consultations in general practice, and use of telephone consulting has expanded instead. Ongoing studies will monitor outcomes of this change and may require expansion to help the NHS identify an optimal blend of consulting modes. With UK general practitioners unconvinced of quality benefits of video consultations, it is likely that compelling evidence of their benefit would be required for use to increase. US policy makers face more difficult choices about ongoing reimbursement for audio-only telemedicine. The Consolidated Appropriations Act of 2022 extends certain telehealth coverages for 151 days after the official end of the federal public health emergency, thus going some way to preventing a “telehealth cliff.” But with the World Health Organization recently discussing for the first time the possibility of ending their emergency declaration on COVID-19, decisions about funding for audio-only and/or video will need to be made relatively soon. In the absence of robust evidence, decisions are likely to hinge on perceptions of the quality of different consultation modes. Arguments against payment parity between audio-only and video telehealth are likely to focus on early perceptions that audio is a lower-quality modality or prone to overuse. These arguments and their rebuttals have been clearly described already. However, given the clear evidence of the meaningful benefits for reaching underserved people, the US should extend coverage of audio-only telemedicine for a minimum of five years. During this time, perceptions of quality can be informed by empirical evidence, such that we can either phase out audio-only in an equitable way or give providers more flexibility to combine use of modalities. Even with reimbursement parity, policy makers will need to invest in complementary enablers of equitable telemedicine access through state-level action. As Elaine Khoong writes, avoiding a two-tier system where video encounters are disproportionately available to the wealthy requires policy makers to expand video-visit capacity in the safety net, alongside community-based strategies to improve digital literacy. Given that telehealth does not necessitate the same geographical constraints as in-person care—for example, with respect to physician licensing or online prescribing—amending policies to streamline provision across states is also vital. A Role For Payment Reform? The past two years have shown that telephone and video consultation can be combined to deliver high-quality and efficient care. Going forward, patients are likely to receive a blended mix of appointments across modalities, tailored to clinical need and individual circumstance. In the NHS, capitated payments give clinicians and managers the flexibility to offer a mix of appointment modalities, based on the clinical situation without the need to consider differential reimbursement or administrative burden. In fee-for-service models, differentiating payment levels across telemedicine modalities is likely to increase bureaucracy and risks decreasing efficiency and quality. In the longer run, experience from both systems suggests that we should move away from modality-based reimbursement. In recent testimony to the US Senate’s Committee on Finance, Robert Berenson suggested that fee-for-service is a particularly flawed payment model for telemedicine, and that the Centers for Medicare and Medicaid Services should consider paying for telehealth services in a similar model to the UK: via monthly capitated payments for primary care physicians as part of a hybrid payment model. Capitated payment systems enable physicians to use the encounter modality considered most appropriate for the situation without worrying about how they will be paid (or the patient billed). Berenson’s proposal would allow physicians and patients to tailor the type of telemedicine encounter more precisely to individual patient need and might reduce bureaucracy associated with billing, in turn increasing efficiency. As evidence on the benefits and risks of each modality emerges, such a payment model also allows rapid translation of evidence into practice. Authors’ Note Professor Sarkar holds current research funding from the National Cancer Institute, California Healthcare Foundation, the Food and Drug Administration, HopeLab, and the Commonwealth Fund. She has received prior grant funding from the Gordon and Betty Moore Foundation, the Blue Shield of California Foundation, and the Agency for Healthcare Research and Quality. She received gift funding from The Doctors Company Foundation. She holds contract funding from AppliedVR, InquisitHealth, Somnology, and RecoverX. Professor Sarkar serves as a scientific/expert adviser for nonprofit organizations HealthTech 4 Medicaid (volunteer) and for HopeLab (volunteer). She is a member of the American Medical Association’s Equity and Innovation Advisory Group (honoraria). She is an adviser for Waymark (shares) and for Ceteri Capital I GP, LLC (shares). She has been a clinical adviser for Omada Health (honoraria), and an advisory board member for Doximity (honoraria). See original article: https://www.healthaffairs.org/content/forefront/audio-only-telemedicine-primary-care-embraced-nhs-second-rate-us#.Y45MpkrZubQ.twitter < Previous News Next News >

