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22 States Changed Telemedicine Laws During the Pandemic Kat Jercich June 2021 Most pursued changes via administrative action, according to a new Commonwealth Fund report, which may not be a permanent solution after the COVID-19 public health emergency ends. The Commonwealth Fund released an issue brief this week reviewing state actions to expand individual and group health insurance coverage of telemedicine between March 2020 and March 2021. It found that 22 states changed laws or policies during that time period to require more robust insurance coverage of telemedicine. "If telemedicine proves to be a less costly way to deliver care, payers and consumers may benefit from expanding coverage of telemedicine after the pandemic," wrote report authors. WHY IT MATTERS In March 2020, federal regulators temporarily relaxed restrictions for telemedicine visits for Medicare patients, raising payments to the same level as in-person visits and reducing cost-sharing, among other changes. Officials encouraged states and insurers to provide similar flexibility under private insurance – and many took that encouragement to heart. Of the 22 states that expanded access to telemedicine during the pandemic, the report found that most pursued changes via administrative action. "Use of executive authority allowed states to move relatively quickly during the crisis, though it has meant that the new telemedicine coverage requirements are temporary," wrote the researchers. They noted, for example, that seven governors included specific telemedicine coverage requirements in executive orders, which will expire after the public health emergency. Some states used bulletins, notices, or executive orders from the department of insurance or a similar agency to enhance coverage. New legislation, which takes more time, but is necessary for permanent changes, passed in eight states. Utah, Illinois, West Virginia, New Hampshire and Massachusetts – which had not previously required coverage – changed their policies during the pandemic. At this point, 40 states require coverage. These policies do not all carry equal impact. Eighteen states required coverage of audio-only services for the first time during the pandemic, bringing the total number up to 21. Four states eliminated cost-sharing for telemedicine services, and three added a requirement that cost sharing not exceed in-person identical services. And 10 states newly required insurers to pay providers the same for telemedicine and in-person visits. Report authors noted that insurers were cooperative with these changes, but longer-term adoption of policies like reimbursement parity "would likely be contentious." They pointed out the states will need data to inform debates on how best to regulate telemedicine. In 2021, at least 30 states have weighed legislation that would revise telemedicine coverage standards, found the Commonwealth Fund. Despite the known benefits of telemedicine, researchers also cautioned that it has not been equally beneficial to all patients. "Research shows telemedicine use is lower in communities with higher rates of poverty and among patients with limited English proficiency, potentially undermining goals of expanding access to underserved communities and exacerbating health inequities," read the report. THE LARGER TREND As the report notes, multiple states have implemented pro-telehealth policies to enable access during and beyond the COVID-19 public health emergency. But a major question remains regarding federal legislation, which could fill in many state-by-state gaps and prevent a so-called "telehealth cliff." "If Congress does not act before the public health emergency ends, regulatory flexibilities that now ensure all Medicare beneficiaries maintain access to telehealth will go away," said Kyle Zebley, director of public policy at the American Telemedicine Association, during a conference panel earlier this month. ON THE RECORD "Whether telemedicine reduces overall healthcare costs depends on how services are reimbursed and if virtual visits reduce other services or simply add to utilization," said Commonwealth researchers. "Having access to data can help stakeholders understand how longer-term expansion of telemedicine affects access, cost, and quality of care." Source: https://www.healthcareitnews.com/news/22-states-changed-telemedicine-laws-during-pandemic < Previous News Next News >

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

Final CY 2023 PHYSICIAN FEE SCHEDULE FACT SHEET CCHP November 1, 2022 On November 1, 2022, the Center for Medicare and Medicaid Services (CMS) released their final rule for the CY 2023 Medicare Physician Fee Schedule (PFS). CMS had previously released their proposed version on July 7, 2022. After receiving submitted feedback from the public during the comment period, CMS published the final version that, unless otherwise stated, will have policies going into effect January 1, 2023. Much of what was proposed in July remains in this final version. End of the Public Health Emergency (PHE) CMS is going forward with the policies required of the Medicare program that were in the 2022 Budget Act. These policies included allowing some of the temporary telehealth COVID policies to continue through a 151-day grace period after the end of the PHE and delaying other permanent policies: • Federally qualified health centers (FQHCs), rural health clinics (RHCs), physical therapists, occupational therapists, audiologists and speech-language pathologists remain eligible providers to be reimbursed by Medicare if they provide certain services via telehealth during this grace period. • The patient may be in the home when receiving these services and the geographic limitation would also not apply during the 151 day grace period. • Policies around the provision of mental health via telehealth that were put into law by the Consolidated Appropriations Act (CAA) passed in December 2020 and administrative policies from the 2022 PFS are also delayed during this 151 day grace period. • The temporary telehealth eligible services COVID-19 list will remain fully available during this 151-day grace period. See full fact sheet: https://www.cchpca.org/2022/11/FINAL-2023-MEDICARE-PHYSICIAN-FEE-SCHEDULE.pdf < Previous News Next News >

Billing & Reimbursement Guides Southwest Telehealth Resource Center & ruralMED Revenue Cycle Resources Medicare, Medicaid and private payor: Payor Matrix Allowable, Conditional, Not Allowable 4 virtual visit types E-Visit, Telehealth, Virtual Check-In, T elephone NEW MEXICO RESOURCES 2024 Virtual Visit & Reimbursement Guide for New Mexico (Find a ll SWTRC /ruralMED Regional 2024 Billing Guides a nd Resources: HERE ) NATIONAL RESOURCES American College of Emergen cy Physi cians (ACEP) ED Facility Level Coding Guidelines Center for Connected Health Pol icy (CCHP) 2023 Billing for Telehealth Encounters: An Introductory Guide on [Medicare] Fee-For-Service Final Rule for CY 2024 Physician Fee Schedule Centers for Medicare and Medicaid Services (CMS.gov) 2024 List of Telehealth Services: Medicare Physician Fee Schedule 2024 Medicare Learning Network Telehealth Services Fact Sheet “What’s Changed?” Health and Human Services (Telehealth.HHS.gov) Billing for Telehealth

