CCHP Leadership Provides A Look Back at Telehealth Policy in 2022: Yes...The Year is Almost Over! Mei Kwong December 20, 2022 As another full year of living under the public health emergency (PHE) for COVID-19 comes to an end, we are taking a look back to see what has happened this year with telehealth policy on both the federal and state level. Since the PHE is still in place and likely to continue into 2023, permanent changes on the federal level have been fewer in comparison to what many states have been doing. In fact, some states began making permanent telehealth policy changes as early as late 2020. Other states have taken similar actions to their federal counterparts and put a definitive future expiration date on temporary telehealth policies. FEDERAL The most significant federal legislative telehealth policy action seen this year took place in the Budget Act of 2022 which included language extending some of the temporary waivers to telehealth in Medicare for an additional 151 days after the PHE. This statutory change led to additional clarifications that the Centers for Medicare and Medicaid Services (CMS) made in their Physician Fee Schedule for 2023 (PFS). CCHP also recently released a fact sheet on the relevant telehealth policies. The final result as the policy stands now is: For 151 Days After the PHE: Certain providers including federally qualified health centers (FQHCs), Rural Health Clinics (RHCs), occupational therapists, and physical therapists may continue to provide eligible services via telehealth under the Medicare program. The list of temporary services eligible to be delivered via telehealth and covered by the Medicare program will continue to be available during this 151-day period. The geographic limitations under permanent telehealth Medicare policy will be suspended during this 151-day period and the home will continue to be an eligible originating site for all eligible services during the extension. Audio-only can continue to be used as a modality for eligible services during the 151-day extension. Permanent policy requirements such as a previous in-person visit for mental health services taking place in a non-geographically eligible location, in the home or via audio-only is suspended during this 151-day period. Certain other federal waivers that exist under the PHE are currently not included in this 151-day grace period. This includes the Office of Civil Rights (OCR) exercising discretion in enforcing HIPAA which OCR has noted will expire when the PHE is declared over or expires, whichever comes first. As can be seen by the foregoing, very little has changed this year regarding permanent policy, just what will happen in the immediate aftermath of the end of the PHE. There have been some indications that Congress may pass legislation to extend the federal waivers, or at least some of them, beyond the 151-day period. HR 4040 authored by Representative Liz Cheney (R, WY) passed the House earlier this year, but no further action was taken. That bill would have extended some of the temporary waivers for an additional two years. However, what might be considered by Congress now is rumored to be only a one-year extension. It remains to be seen if some additional action will be taken legislatively. Feeding into the federal policymakers’ decision-making process have been several reports from various federal agencies in the past year. The Office of the Inspector General (OIG) released several reports around telehealth in 2022 including: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks The last study listed above is important to take note of given the concerns raised by policymakers for the potential of abuse and fraud. However, the OIG report noted that in the first year of COVID-19, less than 1% of telehealth claims made to Medicare raised flags for potential fraud, which should provide some reassurance to policymakers. Broadband has been an issue both on federal and state policymakers’ minds. While connectivity is a greater issue beyond how it impacts telehealth, it cannot be denied that telehealth will simply not work if the patient and provider cannot connect, although policy expansions related to audio-only have sought to mitigate this gap to a certain extent. In 2022, the Federal Communications Commission transitioned the Emergency Broadband Benefit Program into the Affordable Connectivity Program which provides assistance in paying for connectivity. The National Telecommunications and Information Administration (NTIA) compiled federal funding opportunities that support broadband planning, digital inclusion and deployment projects on one site. States have also been gearing up activity around broadband, some of it funded by the federal government such as NTIA awards to Nebraska to develop strategic plans to expand high-speed broadband and other investments made by the state itself. No doubt, broadband will continue to be a significant issue in 2023. STATES As CCHP’s recent Legislative Roundup newsletter noted, 2022 was another active year for state telehealth policy legislation, though not as robust as it was in 2021. Overall, in 2022, of the bills enacted and subjects CCHP tracked, licensure proved to be the most popular policy issue addressed with 61 bills across the states passing. This was followed by 27 enacted bills related to professional regulations and telehealth, many having to do with prescribing and 18 bills for pilot/studies/demonstrations. Enacted Medicaid and private payer reimbursement bills were 17 and 12, respectively. The licensure focus is of particular interest to note. While many of the pieces of legislation passed related to joining licensure compacts, states also made exceptions to licensure for specific situations. States are starting to address the various situations usually involving an already established relationship between patients and providers that prior to the pandemic had remained grey areas. A common concern raised during the pandemic related to licensure involved a patient temporarily re-locating to another state, perhaps as a college student, going on vacation or caring for a family member, but still wanting to receive services from their own provider in their home state. Kentucky passed HB 188 that forbids a regulatory board from promulgating regulations related to telehealth that prohibit “the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person’s state of permanent residence.” While clarity is always welcomed, the exceptions individual states are passing will create more complexity in the telehealth policy landscape particularly for practitioners who provide services in multiple jurisdictions. Reimbursement is an area that generates significant interest. For Medicaid related legislation, the type of modality used and services that would be covered under the program were popular issues addressed through legislation. For example, Virginia SB 426 requires the Medicaid state plan be amended to allow for remote patient monitoring (RPM) services for patients with certain types of medical conditions such as high-risk pregnancy and transplant patients when there is evidence that use of RPM is likely to prevent readmission to a hospital. Private payer telehealth legislation can also be quite specific. Louisiana HB 304 now requires telehealth coverage and payment parity equivalent to in-person services for physical therapy in particular. However, what we also saw were legislators moving towards ensuring there were patient protections/choice codified in state laws related to private payer plans and telehealth. Mississippi SB 2738, among other things, states that insurers cannot limit coverage of services to select third-party organizations. Commercial plans only offering telehealth delivered services to enrollees through a third party and not allowing their in-network providers to use telehealth has been a concern that was growing even prior to the pandemic. This stems from concerns raised by policymakers regarding patient choice or patients being “forced” to use telehealth and continuity of care concerns that continue to exist today. Overall, the number of states expanding telehealth policies increased. As noted in CCHP’s latest update to its 50 State Telehealth Policy Summary Report, Fall 2022, compared to its Fall 2021 update, three more state Medicaid programs are covering store-and-forward telehealth, five more states are covering RPM under Medicaid, and state Medicaid programs covering audio-only went up from 22 states to 34 states and DC. Additionally, three states have added payment parity requirements to their private payer laws. WHAT’S NEXT FOR 2023? As noted above, rumors have swirled around that there may be movement on the federal level to extend some of the telehealth waivers beyond the 151-day grace period, similar to what was proposed in the Cheney bill. However, it is likely that any such change will be included in a larger bill, such as the budget bill, rather than a standalone telehealth bill. There are also several outstanding issues that continue to not be addressed such as the registry for telehealth that the Drug Enforcement Administration (DEA) was to finalize regulations for in 2019. Some may recall that among the list of exceptions to allowing telehealth to be used to prescribe a controlled substance without the telehealth provider having examined the patient in-person included when a PHE was declared and the creation of a registry. For the registry, presumably once a provider is qualified to be on the registry, they need not have to meet any of the other narrow exceptions to prescribe via telehealth. That registry has never been created, though Congress had directed the DEA to finalize regulations by the end of 2019. On the state level, we likely can expect to see continued action around coverage, licensure, and professional regulations, as well as continued discussion around patient choice. During this past year, there has been increased discussions regarding “telehealth-first” health plans and the impact on patient choice. Whether policymakers take a more active role in regulating these plans remains to be seen, but the discussion around patient choice protections will continue. One thing is clear: the telehealth policy landscape is by no means “settled” as 2022 draws to a close. Outstanding questions around temporary policies still remain and even settled policies implemented a year or so ago have been tweaked in some states. To hear more about what's occurred in 2022, plus what we can anticipate for 2023, watch CCHP's newest short video. As we head into 2023 we can be certain that the telehealth policy landscape will continue to evolve and change, and we look forward to having you continue on this journey alongside CCHP. Have a Happy New Year and see everyone in 2023! Mei Kwong, CCHP Executive Director See original article: https://mailchi.mp/cchpca/cchp-leadership-provides-a-look-back-at-telehealth-policy-in-2022-yesthe-year-is-almost-over < Previous News Next News >

