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 >

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

Can we provide care across state lines? By Jan Ground PT, MBA, SWTRC Colorado Ambassador March 3, 2021 Snow birds. Not the kind that fly (certainly not now with COVID) but the human kind. For those of you who never heard the term before, snow birds are typically retirees who travel south in the winter to states like Arizona, New Mexico and Florida to get away from the snow and cold up north than go back up north in the summer when the heat hits the south. What does this have to do with telemedicine? A lot actually and not just with snow birds. We are a mobile population. People don’t stay in one place their entire lives anymore – we move around, we travel but when we move from one place to another we don’t get to leave our health conditions behind us. They stay with us and sometimes we just get sick when we travel. Being creatures of habit, however, most people like to have consistency in their health providers. We like to think that our PCP and specialists that we see know us and our problems, that we have a relationship. Back to the snow birds – if my cardiologist lives in Chicago and I see her during the summer I want to see her during the winter as well when I’m relaxing by the pool in Tucson staying warm. Problem is she’s back in Chicago shoveling snow so how can I see her? Telemedicine of course but it’s not that easy. An interstate compact is a contract between two or more states creating an agreement on a particular policy issue, including, but not limited to, the facilitation of licensure of clinicians in states other than that in which the clinician holds his/her home state of licensure. Currently, licensure compacts exist for physicians, nurses, physical therapists, psychologists, emergency management personnel, and speech-language pathologists/audiologists. Licensure compacts for physician assistants, counselors, advanced practice nurses, and occupational therapists are under development. Interstate Compact Models Mutual Recognition (Reciprocity) allows a clinician in a compact state ("home state") to practice in any of the other compact states without obtaining additional licensure in the remote states. The clinician’s home state license is “mutually recognized” by other compact member states. This model allows a practitioner to practice in the compact member states either using a multistate license or by obtaining a “compact privilege”. Expedited Licensure Participating U.S. states work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify. These licenses are still issued by the individual states – just as they would be using the standard licensing process – but because the application for licensure in these states is routed through the Compact, the overall process of gaining a license is significantly streamlined. Physicians receive their licenses much faster and with fewer burdens. The Interstate Medical Licensure Compact is the only expedited licensure compact. With the national and state emergency orders related to COVID-19, the regulations requiring that licensed clinicians provide care only to patients who are physically located in the state(s) in which the clinician is licensed to practice have been relaxed. It is not known if, when, and how these regulations will change when the COVID-19 emergency orders have expired. This table summarizes what is going on in each state for a variety of providers with respect to pending (P) versus enacted (E) legislation as of January 2021. These are of course subject to change as each state makes progress in deciding what to do. FOR FULL ARTICLE SEE: https://southwesttrc.org/blog/2021/can-we-provide-care-across-state-lines Physicians www.lmlcc.org Nurses www.ncsbn.org/nurse-licensure-compact.htm Physical Therapists www.PTcompact.org Psychologists www.psypact.org Emergency Management Personnel ww.EMScompact.gov Speech-Language Pathologists Audiologists www.aslpcompact.com Occupational Therapists www.OTcompact.org Advanced Practice Nurses www.nscbn.org/aprn-compact.htm < Previous News Next News >

As 'telehealth cliff' Looms, Hundreds of Healthcare Orgs Urge Congress to Act Mike Miliard, Healthcare IT News July 2021 More than 400 healthcare and technology organizations are calling on Capitol Hill to eliminate arbitrary restrictions, while helping FQHCs and critical access hospitals offer wider access to virtual care. Leading healthcare industry stakeholders on Monday implored top leaders in the House and Senate to help ensure, among other imperatives, that "Medicare beneficiaries [don't] abruptly lose access to nearly all recently expanded coverage of telehealth." WHY IT MATTERS In a letter to Senate Majority Leader Chuck Schumer, House Speaker Nancy Pelosi, Senate Minority Leader Mitch McConnell and House Minority Leader Kevin McCarthy, 430 organizations – including the American Telemedicine Association, HIMSS (parent company of Healthcare IT News), Amazon, Amwell, Teladoc, Zoom, Epic, Allscripts, Kaiser Permanente, Mayo Clinic, Mass General Brigham, UPMC and many others – called on them to capitalize on the progress that's been made on telehealth before it's too late. If they don't act before the end of the COVID-19 public health emergency, the groups said, Medicare beneficiaries "will lose access to virtual care options which have become a lifeline to many." The groups also called on Congress to get rid of