Transgender Telemedicine and Telehealth Services: A Tremendous Asset Dr. Maheu, Telehealth.org August 2021 Telehealth services can also be effective in reaching communities not isolated by location but marginalized by identity. One of the most significant arguments for telehealth services is their ability to reach people in underserved communities. Telehealth.org described some of the foundational issues in its article The Future of Telehealth, Teletherapy, and Telemedicine. The article specifically highlighted telehealth as a means of overcoming geographic limitations. However, telehealth services can also be similarly effective in reaching communities not isolated by location but marginalized by identity. In particular, transgender telemedicine & telehealth services provide significant benefits to the trans community. Challenges Facing the Transgender Community Telehealth.org outlined many challenges facing transgender individuals seeking services in its article Transgender Telemedicine: Inequities and Barriers in Health Care Access. In seeking therapy services, one of the most substantial dissuading factors reported by transgender individuals is fear of discrimination. This fear does not come without significant evidence. Last year, the Supreme Court decided to extend trans individuals the same discrimination protections other groups already experience under employment laws. Even after that landmark decision, 38% of Americans still indicate they do not support the rights of trans people. With so-called bathroom bills and legislation that prevents trans girls and women from participating on sports teams for women, the current American legislative landscape continues to be challenging. Location and marginalization often intersect. Trans individuals living in rural areas often face a general lack of available services. Additionally, available clinicians usually do not have a trans-informed perspective. Similar concerns exist in politically conservative areas. How Transgender Telemedicine and Telehealth Services Help the Trans Community As noted above, telehealth services have already been an asset to assist individuals who are geographically isolated. It should be just as effective in reaching trans individuals in those areas as helping others. For those isolated by discrimination and fear of discrimination due to their trans status, telehealth can also help. By allowing people in the trans community to reach beyond their geographic limitations, they immediately have access to a larger pool of supportive clinicians who can provide trans-informed services. Telehealth transgender services also provide increased anonymity to a degree for trans people. In many of rural America’s small towns, people know each other by vehicle. Seeing someone’s vehicle parked in front of a mental health or drug treatment facility can often send the town’s gossip mill into a tailspin. By accessing discrete trans telemedicine or telehealth services to their homes, people avoid this harmful exposure. Can Transgender Telemedicine & Telehealth Services Continue? Trans individuals used telehealth 20 times more in the past 18 months than they ever have before. This new safe therapy avenue, however, may not last. Just two weeks ago, four states either ended many of their telehealth expansion policies or announced their intention to do so. Federally, the waivers introduced by the CARES Act will expire in October unless renewed or made permanent. The system is in transition and it may well end up leaving behind some of the progress it has made. Transgender Telemedicine and Telehealth Advocacy The time is now to reach out to your officials, state and federal, and advocate for more permanent laws that expand telehealth services and reimbursement. Sharing case examples without client identifying information and your passion for the issue could be just the sort of personal advocacy needed. Your voice may persuade elected officials to act quickly and empathetically on behalf of the trans community and everyone else who will benefit from telehealth support. Rural Transgender Report: https://www.lgbtmap.org/file/Rural-Trans-Report-Nov2019.pdf < Previous News Next News >

The Punctuated Equilibrium Of Telemedicine: Digital Health Solutions And Government’s Role Richard Schwabacher September 14, 2022 As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. As Covid-19 took hold in our communities, the increase in demand and need for telehealth and other virtual care options accelerated at an unprecedented pace. Action was taken at the state and federal levels, as well as by payers and employers, to make telehealth easily accessible. Nearly overnight, swift changes in payment, reimbursement, coverage and licensing policies were made as the pandemic disrupted every facet of life. Telehelth benefits have proven to be popular, so much so that Congress recently voted 416-12 to extend benefits. Simultaneously, investment in the digital health market has soared to a record $29.1 billion in 2021 to transform a healthcare system that could support digital capabilities. Patients, already accustomed to digital services, like banking, quickly adapted to the change. When radical change occurs in a short period of time and then finds a new balance, we call that a punctuated equilibrium. With respect to telemedicine, we don’t expect to return to life as we knew it before Covid-19 or, at the other end of the spectrum, settle in a place where high rates of telemedicine adoption were during the surges. Ultimately, there will be a new equilibrium that nestles between those two polar opposites. Despite overwhelming investment and adoption of virtual care and telehealth options by patients and providers, barriers still exist. There are specific actions government and businesses can take and should, to support healthcare programs born out of the pandemic—but only if the economics and incentives are aligned. Spotlight Moment For Laboratory Diagnostics Laboratory diagnostics has always been a critical component of healthcare—diagnosis, prevention, management, and so forth—but the pandemic put lab testing and access to it squarely in the spotlight. It became an urgent need that nearly everyone had. The value and role of laboratory diagnostics cannot be understated. According to the CDC, 70% of high-quality care depends on diagnostic testing to make medical decisions by equipping providers with the necessary information to properly address patient needs. Diagnostics are most often the healthcare tools providers rely on when diagnosing, managing and treating a variety of diseases and conditions; for instance, 12 of the 15 most clinically and economically significant disease categories in the U.S. dictate using laboratory diagnostics as the standard of care. Lack of access to laboratory diagnostics for patients has wide-ranging effects, including implications for medication nonadherence that will continue to grow as the burden of chronic diseases grows. The Role Of Government Policy The patchwork approach to solving these problems will not suffice in the long run, which is why the role of government in the sustained expansion of virtual care services is so important. Healthcare policy ought to keep pace with the evolution of healthcare technology. It’s encouraging to see the current administration invest in and promote innovation with information technology to better serve community health. The investment not only includes $34 billion initially invested through the HITECH sections of the American Recovery and Reinvestment Act but also many billions of dollars expended by U.S. industries, including laboratories. Three specific policies can help direct and reward innovation leading to better outcomes. • Ensure that all patient data needed by clinicians for individual and population care is available. While the CURES Act and the ONC CURES Act Final Rules aim to prevent data blocking, business practices among providers and payers sometimes serve as effective barriers to serving patients in their communities. ONC and CMS can refine the rules to ensure data is available in all EHRs from all appropriate sources, facilitating timely availability of all patient data wherever it is needed. • CMS should develop companion coding for telemedicine services and home-based specimen collection for lab testing. The value of telehealth is compromised if the patient must travel to a distant site for lab testing in support of the telehealth intervention. • While the government can mandate that providers report specified data, the results from home-administered testing are not available in standardized electronic formats and do not get reported. This has created barriers to public health responses in communities most at risk. What Can Businesses Do? There are ways for businesses and the government to collaborate that can improve the telemedicine landscape that benefits patients and consumers, as the clear, quantifiable health outcomes speak for themselves and can help influence further adoption and integration. For instance, the number of Medicare beneficiary telehealth visits increased 63-fold in 2020 to more than 52.7 million. While at the Mayo Clinic, ambulatory management of Covid-19 showed effective use of remote patient monitoring with a 78.9% engagement rate. These are just two examples that illustrate the increased adoption and success of making telemedicine an integral part of healthcare protocols. Companies that move to a value-based incentive model from a fee-for-service model and move toward reimbursement models that reward quality can be an alternative to the status quo. Telemedicine can be part of the solution when addressing inequities in access to care, including specialty care and at-risk populations. We already know that lack of access to laboratory diagnostics for patients has wide-ranging effects that will continue to grow as the burden of chronic diseases grows. Virtual Care Is Here To Stay Digital healthcare models are changing the landscape of the healthcare system as we know it, and this is good news for patients and providers. The changes empower patients to take more control of their health, give them more options that cater more to their needs, lower costs for “virtual-first” or “hybrid care” healthcare plans and improve access. Our collective experience during the pandemic has shown that people need healthcare and clear access points. The expanded use, adoption and successful integration of digital healthcare solutions have been received positively and have encouraged more participation. We need to continue to expand telehealth and remote options with policy that supports it—to backtrack on the progress we’ve made would be a mistake. See original article: https://www.forbes.com/sites/forbestechcouncil/2022/09/14/the-punctuated-equilibrium-of-telemedicine-digital-health-solutions-and-governments-role/?sh=523fd49e2deb < Previous News Next News >

