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Controversy about Eliminating Telephone Telehealth Coverage By Dr. Maheu April 7, 2021 Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. A study published in the Journal of the American Medical Association focused on telehealth use among the low-income population in California. The study included data from outpatient primary care and behavioral health visits from February 2019 to August 2020 at forty-one federally qualified health centers representing 534 locations in California. The study showed that, with regards to primary care visits, 48.5% of visits occurred via telephone, 48.3% occurred in person, and 3.4% occurred via video. For behavioral health visits, 63.3% via telephone, 22.8% in person, and 13.9% via video. The study’s key finding was that most telehealth appointments during the pandemic period were conducted over the phone. “Eliminating telehealth coverage for audio-only telemedicine visits would disproportionately impact underserved communities,” according to Lori Uscher-Pines, the study’s lead author. “Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth,” she said. “These are important considerations for policymakers if telehealth continues to be widely embraced in the future.” Since the use of telehealth expanded due to COVID, few studies have examined differences in the use of telehealth modalities. However, one federal agency estimated that 30% of telehealth visits had involved phone therapy sessions alone during the pandemic. According to the study, telehealth visits delivered via over-the-phone therapy peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits. Before the pandemic, many definitions of telehealth excluded phone therapy visits, and private insurers or the government rarely reimbursed them, the study authors noted. Some payers, including the Centers for Medicare and Medicaid Services, have indicated they may stop telehealth coverage reimbursement for phone therapy sessions when the pandemic ends. Read more about previous rulings for COVID-19 Telephone Telehealth Reimbursement. “There are some concerns that telephone visits could result in fraud, abuse, and unnecessary and lower-quality care. Although these concerns are important to assess, eliminating telehealth coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of the clinics to meet patient needs” stated Dr. Uscher-Pines. The Reality of Professionalism and Telephone Therapy It seems a bit dramatic to point out that telephone therapy can be more subject to fraud and abuse when it actually is often the only lifeline for many people in distress during the pandemic, and beyond. Fraud and abuse can potentially exist everywhere. The real question is whether the professional has bothered to learn how to properly use the telephone for clinical interventions – or if they are making it up on the fly. Unfortunately, although a clear evidence base exists for telephone-based interventions, very few professionals have received adequate training, and more likely, no professional training to use only the telephone to deliver services to a patient or client. They may not have yet realized that a good in-person clinician is not the same as a good telephone therapist, regardless of intention or need. This point can be clarified quite readily by looking at the case of the alcoholic therapist-in-recovery who now decides to offer therapy for alcohol use. Assuming of course that the therapist has excellent therapy skills to start, the therapist’s history with alcohol can actually interfere with their functioning as an addictions therapist, narrowing perspective with unchallenged assumptions related to etiology, treatment options, and/or prognosis. This is why the professional standard for qualifying alcohol therapists is not one’s prior experience with alcohol, but rather, a course completion certificate or certification in alcohol interventions. Even a good (or great) in-person therapist approaching telephone telehealth without training is likely to overestimate the quality and/or effectiveness of their communications. If one does read the literature about telehealth in general and telephone therapy in particular, it is very clear that professional training in order. In fact, most published studies directly call for clinicians to get such training for telehealth and telephone therapy as well. The Telephone Telehealth Evidence-Base The research in telehealth, in general, has also been quite clear that therapists who have received training are more likely to use the medium correctly to deliver outcomes that are not only comparable to in-person care but also to minimize frustration in both themselves and their clients/patients and feel more confident about how to protect the privacy of the exchange. In 2018, after conducting a systematic search for articles published over a 25-year period (January 1991–May 2016), Coughtrey & Pistrang published a study of 14 studies that concluded that “telephone-delivered interventions show promise in reducing symptoms of depression and anxiety.” This conclusion is warranted, given that much of the Similarly, in 2020, Castro and colleagues published a meta-analysis looking at 10 studies looking at treatment adherence to telephone therapy for depression. In general, they showed beneficial effects on depression severity when compared to control conditions. However, in these and other published reports showing the effectiveness or adherence rates related to telephone telehealth, treatment models are typically highly manualized. That is, they do not consist of free-form, open discussion common to many psychotherapeutic approaches. Therapists in such studies tend to follow very strict procedural dictates, and often, the recipient of care is given written materials and assignments that coincide with specified topics for each meeting. Conducting a mid-pandemic online qualitative survey of mental health care professionals in Netherlands, Feijt and colleagues (2020) reported, “Regarding the mediated nature of communication, the most frequently reported challenge concerns the lack of nonverbal signals that practitioners normally use in face-to-face communication, such as posture and hand movements, but also general demeanor, including smell. Practitioners find it more difficult to connect with their client or clearly communicate their intended message. This is even stronger when sessions are conducted by telephone when there is only audio to rely on.” Such a conclusion seems warranted, given that in-person training often teaches practitioners to rely on visual stimuli to render a diagnosis, develop and deliver a treatment plan. In evidence-based telehealth professional training, and especially in competency-based certificate programs of professional training, many of these issues can be addressed using protocols that are tailored to the clinician’s specific client for one’s patient population, setting, state, and professional requirements. On the other hand, clinicians who use communication technology without professional training are likely to be as confused by the online delivery of healthcare as someone accustomed to using a handset telephone who now is handed a smartphone to make a simple call. Therapist Vulnerability in Telephone Telehealth? Assessing a client or patient’s emotional state from voice alone can be problematic, particularly if the professional’s prior telephone habits involve multitasking. As discuss by Hilty, Randhawa, Maheu, McKean, Pantera & Mishkin (2020), distractions are the #1 problem with digital interventions. Don’t we all multitask when on the phone? Where then does distractibility leave the busy professional who typically multi-tasks during telephone therapy? Professionals who allow their workspace to be impinged by devices that regularly emit incoming messages, beeps, flashing lights, and other forms of alerts will likely find it difficult to stay focused on the voice input they now are attempting to use to deliver the same standard of care as in-person. Some therapists even so boldly encourage their clients and patients to “take a walk” while they themselves stroll about their neighborhoods or other local public areas while offering telephone therapy. All the while, these professionals profess to be delivering the same standard of care as when the client is seated in front of them, in a closed room. Could these realities be used to discredit an earnest professional who is attempting to deliver quality care via telephone therapy to people in need? Telehealth Service Delivery is Not Intuitive Telehealth service delivery is not intuitive, regardless of one’s experience in person or the need of the client. Faulty assumptions, lack of knowledge, undeveloped skillsets, and naive attitudes can lead to preventable error and potential harm. Pierce, Perrin, & McDonald (2020) stated, “Organizations interested in encouraging telepsychology use should adopt policies supporting the use of telepsychology and provide adequate training to do so.” Such calls for training are common to published reports and mimic those of telehealth in general for more than two decades. In 2000, Maheu and Gordon reported the results of an extensive survey assessing psychologist’s assumptions regarding the legal and ethical requirements for telehealth. Fourteen years later, a similar article was published by Maheu and a larger team of researchers who assessed roughly the same variables. In the 2020 study, two-thirds of clinicians endorsed items suggesting that standard legal and ethical mandates don’t apply to telehealth delivery of psychotherapy (Maheu & Gordon, 2000). In a more extensive survey, Glueckauf, Maheu, Drude, Wells, Wang, Gustafson & Nelson (2018) showed that the number had decreased to one-third. The disturbing fact is, however, that while two-thirds of clinicians endorsed items suggesting an awareness of legal and ethical mandates, it cannot be assumed that those clinicians understood how those mandates apply to their everyday telehealth practices. Where does this leave the average clinician who has no or minimal telehealth training, yet is confident that they are delivering quality care because they “feel good about it” and because it is “needed?” Therapists too are vulnerable to emotional reasoning… Courtroom Realities of Telephone Therapy Knowing how litigating attorneys work, it is quite conceivable that opposing counsel in a lawsuit against a therapist would wield several such recently published telehealth articles in the direction of an unwitting therapist who blithely offers telephone therapy without the proper documentation to prove that they indeed were actually trained in evidence-based telephone telehealth. Perhaps the CIVID emergency would tempter such accusations, depending on the circumstance. Hopefully so. However, the worrisome issue at hand is that most clinicians have never been taught the reality of what actually happens in courtrooms. Such training can be a difficult awakening. To help our readers better understand the issues involved with delivering clinical care in an area where there is a lack of professional training, we will make you privy to a training video that we regularly show in our 2-day certificate training programs. It features Attorney Joe McMenamin demonstrating his litigation skills as a prosecuting attorney for the defense in a “mock deposition.” In this video, he demonstrates exactly how a prosecuting attorney would “prepare” their case against a witness’s testimony for a trial wherein the therapist is being sued by an angry client. The video is painful to watch. Our only solace at TBHI is that Mr. McMenamin has not only worked for decades as a prosecuting attorney for the defense, but he is also a physician. he understands and shares the ethos of many healthcare professionals, and has worked these many years to defend us in court. That’s his motivation for working with TBHI for decades to develop training materials and peer-reviewed books and articles – to help professionals who are poorly informed of what can happen when one is led by the unbridled desire to help rather than a firm grounding in telehealth theory and practice. Caveat While this type of cross-examination wouldn’t happen to professionals who deliver telephone therapy during the pandemic because we are currently in a state of national emergency, but if telephone therapy were to be approved long-term, this is precisely the type of rigor that would be expected of professionals delivering professional services to people in need. As all licensed professionals know, there is a high bar for the delivery of professional services. Practicing licensed healthcare professional in the United States or Canada as well as in many other countries isn’t something one does in the same manner as they would if they were talking to a family member on the phone, multitasking, opening email, glancing at texts, perhaps outside strolling about the park — while the other party probably is also multi-tasking and/or strolling about as well. When we share the video below, please use this information to extrapolate how a skilled professional needs to be able to defend the amount of training they have obtained in any new area of practice including phone therapy sessions alone when a litigating attorney has them on the witness stand. Please note, we at TBHI are not saying this process is fair or right. It simply is reality. Courtroom Realities of Telehealth Malpractice Before watching, please let us explain what is happening in the video. First, this is one of the many training videos that we typically share with our training audiences. You will see how the attorney discredits the psychologist who is named “Dr. Joanne Johnson,” acted by Dr. Marlene Maheu for purposes of this role-play. The cross-examining attorney is Mr. Joe McMenamin, who is indeed a litigating attorney and physician in real life. He, however, defends practitioners in court rather than a prosecuting attorney, which he depicts in this audio lesson. However, having litigated against attorneys who prosecute, he is in a unique position to show you exactly what happens in court, should you ever have the misfortune of experiencing it firsthand. The interactions portrayed in the audio recording are abbreviated because Dr. Johnson provided additional information rather than doing as witnesses are instructed, and that is to give yes/no answers when possible, and offer as little as possible unless directly asked. You will see that Dr. Johnson actually offers a fair amount of information to get to the point of the demonstration. Upon experiencing the agony of witnessing such an exhaustive exchange, but in real life, it would behoove you to obtain the advice of a defense attorney about offering as much information as is depicted. The purpose of the demonstration, in this case, was to show you what a skilled litigator can do to disarm a well-intentioned professional during a deposition. The attorney goes on to explain his rationales, strategies, and how opposing counsel (which he is role-playing) would generally use the information gathered to discredit the plaintiff in court. This first training video is 37 minutes in length. TBHI Position on Telephone Therapy Just to be clear, TBHI is in complete support of phone therapy sessions alone for all clients and patients who need or are interested in such healthcare. However, having been the Chair of the CTiBS Committee on Telebehavioral Health Competencies, the Founder of TBHI is acutely aware of the lack of competence in psychotherapists who deliver such care. Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. All untrained professionals then are encouraged to consider serious telehealth training if they wish to be competence and legally and ethically compliant with the evidence base. References Castro, A., Gili, M., Ricci-Cabello, I., Roca, M., Gilbody, S., Perez-Ara, M.A., Seguí, A. & McMillan, D. (2020) Effectiveness and adherence of telephone-administered psychotherapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 514-526, ISSN 0165-0327,https://doi.org/10.1016/j.jad.2019.09.023. Coughtrey, A. E., & Pistrang, N. (2018). The effectiveness of telephone-delivered psychological therapies for depression and anxiety: a systematic review. Journal of telemedicine and telecare, 24(2), 65-74. Feijt, M., de Kort, Y., Bongers, I., Bierbooms, J., Westerink, J., & IJsselsteijn, W. (2020). Mental health care goes online: Practitioners’ experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychology, Behavior, and Social Networking, 23(12), 860-864. Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205. Hilty, D. M., Randhawa, K., Maheu, M. M., McKean, A. J., Pantera, R., & Mishkind, M. C. (2020). A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care. Journal of Technology in Behavioral Science, 1-28. https://doi.org/10.1007/s41347-020-00126-x Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484. Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Demographic, organizational, and clinical practice predictors of US psychologists’ use of telepsychology. Professional Psychology: Research and Practice, 51(2), 184. Link: https://telehealth.org/telephone-telehealth/?utm_source=ActiveCampaign&utm_medium=email&utm_content=New+COVID-19+FCC+Telehealth+Grant+%7C+TBHI+Telehealth+News+4%2F14%2F21&utm_campaign=April+13th+Newsletter&vgo_ee=L60XUD6gIFzXzaAzbkkf6r35hO7C%2FF3J%2FgQB9Uu3XAY%3D Previous rulings for COVID-19 Telephone Telehealth Reimbursement: https://telehealth.org/reimbursement-covid-19-telephone/ < Previous News Next News >