Making Telemedicine Feasible for Everyone – Especially Those With Physical Challenges Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 In the context of healthcare, nondiscrimination on the basis of disability means equal access to available health care services, whether those services are provided in-person or via telehealth. Telemedicine has for years been touted as providing access to healthcare for everyone, anywhere, anytime and it has been quite successful in doing so in many respects but disparities still exist among a number of patient populations. In particular, those who traditionally have challenges accessing healthcare due to physical challenges often experience similar or even greater challenges with telemedicine. Think about for a minute. Telemedicine is predominantly provided using audio and/or video-based telecommunications technologies. This fundamental fact of how telemedicine visits occur can actually exacerbate digital disparities. According to the Americans with Disabilities Act (ADA), an individual with a disability is defined as: 1. a person who has a physical or mental impairment that substantially limits one or more major activities; or 2. a person who has a history or record of such an impairment; or 3. a person who is perceived by others as having such an impairment Under Section 504 of the 1973 Rehabilitation Act, no qualified individual with a disability shall, by reason of his or her disability, be excluded from the participation in, denied the benefits of, or subjected to discrimination under any services, programs, or activities of the covered entity (e.g., healthcare providers). In the context of healthcare, nondiscrimination on the basis of disability means equal access to available health care services, whether those services are provided in-person or via telehealth. Some basic facts highlight the problem. About 15% of American adults (37.5 million) over 18 report some trouble hearing, 2 to 3 per 1,000 US children are born with detectable hearing loss in one or both ears and overall 1 in 8 people (13%) 12 years or older has hearing loss in both ears. Interestingly, non-Hispanic white adults are more likely than other racial/ethnic groups to have hearing loss and non-Hispanic black adults have the lowest prevalence among adults aged 20-69. Rates increase with age. The statistics for vision impairments are equally high. About 12 million people over 40 years have a vision impairment, with 1 million who are blind and 6.8% of children younger than 18 have a diagnosed eye and vision condition. The annual economic impact of major vision problems for those over 40 is over $145 billion! For blindness, access to healthcare is especially critical as 90% of blindness caused by diabetes is preventable and early detection and treatment of conditions such as diabetic retinopathy is efficacious and cost effective. So what can we do in the telemedicine community to help ameliorate these disparities? The National Consortium of Telehealth Resource Centers has developed a fact sheet to help providers. Some of the key recommendations are actually fairly easy to carry out. Inventory products, services, and factors required to provide effective telehealth services to patients and ensure they meet basic accessibility requirements for people with disabilities. Consider compatibility of assistive technology (e.g., alternative keyboards) and whether they can work effectively with your chosen telehealth modality. Learn about and incorporate accessibility features (e.g., close-captioning) of software programs you use. Be sure to include the patient’s caregiver, family member, or home health aide during telehealth visits. Increase your knowledge and awareness on cultural competency and linguistic sensitivity. The easiest thing to do ask patients with disabilities about their accessibility requirements! Some additional aids to consider may take a little more effort but are worth it. For those with hearing loss consider: qualified sign language interpreter, qualified cued-speech interpreter, qualified tactile interpreter, real-time captioning or communication access real-time translation (CART), video remote interpreting (VRI), use written materials, ensure the patient has access to headphones or a headset, confirm participants are wearing their hearing aids or amplification device, and use video whenever possible to allow lip reading and provide visual clues like gestures. For those with vision loss consider: a qualified reader, information in large print, Braille, or electronically for use with a computer screen-reading program, have an audio recording of printed information, be aware of your background - there needs to be contrast between you and your background and blurring the background may make it challenging for the patient, ensure lighting is bright enough for patients to clearly see your face, use simplified and enlarged text, ensure patients have a computer-screen reading program for transmission of electronic information and try providing an audio recording of printed information provided during the appointment. Additional ideas and tips can be found on the Health & Human Services (HHS) website There is also good news in terms of funding. The Federal Communications Commission (FCC) recently announced that under the National Deaf-Blind Equipment Distribution Program (NDBEDP), also called “iCanConnect,” may provide up to $10 million annually from the interstate telecommunications relay service fund (TRS Fund) to support local programs that distribute equipment to eligible low-income individuals who are deafblind to access telecommunications service, Internet access service, and advanced communications services. This is clearly a boon for telemedicine applications. The announcement includes a state-by-state list of the initial allocations for the 56 covered jurisdictions. Hearing and vision loss are just two common challenges deal with. Other physical, mental and behavioral challenges are very common as well, and many of the tips above can be adapted to these patients as well, especially simply reaching out and asking them what their needs are and how you can help meet them as well as involving the patient’s caregiver, family member, or home health aide during telehealth visits. Basically telemedicine must be available to any patient and programs should make it a priority to develop strategies and tools to empower all patients no matter what their resources and capabilities to access safe, effective and efficient care. < Previous News Next News >

