Telehealth's ‘great opportunity’ at community health centers Emily Olsen June 14, 2022 Ray Lowe, senior vice president and CIO at AltaMed Health Services, discusses his organization's move to virtual care at the start of the COVID-19 pandemic and how such care can evolve. See original video: https://www.healthcareitnews.com/video/telehealths-great-opportunity-community-health-centers < Previous News Next News >

Maximizing Telemedicine Benefits Elizabeth A. Krupinski, Southwest Telehealth Resource Center August 2021 First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. In many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. Further, the use of telemedicine was facilitated at the state and federal levels but widespread waivers and measures being put into place to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements. Those of us in the field for a long time are hopeful that many of these measures will stay in place, but there are clearly some that will or already have expired. We are additionally hopeful that even though in-person practices are clearly coming back full-tilt, that everyone has seen and/or experienced the benefits of telemedicine and will continue to use it to some degree as feasible and appropriate with their patients. As this occurs, however, providers will be faced with new challenges as they take their initial telemedicine set-ups and transition to this new hybrid world of services. As noted, some things will still be allowed (e.g., certain billing codes) but others will likely return to pre-COVID status (e.g., not being able to use non-HIPAA-compliant devices and software platforms). In addition to finding the best software for future telemedicine applications, there are other things to consider when trying to maximize telemedicine benefits. From my perspective, although the technology is critical, telemedicine success has very little to do with the technology and everything to do with the people and the environment within which they practice. Thus, in order to maximize telemedicine these are the elements one should consider and focus on in addition to carefully selecting the most appropriate technology for your practice and providers. First and foremost, the key to a successful telemedicine program is planning and figuring out exactly what role you expect telemedicine to play and how it fits in the mission and goals of your practice or institution. The use cases need to be clearly defined and must match an identified need. Then the who, what, where, why and when must be carefully delineated. Who needs to be involved (e.g., providers, billing, scheduling, IT, legal, administration), what clinical tasks can be accomplished via telemedicine, where will the technology and/or providers be located (e.g., clinic, home) and where will the patients be (e.g., primary care provider office, home, work, school), why will telemedicine be offered as an option (e.g., lack of sub-specialty providers, patients need to travel long distances, no show rates are too high) and when will telemedicine be offered (e.g., certain days/times, any opening in the schedule)? All of this can be accomplished by plotting out in a workflow diagram what the current practice is and how it needs to be adjusted in order to integrate telemedicine into that workflow. Again, the expectation is that although some practices might remain essentially virtual, the majority are going to evolve into a hybrid practice – but such a hybrid will not happen overnight or automatically. Workflow integration is going to be just as critical as integrating telemedicine technologies into a practice – it really is all about the people, setting expectations and establishing standard operating procedures and protocols for everyone that is going to be involved. Another thing that can be done to maximize a telemedicine practice is to properly train everyone on standard operating procedures and protocols, especially the providers who will be interacting with the patients. To date there are very few training programs that incorporate formally telemedicine as part of the curriculum. A number of programs are increasingly exposing trainees to telemedicine if offered at their institution, but typically as an elective or chance encounter in the clinic. There are however a number of organizations that are working on developing and promoting telemedicine competencies and the Association of American Medical Colleges (AAMC) recently developed a set of Core Competencies. Although specific to medical college trainees, they are comprehensive enough to cover nearly every other specialty/profession in many respects. Very briefly, the AAMC Telehealth Competencies consist of three domains, each with a set of explicit skills that increase in complexity and responsibility across three stages of practice: entering residency, entering practice and experienced faculty physician. The skills from each prior stage of training should carry over to the next phase as the provider becomes more expert and acquires additional skill sets. The six domains are: patient safety and appropriate use of telehealth; access and equity in telehealth; communication via telehealth; data collection and assessment via telehealth; technology for telehealth; and ethical practices and legal requirements for telehealth. Patient safety and appropriate use of telehealth includes 4 skill sets ranging from being able to explain to patients are caregivers the benefits and limitations of telemedicine to knowing when a patient is at risk and how/when to escalate care (e.g., convert to in-person) during an encounter. Access and equity in telehealth has 3 skill sets including knowing your biases and implications when considering healthcare, how telehealth can mitigate or amplify access to care gaps, and taking into account all potential cultural, social, physical and other factors when considering telemedicine. Communication via telehealth has 3 skills covering establishing rapport with patients, creating the right environment (e.g., lighting, sound) and knowing how to incorporate a patient’s social support into an encounter. Data collection and assessment via telehealth covers how to obtain a patient history, how to conduct an appropriate remote exam, and how to deal with patient-generated data. Technology for telehealth does not expect everyone to be an engineer or IT expert, but they should be able to explain equipment requirements for a visit, explain limitations and minimum requirements, and explain risks of technology failure and how to respond to them. Similarly, ethical practices and legal requirements for telehealth does not expect everyone to be a lawyer but should be able to describe local legal and privacy regulations, define components of informed consent, understand ethical challenges and professional requirements, and assess potential conflicts of interest (e.g., interest in commercial products/services). Many of these skills can be acquired by those already in practice by attending the wide variety of courses and webinars available for telemedicine skill building. It is also highly recommended that before engaging with patients for the first time via telemedicine to engage in some simulated practice sessions – from start to finish practicing each skill and developing your “style” for interacting with patients via this virtual medium. Finally, in order to maximize benefits you need to assess your program. This does not require a degree in statistics or setting up a complex experimental study. It really requires just two things – a set of metrics and a process. There are lots of metrics available and most have been studied in a wide variety of clinical applications so a good lit review will always help get you started. It is important to keep in mind that the things you measure need to reflect your goals/mission for using telemedicine and the bottom line of making a profit is not always the most appropriate metric to use. There are lots of relevant metrics and as a good starting place the article by Shore et al. “A lexicon of assessment and outcome measures for telemental health” is a great place to get some ideas. Although developed for the telemental health community the metrics provided apply quite well to nearly any specialty or practice. The metrics include such things as patient/provider satisfaction, no shows, symptom outcomes, completion of treatment, wait times, number of services, cultural access, cost avoidance and patient safety. Once you decide on metrics that are appropriate for your practice (recommend starting with 2-3 then add more as your practice grows) there is a very easy, straight-forward process for getting to outcomes. First, consider a given measure an indicator – these are concrete activities, products etc. that can be measured readily (e.g., from the patient record). For example, you could measure A1C levels in patients as a function of being enrolled in a telenutrition program. The next step is to set performance targets – these are concrete goals that are time limited and based on the indicator metrics. For example, you would like to see a 25% reduction in A1C levels in at least 50% of patients enrolled in the telenutrition course at 6 months post-baseline. Finally, you will have quantifiable outcomes (without fancy statistics) at the end of your set time period – if you meet your 25% reduction goal in 50% of patients great. If not, then maybe reassess the program or whether your goals were realistic. In any case, you now have concrete outcomes of your program demonstrating its benefits that you can provide to funders, administration, your care team and even patients and the community. In order to maximize telemedicine benefits you need to get the word out about its availability and its effectiveness! < 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 >