Telemedicine and diagnosis Adriana Albini September 27, 2022 The adoption of telemedicine and its range of applications grew exponentially in the early days of the Covid-19 pandemic, and the general consensus now is that it is here to stay, albeit perhaps with a more hybrid bias of in-person and remote visits. Telediagnosis, or TeleDx, i.e., the identification of a disease at a site remote from the patient, has expanded to include primary care, revolutionising the way in which patients and doctors communicate with each other and establish rapport. It is still early days to fully evaluate the effect of virtual vs in-person visit on diagnostic error, but there are guidelines for health professionals to conduct effective virtual examinations, and many best practice examples, both in terms of ways to gather information from the patient (from wording of questionnaires to digital records, home environment, and so on) and technological innovations. In cancer care, pathology plays a central role in the final diagnosis upon which clinicians will develop treatment for their patient, and remote pathology can offer many advantages, such as easier access to pathology experts, consultation among specialists, timely and secure availability of images, and so on. Up until the 1990s, pathologists worked almost entirely within the constraints of the analogue world, with physical glass slides and microscopes. Some attempts were made at capturing virtual images of slides through a tiling method, which was time consuming and prone to error, as it required accurate placing and extensive stitching together of images. But at the end of that decade, engineer Dirk G. Soenksen (founder, and CEO of Aperio) devised a much more efficient system based on a linear scanner, the ScanScope, that allowed for tightly focussed and fast slide image capture, opening a new era for the practice of pathology. Whole slide imaging, or WSI, was first employed in education and research but in recent years, with the improvement of its technology, it has received regulatory approval by the FDA and around the world for diagnostic use as well. The potential for feeding AI algorithms to provide diagnostical support is massive, as virtual slides are accumulating fast and standardised databases are being built. “Telemedicine in Cancer Care Continuum: implementation and integration”, was an online conference developed by the SPCC in collaboration with the American Society of Clinical Oncology (ASCO), which took place on 6-7 May 2022. In his presentation, Liron Pantanowitz, Professor of Pathology, and Director of Anatomical Pathology at the University of Michigan, talked about telepathology in both its non-acute and acute settings, focussing more extensively on the latter. The term ‘telepathology’ was coined by Ronald S. Weinstein in 1986, after he organised the first public event of satellite-enabled dynamic-robotic distant pathology, but the very first live telepathology ever performed dates as far back as to 1968. Massachusetts General Hospital set up a two-way television link with Boston’s Logan Airport that enabled doctors at the hospital to remotely study blood smears, urine samples and X-rays for patients at the airport, and even listen to their heartbeat with an electronic stethoscope. However, as in the case of telehealth in general, the adoption of digital pathology had to wait until the Covid-19 pandemic to be widely implemented. To facilitate continuity of healthcare while social distancing, certain restrictions were lifted, such as CLIA in the US, allowing pathologists to work from home and sign out cases. The first use of telepathology Prof. Pantanowitz looked at was for frozen section consultation. There are several challenges when a pathologist is asked to provide an intraoperative consultation. The pathology specimen is fresh, not easy to cut. The frozen section itself is difficult to prepare and is often filled with artifacts. These artifacts not only make it hard to read the glass slides but can compound the problem when using digital images. The turnaround time needs to be rapid. Usually, pathologists strive for less than 20 minutes to provide the surgeon with an answer. And they are under serious diagnostic pressure because if they get it wrong, it is difficult to reverse the surgical decision that has been made based on their diagnosis. Over the past 54 years different modes of practising telepathology have been developed. A pathologist on site can take static images, which is easy but too time-consuming. There is also video microscopy, live streaming from one pathologist to another. If there is no pathologist present on site to read the slides, there are systems such as robotic microscopy, where the pathologist can remotely take control of the functions on a microscope, such as navigation and focus. And there is also Whole Slide Imaging, which is the entire digitization of a slide to be remotely reviewed. Thanks to advancements in technology, hybrid devices are now available from many vendors with robotics and Whole Slide Imaging functions in one scanner. See full article: https://cancerworld.net/telemedicine-and-diagnosis/ < Previous News Next News >

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

Elo and 19Labs Partner To Offer Next Generation Telehealth Kiosks PR Newswire and 19 Labs July 2021 The partnership allows pharmacies, schools, and rural communities to go beyond just video calls and deploy eClinics with smart diagnostic devices and remote monitoring. The hospital-at-home trend is rapidly changing the healthcare industry. COVID-19 has accelerated telehealth technology's rate of innovation, and the industry has advanced by more than five years in just five months. Healthcare companies are now moving quickly to provide care in new locations and serve new use cases, bringing healthcare access not just to the home but also to other places like rural communities, schools, and pharmacies. 19Labs and Elo are working together to bring eClinics to these new locations globally. 19Labs' GALE eClinics are next generation point-of-care platforms that seamlessly integrate leading mobile and healthcare technologies into cost-effective and smart solutions such as telehealth carts, healthcare kiosks, or portable telehealth kits. They are highly secure, easily deployable, and can be operated by anyone with minimal training. "19Labs' eClinics enable our customers to easily deploy enhanced telehealth using the world's most advanced diagnostic devices: from ultrasound, ECGs, and even blood pressure," said Dan Ludwick, Chief Product Officer, Elo. "The eClinics do more than just video calls. They bring together Zoom, Amwell, custom wellness applications, and remote patient monitoring into a solution that can be easily used by anyone, which can drastically reduce operating and deployment costs." "Elo has been a great partner," says Ram Fish, 19Labs CEO & Founder. "They are a dynamic, innovative company with global reach, and we are happy to work with them in making healthcare more accessible worldwide. Their Android-based touchscreen systems are beautiful, well-engineered, and provide a unique, affordable solution to deploying kiosks in different form factors within the healthcare industry. Elo's tablets are built-to-last and highly reliable. Their commercial-grade hardware is complemented by great Android implementation. These make Elo's solutions perfect for enhanced telehealth." In Oaxaca, Mexico, the state's health ministry has been rapidly deploying 19Labs' eClinics. Dr. Lorena Ocampo, Chief Coordinator of Telemedicine at Oaxaca's Ministry of Health, says the next generation healthcare kiosks will significantly increase healthcare accessibility and quality in the region. "It's been a pleasure working with 19Labs and Elo. The impact these units have on the healthcare conditions within the community, and the ability to easily access advanced medical care, radically improves the quality of service that we are able to provide." About Elo As a leading global supplier of interactive solutions, #EloIsEverywhere. To date, we have deployed more than 25 million installations in over 80 countries. A new Elo touchscreen is installed every 21 seconds, on average, somewhere in the world. Built on a unified architecture, Elo's broad portfolio allows our customers to easily Choose, Configure and Connect & Control to create a unique experience. Choose from all-in-one systems, open-frame monitors and touchscreen monitors ranging from 10 to 70 inches. Configure with our unique Elo Edge Connect peripherals that allow use-specific solutions. Connect & Control with EloView®, a secure cloud-based platform for Android-powered devices. EloView enables secure deployment and management of a large network of interactive systems designed to reduce operating costs while increasing up-time and security. Consumers can find Elo touchscreen solutions in self-service kiosks, point-of-sale terminals, interactive signage, gaming machines, hospitality systems, point-of-care displays and transportation applications—to name a few. Learn more at EloTouch.com. About 19Labs 19Labs is the creator of GALE, Next Generation Point-of-Care platform for pharmacies, schools, and rural communities. GALE brings together "best of breed" diagnostic technologies from industry leaders like Zoom, Elo, Amwell, Eko, Samsung Mobile, MIR, Omron, Viasat, and many others in one smart, efficient, and cost-effective platform. It was designed from the ground up to be operated by non-healthcare professionals, in locations with limited infrastructure and optimized for low bandwidth and intermittent connectivity. To learn more about GALE, please visit www.19labs.com/platform. < Previous News Next News >