CMS Proposes to Extend Telehealth Flexibilities Through 2023 Thomas Sullivan Oct 24, 2021 CMS Proposes to Extend Telehealth Flexibilities Through 2023 The Centers for Medicare & Medicaid Services (CMS) proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through this year. Physician groups in comments on the rule called for a permanent solution beyond the dates set by CMS. Groups also submitted comments on MIPS Value Pathways (MVPs), ACO policies, and pending payment cuts. The final rule is expected around November 1, 2021. Telehealth Telehealth advocates called upon CMS to amend the proposed 2022 Physician Fee Schedule to permanently extend emergency measures on telehealth access and coverage that were enacted to deal with the pandemic. Many also called upon Congress to expand telehealth services. “The ATA commends the Biden Administration for their actions in support of telehealth, and we appreciate CMS’ intent to ensure Medicare beneficiaries continue to have access to quality healthcare when and where they need it,” ATA CEO Ann Mond Johnson said in its letter to CMS Administrator Chiquita Brooks-LaSure. “However, as important as the Physician Fee Schedule is, we urge Congress to act before the vast majority of Medicare beneficiaries go off the ‘telehealth cliff’ at the end of the public health emergency.” “The ATA understands that CMS is simply following Congress’ lead, though we are hopeful Congress will correct this wrong in the statute,” Johnson said. “There is no clinical evidence for an arbitrary in-person requirement before a patient can access telehealth services. However, in the proposed rule, CMS considers requiring an in-person visit, not only within the ‘six-month period prior to the first time’ the provider furnishes telehealth to the individual, as stated by law, but also within six months prior to subsequent telehealth visits. This effectively creates a new, arbitrary requirement for the patient to have an in-person mental health visit every six months should the patient plan to seek telehealth services with that provider.” The Medical Group Management Association also commented that removing services after a “predetermined or prescriptive date” could create a major administrative burden for practices already strained financially by the pandemic. “Member group practices report that adjusting workflows to operationalize the use of new telehealth codes requires additional resources, such as clinician and staff training and patient education,” MGMA said in comments. “Removing telehealth services from the covered code list will prove disruptive to both practices and patients alike, as patients have become accustomed to receiving these services virtually.” MIPS Value Pathways and ACOs The proposed rule calls for beginning use of the value pathways program in MIPS for 2023 and having it replace MIPS entirely in 2027. MVP is intended to align clinician reporting requirements, but the American Hospital Association (AHA) said it’s unclear whether the program would reduce administrative burden as expected or that it would be equitable across specialties. AHA said it “believes that unless and until CMS can address several conceptual issues with MVPs … CMS should not set a date certain for transitioning to mandatory MVP participation.” The Medical Group Management Association also had concerns, particularly about provider burden. Group purchasing organization Premier addressed the proposed rule’s changes to reporting from accountable care organizations. It applauded the more gradual move to using electronic clinical quality measures, citing the reporting burden associated with them. Premier also asked CMS to recognize that ACO reporting is “fundamentally different from reporting by clinicians and groups.” The National Association of ACOs echoed those comments. Pay Cuts In comments on the proposed rule, physician groups were also worried about a looming 3.75% cut in the 2022 Medicare conversion factor, which calculates reimbursement for procedures under fee-for-service. The cuts are mandated under a budget neutrality provision in Congress and comes after a pay bump from Congress that expires in 2022. The AMA said that it is urging CMS to work with Congress for relief on the budget neutrality issue. “CMS should exercise the full breadth and depth of its administrative authority to avert or, at a minimum, mitigate these unconscionable payment cuts,” the group added. https://www.policymed.com/2021/10/cms-proposes-to-extend-telehealth-flexibilities-through-2023.html < Previous News Next News >

US Reps Push for Extension of Telehealth Flexibilities for HDHP Members Mark Melchionna December 15, 2022 Three US Representatives led a bipartisan group of lawmakers in submitting a request to Congress to extend telehealth flexibilities for some high-deductible health plan members. In anticipation of critical telehealth flexibilities expiring on Dec. 31, US Representatives Michelle Steel (CA-48), Brad Schneider (IL-10), and Susie Lee (NV-3), along with a bipartisan group of 30 Congress members, sent a letter requesting that House leadership include two pieces of legislation that extend some flexibilities in a year-end package. When the COVID-19 pandemic began, patients and providers turned to telehealth in droves to maintain care. According to the Centers for Disease Control and Prevention (CDC), there was a 154 percent increase in telehealth visits when comparing data from the last week of March 2020 with that of March 2019. This uptake of telehealth was likely associated with the withdrawal of regulatory restrictions in response to the limitations placed on