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 >

Social Determinants of Health Continue to Limit Access to Care via Telehealth Center for Connected Health Policy April 2021 A study published in JAMA Network Open found that over 27% of visits were conducted virtually in socially advantaged neighborhoods, compared to nearly 20% in disadvantaged areas. While telehealth increased care delivery during COVID-19, social determinants of health continue to limit access and highlight existing disparities related to the digital divide. A study published in JAMA Network Open found that over 27% of visits were conducted virtually in socially advantaged neighborhoods, compared to nearly 20% in disadvantaged areas. Meanwhile 24% of visits in urban areas were virtual compared to 14% in rural areas. The study also found that virtual care occurred more frequently for mental health visits than medical, that higher age and number of chronic diseases also correlated with higher telehealth utilization, and that increased use of telehealth was seen in areas with “COVID-19 hot spots” as well. The researchers stated that they hope these findings guide policymakers when looking to address ensuring access to care for all populations via telehealth moving forward. JAMA Network Study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777779 < Previous News Next News >

Senator Warner Encourages DEA Action on Telehealth & Prescribing Center for Connected Health Policy May 2021 A lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. Earlier this month Senator Mark Warner (D-VA) sent a letter to Attorney General Merrick Garland regarding the long-delayed regulations from the Drug Enforcement Agency (DEA) for a telehealth registry to prescribe controlled substances. In the letter, Senator Warner expressed great concern for the delay and that “the DEA’s failure to address this issue means that a vast majority of health care providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need.” The Ryan Haight Act of 2008 allowed for certain exemptions to the use of telehealth to provide controlled substances without the telehealth provider having seen the patient in-person first, however these exemptions are narrowly tailored. Two such exemptions are: when a public health emergency (PHE) is declared, and if a provider is registered on a telehealth registry that the DEA will create. Due to the current COVID-19 PHE, providers now are able to prescribe a controlled substance without an in-person visit, but the exemption will disappear once the PHE is declared over. In 2018 under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, Congress directed the DEA to promulgate final regulations for the registry by the end of 2019. Although a December 2019 regulatory posting indicated the DEA’s intent to publish the rule, the deadline came and went without even draft regulations being released for public comments. In March 2020, a PHE for COVID-19 was declared allowing one of the exceptions for prescribing to be activated. However, the PHE is not slated to last indefinitely and many, including Senator Warner, are looking for a more lasting change. Senator Warner also sent inquiries to the previous administration regarding the status of the registry regulations that went unanswered. During COVID-19, concern for the ability of patients with substance use disorders (SUD) to access services rose as demands on health services focused on responding to the pandemic and people sheltered in place. While much of the country is beginning to open up again, a lack of a more permanent fix to the prescribing issue could create hurdles for patients to access treatment to SUD services. < Previous News Next News >

Studies Show How Telehealth Can Increase Equitable Access to Care Center for Connected Health Policy May 24, 2022 Focus on the relationship between telehealth and disparities in access to care continues to result in new research examining pandemic era data and the use of telehealth among disadvantaged populations. While policymakers and studies often try to put findings into two groups, whether telehealth increases or decreases inequities, recent research shows that the study framework used and considerations made may impact outcomes more so than telehealth itself. For instance, this month a new study published in Health Affairs found that as a result of emergency federal telemedicine coverage expansions access increased for all Medicare populations, including those in the most disadvantaged areas. The study was framed to examine the impact of expanded telehealth coverage policies on different populations, rather than looking at access generally where inequities have unfortunately always existed. Comparing pre-COVID temporary waiver data with post-waiver implementation data, the authors discovered that the highest odds of utilization were among those in disadvantaged and metropolitan areas. As reported in a Managed Healthcare Executive article on the study, the Johns Hopkins researchers concluded that the results suggest that increased Medicare telemedicine coverage policies improve access to underserved populations without worsening disparities. An additional study just published in Telemedicine Journal and e-Health and covered in a healthleaders article showed that a virtual care program at Penn Medicine is reducing barriers to access specifically for Black patients and eliminating historic disparities. The authors looked at approximately one million appointments per year in both 2019 and 2020 for Philadelphia area patients and found that Black patients used telehealth more than non-Black patients and that appointment completion gaps between Black and non-Black patients closed. Also recently released, the National Committee for Quality Assurance (NCQA) produced a white paper titled The Future of Telehealth Roundtable: The Potential Impact of Emerging Technologies on Health Equity, which focuses on how to ensure telehealth increases equitable access to care. Following up on its previous pandemic telehealth work, in late 2021 NCQA pulled together a multidisciplinary panel of equity and technology experts for a discussion on equitable access and virtual health care delivery. Reviewing hypothetical case studies and responding to various questions, participants highlighted potential challenges and identified three primary ways to ensure equitable access in telehealth delivery: Tailoring Telehealth Use and Access to Individual Preferences and Needs Addressing Regulatory, Policy and Infrastructure Barriers to Fair Telehealth Access Leveraging Telehealth and Digital Technologies to Promote Equitable Care Delivery The white paper suggests the need to prioritize language and cultural humility, address digital literacy, and optimize telehealth for people with disabilities. In addition, in terms of barriers, the authors stress the need to address broadband infrastructure and licensure limitations, while also updating laws and regulations that restrict telehealth use, including payment policies. Another Health Affairs article published this month, Policy Considerations to Ensure Telemedicine Equity, also looked at various factors that must be taken into account to allow telehealth to increase equitable access to care. The author clarifies that equity is a matter beyond telehealth and is related to patient-level barriers that include family, community, and general health care delivery level factors, such as issues related to the digital divide. In addition, the article cautions against policies focusing on increased utilization concerns, stating that increased use may mean that patients are finally attaining the care they need, in addition to the fact that increased access may reduce overall health care costs. Therefore, policies seeking to reduce reimbursement or limit audio-only modalities to address utilization and cost concerns may instead primarily reduce clinicians’ willingness to offer telehealth and modalities that mitigate access barriers for historically excluded groups. The article also highlights how varying payer policies, such as those that allow reimbursement for telehealth visits with new patients versus those that do not, creates inequities, and that differing medical licensing and/or prescribing regulations by state can create inequitable access issues on top of differing coverage policies. These policy considerations are key to ensuring telemedicine mitigates inequities rather than exacerbates them. While the pandemic generally has highlighted and exacerbated existing inequities, it has also provided the information necessary to show telehealth’s ability to address disparities and increase equitable access to care. It is important that policymakers take such findings and opportunities from studies on telehealth equity into account when looking to potentially make pandemic policies permanent in order to properly preserve telehealth’s positive impacts. It is also important that the framework used in the study be placed in context to help explain why some research speaks to telehealth disparities, or health care disparities, versus how telehealth is decreasing health care disparities. As shown in the aforementioned studies and articles, the difference in framing showcases that telehealth in and of itself does not create or exacerbate disparities, rather it is a tool that can be utilized to decrease disparities in access to care. The tool has to be allowed to be effective, however, and that is where the role of public policy comes in. Policies must support broadband and telehealth infrastructure and promote the use of technology to deliver care equal to the delivery of in-person care. For instance, Medicaid policies that limit when telehealth can be used and/or certain allowable modalities can create inequities in comparison to more expansive commercial policies that guarantee better telehealth access to non-Medicaid patients. Therefore, policymakers must recognize that regulatory restrictions around telehealth cannot prevent already existing general access disparities, rather it is often the regulatory restrictions around telehealth that lead to exacerbating disparities. It becomes vital that research be put into context so that subsequent policies are implemented that allow telehealth to reach its full potential to reduce disparities. For full article: https://mailchi.mp/cchpca/the-latest-telehealth-research-studies-show-how-telehealth-can-increase-equitable-access-to-care < Previous News Next News >