Packard Foundation COVID-19 Policy Flexibilities Report – Impacts and Recommendations Related to Children and Youth with Special Health Care Needs Center for Connected Health Policy July 2021 Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Last month the Lucile Packard Foundation released a report on COVID-19 policy flexibilities that focused on impacts and recommendations related to children and youth with special health care needs (CYSHCN). In addition to analyzing emergency policies, they looked to clinicians, family advocates, and other stakeholders to identify both challenges and opportunities based on their experiences. The number one policy change highlighted by all interviewees was how greater use of telehealth expanded access to care and had significant advantages, particularly for CYSHCN and their families. Telehealth ensured better access to distant and specialized services, especially for those in rural areas and needing services in nearby states, as well as the potential to reduce disparities and address workforce shortages, such as those related to pediatric specialists. Stakeholders also spoke to how telehealth addresses transportation and logistical barriers, mitigating challenges such as traveling long distances, missing work, and bringing other family members along as well as cumbersome medical equipment. The report also noted that the greatest challenges were identified as systemic infrastructure issues affecting broadband access, digital literacy, and lack of interpretation services. Based on their analysis and interviews, the report recommended CMS and state Medicaid programs extend emergency flexibilities on payment parity, audio-only and synchronous reimbursement, as well as remove geographic or rural/urban site restrictions and ease cross-state licensing laws. They also suggested the use of targeted federal funding to reduce disparities and providing grants for telehealth infrastructure and training, as well as increasing flexibility of privacy rules. For state Medicaid programs in particular, they recommended piloting additional modalities for future use such as texting, expanding school-based reimbursement and guidance, and considering reimbursement in childcare settings. The authors heard universally from stakeholders that reimbursement and payment parity requirements were essential to the availability of telehealth. According to their review, 38 states plus DC provided Medicaid payment parity by the end of April 2020, and by September, 17 states enacted laws requiring payment parity from private insurers. In addition, some clinicians reported that telehealth reduced emergency room and inpatient utilization, but because the costs saved were not shared with hospitals, the hospital shut down the program and they are now seeing increased emergency room use and negative health outcomes. For more information, please access the full report at https://www.lpfch.org/sites/default/files/field/publications/covid-19-hma-report_1.pdf. < 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 >