in-person care during the public health emergency. As part of the CARES Act of 2020, Congress passed reforms that expanded access to telehealth services. For instance, prior to the CARES Act, Americans with high-deductible health plans (HDHPs) coupled with health savings accounts (HSAs) had to reach the minimum deductible before they qualified for telehealth coverage. However, Section 3701 of the CARES Act eliminated this requirement initially through Dec. 31, 2021. The provision was later extended through the Consolidated Appropriations Act, 2022. This led to wider coverage of telehealth services as health plans and employers were able to expand access to virtual care services for individuals with HDHP-HSAs pre-deductible. According to the representatives, increased access has led to many benefits for patients, particularly those without access to transportation services and those who reside far away from clinical locations. “Access to telehealth has also provided a significant portion of the U.S. workforce relief at a time when household costs are rising. Telehealth has allowed families to avoid taking time off from work to travel to and from appointments, and timely care has helped prevent costly visits to urgent care or the emergency room. Unfortunately, those with a high deductible may decide to skip critical preventative services – including primary care and behavioral health services – if the deductible is not waived, often leading to poor health outcomes and more costly care down the line,” the letter states. Due to the increasingly apparent benefits of telehealth, the US representatives are requesting that House leadership include the Primary and Virtual Care Affordability Act and the Telehealth Expansion Act in the end-of-the-year package. The Telehealth Expansion Act would make the telehealth flexibility permanent for people with HDHP-HSAs. The Primary and Virtual Care Affordability Act would both extend the flexibility and allow insurance providers to cover primary care services pre-deductible. This letter is part of a larger effort among healthcare stakeholders to ensure that expanded access to telehealth is solidified. Another letter written by the Connected Health Initiative (CHI) requested that Congress extend the safe harbor for telehealth coverage by HDHPs. In the letter, CHI noted its support for removing restrictions impeding telehealth access among Medicare beneficiaries. It also emphasized the upcoming telehealth deadline Americans with HDHPs will face at the end of 2022. Due to this, CHI requested that Congress extend the safe harbor for HDHPs to cover telehealth with first-dollar coverage. This would also allow them to maintain HDHP status. See original article: https://mhealthintelligence.com/news/us-reps-push-for-extension-of-telehealth-flexibilities-for-hdhp-members < Previous News Next News >

Biden’s American Jobs Plan Increases Investments in Broadband Infrastructure Center for Connected Health Policy April 13, 2021 President Biden’s recently released American Jobs Plan includes $100 billion to increase access to affordable, reliable, and high-speed broadband throughout the country. President Biden’s recently released American Jobs Plan includes $100 billion to increase access to affordable, reliable, and high-speed broadband throughout the country. Comparing digital infrastructure today to affordable access to electricity in the 1930s, the Fact Sheet on the Plan released by the White House states how the pandemic has highlighted existing disparities related to the digital divide and the lack of broadband access to more than 30 million Americans. The $100 billion investment will prioritize broadband infrastructure in unserved and underserved areas to reach 100% high-speed broadband coverage. It also sets aside funds for tribal lands and promotes broadband providers less focused on profits, such as those affiliated with municipalities, and seeks to improve price transparency and competition among internet service providers. The plan will include internet subsidies to low-income consumers, but states that in the long-term, the President is committed to working with Congress to reduce internet prices negating the need for such short-term solutions. The full Fact Sheet on The American Jobs Plan can be accessed on the White House website, https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/31/fact-sheet-the-american-jobs-plan/. < Previous News Next News >

Teledentistry – Lights. Camera. Open Wide. By Trudy Bearden April 7, 2021 The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. Well… not quite; but it may not be what you think. I’m not here to make the case about the importance of good oral health, the impacts of poor oral health on overall health and chronic disease, the potential to lower health care costs and our countless opportunities to integrate oral health into health care services. Rather I ask that you join me to learn just a bit more about what teledentistry is and how it can be used to expand access, provide education and elevate team-based care. Teledentistry. The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. According to the ADA, teledentistry includes patient care and patient education delivery using (but not limited to) four modalities: Synchronous (live video) – use of audio and video for real-time communication Asynchronous (store and forward) – secure electronic transmission of radiographs, photos, video, digital impressions or photomicrographs, etc. to evaluate, render an opinion or service or develop a treatment plan Remote physiologic monitoring – electronic transmission of physiologic data (e.g., weight, oxygen saturation, blood glucose levels) Mobile health (mHealth) – sharing of education and/or information by mobile communications or use of apps (e.g., reminds or monitors