CMS-Supported Telehealth Will Continue To Be A Driving Force – But Watch for Greater OIG Enforcement The National Law Review March 3, 2022 As mindsets pivoted to a post-pandemic life, telehealth advocates petitioned CMS to embrace telehealth as a permanent care option, and CMS responded with regulatory action at the end of 2021. During the Covid-19 Pandemic, telehealth usage surged as patients and providers turned to it as a safer care alternative. McKinsey estimated telehealth claim volumes reached 80 times pre-pandemic levels at its peak, ultimately stabilizing at 38 times pre-pandemic levels by early 2021.1 This increase was mostly driven by CMS’ waivers and relaxation of regulatory constraints for telehealth reimbursement. But, the temporary nature of both left questions regarding telehealth’s future. In December 2021, CMS issued new regulations which, collectively, steer telehealth toward becoming a part of the telebehavioral health toolkit accepted by Medicare post-pandemic. In the CY2021 Physician Fee Schedule Final Rule2 , further discussed here, CMS broadly expanded access to telebehavioral health services. Specifically, Medicare permanently authorized payment for telehealth services furnished “for purposes of diagnosis, evaluation or treatment of a mental health disorder” under the following relaxed criteria:3. Read full article here: https://www.natlawreview.com/article/cms-supported-telehealth-will-continue-to-be-driving-force-watch-greater-oig < Previous News Next News >

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

Athena Health Telehealth Adoption Report Center for Connected Health Policy May 2021 How providers are taking advantage of virtual care and their perceived benefits Athena Health began conducting research in 2020 on de-identified data from across their healthcare network (which spans the nation) to understand how providers are feeling about the increased adoption of telehealth. With the onset of COVID-19, the use of telehealth has skyrocketed, and beyond understanding the increased utilization numbers, it’s also important to understand provider adoption rates, their attitudes toward telehealth, which specialties and what services telehealth is being used in the most. An interactive infographic tool on their website can be utilized to identify the amount of care across their system that has gone virtual by specialty (primary care, mental health, cardiology, pediatrics, OB/GYN or all specialties). Users can also view by specialty how providers are taking advantage of virtual care and their perceived benefits (for example, virtual appointments are more convenient), and the reasons why providers are turning to telehealth to keep their practices running. For a complete breakdown of their findings, visit Athena Health’s interactive webpage: https://www.athenahealth.com/knowledge-hub/clinical-trends/the-athenahealth-telehealth-insights-dashboard. < Previous News Next News >

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

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

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 >

Effects on Patient Access to Telehealth as Some State Emergencies End Center for Connected Health Policy July 2021 With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. With state of emergency declarations expiring or being lifted in states, there is growing concern patients are being left with reduced access if no permanent telehealth policy changes have been enacted. According to the National Academy for State Health Policy (NASHP), nearly 20 states no longer are under emergency orders, with many soon to follow. Many states attached telehealth flexibilities to the federal public health emergency (PHE) while others made them contingent on state emergency declarations. Some states have successfully passed legislation to extend certain telehealth flexibilities in advance of state of emergency expirations, such as Connecticut and Delaware. The federal government Emergency Preparedness and Response for Home and Community Based (HCBS) 1915(c) Waivers were often originally tied to state emergencies, but appear to now extend 6 months after the federal PHE ends. Alaska is one of the states no longer under a state of emergency. During the pandemic a local outlet reported thousands of patients were being referred to out-of-state providers, especially in Washington, via telehealth for a variety of reasons including lack of specialty care and long wait times. Once the emergency licensing waivers expired, however, Seattle hospitals were sent rushing to reschedule Alaska patients and resume the more stringent process of becoming licensed in Alaska. According to recent local reports, Florida’s emergency expiration also took away audio-only and the ability to use telehealth to prescribe controlled substances and recertify medical cannabis patients. The Florida Medical Association told the local news outlet they will continue the push to make telehealth changes permanent in the next state legislative session, especially those requiring insurer reimbursement and payment parity, without which they say telehealth will simply no longer be made available to patients. For more information on the status of the emergency orders in each state visit the NASHP website - https://www.nashp.org/governors-prioritize-health-for-all/. < 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 >