A staffing expert shows how telehealth is stepping in to fill the staffing shortage Bill Siwicki December 19, 2022 "As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience," he says. The staffing shortage is a huge challenge in healthcare today. Another challenge is finding a solution to this vexing problem. But telehealth may be becoming an emerging strategy to help fill in gaps within hospitals and health systems, contended Chris Franklin, president of LocumTenens.com, a self-service job board and a full-service physician and advanced practice recruitment agency working in high-demand medical specialties. Healthcare IT News sat down with Franklin to discuss changes occurring in healthcare staffing, what he calls hybrid staffing strategies, and the results of a new LocumTenens.com survey. Q. Overall, what changes are you seeing occurring in healthcare staffing? A. The changes we've seen in the broader economy regarding contingent employment over the past three years are incredibly impactful on healthcare staffing. There are a few key numbers that tell the story. There currently are 3.5 million fewer workers in the U.S. than there were two years ago. Since February 2020, job openings have gone up by 50%, while total employment in the U.S. has gone slightly down. Because demand is outpacing the available supply, workers are demanding not just increases in pay, but also more choice and control over when, how and where they work. This is incredibly true in healthcare, based on every indicator we watch. New data shows more than 300,000 healthcare workers dropped out of the workforce in the last two years. Physicians report they are choosing early retirement or leaving the full-time practice of medicine for other kinds of work, in and outside of our industry. Nurses on the frontline have made the news due to the difficulties they have experienced, and also because of the freedoms they are newly experiencing due to the uptick in travel nursing. According to a 2021 study from Health Affairs, nearly 100,000 nurses exited the profession last year – most of them under the age of 50. Another 32% of nurses have said they may leave the profession. The Bureau of Labor Statistics estimates we'll need to fill nearly 200,000 nurse vacancies a year until 2030. Patients are sicker than they have ever been. Over the past year, nearly every hospital has seen increases in patient acuity, largely driven by care that was delayed during the [COVID-19] pandemic. And chronic disease and obesity continue to be primary drivers of healthcare consumption in the U.S. Even though it's been on the horizon for years, the impact of a big population of aging baby boomers – the oldest turned 75 this year – is finally here, and demand for healthcare is about to increase dramatically as a result. Burnout also is at an all-time high. A recent survey from MGMA and Jackson Physician Search highlights a sobering pair of statistics: Nearly two-thirds of physicians (65%) report they are experiencing burnout in 2022, up four percentage points from the 2021 study. Of those experiencing burnout, more than one in three physicians (35%) said their levels of burnout significantly increased in 2022. All of this points to a big, industrywide shake-up, and we are seeing first-hand that traditional workforce staffing models are no longer working, especially in healthcare. What's emerging is something very different – hybrid models that anticipate both permanent and contingent workers, an uptick in models that combine site-based care with a robust telehealth presence, an increase in APP staffing overall, and in general, a growing commitment to giving providers access to the kind of work-life balance they are desperately seeking. Q. You say you are seeing a hybrid staffing strategy that includes elements of locum tenens, more advanced practice providers and more telehealth coverage. Please elaborate on this. A. Healthcare leaders are looking for new and creative solutions now more than ever – and all amidst this backdrop of healthcare workforce shortages. We have seen first-hand the impact the gig economy is directly having on the healthcare workforce and know the biggest concerns for healthcare facilities are attracting talent, retaining talent, and avoiding or mitigating burnout. To help clinicians' desire to achieve a more viable work-life balance, healthcare leaders are evolving their hiring models to reflect a new appreciation for the flexibility that hybrid staffing models represent. Solely relying on traditional staffing models and solutions just won't work anymore. Through staffing innovation, hospitals and healthcare organizations are actively seeking options to improve access to care with more sustainable models. Healthcare staffing is complex and there's never a one-size-fits-all solution, but we are seeing an increase in interest in alternative models of staffing, including a growing use of locum tenens staff and improving patient access to care with advanced practice providers (APPs) and telehealth expansion. Awareness of and interest in locum tenens are at an all-time high for both healthcare organizations and clinicians. People are actually taking their own well-being into account in terms of their employment, opting into contingent work as a way to manage their levels of stress and burnout. We had a locum tenens physician tell an audience at a recent conference: "If you have burnout in locums, you are not doing it right." There's no doubt flexibility of locum tenens offers a desirable outcome on what physicians are wanting out of life. According to the recent survey: Nearly 90% of healthcare facilities already use locum tenens staffing. Nearly 57% of facilities that have not used locum tenens staffing in the past are planning to use it in the next year. According to a recent survey we conducted on innovation and flexibility in staffing, when most administrators consider locum tenens, they most commonly think about onsite physician care. Data shows hospitals utilize onsite locum tenens more than three times as often as telehealth, but that is starting to change. Facilities that were previously reliant on onsite are now embracing telehealth. COVID-19 expedited this adoption, as hospitals looked beyond traditional models to meet their patients' needs. In some cases, hospitals are taking a flexible, hybrid approach that integrates telehealth and onsite care, providing the best of both worlds and delivering value to patients. Additionally, the use of APPs in combination with physicians as a strategy is growing, with 73.9% affirmatively responding to the question, "Do you plan to expand APP coverage?" Q. Your company recently did a survey of hospital administrators to get a clearer view of the challenges in today's landscape. What did you learn as it relates to telehealth? A. Our recent survey results – which are detailed in the Innovation & Flexibility: Journey to Sustainable Healthcare Report – revealed that hospital administrators have strong feedback when it comes to managing today's challenging landscape. With regard to how it relates to telehealth, more facilities are using telehealth than ever before. COVID-19 expedited this adoption, but over the coming year, most hospitals expect to expand their use of telehealth even further – there is no turning back. Patients across the board now are more comfortable using telehealth as the COVID-19 pandemic drove a surge in virtual visits, including those who have historically hesitated to use technology. Traditionally, psychiatric services dominated locum tenens telehealth services, with behavioral health accounting for 79% of telehealth services for LocumTenens.com. However, utilization has started to shift as hospitals look at other specialties, including oncology, cardiology and physiatry. By expanding telehealth offerings, facilities can expand access to care and reach more patients in new locations. Over the past year, many facilities have been able to deliver a higher level of specialty care to satellite or remote locations through telehealth. Going forward, better reconciling reimbursements to align with the level of care provided in a telehealth setting will lead to broader adoption. Q. Where do you see the telehealth component of staffing in five years? A. The feedback we have gotten shows that more than half (60%) of those surveyed plan to expand telehealth. Through innovation, healthcare providers will continue to adapt to flexibility and improved access to care. These flexible solutions create a more sustainable model to provide quality care to patients and their communities. As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience. The beauty of telehealth is that it provides access to a qualified provider at any time. For example, we have a client that provides psychiatric services across the country. During a busy day, a patient presented who was experiencing domestic violence trauma, and she wasn't comfortable talking with a male doctor. The problem was there were only male psychiatrists on call at her presenting hospital. The hospital contacted our team, and we in turn reached out to two privileged and credentialed female providers that weren't on-call that day. Although one was heading out to attend a wedding, she accepted the assignment to immediately provide care for this patient. So, even though this psychiatrist worked five states away from the hospital, she was able to provide care because of the access to telehealth. The result: The patient received the "right care" that she needed at the right time with an experienced provider. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/staffing-expert-shows-how-telehealth-stepping-fill-staffing-shortage < Previous News Next News >

Telehealth helps stop suicidal ideation for many patients, study finds Bill Siwicki December 29, 2022 One person dies from suicide every 11 minutes in the U.S. A new study shows that telemedicine can be used to treat more severe mental illness – contrary to previous thought. Recently, the Journal of Medical Internet Research published some significant data highlighting the efficacy of psychiatric care delivered through telehealth: Those in the treatment group were 4.3 times more likely to have suicidal ideation remission. This is noteworthy because telehealth has not traditionally been equipped to treat those with the most severe symptoms of mental health due to the oversight necessary to actually provide safe, effective treatment, said Dr. Mimi Winsberg, chief medical officer at Brightside Health, which led the study. We spoke with Winsberg to get an in-depth look at this study and what the results mean for the future of telehealth and mental healthcare. Q. Please talk about your new study that examines the impact of telepsychiatry on reduction in suicidal ideation over time. Who was involved? What kind of care did they receive? What role did technology play? A. The study, which was published in JMIR Formative Research, sought to determine if Brightside Health's telehealth platform, which is equipped with precision prescribing clinical decision support, could successfully reduce suicidal ideation among enrolled patients, versus a control group who tracked their symptoms on the platform without receiving care. Another goal of the study was to describe the symptom clusters of patients who present with suicidal ideation in order to better understand the psychiatric symptoms associated with suicidal feelings. The study was large scale including participants of diverse geography and social demographics. It included a total of 8,581 people who completed a digital intake on the Brightside platform. Of those, 8,366 elected to receive psychiatric care from Brightside, while 215 tracked their symptoms on the platform without receiving care. Those who elected to receive psychiatric care through Brightside received a minimum of 12 weeks of treatment that included video visits with their providers, asynchronous messaging, and a prescription of at least one psychiatric medication. Brightside's technology platform was used to deliver clinically validated measures of depression and anxiety, as well as questions about clinical presentation, medical history and demographics. The proprietary precision-prescribing platform embedded in the tech platform analyzes these data points using an empirically derived algorithm to provide real-time care guidelines and clinical decision support to its providers using a computerized symptom cluster analysis. Q. The study led to some very promising outcomes. Please describe them and the success you achieved with telemedicine. A. The study found that patients enrolled in Brightside Health's telehealth platform had reduced suicidal ideation after 12 weeks of treatment. Patients who received treatment via Brightside Health were also 4.3 times more likely to have remission of their suicidal ideation than the control group who were monitored on the platform but did not receive care. The results demonstrated that a telehealth platform equipped with clinical decision support was an effective intervention for the symptom of suicidal ideation. In addition, we found that suicidal ideation had higher correlations with cognitive symptoms of hopelessness and poor feelings of self-worth, than with the physical symptoms of depression such as disrupted sleep and low energy. Q. Telehealth hasn't traditionally been equipped to treat these kinds of patients. What made the difference here? A. Historically, we have not relied on telehealth solutions to address more serious symptoms of depression. Clinicians are hesitant to treat individuals with suicidal ideation over telehealth because of the perceived risks. However, the results of this study are significant because they demonstrate effectiveness in treating these symptoms through a telehealth platform with clinical decision support, which may help alleviate concerns about the use of telehealth in addressing suicidal ideation. Telehealth can involve more than simply connecting a provider and patient via video camera. The telehealth platform used for the study was equipped with novel features such as remote patient monitoring and clinical decision support. A sophisticated telehealth intervention can assiduously track symptom presentation and outcomes with measurement-based care and offer real-time interventions along with machine learning and algorithmically based clinical decision support to select the best treatment. Q. What does all of this mean for the future of telemedicine and mental health? A. The future of mental health via telemedicine promises more widespread adoption of solutions for the majority of behavioral health conditions, even those with increasing severity of symptoms. We may see telehealth deployed for more serious mental illness, particularly when the telehealth platform can incorporate novel technologies to optimize care delivery. Additionally, as payers and providers collaborate to deliver more effective care, telehealth will likely become more than a means to deliver care, but also a way to enhance care delivery and provide highly effective care to those who need it most with expediency. At Brightside Health, we will continue to research the impact of telehealth treatment across the spectrum of mental health conditions, including those on the higher end of the severity axis. To that end, we are launching Crisis Care, a first of its kind program delivered nationally and over telehealth to treat patients with active suicidal ideation. The program is grounded in the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) framework. This study in JMIR Formative Research laid the foundation for this program, and we are seeing an obvious need for such a national program in the U.S., where one person dies from suicide every 11 minutes. We look forward to furthering this important – and life-saving – work. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telehealth-helps-stop-suicidal-ideation-many-patients-study-finds < Previous News Next News >