New SAMHSA Telehealth Guide: Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders Center for Connected Health Policy June 2021 Telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth The Substance Abuse and Mental Health Services Administration (SAMHSA) and its National Mental Health and Substance Use Policy Laboratory recently released a new evidence-based resource guide titled, Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders, to support implementation of telehealth across diverse mental health and substance use disorder treatment settings. The guide examines the current telehealth landscape, including evidence on effectiveness and examples of programs that have integrated telehealth modalities (live-video, telephone, and web-based applications) for the treatment of serious mental illness (SMI) and substance use disorders (SUDs). Also included is guidance and resources for evaluating and implementing best practices which are presented across a continuum of services, such as screening and assessment, treatment, medication management, care management, recovery support, and crisis services. The report speaks to how telehealth is known to improve access to care during emergencies and in rural and underserved areas, but stresses that implementation should be expanded outside of such situations and integrated into an organization’s standard practices to improve provider and patient communication, satisfaction, timeliness and continuity of care. The authors highlight how this is increasingly important when it comes to mental health issues, which impact millions of Americans that often face unique treatment gaps and barriers. Ultimately, it is suggested that with the right resources and upfront work, the evidence shows telehealth has the capability to address these barriers, improve health outcomes and care coordination, decrease costs and reduce health disparities. Notable findings related to telehealth use and mental health include: *Telehealth use doubled from 14% to 28% between 2016 and 2019 *Telehealth visits for mental health increased 556% between March 11 and April 22, 2020 *SUD treatment via telehealth increased from 13.5% to 17.4% between 2016 and 2019 *Telehealth use increased 425% for mental health appointments among rural Medicare beneficiaries between 2010 and 2017 The guide presents specific strategies to increase patient access and comfort using telehealth, such as providing devices to those that need them and offering trial sessions to address any technological challenges. It is also suggested that providers first screen patients for their willingness and readiness to receive care via telehealth, as it may not be appropriate for some patients. Additionally, telephone should be encouraged when it reduces prior structural and institutional barriers that have made contacting underserved communities difficult. The guide also offers strategies to increase provider comfort using telehealth, such as: *trainings and designating certain staff to support and evaluate its use *how to create a similar environment to that of an in-person visit for patients *addressing organizational infrastructure issues Understanding and knowledge of relevant and ever-evolving regulatory and reimbursement policies is included as an important consideration as well, to which the authors offer a variety of tracking resources, including the policy finder tool on CCHP’s new website. Regardless of where state and federal telehealth policies land, the guide includes a number of telehealth implementation and outcome evaluation tools that will continue to assist treatment providers and organizations seeking to increase access to mental health services via telehealth. Additional resources can be accessed on the SAMHSA website. For more information read the full SAMHSA resource guide- https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-06-02-001.pdf < Previous News Next News >