Top of Page Video Access Highlighted Webinars Clincal Innovation Business Funding NMTHA Town Hall Experts in TH Webinars, Interviews, & Videos Video Access Featured Webinar & Video Series Highlighted Videos NMTHA provi des videos by topic: Clinical Innovation Business Funding Town Hall Meeting Expert Interviews Webinars FEATURED WEBINAR NMTHA Town Hall Event: The Future of Telehealth As our world changed due to the COVID-19 pandemic, so did the world of telehealth. But, what happens next? Featuring nationally recognized speaker and telehealth pioneer Dr. Weinstein, plus Russel Toal from New Mexico's OSI. View Webinar FEATURED SERIES Experts in Telehealth: An Interview Series NMTHA brings "Experts in Telehealth" a video series interviewing experts from various areas within the Telehealth arena. View Series Featured The Modern-Day House Call. Duke City’s Medic Buddy: House Call/Telemed Hybrid August 24, 2022 Mark Maydew, CFO/COO and Kelly Spring, PA-C from Duke City Cares walk us through their Medic Buddy Mobile Medical Care service. Duke City Cares is not only making house calls but connecting patients when needed to physicians via telemedicine via this mobile service. Performing a Physical via Telemedicine April 15, 2022 Dr. Tarun Girotra, Clinical Educator and Assistant Professor of Neurology at the University of New Mexico. Dr. Girotra presents various levels of physical exam documentation over telemedicine and demonstrates how to perform the best possible physical exam during a telehealth visit. CLINICAL Leveraging Telehealth for Behavioral Health in Challenging Times December 14, 2022 Molly Brack, Clinical Director at the Agora Crisis Center and Wendy Linebrink-Allison, Program Manager of the NM Crisis Line and Elizabeth Glantz, 988 Project Manager with NM Behavioral Health Services Division. Presentation on how crisis line services can assist in closing gaps and build bridges for people who experience mental, emotional, and behavioral health and substance use concerns which do not replace community services, but fill in the gaps and create connections to support people in communities. Performing a Physical via Telemedicine April 15, 2022 Dr. Tarun Girotra, Clinical Educator and Assistant Professor of Neurology at the University of New Mexico. Dr. Girotra presents on the various levels of physical exam documentation over telemedicine and demonstrates how to perform the best possible physical exam during a telehealth visit. Addressing Provider Burnout December 01, 2021 Rick Vinnay, LCSW, CEAP - The Solutions Group EAP and Wellness Programs, and Pierce Ferriegel, CEO - The Community Lighthouse. Rick Vinnay and Pierce Ferriegel each have a different vantage point and discuss what their organization experienced and how they managed burnout. Telemedicine Clinical Specialties October 27, 2021 Dr. Randy Nederhoff, Neonatology, Dr. Rina Patel-Trujillo, Endocrinology, and Dr. David Phelps, Medical Director, PHS Urgent Care Clinics. For this webinar we bring you three medical specialists and their experience using telemedicine. They cover conducting a physical exam via telemed, using telemed for endocrinology, primary care, specialty care, surgical specialties and neonatal care. Telemedicine Clinical Specialties: Behavioral Health October 20, 2021 Lora Blazina, LPCC, Clinical Supervisor at The Mountain Center, Santa Fe’, Dr. Caroline Bonham, Vice Chair of Community Behavioral Health Policy, Department of Psychiatry and Behavioral Sciences, and Dr. Marita Campos-Melady, Clinical Psychologist and Director of Specialty Behavioral Health Therapy services at Presbyterian Medical Group. In this webinar we have three speakers as we explore tele behavioral health - the challenges, the successes and the innovations when using telehealth for serious mental illnesses, complex trauma, use in BH and medical settings and for adults as well as children. Expanding Your Telemedicine Services September 29, 2021 Dr. Elizabeth Krupinski, Phd, Southwest Telehealth Resource Center, and Dr. Van Roper, University of New Mexico. Whether you have been using telemedicine for 1 year or 10, Drs. Krupinski and Roper have some ideas for making the most of your telemedicine services, which can contribute to further sustaining your practice. Telehealth and COVID: Lessons Learned February 17, 2021 Van Roper, PhD, FNP-C, Associate Clinical Professor. This presentation covers telehealth basics, primary care specific applications, and lessons learned in the implementation of telehealth in small rural clinics during the COVID-19 pandemic. Care Integration in the Time of Covid: Focus on Patient Experience January 13, 2021 Elizabeth Krupinski, PhD, Southwest Telehealth Resource Center. This presentation focuses on ensuring patients have a positive experience during telemedicine encounters, starting from the first encounter at scheduling through the actual visit with the provider. Topics include incorporating the entire care team in telemedicine encounters and finding relevant quality indicators to measure success. INNOVATION The Ups and Downs of Digital Innovation in Healthcare November 16, 2022 Alex Carter, certified Physician Assistant, Presbyterian Healthcare Services’ Innovation Hub. A sought after speaker on this topic, Alex's presentation includes TytoCare as a case by which to discuss a system-wide Telehealth implementation, and get real with the many challenges they have. She weaves in other projects and tools as well. Rethinking How We Connect Hospitals, Specialists and Patients September 21, 2022 Darcy Litzen, MS, BSN, RN, VP of Sales for AmplifyMD. Physician video visits became necessary during the pandemic and are now widely accepted. But what if we take them a step further and use virtual care to provide a holistic solution to the ever-present cost-of-care and network adequacy pressures on health systems and insurers, while also addressing physician burnout and the complexities of providing timely specialty care locally? All with built-in continuous improvement? The Modern-Day House Call. Duke City’s Medic Buddy: House Call/Telemed Hybrid August 24, 2022 Mark Maydew, CFO/COO and Kelly Spring, PA-C from Duke City Cares walk us through their Medic Buddy Mobile Medical Care service. Duke City Cares is not only making house calls but connecting patients when needed to physicians via telemedicine via this mobile service. Growing Peer Support in the Virtual World. How Presbyterian Healthcare Service’s Community Health Built a Virtual Peer Network March 17, 2022 Valerie V. Quintana, MA, PTP, and Donald M. Hume, CPSW with Presbyterian Health Services, Community Health. Presbyterian Healthcare Service's Community Health department stood up a virtual peer network. In this presentation, Valerie Quintana and Donald Hume describe what they built and bring us their experience - the challenges, the successes, and what they learned in creating this new network. BUSINESS OF TELEHEALTH Telehealth Needs & Opportunities: Emerging Findings from BH Providers December 08, 2021 Margy Wienbar, MS, and Renee G. Sussman, RN, MA, MSN. This presentation briefly reviews the findings of the report “Telehealth Needs & Opportunities: F indings from Nonprofit Behavioral Health Providers in Northern New Mexico” that was published by the New Mexico Telehealth Alliance and Anchorum St. Vincent in July of 2021. Participants will hear from three of the organizations that were interviewed and contributed to the report’s findings. Telemedicine Billing & Coding: What You Need to Know September 08, 2021 Steve DeSaulniers from Blue Cross Blue Shield of New Mexico, Jennifer Sandoval from Molina Healthcare, Julie Wohrlin from Western Sky Community Care, Dr. Denise Gonzales from Presbyterian Healthcare, Lorelei Kellogg, NM HSD, and Moderator: Stetson Berg, UNM Center for Telehealth This full panel of speakers present and answer questions from attendees. Delta Variant is on the Rise: Is Your Telemedicine Practice HIPAA Compliant? September 01, 2021 Michael Herrick, Founder & CEO Matterform. With the rise of the Delta Variant, you may be thinking that we will be relying on telehealth more this fall. Are you compliant? Do you have concerns about your platform? Have you been relying on tools that won't be compliant once the Public Emergency Health order ends? Collective Learning of the Telehealth Learning Community March 31, 2021 Kate Gibbons, LCSW, LISW, Ph.D., of Janus LLC. A summation and update on the learning and data collected during the first cohort of the Telehealth Learning Community (TLC) for behavioral health providers. Show Me the Data: How COVID-19 Impacted Telehealth Claims & What Happens Next March 17, 2021 Stefany Goradia, MSIE-VP Health Analytics, RS21 Health Lab. COVID-19 caused a spike in telehealth as new payment models were approved and the healthcare industry pivoted rapidly to continue providing care via telehealth at the March onset. Since that time, organizations have witnessed declines in overall telehealth utilization, with some services slowly dwindling and others converting entirely back to in-person visits. In this case study, we will review an anonymized payer’s telehealth claim trends, services and conditions that were identified to be the most widely-adopted for telehealth between March and December 2020, and considerations for an ongoing telehealth strategy going into 2021. New Mexico’s Telehealth Stature Simplified: What You Need To Know March 10, 2021 Beth Landon, MBA, MHA-NMTHA Chair, and Stetson Berg, MHA-NMTHA Vice Chair. New Mexico enjoys one of the nation’s most progressive telehealth laws. Full payment parity and zero geographic restrictions comprise just part of the law; we also suffer zero limitations on eligible providers and no lifetime limits. This presentation and ensuing discussion intends to demystify the law, answer your questions, and gain your ideas on how to further improve the statute in subsequent legislative sessions. Developing Telehealth Workflow for Best Possible Patient and Provider Experience February 10, 2021 Jen Gruger, PMI-PBA. Delivering a successful telehealth visit is as much about the step-by-step workflow and how each individual involved executes their portion, as it is about the technology used and the clinical outcome we desire. This session will cover three essential components of building (or repairing) an effective and efficient workflow for this type of visit regardless of the telehealth platform being used. Using Remote Monitoring Technology to Improve Patient Outcomes & Retain Staff January 20, 2021 Arlene Maxim, RN. This presentation focuses on technology to augment home health care, an extremely valuable tool when clinicians use it effectively. Agency owners and managers are beginning to see the critical role that telehealth and remote care monitoring can play in keeping patients at home and improving patient satisfaction. Telehealth and remote care monitoring can also improve clinician satisfaction. During this session we discuss what to look for in a telehealth/remote care monitoring provider and how to market technology’s ability to improve patient outcomes and staff satisfaction. FUNDING FCC Rural Health Care Program Funding Opportunities March 24, 2021 Steve Constantine, SVP/CIO, Prairie Health Ventures & COO, and Marci L. White, FCC Rural Health Care Program Funding Specialist. The FCC Rural Health Care Programs provide funding opportunities for eligible healthcare providers across the U.S. to develop and grow their telemedicine programs. The two programs fund telecommunications and broadband services necessary for the provision of health care. In addition, the Healthcare Connect Fund allows opportunities for some urban participation as well as funding for data centers, administrative offices and certain network equipment. NMTHA TOWN HALL Town Hall: The Future of Telehealth September 22, 2021 Dr. Ronald S. Weinstein, na tional telemedicine pioneer, and Russell Toal, New Mexico Superintendent of Ins urance and local community. This special 90-minute town hall explores the possibilities of where we go from here. The town hall features speakers from local and state leadership, healthcare and YOU. INTERVIEWS: TELEH EA LTH EXPERTS Elizabeth Krupinksi , PhD, Southwest Telehealth Resource Center Jen Gruger , PMI-PBA, EHR Sup port Dept., Gerald Champion Regional Medical Center Geof Empey , Progra m Operations Director, University of New Mexico Center for Telehealth Kelly Schlegel , Director of the New Mexico Office of Broadband Access and Expansion Clincal Innovation Business Funding NMTHA Town Hall Highlighted Videos Experts in TH Highlighted NMTHA Webinar Series 10-week Educational Series From our 2021 10-week educational series, webinars focused on data, broadband in New Mexico, client engagement, and more! These webinars were hosted by the New Mexico Telehealth Alliance and made possible through funding by Health Resources and Services Administration Office for the Advancement of Telehealth and the Southwest Telehealth Resource Center. View Webinar Fall 2021 Webinar Series Topics include the future of telehealth, billing, using telehealth for clinical specialties, and more. View Webinar Webinars