Healthcare Connect Fund The FCC's newest component of the Rural Health Care (RHC) program: Funding may significantly improve access for patients and service providers. Participants may receive a subsidy of up to 65%. Funding recipients must provide 35% cash match. The New Mexico Telehealth Alliance (NMTHA) manages the Southwest Telehealth Access Grid (SWTAG), a Federal Communications Commission (FCC) approved consortium for funding through the Healthcare Connect Fund (HCF). If you manage one or more healthcare provider sites serving clients in New Mexico, contact NMTHA to discuss joining SWTAG. Advantages to applying to SWTAG via NMTHA include: Lower application and administrative costs .* Access to expert funding advice for a mix of rural and urban sites. Professional assistance with proven track record of funding success . ELIGIBILITY Eligible healthcare sites must meet all three following criteria: Non-profit or public entity In a rural area (as defined by the FCC: Eligible Rural Areas Search Tool Designated type of facility: Post-secondary educational institution offering health care instruction (e.g., teaching hospital, medical school) Community health center or health center providing services to migrants Dedicated emergency department of a rural for-profit hospital Local health department or agency Community mental health center Not-for-profit hospital Skilled nursing facility Rural health clinic Part-time eligible entity located in an ineligible facility *NMTHA contracts with Prairie Health Ventures to manage the application process and other bureaucratic aspects of the HCF. SWTAG members span over 200 sites in several States including many rural and urban facilities in New Mexico. SWTAG members have secured millions of HCF funding dollars to date. Current funding requests are under development. Universal Service Administrative Company ( USAC) Funding "Lingo" Form 460: Confirms Eligibility Step 1: Determine Eligibility of Your Site Form 461: Request for Services Step 2: Develop Bid Evaluation Criteria & Select Services Form 462: Funding Request Step 4: Submit Funding Requests Form 463: Invoice USAC for Release of Funds Step 6: Invoice USAC Evergreen Contract: Evergreen Contracts Funding Request Number (FRN) Funding Commitment Letter (FCL) Health Care Provider (HCP) Network Cost Worksheet (NCW) F or additional information about the Healthcare Connect Fund, please consult the following resources: HCF web page Related FAQs FCC orders