oral hygiene activities) Store and forward. Dental hygienists can assess the mouths of patients, chart areas of concern, decay or periodontal disease, take high-resolution photographs and x-rays and transmit that information to a dentist who can review the materials and develop a treatment plan for a patient. Expand access. In rural areas with shortages of dentists, primary care clinics can “bring” a dentist or other oral health specialist into the exam room by synchronous (live video) communication to assess and discuss a dental issue and subsequent treatment plan for a patient. This is a far superior option than just prescribing antibiotics and pain medications, which may end with the patient in the emergency department. Education. Using a synchronous modality, there are ample opportunities for providing oral health education to patients and families, those in dentistry, those in the medical field, teams considering oral health integration and more. While there are several teledentistry modalities available, the following are the high leverage applications: Using store and forward technology for dental hygienists and others on dental and medical care teams Including dentists and other oral health and dental specialists (e.g., orthodontist) to join primary care office visits Using synchronous and asynchronous (e.g., secure messaging/email) options for provider-to-provider consults Providing synchronous and broad oral health education What’s in it for us and ours? How do we harness teledentistry to improve oral health? As an individual, it’s reasonable to ask your dentist what they are doing or are planning to do to implement or expand teledentistry to know whether there are additional options for you. If delivering health care services to patients, whether in the outpatient, inpatient, specialist, long-term service supports or elsewhere, we should: Know what the teledentistry options are in our area, especially if we are in a rural area with a shortage of dentists Ensure that all patients have a dental home and are receiving preventive and curative dental services – by teledentistry if necessary and available to them Consider an oral health education program that is delivered virtually or remotely and/or includes mHealth or app-based options If you are particularly passionate about the potential of teledentistry, know the barriers in your state and area and find ways to overcome those barriers, which include parity of coverage, parity of payment, and statutes governing teledentistry in your state. Checking this interactive map from the Center for Connected Health Policy is a good starting place. Adequate and access to bandwidth and provider, patient and family buy-in can be significant factors as well. Either way – let’s get our teeth into teledentistry and do what we can to leverage the full range of options to help individuals optimize their oral health. Interactive map: https://www.cchpca.org/ < Previous News Next News >

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

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

Q&A: How retail healthcare, telehealth trends could evolve in 2023 Emily Olsen December 16, 2022 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. As another year shaken by the lingering COVID-19 pandemic ends, stakeholders are still exploring how virtual care trends that accelerated in 2020 will affect the healthcare industry long term. Though telehealth use spiked out of necessity during the early months and remains higher than pre-pandemic levels, utilization has slowed over the past two years. Meanwhile, big retail companies and pharmacies are offering more care options to patients. Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, sat down with MobiHealthNews to discuss the future of virtual care, how big retail entrants will affect the industry, and the importance of care coordination between traditional health systems and emerging retail players. MobiHealthNews: What are some of your big takeaways from 2022 when you're thinking about telehealth, digital health and other tech-enabled care? Sanjula Jain: A big thing that I'm thinking a lot about is that patients aren't coming back to care, despite all the investments in more supply or access points, whether that be virtual care access points or new retail entrants or traditional urgent care. We've just had this huge mismatch between supply and demand. We're kind of post-vaccines; we have Americans returning to work to some extent. A lot of folks are going into an office a couple of days a week, folks are traveling, yet they're not going back to see their doctors. We've tried to make care more convenient and more accessible. And some of these new supply points are lower cost, and yet, they're still not engaging. I think there are many reasons for that. COVID scared away a lot of patients, and I think we're starting to see signs of more distrust in the healthcare system. And then cost and affordability, with a lot of the price pressures and inflation and recession discussions. That's going to continue to be a factor. There's a lot of health consequences for when patients don't actually engage in necessary healthcare. MHN: What do you think is the future of virtual care when you're looking at 2023 and beyond? Jain: The market for virtual care is a commoditized market. So, we're seeing that generally it's being used amongst a discrete subset of the population. And we have to think about, who are the individuals who like to use virtual care and what are they using it for? Primarily, as a health economist, I think a lot about substitute goods. We are seeing that virtual care is really only a substitute good for behavioral health. It's both a clinical and financial substitute, right? Clinically, having some distance between you and your provider in a behavioral