Telehealth Legislation Re-Introduced National Council for Behavioral Health March 12, 2021 This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. This week, Sens. Portman (R-OH) and Whitehouse (D-RI) and Reps. McKinley (R-WV), Budd (R-NC), Cicilline (D-RI), and Trone (D-MD) re-introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. The legislation, first introduced last Congress, seeks to support the expansion of telehealth services for substance use care. The TREATS Act would allow for the prescription of medication-assisted treatment (MAT) without a prior in-person visit, and for Medicare to be billed for audio-only telehealth services. The National Council supports these efforts to expand access to needed substance use services. < Previous News Next News >

Legislation Legislation New Mexico Legislation S.B. 93 - Broadband Access and Expansion Act H.B. 141 - ED Infrastructure Technology Definition S.B. 24 - Parity of Regulation of Telecommunication Federal Telehealth Legislatio n H.R. 7992 - Telehealth Act (2019-2020) H.R.3228 - VA Mission Telehealth Clarification Act (2019-2020) H.R.4900 - Telehealth Across State Lines Act (2019) H.R.5473 - EASE Behavioral Health Services Act (2019-2020) H.R.7233 - Knowing the Efficiency and Efficacy of Permanent Telehealth Options Act (2020) H.R.7338 - Advancing Telehealth Beyond COVID–19 Act (2020) S.2408 - Telehealth Across State Lines Act (2019) S.3988 - Enhancing Preparedness through Telehealth Act (2019-2020) S.4039 - TELEHEALTH HSA Act (2020) S.4216 - KEEP Telehealth Options Act (2020) Federal Broadband Legislation H .R.205 - To accelerate rural broadband deployment. H.R.4229 - Broadband Deployment Accuracy and Technological Availability Act S.4021 - Accelerating Broadband Connectivity Act of 2020

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 >

Audio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny Scott Mace October 03, 2022 The federal oversight agency recommends CMS adopt new coding procedures to compare care quality to in-person visits. With pandemic-fueled temporary waivers on telehealth leading to a surge in telehealth visits in 2020, especially on audio-only platforms, the practice is overdue for its own exam for effectiveness and privacy, according to a new Government Accounting Office (GAO) report. The use of telehealth services topped 53 million visits in the period between April and December 2020. During the same period in 2019, only 5 million such visits occurred. Many of those were conducted by phone or non-video telehealth, which was rarely allowed prior to the pandemic. [See also: CMS Proposes to Cut Audio_only Telehealth Coverage.] The Centers for Medicare & Medicaid Services has monitored some risks to program integrity related to these telehealth waivers, but the GAO report found that CMS "lacks complete data on the use of audio-only technology and telehealth visits furnished in beneficiaries' homes," in part because no billing mechanism exists to identify all these telehealth visits. "Providers are not required to use available codes to identify all instances of audio-only visits," the GAO reported. "Moreover, providers are not required to use available codes to identify visits furnished in beneficiaries' homes." The GAO said this coding is important to monitor the quality of these telehealth services as compared to equivalent in-person services. "CMS has not comprehensively assessed the quality of telehealth services delivered under the waivers and has no plans to do so, which is inconsistent with CMS' quality strategy," the GAO said. "Without an assessment of the quality of telehealth services, CMS may not be able to fully ensure that services lead to improved health outcomes." The GAO offered three recommendations for CMS going forward: 1. Develop a new billing modifier or make clearer how to bill audio-only office visits for better tracking; 2. Require providers to use existing site of service codes when beneficiaries receive Medicare telehealth services at home; and 3. Assess the quality of telehealth services delivered during the public health emergency. Finally, the GAO urged the Health and Human Services Department's Office of Civil Rights to offer additional education, outreach, and other resources to providers to help them explain risks to privacy and security that patients may face during telehealth visits. Scott Mace is a contributing writer for HealthLeaders. See original article: https://www.healthleadersmedia.com/technology/audio-only-telehealth-visits-during-pandemic-draw-gao-scrutiny < Previous News Next News >