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

Amazon Launches Messaging-Based Virtual Care Service Anuja Vaidya November 15, 2022 Called Amazon Clinic, the new service enables healthcare consumers to connect with clinicians via a message-based portal and receive care for common medical conditions like acne and UTIs. A few months after announcing plans to shutter its telehealth business, Amazon has launched a new virtual care clinic. Called Amazon Clinic, the message-based service is currently available in 32 states. It offers virtual care for more than 20 common medical conditions, including acne, cold sores, seasonal allergies, and urinary tract infections. The service also provides access to birth control services. Healthcare consumers can choose to receive care from a network of telehealth providers, including SteadyMD and Health Tap. After selecting a provider, the consumer completes an intake questionnaire. They are then connected with a clinician via a message-based portal. Once the consultation is over, the clinician sends a treatment plan to the patient through the portal. Clinicians can also send needed prescriptions to a preferred pharmacy or Amazon's online pharmacy. The service further allows users to exchange messages with the selected clinician for up to two weeks after the initial consultation. READ MORE: National Telehealth Use Appears to be Stabilizing "We believe that improving both the occasional and ongoing engagement experience is necessary to making care dramatically better," Nworah Ayogu, MD, chief medical officer and general manager at Amazon Clinic, wrote in a company blog post. "We also believe that customers should have the agency to choose what works best for them. Amazon Clinic is just one of the ways we're working to empower people to take control of their health by providing access to convenient, affordable care in partnership with trusted providers." Amazon Clinic costs will vary by provider. Prices will be disclosed upfront, and according to the 'frequently asked questions' section of the blog post, the prices are "equivalent or less than the average copay." The service does not yet accept health insurance, but consumers can use flexible spending and health savings accounts to make payments. They can also use their insurance to pay for medications. Amazon plans to expand the virtual care clinic to additional states in the coming months. The news comes on the heels of the technology giant announcing that it will close its Amazon Care business by the end of the year. Amazon Care included both telehealth and in-person care and was positioned as an employer-focused service. Initially open to only Amazon employees in the Seattle area, the company began offering the service to other businesses in 2021 and even signed deals to extend it to Silicon Labs, TrueBlue, and Whole Foods Market employees earlier this year. But leaders decided to shut down Amazon Care because it was "not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term," Amazon Health Services Senior Vice President Neil Lindsay said in an internal company memo. READ MORE: Telehealth Patient Satisfaction On Par with In-Person Care During Pandemic Unlike Amazon Care, it appears that Amazon Clinic will operate as a connector, enabling consumers to gain access to telehealth provided by established virtual care companies. "By abandoning Amazon Care in favor of Amazon Clinic, Amazon is doubling down on what they are good at — going directly to the consumer," said Allison Oakes, PhD, director of research at market research firm Trilliant Health, in an email. "Capitalizing on what they are good at, it seems like Amazon will create a marketplace for providers and patients to connect, rather than employing their own network of doctors. This will allow them to keep their costs low and scale quickly. It will be interesting to learn more about the economics of a marketplace model, which traditionally are based upon allocating revenue between the provider of the good or service and the operator of the marketplace. Given long-standing prohibitions against fee-splitting, it will be interesting to understand Amazon's economic upside." Further, because of the current cash-only payment model, Amazon Clinic may only attract relatively young and healthy patients, which is unlikely to improve population health, Oakes added. The shuttering of Amazon Care and launch of Amazon Clinic follow the company's purchase of One Medical. This may point to Amazon's growing focus on a hybrid care strategy overall. "It is interesting that Amazon Clinic is doubling down on virtual-only care, despite the fact that telehealth visits have declined by 37 percent from Q2 2020 to Q1 2022," Oakes said. "They may see Amazon Clinic as the 'digital front door' for One Medical patient acquisition." READ MORE: Patients Prefer Telehealth for Primary Care, Mental Health Needs Today's announcement appears to bolster that idea, with Ayogu noting in the blog post that if healthcare consumers are seeking virtual care for a condition that may be better treated in person, the service will let them know before they are connected to a telehealth provider. "Virtual care isn't right for every problem," he wrote. Editor's note: The article was updated at 2:50 om ET with comments from Trilliant Health's Dr. Allison Oakes. See original article: https://mhealthintelligence.com/news/amazon-launches-messaging-based-virtual-care-service < Previous News Next News >

Building Lasting Tele-Behavioral Health Programs to Address Patient Needs Kat Jercich, Healthcare IT News. August 2021 In a HIMSS21 Global Conference Digital session, two experts discuss what it's taken for the University of Rochester to spin up a virtual behavioral health program over the past nine years. Telehealth during the COVID-19 pandemic has allowed many patients – especially those in under-resourced areas – unprecedented access to behavioral healthcare. But as Michael Hasselberg, senior director of digital health at the University of Rochester, discussed with Cleveland Clinic Director of Design and Best Practices Julie Rish during a HIMSS21 Global Conference Digital session, such programs have required being nimble and adaptable in the face of changing needs. Hasselberg outlined the results of a tele-behavioral health model in effect at the University of Rochester, explaining that it grew from a pilot program aimed at primary care doctors to a full-scale initiative in nearly a decade. But the pandemic, he says, ramped up demand – and the supply had to change in response. "Like every health system in the entire country, overnight you had to flip the switch on, and essentially totally pivot to telemedicine," he said. Having the infrastructure and years of experience allowed the team to shift within about a week to providing behavioral health services nearly entirely virtually. Even as vaccines have become more readily available, Hasselberg estimates that about 60% of the team's ambulatory services are being provided via telemedicine. Interestingly, considering reports from other parts of the country, Hasselberg said the team has not encountered patient difficulties with broadband access, even in rural areas – thanks in part to state government efforts to ensure connectivity throughout the region. But one challenge, he said, has been gaining community trust and support. "Learning to build those community partnerships, identify how the stakeholders are, doing focus groups … has allowed us to be successful," he said. For other organizations looking to replicate the university's success, he said, start by reaching out to providers already in place. "Build that partnership there. Find out where their struggles may be, where the gaps may be, how you can join forces to fill those gaps and truly partner," he advised. He also suggests approaching the programs as iterative – being agile and flexible, and not allowing perfect to be the enemy of good. "Just get something out there: See what works and what doesn't work, and continue to build off of that," he said. It's also vital to remember that not every service can be done via telehealth, he said. Having a support network to assist patients with technology is enormously helpful. Rish noted that it's not just about access alone. It's also about comfort and about trust. "Having somebody from your team who can get to the community, who can be onsite – that's really important," said Hasselberg. Hasselberg said it's been useful to examine who can most benefit from telehealth because of transportation hurdles or other barriers to in-person care. "Finding parking at an academic medical center is not an easy thing to do!" he laughed. By merging that information with electronic health record data, he said, the team can get specific about how best to target services. As far as care delivery predictions, Hasselberg said he saw telemedicine as the "tip of the iceberg." "I think the future of behavioral health will be an a la carte array of options," he said. < Previous News Next News >

New MACPAC Report to Congress: Recommendations to improve mental health access include telehealth Center for Connected Health Policy June 2021 Recommended ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2021 Report to Congress last week that recommends ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP). While the report and recommendations did not evaluate telehealth directly, they did occasionally reference telehealth’s ability to increase access to mental health services and recommend that the promotion of telehealth be included in various programmatic guidance. For instance, the report highlights telehealth programs that connect youth to telehealth counseling services and recommends the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issue joint guidance addressing how Medicaid and CHIP can be used to fund a behavioral health crisis continuum that includes how telehealth can be used to ensure access to crisis care. They also recommend that opportunities to cover telehealth and other technology-enabled services be described in CMS and SAMHSA guidance specific to children and adolescents with significant mental health conditions. The report additionally looks at how to promote care integration through electronic health records (EHRs) and value-based payment (VBP) programs, which include measures related to expanded use of telehealth. It also discusses the non-emergency transportation (NEMT) benefit in Medicaid, mentioning that many changes in how the program is administered are occurring which require additional data to assess its value, such as how expanded availability of telehealth services may lessen its need in certain circumstances. For more information, please access the full MACPAC report - https://www.macpac.gov/wp-content/uploads/2021/06/June-2021-Report-to-Congress-on-Medicaid-and-CHIP.pdf < Previous News Next News >