health interaction is probably preferred when you're talking about your feelings and being very vulnerable. And there's no lab work or poking and prodding that actually needs to happen. So it's a viable clinical alternative. Financially, we've been talking a lot about payment parity. Because behavioral health interactions often don't need imaging and lab work, you're kind of making the same amount for an office visit that you are in a virtual care environment. For other use cases like primary care, we see that's not actually the case. The patient goes in for a virtual care visit, and then what really ends up happening is the physician says, "I need you to come in to get some imaging done or get some lab work done." The payment parity, despite the policy incentives to increase telehealth payment rates, it's not true parity. And so, that's why we don't see the full substitute effect. When you boil the ocean down, you see that the market for telehealth continues to be pretty discrete and concentrated to a handful of consumers. That's really where I think the future is, thinking about whether they will continue to use it. The data shows that, in the pandemic, we've seen this tapering. When Americans are given the option for in-person or virtual, they're still preferring to go in-person with that exception of behavioral health. So, I think the market is going to have to be more realistic about the total addressable market size in terms of discrete number of users, the number of visits per user, and then invest accordingly. I think that's a large part of why we've seen a lot of struggling amongst some digital health players, because I think they've overestimated the amount of utilization of virtual care modalities. But the number of discrete users just isn't up to par with what individuals had estimated it to be. MHN: Going back to those retail entrants, Amazon made a ton of news this year. Walgreens, CVS, Walmart — they're also boosting their care delivery operations. How do you think these moves will affect the healthcare industry overall? Jain: It ultimately comes down to, who is your customer or your consumer or patient persona? Who is Amazon actually going after? Who is their target patient population, and for what services? Amazon is really focusing on more low-acuity services, and health systems are particularly good at the higher acuity things like surgeries. What Amazon and other new entrants mean is that they provide the consumer with more care options. But it also creates a need to coordinate care better and create these really strong referral relationships. To go back to my earlier point about patients not coming back, of the patients we do see coming back, we're seeing them really seek out care in these low-acuity, commoditized care settings. They're going in for flu and strep, but they're not getting their screenings. It's going to be really important for groups like Amazon to coordinate with health systems to actually get patients to go follow up for those necessary services and figure out how to refer them out. MHN: How do you think the growth of these retail players will affect patients? Jain: I think it's a bit of a toss up. For some patients, they're going to view it as a better experience, because they can get what they want when they want it. But I think from a clinical perspective, it creates a lot of risks and challenges for the health of the patient. There really isn't someone owning the care or steering the patient through their healthcare journey. Have you gotten this lab workup? Have you gotten this mammogram? For some of these more retail players, it's consumer-directed. You can walk into urgent care and you can go to a telehealth visit, and it's really up to the consumer. But healthcare is complicated, and the average consumer may not have all the necessary information to go make those decisions. I think that there's a lot of positives to retail players in terms of catering to consumer preferences and providing care in a more convenient way. But for a lot of complex care, acute care — that every American is going to need at some point in their life — there is a little bit more fragmentation. MHN: Do you think there's an appetite among health systems to partner with Walgreens or CVS or Amazon and say, "If you see someone, send them to me when they need a cancer screening?" Jain: Absolutely. So, I actually just this week was with one of the health systems, talking to their leadership team. That's very much a conversation that is happening in the boardrooms — what is the right partnership structure with some of these new entrants and primary care providers? I think the challenge is, you could have those great partnerships. But ultimately, it's the consumer and the patient that's still having to make the decision. Are they going to follow up on those recommendations? Where are they going to go next? So, I think it's something that we're going to have to spend more time thinking about as an industry, how to coordinate that care for that patient over time, but with more choice and options in the market. See original article: https://www.mobihealthnews.com/news/qa-how-retail-healthcare-telehealth-trends-could-evolve-2023 < Previous News Next News >