HHS Awards Nearly $55 Million to Increase Virtual Health Care Through Community Health Centers Dr. Maheu June 3, 2022 Virtual care has been a game-changer for patients, especially during the pandemic… This funding will help health centers leverage the latest technology and innovations to expand access to quality primary care for underserved communities. Today’s announcement reflects the Biden-Harris Administration’s commitment to advancing health equity and putting essential health care within reach for all Americans. n February, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded nearly $55 million to 29 HRSA-funded health centers. Funding was earmarked to increase virtual health care access and quality for underserved populations through telehealth, remote patient monitoring, digital health tools for patients, and health information technology platforms. This telehealth funding builds on over $7.3 billion in American Rescue Plan funding invested in community health centers over the previous year to help reduce the impact of the COVID-19 pandemic. Health centers quickly expanded their use of virtual health care to maintain access to essential primary care services during the pandemic. The number of health centers offering virtual visits grew from 592 in 2019 to 1,362 in 2022, an increase of 130 percent. The February telehealth funding will reportedly be used to enable health centers to sustain an expanded level of virtual health care and identify and implement new digital strategies. HRSA Administrator Carole Johnson added: Today’s awards will help ensure that new ways to deliver primary care are reaching the communities that need it most… Our funding will help health centers continue to expand their virtual work while maintaining their vital in-person services in communities across the country. The press release also explained that the more than 1,400 HRSA-supported health centers in this country serve as a national source of primary care for at-risk communities. They are community-based and patient-directed organizations that deliver affordable, accessible, and high-quality medical, dental, and behavioral health services to nearly 29 million patients each year. As of late January, health centers have delivered over 19.2 million vaccine doses, with 68 percent going to racial or ethnic minority patients. More than 90 percent of health center patients are individuals or families living at or below 200 percent of the Federal Poverty Guidelines (about $55,000 per year for a family of four in most states) and approximately 62 percent are racial/ethnic minorities. For more information: https://telehealth.org/hhs-awards-nearly-55-million-to-increase-virtual-health-care-through-community-health-centers/?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Telehealth now serves unmet needs, says athenahealth Andrea Fox October 04, 2022 Virtual care is playing a more significant role in filling gaps in delivery, having evolved from pandemic-era visit replacement, according to a new study from the cloud IT developer. Increased telehealth utilization points to wider use as a diagnostic and triage tool, particularly among those with chronic conditions. WHY IT MATTERS New research, based on a Dynata survey of 2,000 U.S. adults that was commissioned by athenahealth conducted in June and July of this year, and data on booked and completed appointments through the athenahealth electronic health record suggest telehealth is now integrated across the care continuum. "Our data shows that after the height of the pandemic, many physicians continue to rely on telehealth, as they see the tremendous value it can provide," said Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, in a statement. The use of telehealth is especially evident among those with chronic conditions. While 24% of those surveyed say their health concern didn't warrant an in-person visit, 23% of respondents indicated their telehealth visits were scheduled check-ins related to chronic conditions, and 9% used telehealth as well for ad hoc care for their conditions. The respondents with chronic conditions reported using telehealth in place of as well as between visits to help manage their conditions, suggesting telehealth is serving a previously unmet need for proactive healthcare. Telehealth has also increased the willingness of patients to seek mental healthcare, with 25% of survey respondents indicating they opted for telehealth sessions to address new mental health conditions. Twenty-three percent shared that they were more likely to ask for mental health support because telehealth was available to them. The findings also revealed patterns of use based on gender and race. The EHR data from January 1, 2019, through April 30, 2022, evaluated in the study showed that in 2021, male providers had 24% lower odds of providing a telehealth visit than their female counterparts. Provider gender also affected patient adoption of telehealth. Patients who worked with a single male provider had 60% lower odds of adoption compared to patients with only a female provider. "Additionally, previous research has shown that female clinicians tend to spend more time with patients, which could further explain higher provider adoption of telehealth among females compared to males, with female providers using telehealth as an additional tool for connecting with patients," said Sweeney-Platt. The research also showed Black and Hispanic patients were more likely to use telehealth services, but less likely to do so with one dedicated provider, suggesting improved access to care but not improved continuity of care. THE LARGER TREND A previous study of 40.7 million commercially-insured adults in the United States – a study of a nationally representative population – published earlier this year found that patients with acute clinical conditions who first sought care via telehealth were more likely to follow up at the emergency room or be admitted to the hospital that those who sought care in person. However, when it came to chronic conditions, follow-up was less likely for those with an initial telehealth visit, finding telehealth comparable to in-person care. The researchers from Johns Hopkins Bloomberg School of Public Health, along with collaborators from Blue Health Intelligence and the Digital Medicine Society compared telehealth and in-person encounters by looking at factors associated with changing patterns of telehealth use beyond the initial months of the pandemic. ON THE RECORD "Our research brings to light the vital role telehealth can play in patient care. Not only does it increase access to care, but it can drive better patient outcomes when used as an extension of in-person visits to provide continuity of care," said Sweeney-Platt in announcing the findings. "Telehealth is now a core tenet of healthcare delivery in the U.S.," said Greg Carey, director of regulatory and government affairs at athenahealth, according to a prepared statement about telehealth fulfilling its promise on the company's website. Correction: The original version of the article indicated that the Dynata survey was of athenaOne network patients. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org Healthcare IT News is a HIMSS publication. See original article: https://www.healthcareitnews.com/news/telehealth-now-serves-unmet-needs-says-athenahealth < 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 >

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

Improving digital engagement — patients say, 'Show me you know me' Beckers Hospital Review February 1, 2022 Patients are consumers. The best brand experiences, whether online or in person, influence consumers’ expectations about healthcare encounters. Today's patients want the healthcare journey to be user-friendly and tailored to their needs. Becker's Hospital Review recently spoke with Zak Pines, vice president of partnerships at Formstack, about digital engagement in healthcare and how health systems can use technology to create patient experiences that are safe, accessible and personalized. 'Show me you know me' Patients expect providers to know them. Mr. Pines recounted a personal experience that illustrates what the patient journey shouldn't look like. "Not too long ago, I scheduled a minor medical procedure. I received a package of paper forms that I had to fill out by hand and mail back to the hospital," he said. "I didn't put enough postage on the envelope, so it was returned to me. It was a nightmare scenario." Instead of an impersonal, paper-based process, the ideal would have been web-based forms with much of the information prefilled based on the provider's knowledge of the patient. "The key is that the healthcare organization shows that it knows who I am," Mr. Pines said. "They're cognizant of the information that patients have supplied to them in the past. With that data, it's possible to offer a 'review, verify and update' experience, rather than constantly asking people for the same information in a disconnected way." Read full article here: https://www.beckershospitalreview.com/improving-digital-engagement-patients-say-show-me-you-know-me.html < Previous News Next News >

Now is the time for doctors to shape what’s next on telehealth Tanya Albert Henry, Contributing News Writer, American Medical Assoc. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. Telehealth, which a minority of patients and physicians used prior to COVID-19’s emergence, is now a household word. And survey after survey shows that patients like the convenience, believe they are getting quality care and still feel connected to their physicians. Most physicians, too, have found telehealth to be a great way to connect with patients when appropriate. “There is no question at this point in time, when you think back on the past 18 months, it’s our opportunity to change completely how we deliver care,” according to Joseph C. Kvedar, MD, professor of dermatology at Harvard Medical School and the American Telemedicine Association’s board chair. Dr. Kvedar made that point during a virtual gathering as part of the AMA Telehealth Immersion Program. The boot camp event featured experts and stakeholders from around the country, who discussed the potential for long-term telehealth programs, raised the questions that need to be considered as telemedicine evolves, and examined the challenges that physicians and patients face moving forward. “I would urge you not to think of virtual video visits as the sky or the ceiling or the vision, but as the floor and the beginning, and the first step into what I would call a real hybrid world with digital-first, with digital tools for our patients where patients instinctively turn to a digital device when they need health care and go from there,” Dr. Kvedar said. The boot camp also included a panel discussion about health-at-home models and strategies, as well as breakout sessions on creating telehealth value in obstetrics and gynecology, and renal medicine. The Telehealth Immersion Program is part of the AMA STEPS Forward™ Innovation Academy , which enables physicians to learn from peers and experts and discover ways to implement time-saving practice innovation strategies. Many questions to answer Data may show that the percentage of telehealth visits as a whole are down compared with the beginning of the pandemic, but Dr. Kvedar said there’s another story to be told. Data from one large payer shows that telehealth is shifting from local physicians and health care organizations to national care providers. In April 2020, 96% of all telehealth claims were local, while national providers accounted for just 4%. One year later, the share of national-provider claims rose to 11%. One big question going forward, he asked, is who is going to deliver telehealth services? “Do we want our own doctors to be providing these telehealth services or do we want to go through a third party,” said Dr. Kvedar, co-chair of the AMA Digital Medicine Payment Advisory Group. “The good news is you will have access either way. But … we have to ponder how we want that to go, and I think we have a role to play in making those decisions or at least in influencing them.” Among the other questions that need to be answered going forward: How do you plan while facing payment uncertainty? What will it cost a practice to offer telehealth and what will make the most financial sense for each practice? How do you rethink calculations of overhead? What are the workforce implications? For example, what new roles will be needed to accommodate telehealth properly? How do you define when it will be best to see a patient via telehealth versus coming into the office? Advocate, advocate, advocate Dr. Kvedar asked the boot-camp attendees to send their elected officials a letter describing what has worked in telemedicine and what is needed. He also recommended talking to your human resource professional and health plan contact to let them know what you and your patients need to create a health system that works best. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. https://www.ama-assn.org/practice-management/digital/now-time-doctors-shape-what-s-next-telehealth?smclient=9a5368e1-1650-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