River Valley Counseling Center boosts productivity and experience with telehealth Bill Siwicki June 01, 2022 From putting band-aids on decades-old computers to conducting high-quality telemedicine visits, the mental health organization is making its clinicians and patients happy. River Valley counseling Center's Holyoke Clinic in Holyoke, Massachusetts, always was trying to make ends meet with its technology. THE PROBLEM Its efforts to revamp and improve its technology were merely trial and error. Staff were putting band-aids on their technologies, struggling to figure out what the root of the issues were when disruptions would occur. Was it the computer itself? Network connectivity? A glitch in the signal? To put the extent of the issues in perspective, some hardware was more than a decade old; it could easily take clinicians five minutes just to reach the login screen. "When we thought one thing was addressed, another hurdle would pop up," recalled Chassity Crowell-Miller, LICSW, a clinical social worker at the clinic. "This element of touch and go was particularly challenging for mental healthcare, in which providers may be helping with sensitive, traumatic issues and were unnecessarily disrupted and inhibited by the outdated technology. "Overall, our clinicians' ability to help, as well as our patients' treatment and overall experiences, were negatively impacted," she added. It's important to note that the organization's Holyoke Clinic tends to an underserved population, with many patients being of low socioeconomic status. Across the community, there are high poverty, school dropout, substance abuse and violence rates. "For providers in our community and beyond, the past two years have been like nothing they have ever seen in the field," Crowell-Miller observed. "At the onset of COVID, while many organizations and communities were able to transition seamlessly to virtual learning and working in order to continue their work, River Valley counseling Center's Holyoke Clinic was not set up for this abrupt move to technology. "While telehealth has improved access to many outpatient services, marginalized patients – rural, poor, older and minority patients – may not have benefited equally from telehealth's expansion," she continued. "With all this in mind, River Valley counseling Center needed to receive the equipment, infrastructure and IT counsel necessary to support its people in our Holyoke location – both in person and via telehealth." PROPOSAL The cost of outdated technology often is not discussed, but for providers to do their jobs effectively, sound technology infrastructure is a table-stakes requirement, said Stephen Moss, senior vice president and general manager, connected workforce, at Insight, a health IT and infrastructure company. "The last two years have forced health providers to play IT catchup and significantly accelerate digital transformation," he said. "For many like River Valley counseling Center, it calls for starting with the basics. "They are navigating the impact of legacy infrastructure that is sometimes decades old, not to mention extremely outdated devices that magnify the frustration of resources that should make their work easier actually impeding their ability to care for patients," he continued. River Valley's challenges stood out to Insight. "To help, we focused on how to improve productivity and the client experience, particularly to address the lag and frozen sessions during telehealth consultations," Moss explained. "A simple upgrade to 50 new Intel-powered desktops and laptops has made daily multitasking an afterthought rather than a source of frustration for clinic staff. "To be able to hold a telehealth session without hang-ups not only allows River Valley's medical providers to more effectively address their clients' needs, by eliminating disruptions, they're gaining credibility and the ability to treat more people on a daily basis," he added. The Insight and Intel teams took a hands-on approach to provide and implement the right technology, at the right price, said Jason Kimrey, vice president, U.S. channel and partner programs, at Intel. "The strategy was informed by the mindset that having the best technology was the most effective way to maximize productivity for River Valley and its counselors," he said. "To help guide the process, we collaborated and leveraged our partner ecosystem to understand the unique challenges and pain points for the organization." 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 With River Valley's considerations in mind, Intel prioritized implementing more modernized devices and hardware that provided an opportunity to update core infrastructures, Kimrey said. Intel upgraded network switches, physical hard drives, chips and more to accommodate for the increased bandwidth necessary for telehealth usage, he added. "As a team, Insight's counsel helped combine and implement all of this," Moss explained. "Going from barely conducting any services remotely before the pandemic to now doing most of their work via telehealth is a monumental culture change. Coping with new technology shouldn't be a burden on caregivers; it needs to be an intuitive, simplified experience. "When we work with organizations like River Valley, we start with understanding what their unique challenges are, who is impacted and what they need to accomplish in their daily work," he continued. "Then we figure out the right technology based on individual caregiver personas and their needs to optimize their user experience, productivity and ability to help their clients." Insight handles rapid provisioning, configuration and deployment for virtual desktop environments so new devices are ready to go out of the box with minimal setup and networking connection required by the organization's IT team or employees, he added. "Insight also has the ability to provide virtual IT support for day-to-day management of the health of the devices, which frees up organizations with limited internal IT resources, such as River Valley counseling Center, to focus on more meaningful transformative projects," Moss said. "For River Valley, they've gained the ability to quickly provide new devices to their staff that are ready to go with the applications they need," he added. "Their care providers now can work just as effectively from home or at the clinic." RESULTS Technology is critical to making peoples' lives better, and River Valley has really felt that, Crowell-Miller stated. Thus far, highlights for River Valley, she reported, have included: Improved client and clinician experience. There have been tangible benefits for the client experience – both internally and externally. The provider organization has increased its telehealth services from 5% pre-pandemic to 95% during the height of the pandemic, while removing common barriers like lag time and income lost from prior no-show rates. Now, because of the ability to adapt, adjust and shift to telehealth, when necessary, clinicians can meet the patients where they're at. Increased productivity. The technology addressed a loss of productivity and slowness for River Valley counseling Center, which impacted the quality of services it was able to provide. Even just logging onto computers is much faster and happens within seconds. Specifically, the organization has dramatically improved productivity by up to an estimated 25% for clinicians with minimal access to technology at home, making it easier to use the office for virtual or in-person visits when necessary. Providing community resources. River Valley counseling Center now is able to get a better foothold to help and serve the community. This technology isn't just transactional from a healthcare provider standpoint; having this infrastructure in place is mutually beneficial for the clinicians and the patients in ways beyond traditional appointments and hosting telehealth sessions. This technology has helped River Valley counseling Center put the resources in the hands of clients. River Valley works on these computers while seeing a patient in person, and staff are able to help provide resources like databases, printed materials and more for the patients. ADVICE FOR OTHERS "Because every organization is different, it's really important to ensure you're working with a technology partner that understands not only the healthcare sector and how technology plays a vital role in patient care, but also the unique challenges and needs of your operations, clinicians, patients and the community you serve," said Crowell-Miller. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/river-valley-counseling-center-boosts-productivity-and-experience-telehealth < Previous News Next News >

State Telehealth Laws and Reimbursement Policies Report, Fall 2022 CCHP October 2022 The Center for Connected Health Policy’s (CCHP) Fall 2022 Summary Report of the state telehealth laws and Medicaid program policies is now available as well as updated information on our online Policy Finder tool. The most current information in the online tool may be exported for each state into a PDF document. The following is a summary of the current status of telehealth policy in the states given these new updates. CCHP provides these bi-annual summary reports in the Spring and Fall each year to provide a snapshot of the progress made in the past six months. CCHP is committed to providing timely policy information that is easy for users to navigate and understand through our Policy Finder. The information for this summary report covers updates in state telehealth policy made between July and early September 2022. Read the executive summary 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. For further information, visit cchpca.org. We hope you find the report useful, and welcome your feedback and questions. You can direct your inquiries to Amy Durbin, Policy Advisor or Christine Calouro, Policy Associate at info@cchpca.org . A special thank you to CCHP Policy Associate Veronica Collins for her invaluable contributions to this report. INTRODUCTION The Center for Connected Health Policy’s (CCHP) Fall 2022 analysis and summary of telehealth policies are based on information contained in its online Policy Finder. The Summary Report provides highlights on certain aspects of telehealth policy and the changes that have taken place between now and the previous edition, Spring 2022. The research for this edition of the Summary was conducted between July and early September 2022. This summary offers the reader an overview of telehealth policy trends throughout the nation. For detailed information by state, see CCHP’s telehealth Policy Finder which breaks down policy for all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. 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 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. See full report: https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2022/ < Previous News Next News >