Telemedicine boosts access, decreases inequities in Montana Bill Siwicki October 10, 2022 The University of Montana College of Health has expanded its telehealth offerings across many disciplines to reach more people, especially in tribal communities. Montana has unique challenges in providing healthcare to its widely dispersed population of just over 1 million people. THE PROBLEM Out of 56 counties in Montana, 55 are designated as Health Professional Shortage Areas (HPSAs), limiting access to both urgent and routine medical visits. The cost of travel and long distances between healthcare providers and patients are commonly cited reasons for patients to delay or avoid medical care. The use of telehealth technology can improve healthcare access for Montanans living in rural and tribal communities by providing access to primary care and specialty services. Montana also is home to a significant Native American population, which makes up about 7% of residents. Tribal members experience significant health disparities due partly to inequitable healthcare access. "These pre-existing strains have left many rural and tribal communities particularly vulnerable to broad-reaching impacts of the COVID-19 pandemic," said Erica Woodahl, director of the L.S. Skaggs Institute for Health Innovation and a professor at the Skaggs School of Pharmacy at the University of Montana. "Rural and tribal populations have a higher burden of chronic disease and comorbidities known to increase the risk of morbidity and mortality associated with COVID-19," she continued. "Life expectancy of all Americans has decreased during the two years since the pandemic, but no group more than tribal people whose life expectancy has dropped almost seven years." The pandemic also further reduced access to routine care leading to an increase in preventable complications due to chronic conditions, including emergency room visits, hospitalizations and overall healthcare costs, she added. "Additionally, communities without nearby clinics or hospitals have not had adequate access to coronavirus testing or care, leaving rural and tribal patients vulnerable to the spread of COVID-19," she noted. "This increases pre-existing strains on rural healthcare systems due to provider shortages, limited hospital beds and other resource constraints." PROPOSAL In the telemedicine work of the University of Montana College of Health in Missoula, services would be provided through a centralized hub at the university with synchronous and asynchronous telehealth services provided to rural and tribal communities in partnership with clinics, hospitals and pharmacies across the state. The equipment purchased with help from a grant from the FCC telehealth grant program would allow for the expansion of services within UM's College of Health. "While the initial utility of telehealth technologies to improve care for underserved populations focused on immediate provision of clinical services disrupted by the COVID-19 pandemic, benefits to patients will extend beyond the pandemic to address the challenges of providing healthcare to Montanans," explained Shayna Killam, PharmD, a postdoctoral fellow at the Skaggs School of Pharmacy at the University of Montana. "Telehealth technologies provide clinicians with the tools necessary to bridge the gap in healthcare access and offer quality healthcare to Montana patients," she continued. "Services will specifically target patients living in rural and tribal communities with chronic medical conditions and comorbidities." The organization anticipates a broad reach across Montana, leveraging partnerships with clinical training sites and clinical affiliates to provide centralized telehealth services to a wide range of patients. "Programs in UM's College of Health were awarded $684,593 from the FCC," Killam reported. "Funds were used to purchase telehealth equipment and connected medical devices, providing critical and remote services for patients in Montana." Telehealth equipment will be used by faculty, residents and students affiliated with the University of Montana College of Health. Recipients of funding include the following: Skaggs School of Pharmacy (SSOP). Family Medicine Residency of Western Montana (FMRWM). School of Physical Therapy and Rehabilitation Science (UMPT). School of Speech, Language, Hearing and Occupational Sciences (SLHOS). 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 Pharmacist-driven programs provide services for community-based chronic disease screening, education and management, including management of diabetes, asthma, cardiovascular risk and mental health through point-of-care testing, medication therapy management visits and consultations with telehealth pharmacists. "Connected medical devices and video conferencing hardware will be used to provide routine and urgent care visits with medical residents and providers affiliated with the FMRWM, including diagnostics and monitoring, chronic disease management, prenatal care and mental health services," Woodahl said. "UMPT programs offer home-based visits and services in end-user sites in rural and tribal communities, including remote evaluations enhanced with telehealth technology, such as vestibular function testing and gait monitoring devices, telepresence robots, and video consults with patients and other healthcare professionals," she added. Clinicians and students in SLHOS will conduct telehealth visits via high-quality video and audio equipment, which facilitate effective evaluation and treatment for articulation and voice disorders. USING FCC AWARD FUNDS The University of Montana College of Health was awarded $684,593 from the FCC telehealth grant fund to purchase telemedicine kits to enable critical, remote telehealth services and to provide internet-connected devices for remote patient monitoring services for underserved, rural and tribal populations within the state. "UM's College of Health has used the FCC telehealth award funds to expand telehealth programs offered by the interprofessional disciplines with an overarching goal of increasing healthcare access and addressing inequities in care," Killam explained. "In addition to providing accessible and equitable healthcare, telehealth technologies will be used to train future health professionals," she continued. "Proactive training of our health professions students has the potential to transform the healthcare landscape in Montana and to overcome the challenges presented by traditional models of care." The equipment purchased has empowered physical therapists to engage in remote monitoring of patients as they complete interventions within their home, said Jennifer Bell, PT, clinical associate professor, school of physical therapy and rehabilitation science. "Oftentimes, patients have difficulty with balance and functional mobility within their home," she noted. "By utilizing technology, we are able to see a patient's home environment and support their ability to move around, minimize the risk of falls and complete a home exercise program." Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telemedicine-boosts-access-decreases-inequities-montana?utm_source=twitter&utm_medium=social&utm_campaign=womeninhit < Previous News Next News >