New Coding Modifier Offers Opportunity To Investigate Audio-Only Telehealth Alexander Beschloss, Ryan Van Ramshorst, Chethan Bachireddy, Christopher Chen, Andrey Ostrovsky November 18, 2022 Prior to the pandemic, Medicaid program coverage of audio-only telehealth services was limited. During the early stages of the pandemic, Medicaid beneficiaries were significantly less likely to complete telehealth visits compared to commercially insured patients. This was likely due to a series of obstacles, including: lack of access to high-quality broadband, a device with video capability, requisite digital skills, and private space to conduct the visit. For example, in 2019, roughly one in four Medicaid enrollees lived in a home without internet or with limited computer access. That said, Medicaid beneficiaries do not have significantly less access to devices with video capability (such as smartphones) than other patient populations, suggesting network connectivity poses more of a barrier than device access. Even further, nearly 50 percent of low-income patients in the US may not have requisite digital health literacy to use virtual telehealth. However, considering that 86 percent of Medicaid beneficiaries own a smartphone, it may be inferred that many more have sufficient digital literacy to engage in audio-only care rather than audio-visual telehealth. Network connectivity and low rates of digital literacy are two barriers that highlight the importance of creating the infrastructure to deliver and measure audio-only visits is of increased necessity. It was in this context that, once the pandemic struck, Medicaid agencies changed policies to augment access to telehealth services. For example, 17 state Medicaid agencies expanded reimbursement to include multiple modalities of telehealth, including audio-only. These changes particularly supported patient populations who had transportation, childcare, employment, or income barriers that prevent in-person care—challenges that are more prevalent in the Medicaid population. These policy innovations narrowed the reimbursement gap among in-person, audio-only, and audio-visual visits. In fact, the Department of Health and Human Services (HHS) recently investigated differences in patient populations who receive telehealth audio-only versus audiovisual use in 2021. For telehealth visits, Medicaid beneficiaries were more likely to use audio-only care than were privately insured patients (35.1 percent versus 45.5 percent). They discovered that compared to White patients, who used audio-only care for 38.1 percent of their telehealth visits, Latino, Black, and Asian patients did so at rates of 49.3 percent, 46.4 percent, and 48.7 percent, respectively. Patients with less than a high school education used it at 61.9 percent of their telehealth visits, compared to those with greater than a bachelor’s degree, who did such at a rate of only 32.6 percent. Across income brackets, there is an inverse relationship between household income and audio-only telehealth use. As the use of audio-only telehealth became more widespread among Medicaid beneficiaries, state Medicaid leaders needed a mechanism to measure clinical outcomes, health care costs, and patient experiences related to audio-only telehealth. Providers also needed a dedicated billing construct that could be used across public and private payers to streamline billing processes. Until recently, such mechanisms simply did not exist. And so, due to these insufficient coding constructs, several Medicaid medical directors spearheaded an application to the American Medical Association (AMA) to create a Current Procedural Terminology (CPT) modifier that would specifically designate audio-only services. In September 2021, the AMA CPT Editorial Panel accepted the addition of the CPT Modifier 93 code for synchronous audio-only telehealth, and the code became active on January 1, 2022. This article provides an overview of the rationale for and process of creating the CPT Modifier 93 code. Potential Benefits Of Audio-Only CPT Modifier Why was the creation of a new audio-only modifier necessary? Several reasons: data collection, policy implementation, health care equity, widespread need, and service specificity. The CPT 93 modifier permits differentiation among audio-only, audiovisual, and in-person care at the administrative level, which subsequently allows health service researchers to monitor and evaluate the use and clinical efficacy among these methods of care delivery. Prior to the introduction of this modifier, such high-quality analyses were impossible to do at scale. Along with the increase in all modalities of telehealth use since the COVID-19 public health emergency (63 fold increase year over year between 2019 and 2020), a survey performed by HHS (across all 50 states and the District of Columbia) discovered that 45.5 percent of all telehealth usage amongst Medicaid beneficiaries was audio-only. Taking things one step farther, several state legislatures including Washington, Connecticut, and New York have recently passed laws mandating or allowing coverage for audio-only services. Audio-only telehealth is being highly used, therefore having a mechanism to collect related data is vital. Implementing this modifier will serve as a tool for policy makers to make informed adjustments in policy around patients who use audio-only services. Implementation of this modifier will also enable claims-based research to monitor for disparities between audiovisual and audio-only care to ensure that all modalities of telehealth are provided in a sustainable, equitable, and high-quality fashion. Additionally, because different states have implemented varying strategies to cover audio-only services during the COVID-19 public health emergency (PHE), the CPT 93 modifier will help health services researchers and policy makers discern the differences between coverage approaches, information that will be crucial in standardizing telehealth data collection/storage across states. From a coding perspective, adding an audio-only modifier to existing and widely used CPT codes is a far more feasible option than alternatives such as individual payers developing their own coding modifiers. That approach would become unreasonably burdensome on providers who would subsequently have to learn and bill using the system established by each payer. Previous Codes Did Not Suffice While CPT codes for services provided through telephone exist, they do not specify the enormous range of behavioral health services, therapies, maternity-related care, post-operative guidance, and other services that have been successfully delivered via audio-only technology since the COVID-19 PHE. For example, CPT code 99441 represents a “telephone evaluation and management service; 5–10 minutes of medical discussion,” which gives no specificity regarding what type of care was delivered. In comparison, the CPT 93 modifier can be attached to theoretically any billing code that is permitted under law, thus allowing for more precise tracking and more useful follow-up research. Prior to the introduction of the CPT 93 modifier, there were