The Data Challenge to Prove Telehealth’s Importance Continues Jan Ground, PT, MBA November 17, 2022 A group of telehealth leaders from 18 states worked the past two years on proving the value of telehealth with data to convince payors and legislators that continuing reimbursement post-COVID 19 is the right thing to do. Over the course of two years, 40 people, including five physicians, four nurses, four other clinicians, and 27 telehealth leaders in provider organizations, contributed to the effort. The group chose to focus initially on video visits for those in need of mental health care. We succeeded in step one: we surveyed 16 mental health provider organizations to find out what data they were collecting, and how success was being measured in 2020. The organizations ranged from large university medical centers to private practices in nine states. Not surprisingly, the data and metrics varied widely, even across large university-based systems. For example, in response to the question “What, if anything, is being measured regarding clinical outcomes?” Four organizations reported no clinical outcomes measurements Four organizations used a wide variety of validated and commonly used clinical outcome metrics: PHQ-9 (used by 3 of 4 ) Patient Health Questionnaire (columbia.edu) GAD7 (used by 2 of 4) GAD-7 (General Anxiety Disorder-7) - MDCalc BASIS-24 (use) BASIS-24® — eBASIS ACES ACE.pdf (odmhsas.org) Adverse Childhood Experiences Study EDE-Q PDFfiller - ede q online(1).pdf (uslegalforms.com) Eating Disorder Examination Questionnaire OCI-R Obsessive Compulsive Inventory - Revised (OCI-R) (psychology-tools.com) SF-12 The SF-12v2 PRO Health Survey (qualitymetric.com) Short Form Health Survey BAI beck-anxiety-inventory.pdf (jolietcenter.com) EDE-Q ede-q_quesionnaire.pdf (corc.uk.net) Eating Disorder Examination Questionnaire EDY-Q Microsoft Word - Hilbert, van Dyck_EDY-Q_English Version_2016 (harvard.edu) Eating Disorders in Youth Questionnaire McMaster Family Assessment Device STAI-C-S State-Trait Anxiety Inventory for Children (STAI-CH) - Assessments, Tests | Mind Garden - Mind Garden State Trait Anxiety Inventory – Child Version – State only DERS Difficulties in Emotion Regulation Scale (DERS) (novopsych.com.au) PCL-5 PTSD Checklist for DSM-5 (PCL-5) - Fillable Form (va.gov) Post-traumatic Checklist In another question on cost savings, the survey question was “What, if anything, is being measured regarding cost savings?” 13 organizations reported no cost savings measurements Two of the three organizations reported savings measurements shared the following metrics (video visits vs in person visits) Handouts, parking vouchers, meal vouchers In person clinicians paid salary, video visit clinicians paid per hour, Future: space cost savings (video visit clinicians providing care from home) In our next effort we wanted to add payor leaders or legislators to join the conversation to determine which, if any of the metrics being used and data being collected, might convince them to support continued reimbursement post-COVID 19. The 40 participants were all associated with provider organizations with insufficient connections with payors/legislators to successfully bring them into the conversation. The group took a break and then decided on a new approach. We came up with what we THINK would be most important to payors/legislators, based on our understanding of what drives their success. Here’s the list: Compare the following data for specific groups of mental health patients (e.g., based on location, disorder, gender, age, first time vs return patients, newly diagnosed vs existing patient, prior telemedicine use, other relevant demographics, and characteristics), with or without access to care by video: number of ED visits number of hospitalizations suicide rates survey results that measure mental health status using validated tools (e.g., PHQ9) timing to access -(i.e., length of time to get patients in front of provider for first visit) provider and patient satisfaction and retention (i.e., remain in care) Interestingly, I have since learned that, in fact, there are many data sources on these topics with many peer-reviewed articles based on well-controlled studies. That leads me to a different question: Why were none of the 40 participants, including me, aware of these data sources and how to access them? It perhaps has its roots in the type of data available. Much of the data available comes from academic institutions reporting on research studies and publishing in peer-reviewed journals. These can be readily found through a PubMed or Google Scholar search using appropriate search terms (e.g., telemental health, outcomes, cost) but if one is unfamiliar with conducting this type of search these articles will not be available to review. Other sources of information include websites of the professional societies of which the providers are members (e.g., American Psychiatric Association) and government websites (e.g., Substance Abuse and Mental Health Services Administration, but one has to know about these before they can be searched. Finally is the fact that although many healthcare systems and funders collect data, they use these data for internal purposes only and simply do not publish or share them. We are currently in search of a few provider organizations interested in/willing to collect some of these data. We have not had success. If you are interested in joining this collaborative effort, please contact me at: janground@gmail.com https://www.linkedin.com/in/jan-ground-3089742/ A new thought is to focus on a current hot topic in the US, such as COVID 19, to identify data to prove (or not!) the value of care by video. Perhaps we could find an organization willing to provide some funding to more likely successfully identify organizations willing to collect the data. It should not have to be this hard! About the Author Jan Ground PT, MBA, led innovation and virtual care at Kaiser Permanente Colorado, where she worked for 18 years. She is the Colorado Liaison to the Southwest Telehealth Resource Center and the Colorado Ambassador to Telehealth and Medicine Today, an online peer-reviewed journal. Active in the American Telemedicine Association, Jan leads a group looking to prove, with data, that telehealth is worth paying for. Jan’s expertise is in leading change, and in clearly defining a problem before implementing a new approach to care. Her greatest passion is to lower the cost of the American healthcare system without lowering clinical outcomes. See original article: https://southwesttrc.org/blog/2022/data-challenge-prove-telehealth-s-importance-continues < Previous News Next News >

Bipartisan Policy Center Report Highlights Telehealth Policy Considerations CCHP November 01, 2022 Last month, the Bipartisan Policy Center (BPC) released a comprehensive report on The Future of Telehealth After COVID-19. The report is based upon an analysis of Medicare Telehealth Utilization and Spending Impacts 2019-2021, stakeholder input and interviews, a literature review, and a national consumer survey. The BPC report examines the impact of increased access to telehealth during the pandemic and makes recommendations to policymakers on which COVID-19 policy expansions should be maintained post-public health emergency (PHE). Ultimately, BPC urges the federal government to extend emergency flexibilities for two years to preserve access while further evaluating telehealth effectiveness. In its analysis, BPC made a number of key findings showcasing telehealth’s ability to alleviate access barriers for Medicare beneficiaries, address inequities in access and outcomes for racial and ethnic minorities, low-income earners, and individuals with chronic conditions, as well as improve patient continuity of care. The report also noted that patients and providers generally feel satisfied with telehealth services. Other findings include: A decrease in telehealth utilization since initial pandemic peaks, although 2021 rates remained nearly 40 times higher than pre-pandemic telehealth visits Most telehealth visits were for primary care visits and 44% of all behavioral health visits in 2021 occurred via telehealth About 1 out of 5 telehealth visits were audio-only in 2021 Telehealth utilization was higher in urban areas and for non-white beneficiaries Beneficiaries with disabilities and dually eligible for Medicare and Medicaid were more likely to use telehealth in 2021 Medicare spending on telehealth remains a small percent of overall spending – for the outpatient codes BPC examined, telehealth spending was between 1.5% and 3.3% of total spending in 2020 and 2021 In applying its findings to policy recommendations, BPC discusses an attempt to balance competing goals, for instance the need to increase access to care against the need to ensure quality and cost-effectiveness. The report also highlights areas to focus future research and notes the need to examine telehealth outside of PHE conditions to truly generalize findings. In addition, BPC acknowledges limitations in its spending analysis that don’t factor in the potential reduction in long-term costs related to emergency room visits in correlation to increased telehealth visits. In addition to extending Medicare telehealth flexibilities for two years, key BPC recommendations to Congress and the Biden administration include: Maintain access to telehealth for Medicare beneficiaries regardless of location or medical diagnosis – including the home/patient location as an authorized originating site and removing geographic limitations (with protections to require providers to see patients in-person or refer to in-person care when necessary) Authorize FQHCs/RHCs to permanently serve as distant site providers Continue access to primary care and behavioral health services with minor adjustments post-PHE (the recommendation notes that if further research supports it, CMS could consider limiting certain services to existing patient-provider relationships – except in rural areas and for alternative payment methodology (APM) providers) Continue audio-only coverage and incorporate audio-only into telehealth definition (post-PHE audio-only restrictions should limit coverage to established patients and at patient request) Permanently expand asynchronous services beyond virtual check-ins and Alaska and Hawaii demonstration projects for both new and established patients Make Health and Human Services (HHS) 1135 temporary waiver authority permanent for future PHEs Eliminate the requirement for in-person visits for telemental health services (BPC states this is an undue burden on those who cannot access behavioral health providers in-person) Require evaluation of controlled substance prescribing via telehealth and for non-hospice, non-cancer patients, first require an in-person exam prior to prescribing substances prone to abuse (BPC additionally recommends the Department of Justice (DOJ) follow through on its requirement to create a special telemedicine registration process to allow for certain in-person requirement exemptions) Refine reimbursement rates and end broad payment parity between telehealth and in-person care to offset any cost/utilization increases, including implementing different rates for audio-only and video visits In regard to transparency and consumer protections in particular, the report also recommends clear information to beneficiaries be provided regarding benefits appropriately delivered by telehealth and ensuring that beneficiaries consent to the use of telehealth. BPC additionally recommends the ability to distinguish between traditional and fully virtual providers be determined, and that enforcement resume related to HIPAA. In regard to fraud, waste, and abuse protections, the report calls for sufficient funding to the HHS Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) to modernize and track telehealth use, the requiring of outlier provider audits, and that high-cost durable medical equipment (DME) and laboratory tests be limited to established patients, unless providers are part of APMs. To improve data quality, the BPC suggests CMS simplify telehealth billing and develop additional guidance for providers to ensure uniformity and coding accuracy. Lastly, the BPC recommends requiring MedPAC complete a formal evaluation of post-PHE telehealth impacts on access, quality, patient outcomes, and cost to truly determine long-term trends and policies. BPC’s report is extremely thorough and highlights the many issues policymakers are facing in contemplating permanent telehealth policies. Some of BPC’s attempts to balance recommendations and exceptions to address concerns raise additional complexities behind the considerations further showcasing where policymakers and future research should focus. For instance, in terms of audio-only, BPC notes that continued coverage is critical for beneficiaries lacking broadband and technology access, although additional restrictions should be adopted to address concerns related to quality and potential for overuse. However, policymakers should consider whether these additional restrictions may ultimately limit the access the report describes as critical. In terms of payment parity, BPC notes that it has been an important tool to increase access to care and ensure that practitioners provide telehealth services. However, given payer and policymaker concerns, BPC recommends that perhaps the best post-PHE policy would be to cover certain telehealth services at higher rates than pre-PHE rates, but not necessarily equivalent to in-person rates. That may go against other recommendations in the BPC report to simplify telehealth billing, although ultimately BPC does state that CMS should look carefully at cost differentials when determining appropriate rates. Since many providers state that the cost and time of providing services via telehealth and in-person are equivalent it is important that researchers and policymakers look carefully at that issue. In addition, BPC suggests that different reimbursement rates may ensure access to in-person services, yet also states that parity in rates ensures access to telehealth services, showing the difficulty in sufficiently balancing these various considerations. Researchers and policymakers must pay careful attention to all perspectives and data around these issues in order to truly ensure telehealth’s ability to increase access to necessary health care. For additional details on BPC’s findings and recommendations, please view the report in its entirety. See original article: https://mailchi.mp/cchpca/bipartisanpolicycenter-report-highlights-telehealth-policy-considerations-recommends-2-year-extension-of-federal-flexibilities-further-research < Previous News Next News >