Telehealth Requires Efforts to Improve Access to Reach Full Potential Mark Melchionna November 29, 2022 New research found that telehealth expansion lacks benefits when efforts to improve access are not present, which may often lead to health disparities. Regions with limited healthcare resources may not benefit from telehealth expansion, prompting the need for efforts to improve access, a new JAMA Network Open study finds. Throughout the recent expansion of telehealth, researchers continuously gained insight into new methods for reaching areas with limited amounts of healthcare resources, highlighting many areas and populations facing limited healthcare resources. The fact and theories about the relationship between telehealth and health disparities led researchers to conduct a cross-sectional study containing 2015 to 2019 American Community Survey data which was linked to national, state, and county-level metrics of healthcare access. Prior to the study, the authors hypothesized that internet access was poor in areas that lacked sufficient access to traditional healthcare resources. Known as healthcare deserts, communities with limited healthcare services such as pharmacies, hospitals, PCPs, and low-cost health centers were reviewed for the study. The data sources included dataQ and GoodRx databases for 60,249 pharmacies, federal information on primary care health professional shortage areas, and geospatial information. Researchers calculated the proportion of populations with internet access and the expected number of healthcare deserts, which represented the population-weighted mean number of deserts in a given region. They also noted statistics for metropolitan status for each state. Among 3,140 counties reviewed in the study, researchers determined that healthcare access and internet service availability corresponded with one another. They found that the states with the largest percentage of households without internet service were Mississippi, Arkansas, Louisiana, New Mexico, West Virginia, and Alabama. The states with the lowest number of households without internet service and the lowest fitted number of healthcare deserts were Washington, New Hampshire, Colorado, Utah, California, and Maryland. Rural areas were more likely to have more health deserts and less internet service availability —78 percent compared to 26 percent of urban counties. Based on these findings, researchers concluded that telehealth expansion may not produce benefits within counties where telehealth is highly needed. Key factors that contribute to rural-urban health disparities in the US may include telehealth expansion without improving internet access as well as clinician shortages. Despite this conclusion, researchers noted limitations, which mainly related to the lack of digital literacy data that may have increased urban-rural disparities, along with the co-occurrence of poor internet and healthcare access across six domains. Previously, however, efforts have been made to support rural communities in obtaining telehealth resources. In September, Equum Medical worked with the National Rural Health Association to provide underserved rural communities with virtual resources. The goal of the collaboration was to assist rural hospitals as they aim to fill gaps in specialty care through tools such as of patient transfer assistance, remote patient monitoring, and help with telehealth implementation. See original article: https://mhealthintelligence.com/news/telehealth-requires-efforts-to-improve-access-to-reach-full-potential < Previous News Next News >

CMS Warns Providers to Bill Correctly Center for Connected Health Policy May 2021 OIG is currently conducting several audits on telehealth In mid-April, CMS sent out a Medicare Learning Network (MLN) Connects Newsletter with a reminder to providers to bill correctly for telehealth services. In the short section in their newsletter, CMS cites a 2018 Office of Inspector General (OIG) report that found that there was a significant amount of telehealth claims that were improperly paid, and thus not billed correctly. As the OIG is currently conducting several audits on telehealth, it is possible that they may come to a similar conclusion again. The section also refers providers to several resources to ensure they are billing correctly, including the: Telehealth Services MLN booklet: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Telehealth Payment Eligibility Analyzer https://data.hrsa.gov/tools/medicare/telehealth List of Covered Telehealth Services https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes For policies specific to the public health emergency (PHE), CCHP also recommends providers review the CMS resources listed in the Federal COVID-19 section in CCHP’s Policy Finder, as there are several telehealth flexibilities currently in place as a result of the PHE. CCHP's Policy Finder: https://www.cchpca.org/federal/?category=covid-19&topic=originating-site < Previous News Next News >