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

82% of Americans Want Telehealth Flexibilities Extended Mark Melchionna November 30, 2022 A recent survey indicates that 82 percent of respondents with employer-provided coverage believe that the government should extend telehealth flexibilities. A recent survey conducted by America's Health Insurance Plans (AHIP) found that a majority of respondents are requesting that the government sustain the telehealth flexibilities enacted during the COVID-19 pandemic. In 2020, the number of people using telehealth increased dramatically, largely due to the withdrawal of various regulatory restrictions as well as the new barriers imposed on in-person care. According to data from market research firm Trilliant Health, telehealth use peaked in the second quarter of 2020. Though telehealth use has waned since 2020, it remains popular among patients and providers. As a result, Congress is faced with deciding whether to continue or terminate telehealth flexibilities. A survey from the Morning Consult on behalf of AHIP’s Coverage@Work campaign collected data on patient preferences regarding telehealth and how they feel about its future. The survey polled 818 voters with employer health insurance between Nov. 11 and 13. The main survey findings related to whether patients would consider seeing a doctor through telehealth, reasons for using telehealth, and their opinions on the government extending telehealth flexibilities. The survey shows that 65 percent of those with employer-provided coverage reported being likely to consider seeing a doctor or receiving treatment through telehealth. This finding was consistent across age, income, and ethnicity groups. Also, 49 percent claimed that interest in telehealth is mainly backed by convenience, and 35 percent stated that it saves time as it eliminates the need for travel. Among all respondents, 82 percent believe that the federal government extending telehealth flexibilities is important. This included a bipartisan majority of Democratic voters (95 percent), independent voters (77 percent), and Republican voters (70 percent). Considering the survey results, AHIP concluded that respondents would advocate for the government to continue telehealth flexibilities. This is not the first indication of healthcare stakeholders seeking this end goal. In September, a letter to the US Senate composed by the American Telemedicine Association (ATA) and its advocacy arm known as ATA Action asked for a continuation of expanded telehealth access. Specifically, the letter urged the US Senate to sustain telehealth flexibilities for two years through 2024. These flexibilities included waivers put into place during the pandemic, including removing initial in-person requirements for telemental health and eliminating restrictions on the location of providers and patients engaging in telehealth. Signed by 375 stakeholders, such as Amazon, the American Nurses Association, and Bicycle Health, the letter also detailed concerns about a forced return to in-person care. Also, in March, Senators Tom Carper (D-Delaware) and Tim Scott (R-South Carolina) introduced a bill known as the Hospital Inpatient Services Act, which allowed for a two-year extension of the federal acute hospital-at-home waiver. Introduced in November 2020 by the Centers for Medicare and Medicaid Services, the waiver enables treatment for common acute conditions in home settings. This waiver was highly used throughout the COVID-19 pandemic, with 92 health systems, comprising 203 hospitals across 34 states, using it as of March 4. See original article: https://mhealthintelligence.com/news/82-of-americans-want-telehealth-flexibilities-extended < Previous News Next News >