Report: Telehealth Programs Increase Workload for Nurses and Support Staff Katie Adams December 20, 2022 Many providers think their telehealth program increases the workload for nurses and support staff, according to a recent report. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators. Telehealth isn’t as widely utilized as it was at the dawn of the pandemic, but the care modality is definitely here to stay. However, many providers believe their telehealth program increases the workload for nurses and support staff, according to a recent report from research firm Sage Growth Partners. Providers also said they don’t think physicians enjoy using telehealth visits to treat patients. In 2023, hospitals and physician practices will have to focus on making their telehealth workflows more efficient, which may involve partnering with third-party administrators, the report said. In September, Sage Growth Partners surveyed 95 health system executives and 75 leaders of physician practices. Practices with fewer than five physicians were excluded from the survey. Most respondents said that their organizations will focus on optimizing and sustaining their current telehealth programs in 2023 rather than expanding them. In fact, only about 10% of participants — 11% of hospitals and 8% of practices — said they are looking to grow their telehealth offerings next year. Health system executives were more likely than practice leaders to say that telehealth visits should make up a higher percentage of their ideal in-person-to-telehealth visit mix. Health system leaders said the mix should be 30% telehealth and 70% office. Among practice leaders, the ideal mix looks more like 20% and 80%. Their difference of opinion also extended to another question on how they think telehealth utilization will grow by visit type over the next two years. Health system leaders said that utilization will fall slightly for most visit types — even behavioral health. They said that 36% of behavioral health visits were delivered via telehealth in September, but they expect this to fall to 33% in September 2024. Urgent care and telepathology were the two visit types for which health systems leaders predicted telehealth growth — they expect telehealth utilization to increase from 3% to 7% for urgent care and from 2% to 4% for telepathology. Practice leaders expected telehealth utilization to increase slightly or remain the same for most visit types. Specialty care was the only exception — for this visit type, practice leaders predicted utilization to fall from 23% to 20% over the next two years. Both groups agreed that telehealth actually increases burden on staff though practice leaders seem to feel it more acutely. More than half of practice leaders said telehealth has increased support staff’s workload, and 28% said it generates more work for nurses. Among health system executives, 35% said telehealth increased support staff’s workload, and 30% said it creates more work for nurses. Additionally, less than half of total respondents (46% of hospitals and 47% of practices) agreed that telehealth increases physician satisfaction and physicians like using telehealth visits to treat patients. A key reason for this is that many providers are operating their telehealth programs using inefficient workflows, according to the report. Nearly 60% of survey respondents said they have not yet created new workflows for telehealth visits. Instead, hospitals and physician practices are still relying on workflows that mirror in-person visits. In 2023, providers will need to improve these workflows, and many will consider bringing on the help of third-party telehealth administrators, such as Amwell or Caregility, the report said. Hospitals are more than twice as likely to use third-party partners to administer telehealth services — with 20% of hospitals doing this compared to 9% of practices. Hospitals were also more likely to say they would change their telehealth administering party over the next two years — with 44% of hospitals saying this compared to 25% of practices. Photo: Anastasia Usenko, Getty Images See original article: https://medcitynews.com/2022/12/report-telehealth-programs-increase-workload-for-nurses-and-support-staff/ < Previous News Next News >

San Juan Regional Medical Center gets CARES Act funding to expand telehealth services By Hannah Grover, Farmington Daily Times February 15, 2021 AZTEC — Before COVID-19, San Juan Regional Medical Center used telehealth in a limited fashion to support providers and to do provider consultations, according to Chief Information Officer Matt Miliffe. AZTEC — Before COVID-19, San Juan Regional Medical Center used telehealth in a limited fashion to support providers and to do provider consultations, according to Chief Information Officer Matt Miliffe. The pandemic changed things. San Juan Regional Medical Center and San Juan Health Partners worked quickly to expand telehealth offerings. Now the hospital is receiving CARES Act funding to help improve its technology and better provide that service. "Demand (for telehealth) was immediate and has continued to grow," Miliffe said. San Juan Regional Medical Center will receive $1.25 million in CARES Act funding to supply emergency generators as well as to make upgrades in the IT network, according to a press release from the office of Sen. Martin Heinrich, D-NM. IT upgrades, new generators on the way These technology upgrades will support telehealth and field hospital operation projects that have been implemented in an effort to bolster the hospital's response to COVID-19. The grant funding will be matched with $617,000 in local funds. All locations except for San Juan Health Partners Urgent Care began offering a mixture of telephone and video visits in an effort to comply with public health orders, sustain the services offered and prevent the spread of the coronavirus, according to Barbara Charles, administrative director for San Juan Health Partners. The medical center's network infrastructure wasn't designed to service the high demands of video consultations and Miliffe said the IT team has had to push the current capabilities. "However, significant upgrades to the wired and wireless infrastructure is needed to sustain and improve the existing experience, and allow for the continued growth in telehealth demands driven by the pandemic," he said. "This funding will make a fundamental difference in our ability to serve our community’s needs." Your stories live here. Fuel your hometown passion and plug into the stories that define it. Create Account COVID: State health department closes Home Depot over COVID-19 cases One of the barriers that the center has seen is the remote nature of the community. Many patients can only connect through phone due to limited internet connectivity or cell service that can't support video. "The inability to consistently connect by audio and video is an ongoing barrier," Charles said. This funding is part of more than $2.24 million of CARES Act money that will be coming to northwest New Mexico to address healthcare and economic needs. In addition to San Juan Regional Medical Center, the Northwest New Mexico Council of Governments, which is based in Gallup, has been awarded $990,000 to address economic development needs of small businesses and entrepreneurs that have been harmed by the COVID-19 pandemic. The Northwest New Mexico Council of Governments serves Cibola, McKinley and San Juan counties. According to the press release, the council of governments hopes to create 100 jobs and retain 100 jobs through a revolving loan fund that this funding will assist in creating. Legislative session:New Mexico lawmakers work to address economic impact of COVID-19 U.S. Sen. Martin Heinrich Heinrich said in a press release that he has been "moved by the resiliency and grit" of rural New Mexico communities as they have faced a variety of public health and economic challenges related to the pandemic. "That is why I fought so hard to include funding in the CARES Act to help New Mexico’s rural health care systems, small businesses, and entrepreneurs to weather this storm," he said. "This funding is long-overdue and I will continue working for federal resources that New Mexico’s rural communities need to take on the COVID-19 pandemic and rebuild our economy in a way that supports everyone." Heinrich as well as Sen. Ben Ray Luján, D-NM, and Rep. Teresa Leger Fernandez, D-NM, announced $2.24 million of CARES Act funding for northwest New Mexico on Feb. 12. San Juan Regional Medical Center President and CEO Jeff Bourgeois Hospital: Telehealth is here to stay San Juan Regional Medical Center President and CEO Jeff Bourgeois thanked the lawmakers for the funding in the press release and emphasized that the hospital provides essential healthcare services for the Four Corners area. "This funding will ensure that we can meet the diverse needs of our patients and community and improve care for those we are privileged to serve," he said. While the pandemic jump started the demand for telehealth in the community, Miliffe said the San Juan Regional Medical Center does not anticipate it fading away. "Looking ahead to post-pandemic times, we see a long term and stable need for these services in our community as patients look to receive their healthcare in more of a consumer fashion, with services and offerings tailored around them as the individual," Charles, of San Juan Health Partners, said. "It is expected that the need or demand for telemedicine will continue long term. Many patients with health needs that may not require an in-person or face-to-face visit may find this option more flexible and convenient. Additionally, given the unknowns of the pandemic – this remains a safe alternative to in-person visits for patient to seek as needed or routine healthcare needs." Charles said telehealth also plays a key role in the COVID to Home program, which allows COVID-19 patients to receive close monitoring while in self-isolation at their own houses. "Because of this program’s close monitoring through telehealth visits, many patients have been able to stay out of the hospital and manage their care at home through the telephone or video calls. In other cases, caregivers have been able to intervene to coordinate a higher level of care for patients who needed it," she said. "To date, the COVID to Home program has helped more than 1,200 patients manage their care at home, something that would not have been possible without telehealth." Hannah Grover covers government for The Daily Times. She can be reached at 505-564-4652 or via email at hgrover@daily-times.com . This story has been modified to correct the attribution on some quotes. < Previous News Next News >