arbitrary restrictions on where patients can use telehealth services, remove limitations on telemental health services, authorize the Secretary of Health and Human Services to allow additional telehealth "practitioners, services and modalities," and help ensuring that federally qualified health centers, critical access hospitals, rural health centers and providers like them can can furnish telehealth services. Flexibilities enabled under the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act "have allowed clinicians across the country to scale delivery and provide all Americans – many for the first time – access to high-quality virtual care," the groups wrote," the groups said. "In response, health care organizations across the nation have dramatically transformed and made significant investments in new technologies and care delivery models, not only to meet COVID driven patient demand, but to prepare for America’s future health care needs. "Unfortunately, this progress is in jeopardy," they wrote. "Many of the telehealth flexibilities are temporary and limited to the duration of the COVID-19 public health emergency. Without action from Congress, Medicare beneficiaries will abruptly lose access to nearly all recently expanded coverage of telehealth when the COVID-19 PHE ends. This would have a chilling effect on access to care across the entire U.S. healthcare system, including on patients that have established relationships with providers virtually, with potentially dire consequences for their health." Telehealth, these stakeholders argue, "is not a COVID-19 novelty, and the regulatory flexibilities granted by Congress must not be viewed solely as pandemic response measures. Patient satisfaction surveys and claims data from CMS and private health plans tell a compelling story of the large-scale transformation of our nation’s health care system over the past year and, importantly, demonstrate strong patient interest and demand for telehealth access post-pandemic." The letter notes that over the past year and half, virtual care has become ubiquitous, popular, efficient – and has helped address care disparities. One in four Medicare beneficiaries – 15 million – accessed telehealth between the summer and fall of 2020, and 91% of them said they were satisfied with their video visits. Some 75% oof Americans "now report having a strong interest in using telehealth moving forward," the letter notes. "Congress not only has the opportunity to bring the U.S. health care system into the 21st century, but the responsibility to ensure that the billions in taxpayer funded COVID investments made during the pandemic are not simply wasted but used to accelerate the transformation of care delivery, ensuring access to high quality virtual care for all Americans," the groups said. The letter calls on Congress to ensure HHS Secretary Xavier Becerra "has the tools to transition following the end of the public health emergency and ensure telehealth is regulated the same as in-person services." In addition, it asks lawmakers to attend to four key priorities: 1. Remove Obsolete Restrictions on the Location of the Patient and Provider. Congress must permanently remove the Section 1834(m) geographic and originating site restrictions to ensure that all patients can access care where they are. The response to COVID-19 has shown the importance of making telehealth services available in rural and urban areas alike. To bring clarity and provide certainty to patients and providers, we strongly urge Congress to address these restrictions in statute by striking the geographic limitation on originating sites and allow beneficiaries across the country to receive virtual care in their homes, or the location of their choosing, where clinically appropriate and with appropriate beneficiary protections and guardrails in place. 2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and Modalities for Telehealth. Congress should provide the Secretary with the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, Congress should ensure that HHS and CMS maintain the authority to add or remove eligible telehealth services – as supported by data and demonstrated to be safe, effective, and clinically appropriate – through a predictable regulatory process that gives patients and providers transparency and clarity. Finally, Congress should give CMS the authority to reimburse for multiple telehealth modalities, including audio-only services, when clinically appropriate. 3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics Can Furnish Telehealth Services After the PHE. FQHCs, CAHs, and RHCs provide critical services to underserved communities and have expanded telehealth services after restrictions were lifted under the CARES Act and through executive actions. Congress should ensure that FQHCs, CAHs, and RHCs can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers and better equip our healthcare system to address health disparities. 