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

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

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

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 >

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

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 >

CMS Releases Final Calendar Year (CY) 2023 Physician Fee Schedule CCHP November 08, 2022 Last week, the Center for Medicare and Medicaid Services (CMS) released the final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS finalized many of their telehealth proposals, which primarily focused on what services will be covered by the program and what will happen immediately following the end of the public health emergency (PHE), including during the 151-day grace period included in the 2022 Budget Act. CMS clarified that the list of services that were temporarily allowed to be delivered via telehealth and reimbursed by Medicare during the PHE, will still be allowed during the 151-day grace period. Additionally, CMS added more of the temporary telehealth PHE list codes to a category of services that would remain through the end of 2023. The rule also reiterates the requirement for an in-person visit in the first 6-months of an initial telehealth mental health visit and every 12 months afterward (with exceptions), and clarifies that won’t be implemented until 152 days after the end of the PHE. They will address the specifics around coding and reporting these types of services through guidance and a sub-regulatory process in the future to ensure a smooth transition after the PHE ends. Stay tuned for an in-depth In Focus write up from CCHP on the 2023 PFS next week, as well as a new factsheet focused on the telehealth elements in the final rule. See original article: https://mailchi.mp/cchpca/its-here-cms-releases-2023-physician-fee-schedule-plus-new-resources-on-telehealth-policy-from-hhs-cchp < Previous News Next News >