Telemedicine Holds Potential to Help Climate Change Center for Connected Health Policy May 4, 2021 MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. The recent article highlights that the United States healthcare industry is a big contributor to carbon emissions, and although telemedicine doesn’t solve the problem, its increased use does lead the industry in the right direction. This has been proven in two research studies conducted on this very subject. The first study, published in the journal, PLoS One explores the carbon footprint of telemedicine and found that replacing in-person visits with telemedicine resulted in 40-70 times decrease in carbon emissions. They note in their conclusion that for telemedicine to make a significant difference, a paradigm shift is necessary where telemedicine is regarded as an ordinary part of health care rather than exclusively for those who lack access due to geography. The second study, conducted by the University of California Davis Health System, examined travel-related and environmental savings as a result of use of telemedicine appointments for outpatient specialty consultations at the university. They found that telemedicine consultations resulted in significant savings of total emissions and that their telemedicine program had a positive impact on environmental pollutants. CCHP also previously published a catalogue of environmental impacts studies, which included several international studies looking at this same issue and coming to the same conclusion regarding telemedicine’s positive impact on carbon emissions in the healthcare sector. As telehealth has become more widespread due to the COVID-19 public health emergency its not hard to imagine that telehealth will cement its place as a mainstream tool in healthcare as the authors in the PLoS study suggest. However, policy barriers have historically interrupted the growth of telehealth, and it is yet to be seen whether the end of COVID-19 will bring telehealth’s progress to a halt. In a study published in the journal Nature Climate Change, researchers found that as a whole, the temporary reduction in daily global CO2 emissions during COVID-19 saw a decrease by as much as -26% on average, but note that the impact of 2020 annual emissions depends on government actions and economic incentives post-pandemic, which will shape the path forward for decades. It will be important as entities such as the Centers for Medicare and Medicaid Services (CMS), the congressional budget office, state governments and others conduct their analyses on cost estimates for telehealth that they factor in savings to travel costs incurred through the use of telehealth and the implications for the environment. To learn more, see the full mobihealth news article featuring this important issue. Mobile Health News: https://www.mobihealthnews.com/news/telemedicine-came-rescue-during-covid-19-could-it-help-climate-change-too < Previous News Next News >

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

Workers Report Burnout Due to Healthcare Cybersecurity Concerns Jill McKeon Oct. 6, 2021 Three-quarters of industry professionals reported having healthcare cybersecurity concerns about protected health information being communicated via unsecured communication devices. Physician burnout was a growing problem prior to the pandemic, but other healthcare professionals are reporting significant levels of burnout as well, according to a survey conducted by Spok. Over 50 percent of IT staff and contact center staff reported feeling a considerable level of burnout. Meanwhile, over 60 percent of clinical executives reported feeling “a great deal” of burnout since the pandemic. Healthcare professionals overwhelmingly agreed that the risk of clinician burnout is a public health crisis “that demands action by healthcare institutions, governing bodies, and regulatory authorities.” Many credited complicated technologies and poor technological integration as some of the leading factors in clinician burnout. The research suggested that improved communication tools could lessen the risk of clinician burnout. “Survey respondents seem to agree that improving communication technology could help address the risk of burnout through increasing efficiency of workflows, improving exchange of data between care members, and adopting mobile technologies,” the study explained. COVID-19 reshaped many aspects of care delivery, and also highlighted the need for secure communication technologies that can simultaneously comply with HIPAA and seamlessly integrate into an organization’s operations. Just over 80 percent of surveyed healthcare workers reported believing that COVID-19 played a role in protected health information (PHI) being communicated via unsecured or personal communication tools. Researchers surveyed over 200 healthcare executives, physicians, IT personnel, nurses, and contact center representatives about the state of communication in their organizations. Results revealed that the COVID-19 pandemic not only caused significant healthcare worker burnout, but also shifted resources away from valuable cybersecurity initiatives. “With security and privacy issues on the rise in 2021, perhaps it’s not unexpected that survey respondents are concerned,” the survey report stated. “Looking ahead, hospitals and health systems may need to bolster initiatives to meet HIPAA standards for PHI protection and to avoid noncompliance, reputational harm, and serious financial penalties. It could also signify the need for health systems to have in place an advanced, HIPAA-compliant critical communication solution.” All industries have become increasingly reliant on communication technologies, especially during the pandemic when mobile communication devices became the primary method of communication for many workplaces. Smartphones have remained the number one most supported device in healthcare since 2012, as in-house pager use continues to decrease. However, pagers still play a key role in care team communications. Most respondents reported that their organization’s budget constraints continue to prevent them from updating their outdated communication devices. In addition, the complexity of meeting HIPAA requirements and insufficient leadership support are major obstacles in advancing a healthcare organization’s internal communication tactics. Implementing new communication tools also presents new cybersecurity risks and calls for enterprise-wide training programs. Just under half of respondents reported that their teams paused outstanding IT communication projects during the pandemic. While 43 percent of respondents expected to resume these projects within the next six months, the rising prevalence of the Delta variant may alter that timeline. < Previous News Next News >