Telehealth's importance grows amid coronavirus pandemic Rick Ruggles March 12, 2022 The coronavirus compelled doctors to see patients in new ways, and one of those is through a computer monitor, miles away from the patient. The pandemic placed greater emphasis on telehealth, which has been around for years but was put to use urgently when the coronavirus spread in early 2020. Officials with Medicare, the government-sponsored insurance for senior citizens, also increased the number of the occasions in which telehealth could be covered during the pandemic. Whether vast telehealth use and broad insurance coverage for it will continue isn’t certain, those who know the benefits of telehealth say it has proved itself and is here to stay. “It’s become part of life,” said Sharon V. Nir, administrative director of strategic operations with Albuquerque-based Lovelace Medical Group. “I do think it’s the new world.” Lovelace created an extensive program in March 2020, with the arrival of the coronavirus, to make remote visits available to patients and doctors through laptop computers, iPads, cellphones and desktops with cameras and microphones. Presbyterian Healthcare Services, Christus St. Vincent Regional Medical Center, University of New Mexico Health, La Familia Medical Center and most other medical systems also increased their use of telehealth. Santa Fe Preparatory School teacher Brad Fairbanks went head over handlebars on his bicycle last month, breaking a collarbone and three ribs. He spent time in an emergency room, but his follow-up visits with his family physician, Dr. Carl Friedrichs of Presbyterian Medical Group, were done remotely. Fairbanks, 61, said the follow-up appointments and pain medication assessments were as effective by videoconference as they would have been in person. “This was the first time I’d done telehealth,” said Fairbanks, the performing arts chairman at his school. “Yes, it worked great.” He said the accident happened at a bad time, with his students preparing to put on the show 9 to 5 The Musical. He missed four days of work and two rehearsals and had to participate in two other rehearsals by Zoom technology. Friedrichs said there is plenty that can be accomplished in a telehealth appointment. “The patient has the choice,” he said. “It’s an extra tool for patients.” In a big state like New Mexico with vast rural expanses, it makes sense to lean on telehealth, he said. “This is a state that has limited medical resources.” Videoconferencing can’t be used for everything, of course. Annual physicals and diagnoses requiring the doctor to lay hands on the patient must be done in person. Blood draws for lab work require a visit, although the result of that lab work can be covered in a virtual appointment. And some patients aren’t at ease with the technology. But telehealth gives patients in rural areas and those who struggle to find transportation the chance to get some of their services done by videoconference. And when the highly contagious coronavirus roared through the world, patients who were reluctant to visit the doctor’s office had an alternative. Christine and Ed Shestak of Albuquerque have had about four videoconference appointments apiece through Lovelace since the start of the pandemic. “For routine things, it just kind of minimizes the risk of picking up anything anybody else might have” in the doctor’s office, said Christine Shestak, 69. She recalled when she took her children to the pediatrician many years ago, kids would cough, noses would run and children would share toys in the waiting room. Telehealth is a solution, she said, and if she has the flu, she doesn’t have to carry it into the clinic and possibly infect others. Ed Shestak, who will soon be 70, said he has hearing aids and sometimes struggles to absorb everything if there is background noise in the doctor’s office. At home, he puts on headphones for his virtual visits. “I can hear and understand better,” he said. Naturally, insurance coverage of telehealth is complicated. Before the pandemic, Medicare coverage for telehealth generally favored rural patients and also included some specific conditions such as end-stage renal disease and strokes. But when the coronavirus forced patients to work from home and limit travel, the Centers for Medicare & Medicaid Services expanded coverage on an emergency basis to patients in cities, to a wider variety of medical practitioners and for a broader set of reasons. Telehealth used by primary care doctors boomed. Specialists in psychology, the digestive tract, lungs and heart also saw increased use of telehealth. The federal government reported in December that Medicare-covered telehealth visits leaped from 840,000 in 2019 to 52.7 million in 2020. Presbyterian spokeswoman Amanda Schoenberg said scheduled telehealth visits with Presbyterian Medical Group went up by 100 times from 2019 through 2021. Medicare will continue to cover many of those services at least through 2023 while officials evaluate the system. Tennessee-based Baker Donelson law firm says on its website new Medicare provisions also permanently removed geographic restrictions on telehealth for diagnosis, evaluation and treatment of mental health disorders. Stetson Berg, chairman of the New Mexico Telehealth Alliance, said Congress will have to pass laws to cement much of the coverage that was added on an emergency basis during the pandemic. Berg said state law in New Mexico has provided some of the most progressive private insurance coverage of telehealth and has served as a “shining star” in the field for close to 10 years. New Mexico was ahead of the game in part because it is so rural, he said. Other states are catching up. In the journal Annals of Internal Medicine, researchers reported last month that analysis of 38 studies showed videoconferencing “generally results in similar clinical effectiveness, health care use, patient satisfaction, and quality of life as usual care for areas studied.” Those studies were limited to “patients seeking care for a limited set of purposes,” the report added. Christus spokesman Arturo Delgado wrote in a text message that virtual visits “are appropriate for most evaluations. Conditions that can be evaluated include anything from a cough or a cold to more complicated conditions like diabetes or heart disease.” Jasmin Milz Holmstrup, a spokeswoman for La Familia Medical Center in Santa Fe, said the use of telehealth increased considerably at her institution from 2020 to 2021. “It’s an effective way to see patients who have non-urgent needs,” she said. University of New Mexico Health said the institution “utilized all available options to continue to provide patient care, including telehealth. This was a successful way to ensure patients continued to receive care and access to a provider.” Prep teacher Fairbanks said his students prepared for the play while he was “in my recliner, all banged up.” The shows took place March 3 to March 6 and the medical appointments by telehealth and attendance of rehearsals by Zoom didn’t pose a problem. His students came through. “It worked out,” he said. “And the kids stepped up.” < Previous News Next News >