Is telemedicine an answer to physician burnout and staffing shortages? Bill Siwicki May 24, 2022 A physician who works full time via telehealth – and in brick-and-mortar ERs on the side – discusses the benefits to herself and the industry. With the huge initial swell in the use of virtual care in the rearview mirror, many industry experts – from health plans to big tech and practicing clinicians – are considering whether a doubling down on telehealth is just what the doctor ordered for the future of patient care. Many clinicians are hungry for new opportunities that allow them to continue to serve patients without dealing with long-standing administrative burdens and the aftermath of burnout from COVID-19 in their hospitals, health systems and doctor's offices. With too many clinicians continuing to stress that they've lost passion in their careers and considering quitting their jobs altogether, experts say change is needed. The healthcare industry can't afford to lose these highly skilled clinical workers to other industries. On this note, Healthcare IT News interviewed Dr. Pooja Aysola, a practicing emergency department clinician in Boston and senior director of clinical operations at Wheel, a virtual care company. She talks about physicians' newfound familiarity with telehealth and what it means for the future, the possibility of physicians working full time in telemedicine, and how virtual care can help with staffing shortages in healthcare. Q. With the massive uptake in telemedicine during the past two years of the pandemic, clinicians have grown accustomed to delivering care virtually. What do you think this familiarity means for clinicians moving forward? A. I hadn't ever considered a career in virtual care until a few months into the pandemic. I was working in an emergency room in Boston when my shifts were cut after the hospital rolled back elective procedures. I started working in telemedicine as a temporary solution, but I ended up loving the flexibility to see patients at home and on my own schedule. I also quickly realized I didn't have to be in the same room as my patients to deliver great care. I can treat conditions such as UTIs through a screen and provide immediate value to my patients. I'm not alone in my sudden pivot from virtual-care skeptic to virtual-care advocate. Two in three clinicians now say treating patients in virtual only or hybrid care settings best fits their lifestyle, despite a significant lack of interest in telehealth before the pandemic. I'm hopeful this new trend will allow more clinicians to create career paths that work for them, rather than against them. Clinicians should have the flexibility to decide when they want to work, where they want to work, and how they want to work. If we're moving toward a hybrid care model, then we should enable clinicians to adopt hybrid careers, if that's what works best for them. In medical school, we're taught there's only one track you can follow: in-person care. But that's not the case anymore. I want every doctor and nurse to feel empowered to follow the career path that works best for them. Q. You seem to suggest that physicians looking for a change, perhaps due to burnout, can switch to telehealth full time. What would a move to virtual care look like for a physician? A. The past few years have been incredibly tough for clinicians. Burnout, frustration and fatigue are some of the many challenges facing clinicians today. Recent data shows more than half of clinicians have lost passion for their careers because of stress – and close to half believe burnout is the biggest threat to patient care today. Working in virtual care was a less-than-traditional career path before the pandemic. But now, many clinicians are considering working in virtual care to help combat burnout and increase flexibility. A move to virtual care will look different for everyone. For example, some clinicians enjoy having a set schedule each week to see patients. Others enjoy having more flexibility, where they can easily sign on after dropping their kids off at school, sign off before running an errand, or even split their time between virtual and in-person care. At Wheel, more than half of clinicians still work in a brick-and-mortar setting. One of our clinicians currently is driving around the country with her partner in an RV. She customizes her schedule based on her travel plans that day. She can see patients in the morning and go for a hike in the afternoon, or spend a few hours on the road before pulling over and seeing patients in the afternoon. Clinicians interested in telehealth should look for opportunities that prioritize and personalize their experience as clinicians. Some specific factors to consider include: What kind of electronic health record does the company use? And was the EHR created with your experience in mind? Do they offer ongoing training? And provide resources on important topics, such as "webside" manner and guidance on managing state licenses? Do they have a robust clinical quality program in place? How do they provide feedback on quality of care? Q. How can telehealth help with the staffing shortage in healthcare? A. Our current clinician staffing shortage is a national crisis. And it's only expected to get worse. According to an Elsevier study, almost half of U.S. clinicians plan to leave their jobs within the next few years. I've seen firsthand the impact shortages are having on clinician burnout and patient care. And I firmly believe this is a crisis that the entire industry must address. Ensuring clinicians feel encouraged to explore careers in virtual care, if that's what works best for them, is one of many steps to take. Another way for telehealth to help address staffing shortages is by powering the transition to what we call "virtual-first care." With virtual-first care, patients can start their care journey with telemedicine. By leaning on technology, healthcare organizations can more easily triage the patient's care needs and determine the best care setting – virtual, in-person or hybrid care. This is a more efficient way to approach care delivery while simultaneously increasing access to care. While telehealth alone is not the only solution, it is one of many steps we can take to help address staffing shortages and help ensure timely patient access to care. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/telemedicine-answer-physician-burnout-and-staffing-shortages < Previous News Next News >

Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017–20 Juan J. Andino, Ziwei Zhu, Mihir Surapaneni, Rodney L. Dunn, and Chad Ellimoottil Abstract During the COVID-19 pandemic, all fifty states and Washington, D.C., passed licensure waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (that is, interstate telehealth). Because many of these temporary flexibilities have expired or are set to expire, we analyzed trends in interstate telehealth use by Medicare beneficiaries during 2017–20, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth made up a small share of all outpatient visits (0.8 percent) and of all telehealth visits (5 percent) overall. For individual states, out-of-state telehealth made up between 0.2 percent and 9.3 percent of all outpatient visits. We found that most out-of-state telehealth use was for established patient care and that a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who did not receive care outside of their state (28 percent versus 23 percent). Our collective findings suggest that the elimination of pandemic licensure flexibilities will affect different states to varying degrees and will also affect the delivery of care for both established patients and rural patients. View Full Article: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01825?journalCode=hlthaff < Previous News Next News >