Once a Temporary Convenience, Telehealth is Here to Stay Beth Wood August 2021 Multifaceted networks supporting virtual medical visits hailed as a positive legacy of pandemic Whether you call it telehealth, telemedicine, e-health, virtual or video visits, the electronic delivery of health care services is coming into its own. The coronavirus pandemic spurred federal, state and private insurance programs to offer more coverage of telehealth to encourage people to follow the stay-at-home rules established in mid-March 2020. “After this last year and the benefits we’ve seen, telehealth is definitely here to stay,” said Kiran Savage-Sangwan, speaking from Sacramento. She is the executive director of the California Pan-Ethnic Health Network, a statewide health-advocacy organization. “The way we pay for healthcare has not robustly supported telehealth in the past,” Savage-Sangwan said. “The state has taken some interim steps before making permanent policy changes. The state will be extending the flexibilities for the Medi-Cal program through the end of next year, I believe, to continue to work out some of the policy issues.” According to the Centers for Disease Control and Prevention, the number of telehealth visits increased in the first quarter of 2020 by 50 percent, compared with the same period the year before. A single week in March 2020 showed a 154 percent increase, compared with the same period in 2019. Behind those numbers was a massive effort among health providers to accommodate this change. Even for UC San Diego Health, a pioneer in telehealth, the quick transition required an all-hands-on-deck approach. “We knew the shutdown would happen, but we didn’t know when,” recalled Marlene Millen, M.D., UC San Diego Health’s chief medical information officer for ambulatory care. “But our operational leads were already prepared for increasing video visits. Over the course of one weekend in March, we trained 1,000 doctors and staff. “We converted appointments and sent patients instructions. That very Monday, when everyone was supposed to be locking down, we were able to convert a couple of thousand appointments into video visits. That’s because we had a really good structure in place.” Millen spent the entire weekend at her home desk with multiple screens open, setting up online patient visits. An internal medicine physician, she has played a role in UC San Diego Health’s development of video visits for 10 years. About two or three years ago, she said, an app-based program was launched, which made it more accessible. But it wasn’t until the insurance coverage changed that telehealth’s potential could be tested. Until the shutdown, video visits were used for patients who had extreme obstacles to making in-person appointments. “Patients we targeted for these visits were ones with medical conditions who couldn’t come into the clinic,” Millen said. “They really embraced it. I had a patient in a wheelchair that had to be carried out of the house and another with a condition that made her use the bathroom all the time. Others had immune conditions. Then there were people who had to get on three buses to get to us. “Some of those patients were in danger of getting kicked out of insurance because of their number of no-shows. Video visits improved those situations. But it wasn’t a general-use case at that time.” Support for telehealth Now that pandemic restrictions have eased, the percentage of telehealth appointments versus in-person consultations has decreased in most of California. At UC San Diego Health, Millen noted, video visits rose to 30 percent during the early 2021 surge in COVID-19 cases. Video visits now account for between 15 and 20 percent of all appointments, a figure higher than prepandemic rates. As headlines attested, the pandemic put socioeconomic disparities in access to health care in stark relief. Some believe telehealth could provide a way to distribute health access more equitably. But there are hurdles. Many low-income people live in Wi-Fi deserts. Some have limited minutes on their smartphones, and others are unfamiliar with the technology. For some, finding a quiet private place in a multiperson home can be a challenge. “California has significant disparities — particularly by race, language and region — when it comes to health care access and health care outcomes,” Savage-Sangwan said. “Certainly, telehealth was helpful during the pandemic. “When people go into a medical office, various medical professionals assist them. Someone checks you in, someone takes your weight. People support you through the process. But when you’re accessing virtual care from home, you’re going to need to get that support a different way. “What we’ve seen to be successful is for the providers’ offices to build that into their workflow. Maybe someone calls you about your doctor’s appointment and would say: `'Hey, are you set up? Do you know how to use the platform? Let me walk you through it.’ We need to support people, so they are truly engaged in their health.” What’s telehealth friendly? Colonoscopies, mammograms and MRIs are obviously not possible through telehealth (at least not yet). But a lot can get done through a video visit, including assessing a medical problem and prescribing remedies for it. Millen, of UC San Diego Health, said her telehealth patients usually followed through on her instructions. She also noted that caregivers and family members became more engaged in video visits, particularly when she asked them to help with the exam. From monitoring diabetes and diagnosing a sinus infection to doing preliminary neurological tests and conducting speech therapy sessions, the use of telehealth has been wide ranging. “Before the pandemic, I would have definitely said: `'Yeah, there are some specialties that won’t be able to do video visits at all,’ ” Millen observed. “I was surprised how well our doctors and staff figured out how to get patient history and information.” Both Millen and Savage-Sangwan of the California Pan-Ethnic Health Network think that behavioral health and counseling services are extremely telehealth friendly. Savage-Sangwan pointed out that the network’s community clinics had been experiencing a high rate of no-shows for these services before the pandemic. With telehealth, the number of no-shows dropped to almost zero. In general, telehealth has proved itself worthy of coming out of the prepandemic shadows and becoming a vital component of equitable healthcare. “I’m happy by how many video visits are still going on,” Millen said. “I was thinking it would fall off rather quickly. But there are certain doctors who really love it and certain patients who really love it. “I see it getting a little more mature. What’s happened in the last few months is that we’ve created more of a system for it that makes sense. On both sides, I think we all know when to hold it and when to fold it.” She laughed. “I mean, when to see them and when to video.” Source: https://www.sandiegouniontribune.com/news/health/story/2021-08-03/once-a-temporary-convenience-telehealth-is-here-to-stay < Previous News Next News >

Telehealth, physical therapy and the pandemic: Lessons for all Bill Siwicki February 14, 2022 A University of Washington clinical instructor explains the benefits and challenges of therapy and technology. For vulnerable patient populations – and for those who just prefer the convenience of care at home – telemedicine has been a success. But it still has its limitations. For example, the precise movements and exercises involved in physical therapy rehab are hard for a patient to accomplish remotely. A provider on a video call may seem about as valuable as a YouTube video. But there are new technologies and strategies that link patients, safely, to at-home physical therapy care that balances telemedicine with in-person visits. Many experts say this is the future of telemedicine: a hybrid of in-person and virtual care. To read the entire article: https://www.healthcareitnews.com/news/telehealth-physical-therapy-and-pandemic-lessons-all < Previous News Next News >