4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services Offered Through Telehealth. Without Congressional action, a new requirement for an in-person visit prior to access to mental health services through telehealth will go into effect for most Medicare beneficiaries. We urge Congress to reject arbitrary restrictions that would require an in-person visit prior to a telehealth visit. Not only is there no clinical evidence to support these requirements, but they also exacerbate clinician shortages and worsen health inequities by restricting access for those individuals with barriers preventing them from traveling to in-person care.15 Removing geographic and originating site restrictions only to replace them with in-person restrictions is short-sighted and will create additional barriers to care. THE LARGER TREND The concept of a "telehealth cliff" – an abrupt end to the progress made in expanding and enabling virtual care once the pandemic is finally over – has been of concern for some time. Since early 2021, an array of telehealth-focused bills have been introduced in the House and Senate, but the major concerns outlined in the July 26 letter are still outstanding and yet to be addressed by statute. ON THE RECORD "With 430 stakeholders in lockstep, and unprecedented bipartisan support for these legislative priorities, we urge Congress to act swiftly to ensure that telehealth remains permanently available following expiration of the public health emergency," said Kyle Zebley, VP of public policy at the American Telemedicine Association in a statement. "The ATA remains committed to working collaboratively to ensure Medicare beneficiaries can continue to access care when and where they need it." “Evidence-based connected care has been at the core of our nation’s health resiliency throughout the COVID-19 pandemic and has established its important role in improving healthcare quality, access, and value for all Americans," added Rob Havasy, managing director of the Personal Connected Health Alliance. "HIMSS and PCHAlliance urge Congress to swiftly act to make the Medicare coverage changes permanent, to give patients and providers access to the tools they need and deserve." < Previous News Next News >

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

Amazon’s New Partnership With Teladoc Is A Huge Milestone For Telemedicine Sai Balasubramanian, M.D., J.D., Contributor March 23, 2022 Last month, global technology and e-commerce giant Amazon and telemedicine company Teladoc announced a landmark new initiative: providing virtual care through Amazon Alexa devices. The announcement indicates that “Customers in the U.S. will now be able to connect with a Teladoc care provider 24/7 from supported Echo devices for general medical needs. Teladoc on Alexa will initially launch via audio with video visits coming soon.” Donna Boyer, Chief Product Officer of Teladoc, explained further: “Teladoc Health’s collaboration with Amazon is yet another step in breaking down barriers to healthcare access […] By introducing and integrating our virtual first care experience with Echo devices, we are providing an innovative and convenient way for users to connect with a doctor. We are meeting consumers where they are, to continue to deliver value and high-quality care to members.” Indeed, this is a huge milestone for both companies. Teladoc went public in a deal worth nearly $157 million dollars in 2015, right when digital health and telehealth were becoming more prominent concepts in care delivery. However, Teladoc found its true stride during the height of the Covid-19 pandemic, when people worldwide were forced into isolation and quarantine—highlighting the value of virtual care services. Indeed, the concept has significant promise in solving many modern day healthcare problems. Congruently, Amazon has continued to make its own strides in healthcare. With the launch of Amazon Care as well as its robust pharmaceutical services, the company is slowly but surely developing an entire ecosystem which will likely soon become a mainstream modus of care delivery. Now, with this new partnership, both companies are significantly increasing their reach. With 100s of millions of Alexa devices currently in use, the potential value of this partnership is endless. It provides consumers with a convenient, easy, and creative way to get their healthcare services inside of their own homes. The process is relatively simple: “To get started, customers can say, ‘Alexa, I want to talk to a doctor,’ to their supported Echo device to get connected with the Teladoc call center. Customers will then get a call back on their Echo devices from a Teladoc doctor for virtual visits related to non-emergency health needs, such as experiencing symptoms of a cold, flu, or allergies. The cost per visit can be as low as $0 per visit with insurance or $75 without insurance.” For full article click this link: https://www.forbes.com/sites/saibala/2022/03/23/amazons-new-partnership-with-teladoc-is-a-huge-milestone-for-telemedicine/?sh=7acb8fcd7f18 < Previous News Next News >

Federal Broadband Funding Negotiations Continue Center for Connected Health Policy June 2021 As the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. President Biden’s American Jobs Plan originally totaled $2.3 trillion, $100 billion of which was designated to broadband. As noted in recent CNBC articles, as the administration and Senate Democrats attempt to come to a bipartisan infrastructure deal over the next month, they have since presented a counter offer of $1.7 trillion, $65 billion of which would expand broadband funding. While Senate Republicans then put forward a $928 billion counteroffer, there appears to be agreement on both sides with the piece of the proposal designating $65 billion to broadband. Nevertheless, discussions on other issues remain far apart and it is possible to pass the bill without Republican support in the evenly split Senate, therefore Senate Majority Leader Chuck Schumer recently expressed his desire to continue the process with or without Republicans to get comprehensive jobs and infrastructure legislation done this summer. For more information read the American Jobs Plan in its entirety - https://www.whitehouse.gov/american-jobs-plan/. < Previous News Next News >