TELEHEALTH: THE JOURNEY FROM VIDEO VISITS TO STRATEGIC BUSINESS TOOL By Mandy Roth at HealthLeaders April 6, 2021 New approaches to telehealth can help organizations meet their key objectives. KEY TAKEAWAYS: *Asynchronous communication increases provider efficiency and provides a way to address physician shortages. *Virtual hospitals reduce healthcare costs and support the transition to value-based care. *A cloud-based platform enables 24/7 personalized care, moving care upstream to improve outcomes and reduce the cost of care. 2020 was a remarkable year for healthcare innovation, and telehealth finally achieved scale across the industry. Driven by a need to deliver healthcare at a distance, hospitals and health systems stood up new services seemingly overnight, fanned the flames under languishing programs, or found new uses for thriving virtual care initiatives. Now that telehealth has become a fixture in the healthcare delivery firmament, it's time to examine what comes next. While current use predominantly focuses on televisits between providers and patients, and mysteries remain about reimbursement and licensure issues after COVID-19, forward-thinking healthcare executives are using the technology to enable new models of care. Health systems are employing telehealth to transform healthcare delivery in ways that address strategic business objectives: improve outcomes, reduce provider burden, enhance patient experience, improve access, and ameliorate workforce labor issues. HealthLeaders spoke to visionary leaders and digital healthcare experts who shared their insights and perspectives about what organizations should focus on now, next, and in the future to unlock the potential of telehealth. Coverage includes case studies about asynchronous care, remote monitoring, and a futuristic cloud-based platform fueled by artificial intelligence. Health systems shared details about how these initiatives work and how they evaluated the return on investment. These new approaches to telehealth can help organizations meet their strategic objectives and provide information to inspire other organizations on their own telehealth journeys. WHAT'S NOW: PRESBYTERIAN HEALTHCARE SERVICES ENHANCES EFFICIENCY WITH ASYNCHRONOUS COMMUNICATION Strategic Objectives: *Increase provider efficiency and address physician shortages *Reduce costs per patient encounter *Reduce ER and urgent care utilization At the beginning of 2020, physicians and consumers had not yet fully embraced the concept of virtual video visits; many were skeptical about the ability to deliver care effectively in this manner. Yet after the pandemic forced the adoption of virtual visits, their reputation and usage forever changed. Today, asynchronous communication faces the same hurdles. Providers and patients don't understand how it works and question its value. "It's a technology whose time has not yet come," says Oliver Lignell, vice president of virtual health at health system consultancy AVIA, which helps members accelerate their digital transformation initiatives. "It's not yet mainstream, but it should be." Presbyterian Healthcare Services, an Albuquerque, New Mexico–based nonprofit integrated healthcare delivery system, began investigating this approach to healthcare four years ago. "It's been incredibly effective," says Ries Robinson, MD, senior vice president and chief innovation officer. Between the system's nine hospitals and a health plan it offers, the organization serves a third of the state's residents. With a shortage of practitioners in New Mexico, and 70% of the care it provides covered by capitated contracts, Presbyterian needed to find a way to operate more efficiently. Asynchronous communication worked. Last year, a designated group of employed urgent care physicians handled 50,000 asynchronous visits for low-acuity care, and spent an average of two minutes on each encounter—far less than the 15–18 minutes it takes to conduct a typical video call. This form of care does not occur in real time. Depending on the platform used, a patient completes and submits an online form via secure email, text, or an app, detailing his or her complaint and relevant history. A physician receives the information, processes it, and sends a response back to the patient with instructions and prescriptions, if necessary. Presbyterian physicians usually respond within 15 minutes; some health systems using asynchronous communication allow up to 24 hours. There is no direct audio or video exchange with the patient unless the physician thinks it is warranted and escalates the encounter. Asynchronous communication offers some distinct advantages to health systems, say the experts. Synchronous care, which includes video, audio, and in-person visits, comes with an Achilles' heel: Regardless of venue, the physician spends about the same amount of one-to-one time with the patient, says digital medicine expert Ashish Atreja, MD, MPH, chief information and digital health officer at UC Davis Health in Sacramento, California. "The real growth you're going to see in value," he says, "is the ability to deliver one-to-many care." Asynchronous communication is a step in that direction. "One of the most important things asynchronous communication does is help scale response," says Ann Mond Johnson, MBA, MHA, CEO of the American Telemedicine Association. In addition, because patients can use it with a phone or the internet, it can address issues of access, she says. Robinson says the SmartExam™ platform Presbyterian is using, made by Bright.md, includes features that appeal to its physicians. It automatically enters chart-ready SOAP (Subjective, Objective, Assessment, and Plan) notes into the electronic medical record (EMR), creates billing files, and manages patient follow-up communications. "It's extremely elegant," says Robinson. SmartExam's design, which asks patients questions in an interview-style exchange, and advanced logic has earned the trust of the physicians who use it, he says. "I remember the first time [physicians] said, 'I trust it'; I thought that was kind of a funny term to use," Robinson recalls. When he asked the doctors what they meant, they explained that the tool is thorough and consistent in a way humans cannot replicate. "That's what the providers really like." Even the best medical assistant, he says, may vary in how they ask questions of patients, forget to include certain details, or package assessments differently. While Robinson says the health system has detailed financial models that justify the cost of the platform, he declines to disclose the figures, but notes, "It hasn't been an astronomical investment by any stretch of the imagination." Expenses include a one-time cost for EMR integration, ongoing charges for using the platform on a per-patient per-use basis, and marketing and promotion. He also provides formulas to calculate estimated cost savings. They include: *Better utilization of providers' time and related staffing expenses, by reducing each of 50,000 encounters from 15–18 minutes for a video encounter to two minutes for an asynchronous visit. *More appropriate ER usage. Out of 50,000 patients, 8% were redirected away from the ER. This figure is based on patient survey responses indicating they would have visited the ER had the platform not been available. With an average ER visit costing more than $500, says Robinson, "there's a significant savings." *Reduced workload at urgent care facilities. "Just assume 20,000 [of these patients] would have gone to an urgent care that we own," he says. The time and expense of urgent care staffing is used to calculate the savings. Patients also save money, says AVIA's Lignell. Nationally, he says the typical cost for an asynchronous visit is about $20, and many health systems offer these visits for free. This compares to a national average cost of $50 for a video visit and $125 for an in-person visit. There is one additional element that has contributed to the success of asynchronous visits for Presbyterian: a digital front door. Patients visit the pres.today webpage, enter their condition and insurance information, and are automatically directed to the appropriate level of care, one of which includes the option for online visits (using asynchronous care). Because of the asynchronous initiative's success, the health system is expanding its use beyond low-acuity care. Future plans involve developing new uses for the platform, capturing symptoms and history to create greater efficiencies for video visits and even in-person care. "We have gotten religion around the idea of capturing as much information as you can in a sophisticated manner before the visit," says Robinson. "You maximize the quality of care and the efficiency of the visit. We're taking that idea and pushing it forward in multiple avenues of care here at Presbyterian." Value-based care will drive further adoption of these models, says Lignell. "The advantages from a total cost of care standpoint are huge," he says. "It's much less expensive to deliver care this way." While the bulk of growth has been in low-acuity primary care, he says asynchronous care is now being explored in specialty and higher-acuity care, as well as in e-consults between providers. "The asynchronous model is proving to be incredibly efficient for health systems," says Lignell. "That's one of the reasons why it has so much promise." WHAT'S NEXT: ATRIUM HEALTH LAUNCHES A VIRTUAL HOSPITAL Strategic Objectives: *Increase bed capacity, limit staff and patient exposure to COVID-19, and conserve PPE *Reduce costs and support the transition to value-based care *Improve patient satisfaction and experience "Remote patient management is widening the aperture from the episodic-based healthcare reality that we've known for decades towards a 24/7, always-on ubiquitous reality," says Rasu Shrestha, MD, MBA, executive vice president and chief strategy and transformation officer at Atrium Health. Long before COVID-19 hit American shores, health systems began launching remote monitoring programs, particularly to manage chronic diseases. Hospital at home initiatives, or virtual hospitals, are a robust manifestation of this endeavor. While these models have demonstrated cost savings, adoption has been slow due to reimbursement issues. The pandemic offered a trifecta of motivating factors to accelerate adoption of the virtual hospital model: bed capacity issues, a need to limit staff and patient exposure, and dwindling supplies of personal protective equipment (PPE). With these issues in mind, during March 2020 a handful of clinicians approached Atrium Health administrators, suggesting that the 42-hospital Charlotte, North Carolina–based nonprofit health system consider launching a hospital at home initiative. Two weeks later it was operational, says Scott Rissmiller, MD, executive vice president and chief physician executive. In the first 10 months, the virtual hospital admitted 51,000 patients. "We are able to keep patients in their homes, protect our teammates from infection, and also protect patients," Rissmiller says. "It freed up a good bit of capacity in our acute facility," enabling the health system to reserve that space for its more acute COVID-19 patients. The virtual hospital maintains two "floors." The first floor functions as an observation unit; the second floor is reserved for patients requiring more intensive care, says Rissmiller. Any COVID-19-positive patient is admitted to the first floor of the virtual hospital and receives digital tools to monitor temperature, blood pressure, pulse, and oxygen levels. These devices deliver data via Bluetooth® to a smartphone app developed by the health system's IT department. That data feeds into the patient's EMR, fully integrating into the patient's continuum of care, Rissmiller explains. In a bunker back at Atrium Health's call center, a team of clinicians monitors data and checks in with first-floor patients daily. Second-floor virtual patients have the same home monitoring tools, but receive "much more intensive management" and frequent check-ins, he says. In addition, community-based paramedics visit homes to administer IV fluids, IV antibiotics, breathing treatments, EKGs, and other interventions. This arrangement created additional opportunities to reduce hospital bed capacity. "We were one of the first in the nation to get in-home remdesivir, one of the COVID treatments," says Rissmiller. "To receive remdesivir, you have to be on oxygen therapy, so these patients are sick." In a 10-month period, Atrium Health administered about 150 therapeutic rounds of the drug, he says, which saved about 500 hospital days that would have been required if those patients had been hospitalized. "From a quality standpoint, we do not view this any differently than if these patients were within the walls of our hospital," says Rissmiller. All measures, including length of stay as well as readmission, transfer, and mortality rates, have been almost identical to inpatient stats, and patient satisfaction has been "extremely high," he says. "Patients really would rather be in their home surrounded by their loved ones and support system." The hospital at home initiative has been a "costly endeavor," says Rissmiller. "When we realized this pandemic was going to be significant, our CEO [and President Eugene Woods, MBA, MHA, FACHE] called me and said, 'Scott, whatever you need to care for our patients and communities—do it. We'll figure out the costs later.' It freed us up to be able to do things like this." As it turned out, costs have been offset by funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which enable Atrium Health to bill for many of the services provided. The organization also is one of a handful of healthcare systems that are doing a pilot with the Centers for Medicare & Medicaid Services, which views virtual beds as real hospital beds. "The reimbursement is similar because of the level of service we're providing," says Rissmiller. Initially, though, "it was all upfront costs for us, but the return was in bed days." A focus on reimbursement continues "as we are now maturing the program," he says. "Our concern is that the reimbursement will go away once those [pandemic] emergency orders expire. We're working with the state, our payers, Medicare, and others to make sure that this continues to be reimbursed at a level that allows us to continue to grow it and cover our costs." "Out of necessity, COVID ultimately accelerated health systems' desire to think through their digital strategies and determine how digital fits into their overall care and business models," says Brian Kalis, MBA, managing director of digital health and innovation in consulting firm Accenture's health practice. "New models are starting to pop up, and care is shifting to the home." Strategic goals include producing outcomes that equal or exceed inpatient care, while also improving labor productivity, Kalis says. "A majority of health systems coming out of COVID are putting care at home as a key strategic focus. That requires a collection of new models to deliver care, putting different care team compositions in place, and [utilizing] technology to help a broad range of conditions for pre-acute, acute, and post-acute care." Atrium's virtual hospital has already expanded beyond COVID-19 patients. Once the surge diminished in July, Rissmiller "challenged the team to look at [the initiative] through the lens of a non-COVID world. Can this become a new way of caring for patients that makes sense to the patient and to us as a healthcare system?" There is now a list of 10 diagnoses to be considered for hospital at home care, and congestive heart failure patients have already been admitted into the virtual facility. "We're starting to branch out," he says. "We're also starting to focus on different communities to make sure that we're doing this in a way that helps with our underserved populations and gives them the resources they need to manage care at home rather than coming through the emergency department." While Atrium Health rolled out its program in two weeks, Rissmiller says, "this is something that would be incredibly hard to start up on your own if you hadn't had the 10 years of virtual experience that we've had building these capabilities, but also the confidence to be able to deliver these kinds of services at home. It takes a while for clinicians to understand that care can be delivered safely virtually. We also have a culture at Atrium Health that really enables our clinical leaders to lead and their voices to be heard. That, more than anything, is the secret sauce that's allowed for innovations like hospital at home." WHAT'S IN THE FUTURE: HIGHMARK HEALTH DEVELOPS PLATFORM TO DRIVE 24/7 CARE Strategic Objectives: *Move care upstream to improve outcomes *Reduce cost of care, patient traffic, and volume *Enable 24/7 personalized care Unleashing the potential of virtual care requires strategic innovation fueled by imagination. Highmark Health is one organization traveling along this path. To understand the power of an initiative now underway at the Pittsburgh-based payer-provider system, one must imagine the potential to do something that is currently not possible. For example, take the hypothetical case of an individual living independently at home with six medical conditions. What if real-time data alerts her care team that her health status has subtly changed? What if this alert takes the complexity of her medical history into account and offers decision-support tools to accelerate clinical action before her health deteriorates? The Living Health Model, fueled by the Living Health Dynamic Platform—a Google Cloud–based technology infused with artificial intelligence and advanced analytics—could be the missing link that will enable care to move upstream. The concept revolutionizes the current perception of telehealth and enables 24/7 care. It aims to connect the provider, patient, and payer in novel ways to improve health outcomes, reduce clinician administrative burdens, enhance patient engagement, and reduce costs, says Karen Hanlon, executive vice president and chief operating officer at Highmark Health. "We believe that we have the capabilities and resources to pull it together," says Tony Farah, MD, FACC, FSCAI, Highmark Health's executive vice president and chief medical and clinical transformation officer, who is also a practicing cardiologist. The platform will amplify the impact of remote monitoring tools, which many health systems already use for chronic disease management. By adding sophisticated data analytics, machine learning, decision support, and patient education tools, the system will support comprehensive care rather than managing diseases in silos, Farah says. "Our partnership with Google Cloud is going to not only accelerate our strategy, but also help us scale it." Data will be constantly mined to determine the "next best action" required to proactively care for a patient and formulate a personalized care plan that delivers a "curated" experience based on the patient's personal needs, says Hanlon. For patients with no apparent health conditions, the system may focus on wellness. While full realization of this concept may be years down the road, Hanlon says the first iteration of the platform will be functional at the end of 2021. Accenture cloud expert Geoff Schmidt, managing director, global lead—life sciences technology, says Highmark Health's plans align with what he's seeing in the life sciences sector. Health leaders should not think of the cloud as a capability or an IT initiative, he says; "think of it as a business transformation enabler." Cloud technology is accelerating companies' three- to five-year strategic plans, compressing those timelines down to 12 to 18 months. "We're seeing dramatic transformations and acceleration of CEO agendas because of the capability that the cloud can provide." Partnering with an outside player is a smart move for health systems that want to expedite their transformation initiatives, says Schmidt. "Major technology partners are innovating at a scale that is, just frankly, hard for payers or providers to keep up with." Prior to its partnership with Google Cloud, Highmark Health piloted "analog" proofs of concept, according to Farah. These pilots involved addressing healthcare for several patient populations, including high-risk patients with multiple comorbidities as well as individual chronic conditions like COPD, heart failure, diabetes, and hypertension. Physicians were asked to improve health outcomes in 12 months. "The patient experience went through the roof, and in almost every case—with the exception of diabetes—the total cost of care came down," says Farah. "I would say physician engagement was our secret sauce." "Consumer engagement is also a key component," says Hanlon. "There are a lot of solutions out there. They're very siloed and they're not integrated. We can have the best solutions in the world, but if the consumer and the clinician are not using them, they will have no impact." While Highmark Health does not disclose the company's investment in this platform, "you can guess that it is a fair amount," says Hanlon. In addition to activating the initiative at Allegheny Health Network, a nonprofit health system that Highmark owns and operates, "at the same time we're a health plan serving 5.6 million members," she says. "The ability to interact with all of those members is incredibly important to us. When you look across our book of business, we're probably managing somewhere in the neighborhood of $26 billion in healthcare costs a year. When we look at the investments that are needed to support that base of membership and that level of healthcare spend, we feel it's appropriate and we can justify the investment." Being both a payer and a provider imbues Highmark Health with the motivation and influence to transform healthcare delivery in this way, Hanlon says. The company is a Blue Cross Blue Shield–affiliated payer operating in three states, and also functions as a provider through the Allegheny Health Network. "By having both of those assets in the portfolio," says Hanlon, "it's easier for us to align on the path forward and the economic model." But to characterize this venture merely as a mechanism to save money misses the point, she says. The model is designed to improve patient outcomes by moving care upstream, explains Farah. "Conditions that exist today will be prevented from deteriorating, and conditions that haven't developed will be prevented—or, at a minimum, be delayed in development. That's the primary goal, and it results in a reduction in total cost of care. It flips the equation from focusing on finances to focusing on health." In addition, for the Living Health Model to be effective, it must work with entities outside of the facilities owned by the Highmark Health system, which provides health plans in Pennsylvania, Delaware, and West Virginia. Allegheny Health Network operates facilities in 29 Pennsylvania counties and portions of New York, Ohio, and West Virginia. "We're looking to have impact across all of the markets that we serve as our insurance company, not just where we own a provider asset," says Hanlon. "The progression of value-based care has been a slow march. I think this platform will be a tool to enable providers to continue down that path. Part of our focus is developing other tools we believe will be necessary for the providers to succeed in a value-based environment. We recognize that we're going to have to be a leader in helping others to move down that path." A FRAMEWORK FOR MOVING FORWARD Planning for the future of telehealth requires rethinking the present. "If the only way that you look at telehealth is as a way to replace one-to-one physical visits with a telehealth visit, you're not changing the world; you're just creating a little bit more convenience," says Roy Schoenberg, MD, MPH, president and CEO of Amwell, a Boston-based technology company that provides telehealth technology to health systems. "If you look at telehealth as a product, you're going to end up behind the competitive landscape curve. If you look at telehealth as an operating system, [it becomes a] mechanism for the digital distribution of care." Transforming the way healthcare is delivered requires changing, from the ground up, the way health systems think about their relationships with patients, Schoenberg says. Telehealth can alter dynamics related to patient traffic and volume, patient flow, transitions of care, and assumption of risk. "When you equip yourself with telehealth capabilities," Schoenberg says, "you should ask yourself, 'Does the system that I buy allow me to create new applications for telehealth that the vendor didn't think about?' [You] should imagine plans for patients that incorporate and take advantage of telehealth. The result of that is a completely different beast." This article appears in the March/April 2021 edition of HealthLeaders magazine. - https://www.healthleadersmedia.com/telehealth/telehealth-journey-video-visits-strategic-business-tool < Previous News Next News >