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

Accessibility to Telehealth Andrew Donnellan, Nov 03, 2021 Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Telehealth has many benefits including reduced, or eliminated travel and wait times; decreased exposure to communicative diseases; easier access to healthcare professionals and therapeutic interventions; and greater flexibility. However, for many individuals with disabilities, Telehealth and its associated benefits may be out of reach due to web inaccessibility. Benefits can become barriers because of websites’ inconsistent compatibility with screen readers, closed captions, magnifiers, speech to text software (used by individuals with limited dexterity), easy to understand instructions and hyperlinks (for individuals with cognitive disabilities), and alternative text formats. Although Telehealth companies provide guidance on ensuring accessibility by conforming to guidelines laid out in Section 508 of the 1973 Rehabilitation Act, it is only voluntary because the Act only applies to federal agencies and not private companies. So, while an individual with a disability will be met with a relatively accessible federally funded Telehealth website, that same individual may be greeted by an inaccessible private Telehealth website. But wait! What about the Americans with Disabilities Act (ADA)?! Surely it requires public accommodations like Telehealth websites to be accessible?! While the ADA does require brick-and-mortar private businesses that are labeled as public accommodations to be accessible, there is no such mandate for websites. Because of this, federal courts are split by jurisdiction on how to apply the ADA to websites: some jurisdictions say the ADA applies to all websites; some say it is inapplicable to all websites; and others conclude it applies only if the website has a connection, or "nexus," to the physical, brick-and-mortar place it represents. This lack of consistency can leave a disabled Telehealth user without an accessible Telehealth website simply because they live in a jurisdiction that does not ensure accessibility to websites. What can be done to help solve this problem? Perhaps the most comprehensive solution would be for the Department of Justice (DOJ), the federal Department tasked with enforcing the ADA, to finally answer the repeated calls by private business owners, courts, and other federal agencies for guidance by issuing a concrete rule requiring website accessibility under the ADA. However, because the Department proposed such a rule in 2010 and then withdrew from its proposal in 2017, it appears that those calls for guidance will go unanswered, save for a few amicus briefs and unofficial statements. Another, and perhaps more viable, solution is to lobby state senators to implement legislation requiring accessible Telehealth. It appears the ball has already started rolling because just this year, the New Jersey legislature has proposed a new bill that requires Telehealth to “ include accessible communication to facilitate the use of… Telehealth by individuals with a disability….” Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Since we are all human, we all deserve accessible Telehealth — it is a right. This right will not be realized unless, and until, we stand up and demand mandated accessible websites. https://southwesttrc.org/blog/2021/accessibility-telehealth < Previous News Next News >

Closing 2022 with New Telehealth G-Codes for HHAs, Uncertainty for Telehealth Startups, Plus State & Federal Telehealth Developments (and much more!) CCHP December 13, 2022 New G-Code Reporting Requirements for HHAs under CY 2023 CMS PPS Rule The Centers for Medicare and Medicaid Services (CMS) has finalized new G-codes to report use of telecommunications technology under the home health benefit for Home Health Agencies (HHAs) under their finalized Calendar Year (CY) 2023 Home Health Prospective Payment System (PPS) Rate Update. HHAs are asked to voluntarily start reporting on January 1, 2023, and the requirement to report would kick in July 2023. CMS notes that in 2020 the home health benefit was temporarily altered due to COVID-19 (and made permanent in 2021) requiring any provision of remote patient monitoring or other services furnished via a telecommunications system to be included in the plan of care. The telecommunication service, however is not allowed to substitute for a home visit ordered by the plan of care or for purposes of eligibility or payment. Reporting of the new G-codes will allow CMS to analyze the characteristics of beneficiaries utilizing services remotely and have a broader understanding of the social determinants that affect who benefits most from these services. The codes HHAs will be asked to submit are detailed in a Medicare Learning Network (MLN) document, and include: G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring) For more details on the G-codes and reporting expectations, see the full MLN Guidance and the full text of the finalized CY 2023 Home Health PPS Rate Rule. Falling Investment for Telehealth Startups A recent article in Politico [subscription required] brings to light the stark decrease in investment in telehealth companies in 2022 (compared to 2021), as the pandemic subsides and a recession likely kicks in. In fact, while telehealth funding for digital health in the US peaked in 2021 with $11 billion dollars, that has fallen to only $3 billion by the third quarter of 2022. The effects of this slow down in capital is bound to ripple across the industry. As a result, many startups are laying off workers and focusing on just a few key offerings. Adding to the uncertainty of the future for these companies is how telehealth policies will impact them moving forward as state and federal governments shift from pandemic era temporary policies to often stricter permanent telehealth requirements with greater oversight. Cerebral, a digital mental health company, for example is currently under federal investigation for over-prescribing ADHD medication. This is the type of occurrence other telehealth companies may take note of and may shape the way they think about the future of their products and services in order to avoid such situations. Additionally, consumer demand has shifted post-pandemic. While consumers were enthusiastic about utilizing telehealth for most forms of healthcare in order to avoid crowded doctors’ offices and hospitals at the height of the pandemic, they now prefer to use it for check-ins with their doctors, mental health visits and addiction treatment, according a survey by the American Medical Association. This necessitates a shift for many telehealth start-ups, and according to Megan Zweig, COO of Rock Health, many companies are struggling with this. For more information, read the full Politico article [subscription required]. World Health Organization Telemedicine Implementation Guidance In November the World Health Organization (WHO) released a telemedicine implementation guide based on knowledge and learnings the WHO has gathered since releasing their first report on telemedicine in 2010. The set of recommendations within the new guide is aimed at optimizing the implementation of telemedicine services by providing an overview of key planning, implementation and maintenance processes to inform an investment plan and support countries across different stages in developing telehealth solutions. The guide contains three phases to developing a successful telehealth program, including (1) a situational assessment; (2) planning the implementation; and (3) monitoring and evaluation, and continuous improvement. There are a total of eleven steps within the three phases, including tasks such as performing a landscape analysis, establishing standard operating procedures, developing a budget and determining monitoring and evaluation goals, as well as an adaptive management plan for improvement. Several case studies from different countries, including India, Cabo Verde, Indonesia, Qatar and Mali are also provided in the annex section of the document. Download the full telemedicine implementation document from the WHO’s website for all the detailed steps outlined in their recommended procedures for telemedicine implementation. See full article: https://mailchi.mp/cchpca/closing-2022-with-new-telehealth-g-codes-for-hhas-uncertainty-for-telehealth-startups-plus-state-federal-telehealth-developments-and-much-more < Previous News Next News >

HHS to put $35M toward telehealth for family planning Kat Jercich November 29, 2021 The agency plans to use the funds to award about 60 one-time grants to Title X family planning providers, who must apply by February of next year. The U.S. Department of Health and Human Services announced that it would make $35 million in American Rescue Plan funding available for Title X family planning providers to strengthen their telehealth infrastructure and capacity. Title X family planning clinics help to insure access to a broad range of reproductive health services for low-income or uninsured individuals. "I’ve seen first-hand the critical role that telehealth plays in serving communities, particularly to protect so many families from COVID-19," said HHS Secretary Xavier Becerra in a statement about the grant availability. "As providers transitioned from providing in-person primary care to offering telehealth services, we were able to test, vaccinate, and act as lifelines to communities disproportionately hit by the pandemic," he said. "Increasing our investment and access to telehealth services remains critical." WHY IT MATTERS The Office of Population Affairs funds 71 Title X family planning service grantees and supports hundreds of subrecipients and thousands of service sites around the country. Family planning includes a broad range of services related to reproductive health, including contraception, sexually transmitted infections and pregnancy testing. Although abortion care can be co-located with family planning services, Title X funds cannot be used to pay for it. Although some services require in-person treatment and exams, others can be carried out via telehealth – as evidenced by grantees' use of virtual care to help their patients during the COVID-19 crisis. Still, facilities may not have adequate technology available. "During the global COVID-19 pandemic, family planning programs have accelerated the use of telehealth," said Dr. Rachel Levine, assistant secretary for health, in a statement. "These ARP funds will facilitate the delivery of quality family planning services and reduce access barriers for people living in America who rely on the health care safety net for services," she added. HHS plans to use the funds to award about 60 one-time grants to active Title X grantees. Organizations must apply by February 3, 2022, and notices of awards will be announced before the project start date of May 1, 2022. THE LARGER TREND Even as the government has moved to shore up telehealth infrastructure via funding, the question of virtual care's future continues to hang over Congress. Despite requests from hundreds of advocacy organizations, legislators have so far failed to take action to permanently safeguard telehealth after the end of the COVID-19 public health emergency – what some activists have referred to as "the telehealth cliff." "We recognize there are many unknowns related to the trajectory of the COVID-19 pandemic over the next 12 to 24 months," said American Telemedicine Association CEO Ann Mond Johnson in October. "However, we implore Secretary Becerra to provide as much predictability and certainty as possible to ensure adequate warning before patients are pushed over this looming cliff." ON THE RECORD "The pandemic has laid bare the important role that telehealth can play in our nation’s healthcare service delivery, and we are profoundly grateful for the opportunity to support continued investments in telehealth for the nation’s family planning safety net," said Jessica Swafford Marcella, HHS deputy assistant secretary for population affairs, in a statement. < Previous News Next News >