2022 In Review: State Telehealth Policy Legislative Roundup CCHP December 06, 2022 LEGISLATIVE ROUNDUP As the year winds down, the Center for Connected Health Policy (CCHP) is providing its annual State Legislation Roundup. Enacted state telehealth bills in the 2022 legislative session followed trends forged in the previous 2021 legislative cycle, although at a slightly lesser volume. While 2020 was largely focused on scrambling to meet the needs of the population during the COVID pandemic through temporary telehealth waivers and flexibilities, both 2021 and 2022 challenged states to decide how to translate their temporary COVID policies into permanent telehealth policies, and in many cases making adjustments to their previously passed laws concerning telehealth. There was also a proliferation of legislation that addressed cross-state licensing issues in earnest through registration processes, targeted licensing exceptions and compacts. Among 41 states and DC, 180 legislative bills tracked by CCHP passed in the 2022 legislative session. While this is down from the 201 legislative bills enacted in 47 states in 2021, it’s still significantly higher than the bills passed in 2020 (104 bills). The number of bills in each individual topic area CCHP tracks varied from previous years. For example, while bills addressing private payer reimbursement, Medicaid reimbursement and regulatory requirements were lower this cycle than 2021 levels, bills addressing cross-state licensing were significantly up, while bills addressing online prescribing, and demonstrations, studies and reports were also somewhat higher than in 2021. Note that CCHP began tracking Puerto Rico and Virgin Islands legislation in September 2022 for the first time. However, no enacted bills were found related to telehealth in either of the territories during the 2022 session. See full article: https://mailchi.mp/cchpca/2022-in-review-state-telehealth-policy-legislative-roundup < Previous News Next News >

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

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

NH Lawmakers Seek to End Telehealth Parity, Audio-Only Phone Coverage By Eric Wicklund January 28, 2021 New Hampshire lawmakers are debating a new bill that would eliminate payment parity for telehealth and coverage of audio-only phone calls, both of which were included in legislation signed into law last year. New Hampshire lawmakers are debating a bill that would revise the state’s telehealth rules to eliminate payment parity and coverage for audio-only services. HB 602, recently introduced by State Reps. Jess Edwards, Jason Osborne and John Hunt, seeks to roll back certain provisions of a telehealth bill signed into law by Governor Chris Sununu in July 2020, when the country was in the early stages of the coronavirus pandemic. New Hampshire was one of the first states to make permanent emergency measures that had been enacted months earlier to improve coverage for and access to telehealth services. The new bill takes aim at two provisions that have been producing a lot of debate: reimbursing care providers for telehealth services at the same rate that they’re paid for in-person care, and coverage for telehealth services delivered via and audio-only phone or platform. The bill strikes language from state law that compels private payers and Medicaid to reimburse providers “on the same basis as the insurer provides coverage and reimbursement for health care services provided in person.” It also excludes audio-only phones calls and faxes from the list of acceptable telehealth and telemedicine modalities. Spurred by the rapid adoption and success of connected health services during the COVID-19 public health emergency, some states have moved to make payment parity permanent, in particular for mental health and substance abuse services. Many others are keeping these emergency measures in place until the PHE ends and waiting for the federal government to establish a long-term policy. Payment parity for telehealth is a contentious issue. Those opposed to the concept feel the payer industry should be able to negotiate coverage with care providers. They also argue that telehealth services should be valued differently than in-person care. Those in favor of parity say reimbursement should be kept on a par with in-person care – at least for the time being – to give reluctant providers a reason to try telehealth and to spur widespread adoption. As for audio-only phone calls, telehealth advocates say they should be included in coverage because not everyone has access to reliable broadband connectivity or the resources to use or buy audio-visual telemedicine services. Opponents, meanwhile, say the phone isn’t an adequate platform to establish a doctor-patient relationship and provide proper healthcare services. Among those opposed to HB 602 is Scot Wilson, LCMHC, a licensed clinical mental health provider at Seacoast Mental Health Center in Portsmouth with a private practice in Concord. “If HB 602 is passed it will do nothing more than reduce the already sparse amount of services in New Hampshire,” he recently wrote in a post in Seacoast Online. “We will see an increase in wait times for hospital beds as we have more people unable to find a therapist. We will see individuals without access to the internet or the technology to allow telehealth via video to have access to necessary care. We will have more therapists decide that we cannot see people through telehealth because it is not financially viable.” < Previous News Next News >