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

Finding Our Way Out of the Pandemic Haze: What Telehealth Tools Are Medicare Providers Allowed to Keep, and Which Must They Leave Behind? Amy J. Dilcher, Kara Du November 30, 2022 During the COVID-19 pandemic, Medicare coverage expanded to include a vast arsenal of tools that help patients access medical services while keeping patients and practitioners safe. Many of these tools involve telehealth services and were made possible by the COVID-19 emergency blanket waivers, which went into effect when the U.S. Department of Health & Human Services (“HHS”) declared a Public Health Emergency (the “PHE”). Some of these tools: Permitted providers to furnish distant site telehealth services; Expanded the use of audio-only telehealth to behavioral health counseling services; and Facilitated the conducting of telehealth appointments by practitioners from their homes while billing from their currently enrolled locations. As a result of these efforts, the use of telehealth and telemedicine exploded in 2020 according to an HHS Study. This growth was no surprise given the unparalleled advantages of conducting a variety of medical appointments from remote locations in a time where limiting one’s exposure to the COVID-19 virus was paramount. Despite the current trend towards relaxing previously stringent regulations on exposure and contact, many providers and patients prefer telehealth services as the primary method of treatment. This post provides an overview of recent developments in the adoption of telehealth tools by providers, the status of Medicare coverage for telemedicine services, the regulatory vision for the ascent out of the PHE, and fraud, waste and abuse considerations as we begin to make our way out of the pandemic haze. When does the PHE current expire? The blanket waivers that expand Medicare coverage of certain telehealth technology are in effect so long as the Secretary of HHS has declared a COVID-19 public health emergency. The first PHE was declared in 2020 and has been renewed every 90 days since then. The latest HHS extension for the PHE is effective through January 11, 2023. The PHE status is very likely to continue to be extended beyond next January given a possible surge in COVID-19 infections in the United States this winter, according to two Biden administration officials. Moreover, in a letter to the state governors, HHS has indicated that they will provide at least a 60-day notice before the current PHE ends (i.e., on or before November 11, 2022) in the event that it does not intend to issue an extension. To date, the agency has not provided that notice. Updates on the status of HHS declarations of public health emergencies are available via the federal government’s PHE tracker. Adoption of Telehealth Tools by Providers Looking towards the future, many providers anticipate keeping some COVID era telehealth tools in their arsenal after the PHE has ended. According to a recent study by the American Medical Association, tele-visit tools ranked highest in provider enthusiasm, provider adoption and improved patient outcomes in comparison to other digital health tools. The vast majority of physicians who have not yet incorporated these tools are seeking to utilize them in the next three years. The Regulatory Vision For the Ascent Out of the PHE CMS has outlined their strategy for assessing which blanket waivers should stay in effect after the last PHE extension expires. The strategy consists of three concurrent phases: Phase1: Evaluating blanket waivers based on the current stage of the PHE as compared to when the waivers were first issued. Phase 2: Keeping tools in place which would be the most helpful in future PHEs, to ensure a rapid response both locally and nationally. Phase 3: Continuing coverage of flexibilities that are aimed at producing high-quality care and health equity. CMS is working with the healthcare industry to holistically prepare our health care system for future PHEs. Medicare Coverage in Advance of Expiration of the PHE Effective as of January 1, 2022, CMS finalized a rule as part of the FY22 Medicare Physician Fee Schedule that expanded Medicare coverage of telehealth for behavioral health services to facilitate greater access and equitable services for those who may not have access to mental health services providers. Most recently, on November 1, 2022, CMS issued the Medicare Physician Fee Schedule (MPFS) 2023 Final Rule (the “2023 Final Rule”), which includes policy revisions and guidance regarding Medicare telehealth services. For example, several services that are temporarily available as telehealth services for the PHE were made available through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List. CMS also confirmed its intention to implement provisions such as allowing telehealth services to be furnished in any geographic area and in any originating site setting via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. Proposed Legislation to Continue and Expand Medicare Coverage of Telehealth Services The American Hospital Association is one of many groups that urged Congress to expand and make permanent the regulatory flexibilities granted to Medicare telehealth services during the PHE. This strong support in favor of extending and expanding Medicare coverage of telehealth flexibilities was repeated again in a letter sent by 375 organizations to Senate leaders on September 13, 2022. The letter indicates several specific telehealth tools, such as lifting in-person requirements for tele-mental health and waiver of location limitations, that have been among the most integral to bringing needed care to patients in the age of technology. To that end, there are currently several bills in the Senate and House, which would codify much of the progress in telehealth service coverage that providers and industry organizations are seeking. In the Senate, the Telehealth Extension and Evaluation Act was introduced in February of 2022. The bill proposes an extension of and modification to Medicare coverage of four specific telehealth tools. This expansion would continue for two years after the PHE expires. Representatives in the House introduced the Ensuring Telehealth Expansion Act of 2021 in January of 2021. This bill would make Medicare coverage of telehealth flexibilities permanent outside of the PHE. Recently, the Advancing Telehealth Beyond COVID-19 Act of 2022 was passed by the House and is now being reviewed by the Senate. This bill modifies the extension of certain Medicare telehealth flexibilities and provides that some of them continue to apply until December 31, 2024, in the event that the PHE ends before that date. For example, the bill allows beneficiaries to continue to receive telehealth services at any site, regardless of type or location (e.g., the beneficiary’s home), occupational therapists, physical therapists, speech-language pathologists, and audiologists to continue to furnish telehealth services, and federally qualified health centers and rural health clinics to continue to serve as the distant site (i.e., the location of the health care practitioner) for telehealth services. Fraud, Waste and Abuse of Telehealth Services The COVID-19 emergency blanket waivers have been a useful tool for healthcare providers, but the expansion of Medicare coverage of telehealth during the PHE has also presented the opportunity for fraud, waste and abuse. In a recent report (the “Report”) the HHS Office of the Inspector General (“OIG”), identified 1,714 out of 742,000 providers as “high risk” for fraud, waste, or abuse with respect to their billing practices for telehealth services. OIG identified several billing practices that may be indicative of providers it considers to be “high risk” of engaging in Medicare fraud, waste or abuse: Facility fees and telehealth fees are billed for the same visit; The highest, most expensive level of telehealth services is billed every time; Telehealth services are billed for a high number of days in any given year; Medicare fee-for-service and a Medicare Advantage plan are billed for the same service for a high proportion of services; A high average number of hours of telehealth services are billed per visit; Telehealth services are billed for a high number of beneficiaries; and Telehealth services and ordering medical equipment are billed for a high proportion of beneficiaries. Although the “high risk” providers submitted only a small percentage of the total number of claims for telehealth services, the amount of claims associated with these providers represented $127.7 million in Medicare fee-for-service payments. The Report also found that over half of the “high risk” providers were connected with at least one other “high risk” provider. The OIG provided several recommendations to CMS: Strengthen monitoring and targeted oversight of telehealth services; Conduct additional education outreach to providers including training sessions, educational materials, and webinars on appropriate telehealth billing practices; Establish billing modifiers to help providers identify circumstances in which non-physician clinical staff primarily render telehealth services under the supervision of a physician; Identify telehealth companies that bill Medicare by updating the Medicare provider enrollment application or working with the National Uniform Claim Committee to add a taxonomy code that identifies telehealth companies; and Conduct targeted reviews of the “high risk” providers identified in the Report. Final Thoughts The importance of telehealth services cannot be understated. Under the current PHE, providers have had the opportunity to deploy these tools in the emergency context, and at the same time have been able to demonstrate their efficacy and reliability in providing quality medical care to patients who would not otherwise have access to either because of coverage or geographic limitations. Nevertheless, given the rapid growth of the industry in recent years and the amount of Medicare dollars spent on telehealth services, it is prudent for healthcare providers to proactively review their telehealth billing practices and supporting documentation. Doing so will reduce the potential for billing errors and minimize compliance risks while improving quality control and financially protecting their organizations. See original article: https://www.natlawreview.com/article/finding-our-way-out-pandemic-haze-what-telehealth-tools-are-medicare-providers < 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 >