seldom CPT codes that could be used to represent audio-only telehealth for specific services. Even though audio-only telehealth has been delivered at high rates, states have only been able to use temporary or workaround solutions to bill for audio-only services. For example, the Healthcare Common Procedure Coding System (HCPCS) Level II code for crisis response (CR) has been used by some states to support audio-only services during the COVID-19 pandemic. In the two and a half years since the pandemic began, however, the use of audio-only to provide health services has become normalized and may in fact now be expected by Medicaid providers and beneficiaries—a reality for which the CR code, and its temporary application, was not designed. The CPT 93 solves this challenge on a national scale. Another prior attempt to capture audio-only telehealth was the CPT modifier 95 that only indicated a telehealth service and did not differentiate between audio-only and audio-visual care. HCPCS Level II code “G0” has also been used; however, it indicates a telehealth service for diagnosis, evaluation, or treatment specific to symptoms of an acute stroke. Furthermore, CPT code 99401 can be used to reflect counseling services that may be provided via audio-only care; however, this code failed to capture all the nuance of the amount of time of care was delivered. At the end of the COVID-19 PHE, the Centers for Medicare and Medicaid Services (CMS) plans to add the “FQ” modifier on claims for HCPCS code G2080 for counseling and therapy provided using audio-only telecommunications. The HCPCS G2080 code refers to when one provides therapy services that largely exceed the amount listed in the patient’s individualized treatment plan for medication assisted treatment for opioid use disorder. This modifier exists solely for CMS’s Opioid Treatment Program and fails to account for other indications for audio-only telehealth. Creating a CPT modifier that is applicable to all service types simplifies the codification and measurement of audio-only care across all payer types. Conduct More Research On Audio-Only Telehealth Researchers, provider organizations, and policy makers must investigate and ensure that audio-only telehealth drives strong clinical outcomes. Telephone-focused care has been an important part of primary care; however, much of it was after hours, unmeasured, and not reimbursed. There is strong evidence on audio-only telehealth’s efficacy in prenatal visits and insomnia, for example. A randomized clinical control trial in a patient population of the Kaiser Permanente Washington system received audio-only cognitive behavioral therapy through the telephone demonstrated a significant benefit in improving sleep, fatigue, and osteoarthritis-associated pain. A cohort study amongst pregnant women in the Parkland Health System in Texas found that audio-only perinatal visits were not associated with changes in perinatal outcomes when compared to in-person visits in a vulnerable population. While these data are encouraging, they are sparse. Measurement of a CPT modifier may streamline the research methods used in these studies. Researchers must continue to investigate the efficacy of specific therapies when delivered via audio-only modalities. While audio-only telehealth solves several problems in health care, there are also several risks such as its potential use for inappropriate clinical indications and the risk that some may see an opportunity to overbill. An audio-only modifier—and therefore a more granular characterization of telehealth modalities—may help assuage concerns about fraud, waste, and abuse, removing existing ambiguity about the impact of different telehealth modalities on outcomes. We also know that the quality and value of these delivery modalities may vary according to the different demographics being served, including factors such as age, insurance status, payer, income, and region, among many others. Such modalities will likely vary between acuity of patient’s indication for care. Only by studying these differences amongst modalities and the populations served, can we ensure that the care delivered is equitable and valuable. Implementing the 93 modifier is a vital step toward enabling health services researchers to urgently pursue research questions that inform evidence-based policy about the best use of audio-only telehealth—especially amongst the Medicaid population. It is also essential to ensuring that the growth of audio-only health care does not create a two-tiered system between private insurance and Medicaid. For example, audio-only care may in fact be lower quality or lower value compared to audiovisual care or in-person care—although, further investigation is necessary to understand these differences. Considering that audio-only care helps remove barriers to care for underresourced patient populations, inappropriate use of audio-only care may further exacerbate the already large inequities in health care—a concern raised by both clinicians and patients. This reliance on audio-only care may also hamstring innovations that can improve the quality and access to audiovisual telehealth or in-person care. Clearly, there are legitimate concerns about the equity of audio-only health. To resolve them, more precise data and extensive investigations are necessary: Both of which will be enabled by the implementation of the CPT 93 modifier. An Opportunity For Action The new audio-only CPT 93 modifier provides meaningful potential benefits to combat barriers to care that were compounded during the COVID-19 pandemic. The new code creates a potent opportunity for conducting rigorous research into audio-only telehealth to inform federal- and state-level policy around equitable telehealth delivery. But to make the most of this opportunity, regulators, payers, providers, and researchers must take steps to increase adoption and evaluation of the audio-only modifier. To catalyze this work, large health systems should consider leading the adoption of the CPT 93 modifier while also encouraging local private providers to do the same. Payers and purchasers should consider requiring modifier submission, a step that would also facilitate further research into the field with minimal additional administrative burden on providers. Federal health agencies have a role as well. For example, the Agency for Healthcare Research and Quality (AHRQ) may increase awareness of the modifiers amongst affiliated researchers or those who use AHRQ databases while the Health Resources and Services Agency may require community health centers they fund to use the new modifier. Authors’ Note The authors would like to thank Dr. John Morgan and Amanda Brodt for their contributions to preparing this paper. Dr. Ostrovsky is an investor in the following companies, some of which provide telehealth services: https://www.socialinnovationventures.com . However, there are no direct conflicts of interest. See original article: https://www.healthaffairs.org/content/forefront/new-coding-modifier-offers-opportunity-investigate-audio-only-telehealth#.Y3feKa9vXhA.twitter < Previous News Next News >