Telehealth Resources NMTHA's Telehealth Resources provide information on the following topics: New Mexico Organizations New Mexico Broadband Interstate Telemedicine Licensure Telehealth Organizations & Associations Teleheath Training COVID & Telemedicine NM Based Orgs NEW MEXICO ORGANIZATIONS Health Insight New Mexico New Mexico Association for Home & Hospice Care New Mexico Health Resources New Mexico Primary Care Association SYNCRONYS (New Mexico Health Information Exchange) University of New Mexico Center fo r Telehealth UNM Project ECHO NEW MEXICO BROADBAND NM Broadband Program Overview of Broadband Program - Videos Mapping Training Resources Strategic Planning INTERSTATE & TELEMEDICINE LICENSURE Interstate Medical Licensure Compact (NM is not yet a participant) Federation of State Medical Boards New Mexico Physician Licensure Requirements (including telemedicine) New Mexico Physician License Application instructions (see last page for telemedicine) NM Broadband Interstate Licensure TELEMEDICINE ASSOCIATIONS & ORGANIZATIONS American Telemedicine Association (ATA) Center for Connected Health Policy Center for Telehealth & e-Health Law Southwest Telehealth Resource Center National Library of Medicine National Telemedicine Initiative Office for the Advancement of Telehealth (Health Resources and Services Administration, DHHS) Telemed Associations Org. TELEHEALTH TRAINING Telemental Health Training : Providing healthcare organizations and clinicians with ethical, legal, technological, and clinical frameworks for conducting effective telehealth sessions. Telehealth Trainings : The Arizona Telemedicine Training Program and Southwest Telehealth Resource Center offer 1-day training courses on telemedicine and telehealth. National Consortium of Telehealth Resources : Building a telehealth program? Browse through our offerings from Telehealth Resource Centers. If you can’t find what you’re looking for, use our contact form or give us a call. We have an abundance of resources available! Weitzman Institute : Weitzman ECHO (Extension for Community Health Outcomes) provides specialty support for primary care providers seeking to gain expertise in management of certain complex illnesses and conditions, including COVID-19, MAT, Chronic Pain, and more. TH trainings New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. View Statutes Experts in Telehealth: An Interview Series A series of brief interviews from local and regional experts sharing experience, insights, and guidance on telehealth. Access Interviews Get answers from the NM Department of Information Technology (NM DoIT). Contact NM DoIT Broadband Questions? Contact U.S. Senator Ben Ray Lujan to discuss you r telehealth issues, ideas, and goals. Policy & Advocacy Contact Senator Lujan COVID & TELEMEDICINE NEWMEXICO.gov (Guidance for Providing Patient Care by Electronic Means During the COVID-19 Public Health Emergency.) NM Medicaid, COVID-19, and Telehealth Resources NM-HSD April 6, 2020: Special COVID-19 Supplement #3 – Guidance for New Mexico Medicaid Providers NRTRC COVID-19 and Telehealth Resources ATA COVID-19 Response Webinar Series eHealth Initiative COVID-19 News, Resources, and Events Weitzman Institute COVID-19 Resource Page An Analysis of Private Payer Telehealth Coverage During the COVID-19 Pandemic (Center for Connected Health Policy) UNM Resources: COVID-19 briefings COVID-19 practice guidelines COVID-19 therapeutic evidence Covid resources Top of Page NM Based Orgs NM Broadband Interstate Licensure Telemed Associations Org. TH trainings Covid resources