The future of telemedicine: purpose-built, integrated platforms Zoll Data Systems March 1, 2022 Integrated telemedicine solutions can address current pain points. By: Businessperson with tablet pointing to AI and data graphics Maximizing provider returns with big data Stethoscope and calculator on graphs How Emergency Medicine Physicians Can Increase Revenue in 2021 with Medicare PFS Cuts Looming person holding an insurance card. Billing Medicare and Private Payers for Telehealth Visits: What to Expect Post-Public Health Emergency Doctor talking to mother and daughter at reception desk Insurance Verification Technology Prevents Errors that Cause Costly Denials SPONSORED Global Edition Telehealth The future of telemedicine: purpose-built, integrated platforms Integrated telemedicine solutions can address current pain points. By: March 01, 2022 10:27 AM Photo Credit: adamkaz/Getty Images Propelled into mainstream use by the COVID-19 pandemic, telemedicine is becoming standard practice for many healthcare providers. According to David Ernst, MD, president of telemedicine innovator EPOWERdoc, these solutions will transform access to care and continue to drive more cost-effective delivery models, particularly at the EMS and emergency medicine level. Telemedicine’s technological pain points While telemedicine has undoubtedly come a long way, it still has significant limitations. One of the biggest limitations is provider usability. Often, telemedicine “platforms” are actually several disparate solutions cobbled together. These may include a video conferencing app, patient registration portal for demographic and insurance information, EMR, e-prescription app and discharge system. Consequently, providers must toggle between separate software programs to review and enter patient data for a single encounter. This inefficient approach can introduce errors, create frustration for patients and providers, and jeopardize the continuity of care. There is hope, however: Telemedicine technology is making rapid advancements through purpose-built platforms. Read full article here: https://www.healthcareitnews.com/news/future-telemedicine-purpose-built-integrated-platforms < Previous News Next News >

Telehealth’s Newest Frontier: Emergency Medicine Sai Balasubramanian, M.D., J.D. May 24, 2022 Telehealth has been a prominent buzzword for the last few years. With the emergence of Covid-19 and a newfound respect for remote healthcare services, telehealth/telemedicine have been a large focus of healthcare organizations and physicians alike. The U.S. Department of Health and Human Services (HHS) provides a broad definition: “Telehealth — sometimes called telemedicine — lets your doctor provide care for you without an in-person office visit. Telehealth is done primarily online with internet access on your computer, tablet, or smartphone.” Within the realm of this definition, telehealth doesn’t exactly sound like something that the practice of emergency medicine (EM) would embrace, given that the very nature of EM entails high acuity, critical care. Despite this paradox, however, EM as a specialty is slowly adapting in order to better utilize this transformative technology. In fact, there are a variety of different telehealth modalities slowly being introduced into the world of EM. HHS breaks it into five different potential categories of use: Tele-Triage: using telehealth modalities to determine the acuity of a patient’s injuries and the care and resources required Tele-Emergency Care: “Tele-emergency medicine connects providers at a central hub emergency department to providers and patients at spoke hospitals (often small, remote, or rural) through video or similar telehealth technology.” Virtual Rounds: monitoring emergency department patients remotely, reducing the number of physical providers and physicians needed on-site E-Consults: providers and physicians can seek consultations or specialty management for patients Telehealth for Follow-Up Care: “Telehealth technology can also be used to provide follow-up care for patients who were triaged but not sent to the emergency department, or for patients after they are discharged from the emergency department.” The American Medical Association recently published an article that corroborates this concept. Tanya Henry, Contributing News Writer for the AMA, explains that a recent AMA Telehealth Immersion Program in conjunction with American College of Emergency Physicians (ACEP) discussed innovative ways by which telemedicine can become a mainstream modality for emergency care. The article quotes the chair of ACEP’s telehealth section, Aditi Joshi, M.D.: “Emergency medicine doesn’t take place in one spot in the hospital and emergency physicians are trained to take care of emerging acute care situations in any setting,” including telehealth. Congruently, training programs are gearing up to prepare for this. Take for example The George Washington University’s (GWU) Department of Emergency Medicine, which offers a Telemedicine & Digital Health Fellowship. The program’s purpose “is to develop future leaders in telemedicine and digital health […and…] enable physicians to develop clinical competence in the delivery of telemedicine, leadership in establishing new programs, basic technical knowledge of telehealth delivery, and experience in order to significantly impact the rapidly growing and changing field of telemedicine, telehealth, remote health monitoring, and mobile health.” Thomas Jefferson University also offers something similar: the Telehealth Leadership Fellowship. This program’s core focus is four-fold: Leadership Skills Development, Entrepreneurship, Academia & Research, and Clinical Experience, all within the larger realm of telehealth. Indeed, telehealth has already rapidly expanded into other medical specialties, including neurology, cardiology, and primary care settings. Notably, an important benefit of this new modality is that it enables access to care and access to trained medical professionals for otherwise underserved populations and communities. Assuredly, time will tell the significant impact that emergency medicine joining the ranks of potential uses of telehealth will undoubtedly have in the years to come. For more information: https://www.forbes.com/sites/saibala/2022/05/24/telehealths-newest-frontier-emergency-medicine/?sh=76d5908f61cb < Previous News Next News >