Could Telehealth Worsen Inequity? 'Not Under My Watch,' Says HHS Sec. Becerra Kat Jercich June 2021 Top health officials from HHS and VA have signaled their ongoing support for telemedicine in the long term, but also want to ensure that "technology is being used properly." In recent public appearances, U.S. Department of Health and Human Services Secretary Xavier Becerra and Veterans Affairs Secretary Denis McDonough both indicated their support for telemedicine in the long term. Even as states have moved to enact their own laws aimed at telehealth expansion, questions have persisted about a federal response. Becerra emphasizes equity in technology "We are absolutely supportive of efforts to give us the authority to be able to utilize telehealth in greater ways," said Becerra during a Washington Post live event earlier this week. "We want to make sure that we don't leave anyone behind … so that telehealth should be available to all Americans universally," Becerra continued. At the Post event, Becerra reiterated that the Biden administration is supportive of recent moves in Congress that would safeguard access to telemedicine after the COVID-19 pandemic. Becerra also emphasized the importance of making technology available to everyone, not just those with means. "That includes, of course, making sure broadband, and quality broadband, is out there for all communities," he said. When asked about the danger of telehealth exacerbating inequities – which many advocates have warned against – Beceerra said, "not under my watch." "We're going to do everything we can to include everyone. It should make no difference what Zip code you live in, in America," he said. "You should have access to whatever technologies we as a government through our taxpayer dollars make available, and so that's why we want to make sure we do this the right way and that there's accountability on both ends of the system," he continued. He also referred to concerns around spending and overutilization, which have dogged discussions of virtual care. "We want to make sure that these providers are providing a service that might not have been available had we not had telehealth, but that it also results in better quality services and treatment, because we don't want to be billed for things that don't result in better health for Americans," he said. When it came to interstate licensure, another sticky proposition, Becerra called it an "accountability issue." Though he avoided directly weighing in on whether doctors should be allowed to work outside their states, he seemed to lean against the issue. "The farther away you go from the direct connection between patient and provider, the more difficult it will be to try to provide for the accountability, quickly and fairly, for the patient," he said. "So if your doctor is 30 miles away, and you live in rural America, we can track down that doctor 30 miles away from you. But if your doctor was 3,000 miles away from you, that's a tougher sell for a consumer who is now trying to get accountability for a service that wasn't properly provided," he continued. When it came to broader technologies – beyond telehealth – Becerra pointed to the role digital health tools can play in strengthening U.S. public health infrastructure. "COVID-19 showed us where the holes are in our public health system. That's what happens when you have the most technologically advanced healthcare in the world, but it's not evenly distributed, and as a result, we had pockets in America where COVID was devastating," he said. "And technology helps us close those gaps faster, but once again, we want to make sure that technology is our friend and technology is being used properly, so accountability will be so important," he continued. Telehealth options are a hit with vets Meanwhile, VA Secretary McDonough appeared before the Senate Appropriations Committee this week to offer an update on veterans' use of telemedicine. "There were almost 230,000 visits at the end of February this year," said McDonough, as reported by the Military Times. "Nearly 2 million vets have had one or more episodes of video care. That tells us that there’s massive demand." McDonough noted that the department is working on addressing the reluctance of some staffers to pivot to virtual care. "There’s going to continue to need to be things that are done in person, but I think as a system we recognize the huge efficiency gains and and huge satisfaction gains which come from vets spending less time traveling to our facilities while still getting good care," he said. "We want to maintain it, because it’s ease of access for vets who don’t need to be seen in person," he said. The VA has faced scrutiny in other digital health arenas recently, with an Office of Inspector General audit finding that the Veterans Health Administration needs improvement when it comes to integrating non-VA medical data to veteran's electronic health records. Sen. Brian Schatz, D-Hawaii, said he'll encourage VA leaders to preserve the new telehealth options and explore avenues for Congress to enable them. "There’s going to be a tendency to want to snap back to pre-pandemic times, and I just think there’s going to be a patient revolt,” said Schatz, who praised telehealth in a recent interview for HIMSS TV. "Ten years ago, if you told someone to interact with their clinician via iPhone, it would be an insult. Now, if you can’t do that, that’s an insult," Schatz said. Source: https://www.healthcareitnews.com/news/could-telehealth-worsen-inequity-not-under-my-watch-says-hhs-sec-becerra < Previous News Next News >