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 >

Celebrating 2021 National Rural Health Day Southwest Telehealth Resource Center Dec. 1, 2021 Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. This webinar streamed live to a national audience on November 15th and the recording and presentation slides are available at: https://telemedicine.arizona.edu/webinars/previous for on-demand playback. Each year the National Organization of State Offices of Rural Health selects a Community Star from each of the 50 states. The 2021 Community Star report, https://en.calameo.com/read/0045723395dc12ef8ac48, includes stories of how each Community Star is working to improve life in their rural community. Congratulations to all of the 2021 Community Stars! Matthew Probst, PA-C Chief Quality Officer and Medical Director El Centro Family Health Mathew Probst is the Chief Quality Officer and Medical Director for a Federally Qualified Health Center located Northeast of Albuquerque, New Mexico. Under his leadership, Mr. Probst was able to implement initiatives at the start of the pandemic which resulted in his county having one of the lowest fatality rates and one of the highest vaccination rates in the county. Read more about why Mr. Probst was featured in an award-winning documentary named The Providers: https://en.calameo.com/read/0045723395dc12ef8ac48 < Previous News Next News >

Over-the-Phone-Therapy: Rand Report Findings Dr. Maheu May 8, 2022 Preference for Over-the-Phone Therapy Visits A recently published RAND Corporation report confirms telehealth can improve healthcare access and high utilization of over-the-phone-therapy visits, also known as audio-only telehealth visits. Suggestions regarding reimbursement are included. However, the report cautions that more research is needed to ensure the equitable delivery of quality healthcare when using audio-only telehealth. In a bid to assist healthcare centers, the California Healthcare Foundation established a quality assurance program, the Connected Care Accelerator program (CCA), in July 2020. RAND researchers worked with 45 CCA health centers in compiling the report, “Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic.” RAND Report Findings The RAND report found that the number of clinical visits remained the same during the study period compared to before COVID-19. However, over-the-phone therapy for behavioral health issues was a standout in terms of services received by patients. Audio-only visits were favored for both primary health and behavioral health practitioners when the study started. Many primary health visits had reverted to in-person consultations, but over-the-phone therapy for behavioral health care remained high by the end of the study. There were significant differences in video consultations across health centers, particularly behavioral healthcare. Health centers transitioning from audio-only telehealth visits to video visits had varying degrees of success. Of those that transitioned to video visits, the most successful shared these characteristics: Telehealth video platforms were easy to use. Clinicians obtained leadership support and staff training. Everyone involved experienced a sense of urgency. Patients were willing to try the technology. Health center staff who took part in the study noted that it was challenging to set up video calls, which led to the preference for over-the-phone therapy. Also significant were the changes in the telehealth reimbursement policy. Audio Telehealth Can Bridge the Digital Gap According to the RAND report, healthcare centers had varying degrees of success in implementing telehealth. The availability of digital assets is one of the barriers to entry regarding telehealth access. The report suggested that telehealth phone calls offer the next best option where other telehealth resources are lacking. The American Medical Association (AMA) issued a brief, Equity in Telehealth: Taking Key Steps Forward, which recently provided more data about audio-only telehealth. The report points out that one in five adults in the US does not have broadband, which means that these people cannot avail themselves of the benefits of video-based telehealth. The study also reported that 15% of patients don’t have a smartphone to facilitate a video connection with a provider. AMA suggests that hospitals and healthcare providers should invest in initiatives to broaden the reach of telehealth for the inclusion of marginalized communities. According to the brief, some health centers have increased their support staff to help bridge the digital gap. They have also made available wi-fi and telehealth booths. The AMA report also states: The AMA urges health plans to be required to cover telemedicine-provided services on the same basis as in-person services and not limit coverage only to services provided by select corporate telemedicine providers. Telehealth Reimbursement for Over-the-Phone-Therapy In recent years, telehealth reimbursements and healthcare coverage changes are another reason why over-the-phone therapy and audio-only telehealth visits have gained popularity. Before the pandemic, telehealth reimbursement for over-the-phone therapy was rare. Medicare and many states did not classify audio-only calls as part of telehealth services. Many have now increased telehealth reimbursement to include audio-only telehealth visits. See TBHI’s previous articles related to telehealth reimbursement for more information: 7 States Change Telehealth Coverage for Telehealth Reimbursement Telehealth Expansion: 6 Additional States Announce Telehealth Coverage Audio-Only & Other Telehealth Services Approved for Reimbursement Moving Forward with Over-the-Phone-Therapy and Audio-Only Telehealth Reimbursement It is difficult to monitor how audio-only telehealth visits are now being used because historically there were no codes and modifiers on the claims applications. Medicare and Medicaid providers have recently added audio-only modifiers and coding to their listings. See Telehealth Reimbursement Alert: 2022 Telehealth CPT Codes Released. Data collection regarding telehealth phone calls will be forthcoming as a result. There is a general belief that over-the-phone therapy is open to improper use and can lead to increased costs and inequitable use. Data transparency may help mitigate this belief as clinicians’ preference for other modalities is revealed. See Audio-Only Telehealth: A Classic Solution to a Modern Crisis. RAND Report Recommendations The RAND report concluded that audio-only telehealth policies should be limited until evidence is better gathered and understood since audio-only telehealth data is lacking. Implementing policies with in-person and video requirements and different telehealth reimbursement rates is recommended. It pointed out that healthcare centers and professionals need support and resources for effective telehealth implementation. Professional training is also available. A complementary and recently published report described telehealth systems’ use, access, and quality. It showed how telehealth reimbursement and services have spread into all primary forms of healthcare to the satisfaction of providers and their clients. Over-the-phone therapy will remain an essential part of ensuring that clients receive the care they need until we bridge the digital divide. Policymakers need to balance their concerns with interpretations that support audio-only telehealth policies to reduce digital inequities while efforts are made to reduce the digital divide. < Previous News Next News >