Most Americans Support Expansion of Asynchronous Telehealth Options Mark Melchionna July 21, 2022 A new survey shows that a majority of Americans support legislation that would expand asynchronous telehealth, thereby increasing access to care, particularly mental healthcare. Two-thirds (69 percent) of Americans are in favor of legislation to expand access to asynchronous telehealth, according to a new survey. Telehealth company Hims & Hers Health worked with polling firm Public Opinion Strategies to conduct a survey of 1,301 US adults between Feb. 13 and 17. The results indicate that optimizing telehealth and changing policies are critical. The COVID-19 pandemic significantly affected healthcare overall, resulting in an increased need for care, especially for behavioral healthcare. Dig Deeper Why Asynchronous Telehealth Has Been a Boon for Patients, Providers New Bill Seeks Nationwide Medicare Coverage for Asynchronous Telehealth Services Asynchronous Telehealth Can Extend Primary Care at Community Health Networks The survey found that only 38 percent of respondents reported having good mental health, which was lower than the 52 percent who said the same in February 2021. But about 60 percent of respondents said that accessing care is a problem. Researchers then collected data regarding virtual care methods that could help widen mental and physical healthcare access. About 55 percent of survey respondents said they have participated in a telehealth visit, higher than the 10 percent who reported the same in June 2019, 29 percent in April 2020, 43 percent in August 2020, and 51 percent in February 2021, according to the survey. In addition, asynchronous telehealth use is of high interest among survey respondents. About 69 percent of respondents favor legislation that could increase access to asynchronous telehealth. These types of legislation are most popular among Democrats (77 percent) and Black adults (76 percent), though high proportions of Republicans (60 percent) and Hispanic adults (70 percent) are also in support. In addition, a vast majority of healthcare workers (82 percent) indicated high levels of support for expanding asynchronous telehealth. “Patients want to receive care in the way that works best for them, and this is increasingly a combination of telehealth support via synchronous real-time video consultation and asynchronous interactions, as well as in-person care between providers and patients," said Galen Alexander, director of public affairs at Hims & Hers, in an email. "Telehealth, both synchronous and asynchronous, can help address some of the mental health crises our country is facing. Based on this representative survey, Americans want to be in control of their care and would like to see legislators allow for different modes of receiving care.” Previous research has also indicated an increasing need for telemental healthcare. A study published in January showed that despite a slight decline in overall telehealth use, virtual mental healthcare remained popular. It also revealed that mental health conditions were the most common telehealth diagnosis in September and October 2021. Lawmakers do appear to be taking steps to expand telemental healthcare. In May, four US Senators released a discussion draft of telehealth policies for mental healthcare initiatives that focus on increasing access and directing insurers to support virtual care. For original article: https://mhealthintelligence.com/news/most-americans-support-expansion-of-asynchronous-telehealth-options < Previous News Next News >

House reps advocate for audio-only telehealth extensions for opioid treatments Jeff Lagasse October 21, 2022 The lawmakers describe the future of audio-only telehealth coverage as "unpredictable" and say a consistent policy should be established. Two Democratic members of the U.S. House of Representatives have penned a letter to the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Agency, imploring the agencies to extend flexibilities for audio-based telehealth so physicians may continue prescribing medication-assisted treatments to address opioid use disorder. Representatives Ann McLane Kuster, D-N.H., and Lori Trahan, D-Mass., said they're advocates for the development of a long-term policy regarding telehealth flexibilities, particularly, when it comes to administering buprenorphine to patients, a medication that helps prevent overdose death. They cited research from the National Library of Medicine suggesting that the COVID-19 pandemic introduced increased barriers to accessing treatment for those with opioid use disorder. Drug overdoses are increasing and disparities have been worsening over the last several years, with opioid-related overdose deaths reaching an all-time high in 2021. Kuster and Trahan noted that the Physician Fee Schedule proposed rule regarding coverage of audio-only telehealth for buprenorphine initiation depends on if "buprenorphine is authorized by the DEA and SAMHSA at the time the service is furnished." Since payment for services is dependent on Drug Enforcement Agency and Substance Abuse and Mental Health Services Administration guidance, the House members encouraged the agencies to release the public guidance quickly, and to include policies, such as telehealth, that increase access to OUD treatment. WHAT'S THE IMPACT? Audio-only telehealth is an important tool for clinicians in responding to the addiction crisis, the lawmakers said. A 2021 study from the National Library of Medicine backs this up, finding that audio-only telehealth, as a "low-threshold" approach to medication-assisted treatment, was associated with better retention in care. Previous studies also show that providers treating patients with OUD think that telemedicine, including audio-only options, should be offered in some form beyond the COVID-19 pandemic, regulations permitting. The American Society for Addiction Medicine recently released their policy statement on telehealth, saying it's a viable tool to increase access to buprenorphine as part of OUD treatment "and that there is ample opportunity moving forward to study the role that audio-only care can play in responding to the opioid crisis," the lawmakers wrote. Calling the future of audio-only telehealth coverage "unpredictable," the representatives requested that SAMHSA and the DEA grant telehealth flexibilities along with the declaration of a public health emergency for the opioid crisis; evaluate long-term policy for flexibilities based on the utilization and effectiveness of audio-only telehealth in relation to medication-assisted treatment; and detail a projected timeline regarding rulemaking for audio-only telecommunications for the initiation of buprenorphine for treatment of OUD. THE LARGER TREND Overdose deaths were rising prior to the COVID-19 pandemic, but in 2020, there was a significant increase in overdose deaths. According to provisional CDC data, overdose deaths increased more than 30% in 2020, leading to more than 93,000 deaths. This increase was driven by the use of synthetic opioids, such as fentanyl and stimulants, such as methamphetamine and cocaine, or combinations of substances. Pandemic restrictions intended to prevent the spread of COVID-19 have unfortunately also made it harder for individuals with substance use disorders (SUDs) to receive treatment and support services. Providing funding for harm-reduction services is one pillar of a four-pillar approach being implemented at the federal level. Evidence-based harm-reduction strategies minimize the negative consequences of drug use, according to the Department of Health and Human Services. The other three pillars of the administration's opioid mitigation strategy are primary prevention, focusing on the root causes and predictors of SUDs, evidence-based treatment and recovery support. A December 2021 report from the Office of the Inspector General found that while more than 1 million Medicare beneficiaries had a diagnosis of OUD in 2020, less than 16% of those beneficiaries received medication to treat their conditions. They accounted for fewer than 1 in 6 of all Medicare beneficiaries with OUD. Twitter: @JELagasse Email the writer: jeff.lagasse@himssmedia.com See original article: https://www.healthcarefinancenews.com/news/house-reps-advocate-audio-only-telehealth-extensions-opioid-treatments < Previous News Next News >