October 2022: Funding and Grant Opportunities Southwest Telehealth Resource Center October 2022 SWTRC NEWSLETTER- OCTOBER 2022 Bringing you up-to-date telehealth information resources on the southwest region and the USA Funding and Grant Opportunities There are many funding and grant opportunities for community and health-related organizations wanting to increase broadband capabilities and bring in needed funds for unique community health programming. Here’s a list of funding sources in the Southwest focused on broadband and health: AZ HEALTH Legacy Foundation of Southeast Arizona Grants | Legacy Foundation of Southeast Arizona (lfsaz.org) The Legacy Foundation of Southeast Arizona (LFSAZ) is a private foundation that grants funds to nonprofit organizations promoting population health and community wellness in Cochise and eastern Santa Cruz counties. Arizona Systems Change Grants Grants Archive - Vitalyst Health Vitalyst Health Foundation provides Systems Change Grants for collaborative work designed to transform systems through changes to policies and practices to improve health in Arizona communities. Applicants from tribes and rural areas are encouraged to apply. Successful applications will propose projects designed to make a significant, sustainable impact that address the intersection of 2 or more elements of a healthy community through an equity lens. Flinn Foundation Seed Grants Program Seed Grants Program - Flinn Foundation The Flinn Foundation’s 2022 Seed Grants to Promote Translational Research Program is funding 10 research teams, affiliated with an Arizona university, research institution, or health-care system, focused on advancing new products or services to improve patient care. The proposed projects must address compelling clinical needs in the areas of precision medicine, diagnostics, devices, therapeutics, or health-care-delivery processes and have significant potential to turn bench results into viable products or systems impacting patients in Arizona and beyond. CO BROADBAND Colorado Broadband Deployment Board Grant Cycles The Broadband Fund | DORA - COPRRR (colorado.gov) Access to broadband has a strong correlation with economic well-being. Nationwide, the impact it has on the communities it connects is real and measurable. The Broadband Fund exists to connect communities and fuel economic growth in unserved areas across Colorado. The Broadband Deployment Board provides grants through the Broadband Fund to deploy broadband service in unserved areas of the state. The Board has awarded $19.6 million in grants to 29 projects since 2016. As a result, over 17,000 rural households across Colorado will benefit from Broadband Internet access. HEALTH Anschutz Family Foundation Grants Funding Details: Anschutz Family Foundation Grants - Rural Health Information Hub The Anschutz Family Foundation provides grants to organizations in Colorado that work to strengthen families and communities and help individuals become productive and responsible citizens. In 2021, 45% of funding was dedicated to efforts in rural Colorado. Colorado Capital Infrastructure – Increasing Access to Care for Coloradans of Color Funding Opportunity: Capital Infrastructure – Increasing Access to Care for Coloradans of Color | The Colorado Health Foundation This funding opportunity is designed to improve the capacity of clinics to serve more Coloradans of color with high-quality, comprehensive team-based primary care centered on patients’ preferences, needs and values. It will provide shovel-ready capital funding to safety net practices in Colorado. NV BROADBAND Broadband Funding Opportunities Funding Opportunities (nv.gov) Grants are funded on a competitive basis. The evaluation criteria and selection process is outlined in each Request for Applications (RFA). Each grant proposal is evaluated by a team of experts assembled by OSIT. Generally, proposals are evaluated based on: the quality of the proposal and adherence to RFA guidelines; the ability of the organization to accomplish the proposal’s goals; and the impact the proposal will have on Nevada. Applicants that are awarded funding are required to submit regular fiscal and programmatic reports that detail progress toward agreed upon performance metrics and meet State and/or federal reporting guidelines. Awarded projects are subject to inspection and testing prior to final reimbursement. HEALTH Notice of Special Interest (NOSI): Research on Barriers to Care and Risk of HIV-Associated Comorbidities among Vulnerable Population Groups NOT-HL-22-010: Notice of Special Interest (NOSI): Research on barriers to care and risk of HIV-associated comorbidities among vulnerable population groups (nih.gov) This opportunity is a Notice of Special Interest (NOSI) for research that analyzes barriers to care and risk of HIV-associated comorbidities among disproportionally vulnerable and affected population groups of people living with or at risk for HIV infection. Notice of Funding Opportunity (NOFO) for