Advances in telemedicine are on the way in 2022 Bill Siwicki Dec. 20, 2021 A physician expert in virtual care talks technological advances, reimbursement legislation and the continued evolution of remote patient monitoring. 2020 and 2021 saw the mainstreaming of telehealth and the rise of remote patient monitoring. These changes to the healthcare landscape were helped partly by requirements of the COVID-19 pandemic and partly by the subsequent loosening of telemedicine reimbursement and licensure regulations by the government. But what's to happen in 2022? Will the government and commercial payers continue to reimburse for telemedicine? Will new virtual-care legislation pass? Will there be technological advances that push the care paradigm further forward? And what of the future of remote patient monitoring? Healthcare IT News sat down with Dr. Ian Tong, chief medical officer at Included Health, a telehealth technology and services company, to get his read on these questions and his predictions for telehealth in 2022 and beyond. Q. What do you see in the realm of technological advances in telemedicine in 2022? A. While 2021 saw many healthcare technology mergers and acquisitions in response to the pandemic, and growing virtual-care adoption among payers, providers and consumers, much of the technology of these combined entities remains fractured. Though promoted as one offering, consumers still are having to navigate two or more platforms and work to connect the dots themselves. The technology needs to become invisible – so good that you don't even realize it's there. The technology for virtual-care appointments also will continue to advance beyond 1:1 doctor-patient video conferencing. For example, in response to the rising behavioral health provider shortage, we can expect to see technology that can enable group sessions with multiple patients receiving counsel and support at once. Whether it's behavioral, acute or chronic care, the most important role that technology will play is enabling all physicians to have the same window into a patient's medical history and care plan so they can provide integrated, longitudinal care. The technology is what will enable this industry to realize the full potential of virtual care beyond transactional, one-time interactions. Q. All the temporary reimbursement moves by government and payers for the sake of the pandemic really pushed telehealth into the mainstream. What do you foresee happening with reimbursement for virtual care in 2022? Will it become permanent? Will it be expanded? A. With usage rates 38 times higher than pre-pandemic, and the inarguable value for the people who need it most – seniors and the immunocompromised who can't afford in-person exposure – I believe the government will and should expand virtual-care access. Pre-pandemic virtual care was used for urgent, low-complexity issues – cough, cold, rashes. But today, the real value is for integrated chronic-disease management or ongoing behavioral-health therapy, where people need not be burdened by the constant travel in and out of doctors' offices. The more care that shifts to virtual, the less burden of disease the patients will have, which will lead to better outcomes. This is an opportunity that should be afforded to everyone, especially our most vulnerable and historically underserved communities. Q. Remote patient monitoring is a form of telehealth that is of growing interest to healthcare provider organizations. What do you see happening with RPM in 2022? A. Adoption of remote patient monitoring devices continues to rise, and we don't see it slowing down any time soon. Today, one third of consumers are more likely to choose a provider that allows them to share data from a connected health device, which only promotes more positive outcomes. The more real-time data that we can collect in the comfort of people's homes, the more personalized, data-driven virtual care we can provide. However, to really launch adoption in this sector, the costs of these devices need to come down. As costs come down, health plans can more easily find an ROI [return on investment] to subsidize the use of these devices. https://www.healthcareitnews.com/news/advances-telemedicine-are-way-2022 < Previous News Next News >