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

Can digital health increase accessibility as mental health needs soar? HIMSS TV December 23, 2021 Deep Dive: Many adults with a mental illness won’t be able to access care, given greater levels of anxiety and depression during the pandemic. Digital tools can help. Learn more here: https://www.healthcareitnews.com/video/can-digital-health-increase-accessibility-mental-health-needs-soar < Previous News Next News >

A New Model For Healthcare: Adding Telehealth To Unclog Patient Flow ‘Hot Spots’ Dr. Corey Scurlock MD, MBA June 8, 2022 It may not match the scale of the exodus of nurses from the healthcare workforce, but a growing shortage of physicians is no less of a threat to patient care. A recent survey found that one in five doctors plan on leaving the profession in the next two years, hastening a projected shortfall of as many as 124,000 doctors by 2034. This has reached such a concerning level that the U.S. Department of Health and Human Services and U.S. Surgeon General Dr. Vivek Murthy have launched a strategic advisory to mitigate clinical burnout. More Information: https://www.forbes.com/sites/forbesbusinesscouncil/2022/06/08/a-new-model-for-healthcare-adding-telehealth-to-unclog-patient-flow-hot-spots/?sh=248c6d415725 Covid-19 and longstanding concerns about changes in the business of healthcare have left many physicians burned out. Older doctors are seeking early retirement, and younger doctors seek a more balanced work/life ratio. Many aren’t interested in some of the all-consuming specialties such as critical care, neurology, oncology and psychiatry. As with everything else in our world right now, supply is not meeting demand. Action is required, but it can’t just rely on yesterday’s solutions. Opening up more slots in medical schools won’t fill the immediate need for experienced, board-certified physicians. Buying up physician practices is largely played out, as most doctors are already employed. I would argue that we can’t wait for a new MD pipeline to open up. Instead, we need to fix the broken practice of medicine. Doctors are burned out because they are locked into 15-minute appointment cycles wrapped around the exigencies of electronic health records systems that demand complete documentation of each step, leaving little time for the “How are you, Ms. Jones?” moments. Patients are unhappy with eight-month waits for new patient appointments to confirm diagnoses of serious diseases. Within the hospital, a lack of staff and available expertise meets up with broken processes to choke off patient flow from the emergency department to laboratories to medical floors. Staff personnel stand around waiting for paperwork. Patients wait on gurneys for everything. By the time things are straightened out, the original order might no longer be appropriate for a patient. Discharge alone has become a major headache. One antidote to this is to create a hybrid model of care as I have done with my company and as my business helps other companies do. It relies on points in the care process being actively managed remotely by specialist physicians who also have a background in telehealth. These veterans should understand where timely intervention can unblock patient flow at “hot spots” in a patient’s journey caused by delays in care, inappropriate care transitions or potential patient harm. Telehealth-enabled monitoring can reduce transfers by accurately assessing patient acuity and overseeing the work of less-experienced hospital staff. Through these interactions, the goal is to see reduced patient readmissions and ED visits, shorter hospital stays and better utilization of resources. Of course, all of this begs the question: If the hospital can’t find enough specialists, how can virtual care physicians fill these roles? The answer is pretty simple, in my opinion. You bring back the joy of being a doctor. These telehealth doctors work from home, linked to pods of multi-specialists who work with the same hospitals, getting to know the staff. They can work when they like and as much as they like. They access the medical record but are called upon to solve problems, full stop. You can also make sure their work is always varied. Doctors want to heal, not master the intricacies of Epic’s latest software. With the tailwind of favorable policy and reimbursement the telehealth industry is experiencing right now, it might be an opportune time to consider this type of strategy. But as one explores telehealth as a business venture, it's important to recognize that all such business is still highly regulated, as it is in the field of care delivery. The core components of an end-to-end telehealth solution include people, process and technology. Here are some thoughts on each. • Technology: Audio-video providers have matured significantly, and increasing interoperability has enabled new entrants. Health systems have sought to standardize enterprise platforms versus best-of-breed applications. Clinical analytics tools can be overlaid on the EMR leading to simpler clinical insight gathering. While not mandatory, such systems target quality or performance metrics to support ROI. • Process: Efforts to virtualize care can be disruptive to care delivery. Consider what technology platforms to purchase, KPIs to measure and clinical workflow to create. • People: Delivering telehealth-enabled care will place the highest regulatory burden on an organization. Malpractice, state licensing and credentialing, and HIPAA, to name a few, are considerations that need to be tackled first. Secondly, your attention to provider experience is paramount to ensure a healthy and sustainable workforce to attract talent. As Covid-19 wanes, we are facing unprecedented change in the provisioning of care. New care models will emerge. Telehealth is not the only solution, but it is clear that it will be a primary one. A recent survey (registration required) of health system CEOs by the University of Colorado’s Health Administration Research Consortium put virtual care as the No. 1 strategy for future growth. For those looking for solutions to today’s healthcare challenges, here are three points to remember: • Telehealth is here to stay: It could be the great equalizer for care access and equity. • Patient flow is key: By focusing on the patient journey across the continuum, hot spots can be identified and targeted. • Clinical and operational alignment are needed: People, processes and technology can combine as a force multiplier to return greater value, but only if everyone has agreed on a care road map. As telehealth goes, we are not battling efficacy anymore; we are battling inaction and the cost such inaction creates. I believe unlocking the potential of all our nation's providers can deliver better care everywhere. It's time to imagine what the design of the next-generation, digitally-enabled clinical workforce looks like, and it's all about access and equity in care delivery. < Previous News Next News >

Common Wealth Fund Analyzes State COVID-19 Telehealth Changes Center for Connected Health Policy July 2021 Recommending Longer Term Expansion Data to Determine Permanent Policies The Commonwealth Fund recently released an issue brief titled, States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations, to help inform future policy considerations for telehealth post-pandemic. Focusing on private insurance coverage, the authors reviewed pre-pandemic state telehealth statutes as well as state emergency actions related to telehealth between March 2020 and March 2021. The study found that 22 states made telehealth policy changes, mostly in regard to audio-only coverage, cost-sharing requirements, and reimbursement parity. Audio-only coverage and reimbursement parity were the most popular changes made to ensure expanded access to telehealth. Notable pre-pandemic findings include: -35 states required private insurance telehealth coverage -25 states required insurers to limit cost-sharing -15 states required private payer reimbursement parity -3 states explicitly required audio-only coverage Notable policy expansions during the pandemic included: -5 additional states required telehealth coverage -4 new states eliminated cost-sharing for services via telehealth -10 states added a requirement for private payer reimbursement parity -18 states moved to require audio-only coverage The report also looked at methods of emergency telehealth expansion by states, finding that policy changes came in a combination of legislation, executive orders, and other agency actions such as bulletins and notices. The study found 8 states passed legislation, but that the primary method was administrative action, given its ability to be made quickly. Administrative changes also appeared to often hinge on existing statutory authority or executive orders creating such authority. As part of the study’s methodology, the authors additionally interviewed insurance regulators in 10 states that had made telehealth expansions. Regulators highlighted the importance of audio-only coverage, both for older patients and their ease of use, as well as patients with behavioral health conditions that find it more comfortable. While some regulators expressed concerns related to increased costs with audio-only coverage, others highlighted billing parameters and how insurers have the ability to determine which audio-only visits qualify for reimbursement. The regulators also noted that almost all insurers were supportive of the temporary expansions, but that they’d likely oppose long-term payment parity requirements, even though one regulator commented how the work may be the same for a visit via telehealth as in-person. Interviews also revealed an insurer desire to pay lower rates for their third-party corporate telehealth providers, which regulators said may be less costly but also may fragment care, which can result in lower quality care and higher health care costs. The report also covers existing research around the benefits of telehealth and suggests the need to address insurance and audio-only coverage long-term to reduce access issues and stabilize the coverage landscape for providers to continue investing in telehealth use. The study concludes with the recommendation that maintaining telehealth expansions may benefit payers and consumers if telehealth can be shown to reduce health care costs. This will require access to longer-term information to monitor its use, including stakeholder workgroups and formal data collection mechanisms. Of course, longer-term data requires longer-term expansions, which could trend states toward temporary extensions in the short-term, such as those recently enacted in Connecticut and proposed in California. As policymakers continue the call for telehealth data, the primary response from researchers seems to be the same call. In addition to telehealth expansion impacts on health care costs, the issue of improved access to care must remain a primary focus of data collection and evaluation as well to truly result in equitable policy adoption. For more information on the actions states took to expand telehealth during COVID-19, read the Commonwealth Fund’s issue brief in its entirety - https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/states-actions-expand-telemedicine-access-covid-19. CCHP’s Policy Finder tool can also be used to look up COVID telehealth policy documents by state. New Mexico policy finder - https://www.cchpca.org/new-mexico/. < 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 >