Community-Based Behavioral Health Services and Support SAPTAGrants (nv.gov) This Notice of Funding Opportunity (NOFO) is intended to solicit applications from private, public, non-profit and coalitions for the Community Mental Health and the Community Substance Abuse Prevention and Treatment Agency Block Grant funds which includes COVID-19 Supplemental and the American Rescue Plan Act (ARPA). Behavioral Health grants reflect Nevada's health care system's strong emphasis on coordinated and integrated care along with the need to improve services for persons in crisis or with behavioral health disorders. These funds will provide Nevada the opportunity to focus on the specific needs of our State to address gaps in the behavioral health delivery system and crisis services focusing on direct and preventative services. NM BROADBAND Connect New Mexico Pilot Program Connect New Mexico Pilot Program - New Mexico Department of Information Technology (nm.gov) The Connect New Mexico Pilot Program (“Pilot Program”) aims to bridge the digital divide and foster socioeconomic progress by providing infrastructure grants for broadband deployment to unserved and underserved communities across New Mexico. HEALTH CDC Traditional Food Sovereignty and Tribal Workforce Development Fellowship Zintellect - Climb Higher The Centers for Disease Control offers a one year fellowship in Albuquerque, New Mexico working with the Healthy Tribes Program. The program is designed to strengthen the public health infrastructure, promote cultural and traditional practices that support health and wellness, and integrate evidence-based chronic disease interventions to improve the health of tribal communities. New Mexico McCune Charitable Foundation Grants Apply - McCune Charitable Foundation (nmmccune.org) McCune Charitable Foundation Grants are awarded to New Mexico community-based organizations working in one of the following areas: leveraging opportunities in healthcare, local food industry development, strategies for rural development, capacity building in the nonprofit sector, economic development and family asset building, education transformation, building links between arts and community engagement, stewardship of community and natural resources, and influencing planning of built environments. Tribal BROADBAND NTIA Tribal Broadband Connectivity Program Tribal Broadband Connectivity Program | National Telecommunications and Information Administration (ntia.gov) A $980 million program directed to tribal governments to be used for broadband deployment on tribal lands, as well as for telehealth, distance learning, broadband affordability, and digital inclusion. NTIA Digital Equity Program Digital Equity Programs | BroadbandUSA (doc.gov) Too many communities lack access to high-speed internet. Many more can't afford it or don't know how to use it. The divide between those who have internet access and those who don't is stark. To create an equitable economy, we all need access to reliable and affordable high-speed internet. The Digital Equity Act provides $2.75 billion to establish three grant programs that promote digital equity and inclusion. They aim to ensure that all people and communities have the skills, technology, and capacity needed to reap the full benefits of our digital economy. HEALTH Support for 988 Tribal Response Cooperative Agreements Funding Details: Support for 988 Tribal Response Cooperative Agreements - Rural Health Information Hub Resources to improve response to 988 crisis contacts (including calls, chats, and texts) originating in tribal communities and/or activated by American Indians/Alaskan Natives. National BROADBAND State Digital Equity Program Department of Commerce - State Digital Equity Planning Grant Program | BroadbandUSA (doc.gov) The Digital Equity Act, established by the Infrastructure Investment and Jobs Act (IIJA), dedicates $2.75 billion to establish three grant programs that promote digital inclusion and equity to ensure that all individuals and communities have access to the skills and tools needed to for full participation in the society and economy of the United States. The goal of these programs is to promote digital inclusion and advance equity for all to ensure all communities have affordable access and can use the Internet to improve their lives, including low-income households, aging populations, incarcerated individuals, veterans, individuals with disabilities, individuals with a language barrier, racial and ethnic minorities, and rural inhabitants. State Digital Equity Planning Grant Program: $60 million formula grant program for states and territories to develop digital equity plans. FCC Affordable Connectivity Outreach Grant Program FCC Establishes Affordable Connectivity Outreach Grant Program | Federal Communications Commission The Affordable Connectivity Outreach Grant Program will provide funding to support eligible partners in their outreach efforts to increase awareness of the ACP. In the Order, the FCC recognizes the importance of accessible outreach and strongly encourages grantees to make ACP outreach funded through the grant program accessible to individuals with disabilities. A key objective of the grant program is to expand and support diverse and impactful outreach efforts to diverse communities, including persons with disabilities. The FCC encourages entities of all types and diverse organizations, including organizations serving, led, or owned by persons with disabilities, to submit applications for the Outreach Grant Program once a Notice of Funding Opportunity is released. HEALTH Barclay-Giel Seed Grants Barclay-Giel Seed Grants - PHS (phscof.org) Grants for public health projects that have a strong disease and/or injury prevention component that impacts the health of a community by promoting wellness, early detection, and early interventions. Past awards have been given for projects in rural and tribal communities. See full article: https://southwesttrc.org/resources/newsletters/2022/2022-10 < Previous News Next News >