Out-of-State Telehealth Aided Rural Residents Amid the Pandemic Mark Melchionna September 22, 2022 New research shows that several Medicare beneficiaries benefited from expanding out-of-state telehealth services, including rural residents and cancer survivors. September 22, 2022 - A study published in JAMA Health Forum found that many Medicare beneficiaries benefitted from the elimination of restrictions on out-of-state telehealth services during the COVID-19 pandemic, primarily those with cancer, rural residents, and those residing nearby state borders. According to the Centers for Disease Control and Prevention, 95 percent of health centers used telehealth during the COVID-19 pandemic. This sharp uptake has prompted researchers to explore the effects of telehealth and the populations that use it the most. This study examined out-of-state telehealth data from January to June 2021. They selected this time period because it followed the abrupt onset of the pandemic and included vaccine distribution efforts. Further, state-based licensing flexibilities were still in effect during the study period, enabling out-of-state telemedicine. Most flexibilities were eliminated by mid-2021, after which pre-pandemic state licensing laws were reinstated. Overall, 8.3 million Medicare beneficiaries participated in a telehealth visit between January and June 2021. Of these, 422,547 (5 percent) had one or more out-of-state telehealth visits. Through geographical analysis, researchers determined that 57.2 percent of all out-of-state telehealth visits involved patients who lived near a state border, defined as within 15 miles of a border. Upon analyzing out-of-state visits, researchers found that 64.3 percent included a primary care or mental health clinician, and 62.6 percent were preceded by an in-person visit between March 2019 and the telehealth visit involving the same patient and provider. Researchers also found that rural residents were more likely to receive telehealth from an out-of-state location, with 33.8 percent of out-of-state visits involving a rural resident versus 21 percent of within-state telemedicine visits. Also, 9.8 percent of out-of-state telehealth visits were for cancer care, the highest rate among all specialties. Based on this data, researchers concluded that Medicare beneficiaries living in rural areas, seeking cancer care, and living nearby state borders were the most likely to obtain telehealth from an out-of-state clinician. The study results also imply that these populations are highly affected by restrictions that limit out-of-state telehealth. Researchers noted a few limitations within their study, including the potential bias associated with data from the traditional Medicare population and the use of home addresses to determine the state in which a patient resides. Various studies have collected data that reveal the difficulties some patients may face when obtaining care. Highlighting the care disparities between urban and rural residents, research from June found that Native American patients often faced difficulties when accessing cancer care. This was largely due to the large geographic distance between the areas in which American Indian and Alaska Native patients reside and the locations of clinics. Due to the high prevalence of access disparities, organizations often push for regulatory expansions related to telehealth. In September, 375 stakeholders signed a letter sent to the US Senate that requested the solidification of telehealth access for two years after the COVID-19 public health emergency has ended. See original article: https://mhealthintelligence.com/news/out-of-state-telehealth-aided-rural-residents-amid-the-pandemic < Previous News Next News >