CCHP: Audio only vs. Live Video Use... Center for Connected Health Policy February 15, 2022 The National Telehealth Policy Resource Center The Office of the Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy recently released a new Issue Brief titled National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. The analysis found a number of trends that can be helpful in understanding remaining telehealth barriers and their interaction with health care disparities. Utilizing Census Bureau’s Household Pulse Survey (HPS) information from 2021, the study focused on differences in use between live video and audio-only telehealth modalities. Overall findings showed that telehealth use was common and utilization rates were generally similar across most demographic subgroups, except those that were uninsured. Utilization rates of live-video telehealth, however, were found to be lower among underserved populations, such as those with lower incomes and Black, Latino, and Asian respondents. To read the full article: https://mailchi.mp/cchpca/new-aspe-issue-brief-addresses-audio-only-vs-live-video-use-and-interaction-with-healthcare-disparities < Previous News Next News >

NMTHA Webinars Available on Website New Mexico Telehealth Alliance Dec. 14, 2021 Did you miss one of our webinars this year? Did you know you can access them on the NMTHA website and view them at your leisure? Topics include HIPAA compliance, expanding telemed services, billing and coding and more. Did you miss one of our webinars this year? Did you know you can access them on the NMTHA website and view them at your leisure? Topics include HIPAA compliance, expanding telemed services, billing and coding and more. < Previous News Next News >

Academy Health Report Addresses Medicaid Directors Perspective on Telehealth Center for Connected Health Policy May 2021 Views on telehealth since the COVID-19 Public Health Emergency (PHE) began In March 2021, Academy Health released a report detailing results from an environmental scan and discussions with Medicaid Medical Directors (MMDs) on their views on telehealth since the COVID-19 Public Health Emergency (PHE) began. MMDs are physicians and clinical leaders in different specialties who advise Medicaid programs on clinical matters. During the pandemic, many have weighed in on telehealth and how it should be deployed in their states Medicaid program. The report breaks down views of Medicaid directors and resulting recommendations into three topic areas: Equity, Quality and Payment. Examples of recommendations made in the equity category include: 1. Medicaid programs should clearly communicate temporary telehealth policies and when those policies will expire. 2. Medicaid programs should support expansion of telehealth for purposes of equitable access if clinically appropriate and makes sense in terms of cost and quality. 3. Medicaid programs should work to reduce barriers to telehealth, including addressing the technology divide, digital literacy and underlying health disparities. For more details and recommendations related to quality and payment, read the full report. < Previous News Next News >