DOJ Prosecutes Several Telemedicine Fraud Cases Center for Connected Health Policy May 2021 Department of Justice is currently on an offensive against telemedicine fraud According to an article in the National Law Review, the Department of Justice is currently on an offensive against telemedicine fraud. The article cites the following DOJ operations as evidence of the current crack down on telemedicine: *Operation Brace Yourself targeting an international fraud ring that defrauded $1 billion from Medicare for unnecessary devices. *A series of telemedicine fraud prosecutions that occurred in 2020 that found more than $1.5 billion in fraudulent Medicare billing. *On April 22, 2021 the latest crackdown came to light with charges for the owners of orthotic brace suppliers and some marketing companies for a $65 million nationwide kickback and bribery conspiracy. The scheme involved call centers soliciting customers to accept braces even though they didn’t need them and charging Medicare, Medicaid and Tricare. The telemedicine companies involved were paid illegal kickback and bribes for their doctors signing the brace orders and swearing to their medical necessity. These types of incidents are what makes some regulators warry of telehealth. With the increased widespread use of telehealth due to the pandemic, incidents of fraud will likely increase for telehealth. The key will be to ensure that the bad actions of a few don’t interfere with a modality of care that increases access and quality care for so many. Read the full National Law Review article for more information on these fraud cases. Full National Law Review article: https://www.natlawreview.com/article/doj-telemedicine-offensive-pushes-forward-new-charges < Previous News Next News >

Remote Patient Monitoring: Benefits, Barriers, and Billing Center for Connected Health Policy August 2021 Remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. Last month, the California Health Care Foundation (CHCF) released a new report, Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know, which looks at remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. The CHCF report focuses on RPM’s use specific to safety-net providers given system constraints particularly limiting chronic illness management to those patient populations. They note that in California, avoidable hospitalizations are highest for Medicaid beneficiaries and that almost 700 hospitalizations per 100,000 people could be prevented through better access to care and more effective chronic care management. In addition, they discuss that providers have seen how telehealth can improve treatment of diabetes, hypertension, and heart disease, as well as mortality and quality of life. RPM specifically has shown benefits for older patients and those facing barriers such as lack of transportation to care. Nevertheless, as discussed in the report, technological issues and strict reimbursement policies remain barriers to RPM utilization. The report also offers potential best practices for providers considering RPM adoption. RPM Basics and Benefits As noted on CCHP’s state and federal RPM policy tracking page, RPM is considered to be the collection of a wide range of health data from the point of care, such as vital signs, weight, and blood pressure measurements. The data is then transmitted to health professionals in facilities such as monitoring centers in primary care settings, hospitals and intensive care units, as well as skilled nursing facilities. The CHCF report gets into various RPM benefits found within the authors’ research across all settings, including how RPM maximizes use of the entire care team and enhances quality of care and outcomes, as well as how it can improve costs of care. Focus group information gathered for the report also showed that patients feel empowered when able to track trends related to their health information through RPM, becoming more engaged and also more willing to change treatment plans when related to the monitoring information. Other research cited found benefits specific to vulnerable populations, including high adherence and successful self-management education to high-risk and low-income populations. Examples were also provided showing that RPM can give patients, especially those that are Spanish-speaking, an overall sense of support. RPM Barriers Despite the evidence on its benefits, as mentioned previously, RPM is not widely used as a modality of care in the safety net, largely related to a number of technological and reimbursement policy barriers. For instance, ensuring that devices can integrate into electronic health records (EHRs) and that data is seamlessly shared and uploaded is crucial, but often costly. Some technological options also don’t offer an ability to be alerted to new and concerning information in a timely manner. Instead, the report discusses how often lower cost options include devices that are not directly connected to EHR systems and involve patients manually reporting measurements through a patient portal or by text message. The study also cites how many patient groups within the safety net population struggle with lack of broadband connectivity as well as digital literacy issues, which also highlights the need to cover phone and text communication modalities. As the authors note, without additional certainty around RPM reimbursement, providers are limited in properly assessing associated costs and savings to be able to provide RPM related services, especially within the safety net. State Medicaid RPM Reimbursement CCHP’s recent state telehealth policy tracking shows that twenty-seven states now have some form of reimbursement for RPM in their Medicaid programs. Many of the states that offer RPM reimbursement also have a multitude of restrictions associated with its use. The most common of these restrictions include only offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected. One state (Ohio) has reimbursement only for specific remote physiologic monitoring codes modeled after Medicare reimbursement. In California under newly enacted legislation AB 133, the Department of Health Care Services (DHCS) may authorize the use of RPM as an allowable telehealth modality under its Medicaid program. However, the language states that DHCS will establish a new undetermined fee schedule for it and likely limit covered services and providers eligible for RPM reimbursement. More details on AB 133 can be found in CCHP’s newly released fact sheet on California health budget agreement and all of its telehealth components. Medicare Remote Physiological Monitoring (and proposed RTP) Reimbursement As far as Medicare RPM reimbursement in the Centers for Medicare & Medicaid Services (CMS) proposed 2022 PFS they are suggesting the addition of five new CPT codes for remote therapeutic monitoring (RTM): *989X1: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment *989X2: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days *989X3: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days *989X4: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes *989X5: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes According to CMS, the RTM codes are similar to the seven Remote Physiological Monitoring (RPM) codes they have included over the past few years with a couple of differences which are primarily related to the particular equipment being used and data collected, and which providers can directly bill for these codes. For instance, RTM codes are proposed to monitor health conditions and allow non-physiologic data to be collected, including self-reported and digitally uploaded information, though devices for both RTM and RPM must meet the same Federal Drug Administration (FDA) definition of medical device. CMS is soliciting comments on the types and costs of devices that may be used for RTM services under the proposal. In addition, RPM services have been considered to be evaluation and management (E/M) codes which cannot be billed by certain providers, while RTM codes are considered to be general medicine codes. Additional details are still to be determined and questions remain related to billing and code construction that stakeholder comments can hopefully lead them to clarify after the comment period on the proposed PFS closes on September 13, 2021. Details on the other items in the proposed 2022 PFS can be found in CCHP’s fact sheet, explainer video, and slide deck. RPM Adoption Guidance Barriers in mind, the CHCF report suggests providers look to incorporate RPM into programs and workflows prior to considering the use of a specific technology, highlighting a number of considerations and ways providers can assess how to utilize RPM and adopt it consistent with best practices and existing policies. The guidance recommends to those considering starting an RPM program includes: Use RPM as a tool within a wider program, such as on top of an existing chronic disease management or diabetes educational program Invest in organization-wide adoption and management to ensure deployed at scale Identify key performance indicators to prioritize specific populations and results, such as no-show rates and clinical outcomes Estimate enrollment and overall costs, potential partnerships with other health centers Incorporate cultural responsiveness and solutions designed for patients with physical limitations Looking Forward As best practices continue to emerge and interest and understanding increases around use of telehealth modalities, including RPM, hopefully coverage consistency, and clarity, can increase as we move forward. Given existing variance amongst the states and the use of two different terms by the federal government for just this one type of modality – which they consider separate from telehealth – it will remain important moving forward to continue to highlight the benefits of telehealth and how they can outweigh any concerns necessitating the need for such strict and confusing policies that vary by each telehealth modality. For more details on the report’s RPM findings, please download it here - https://www.chcf.org/wp-content/uploads/2021/07/RemotePatientMonitoringSafetyNetNeedKnow.pdf. To track the ever-evolving telehealth landscape, please utilize CCHP’s policy finder - https://www.cchpca.org/new-mexico/ < Previous News Next News >