Bipartisan Policy Center Report Highlights Telehealth Policy Considerations CCHP November 01, 2022 Last month, the Bipartisan Policy Center (BPC) released a comprehensive report on The Future of Telehealth After COVID-19. The report is based upon an analysis of Medicare Telehealth Utilization and Spending Impacts 2019-2021, stakeholder input and interviews, a literature review, and a national consumer survey. The BPC report examines the impact of increased access to telehealth during the pandemic and makes recommendations to policymakers on which COVID-19 policy expansions should be maintained post-public health emergency (PHE). Ultimately, BPC urges the federal government to extend emergency flexibilities for two years to preserve access while further evaluating telehealth effectiveness. In its analysis, BPC made a number of key findings showcasing telehealth’s ability to alleviate access barriers for Medicare beneficiaries, address inequities in access and outcomes for racial and ethnic minorities, low-income earners, and individuals with chronic conditions, as well as improve patient continuity of care. The report also noted that patients and providers generally feel satisfied with telehealth services. Other findings include: A decrease in telehealth utilization since initial pandemic peaks, although 2021 rates remained nearly 40 times higher than pre-pandemic telehealth visits Most telehealth visits were for primary care visits and 44% of all behavioral health visits in 2021 occurred via telehealth About 1 out of 5 telehealth visits were audio-only in 2021 Telehealth utilization was higher in urban areas and for non-white beneficiaries Beneficiaries with disabilities and dually eligible for Medicare and Medicaid were more likely to use telehealth in 2021 Medicare spending on telehealth remains a small percent of overall spending – for the outpatient codes BPC examined, telehealth spending was between 1.5% and 3.3% of total spending in 2020 and 2021 In applying its findings to policy recommendations, BPC discusses an attempt to balance competing goals, for instance the need to increase access to care against the need to ensure quality and cost-effectiveness. The report also highlights areas to focus future research and notes the need to examine telehealth outside of PHE conditions to truly generalize findings. In addition, BPC acknowledges limitations in its spending analysis that don’t factor in the potential reduction in long-term costs related to emergency room visits in correlation to increased telehealth visits. In addition to extending Medicare telehealth flexibilities for two years, key BPC recommendations to Congress and the Biden administration include: Maintain access to telehealth for Medicare beneficiaries regardless of location or medical diagnosis – including the home/patient location as an authorized originating site and removing geographic limitations (with protections to require providers to see patients in-person or refer to in-person care when necessary) Authorize FQHCs/RHCs to permanently serve as distant site providers Continue access to primary care and behavioral health services with minor adjustments post-PHE (the recommendation notes that if further research supports it, CMS could consider limiting certain services to existing patient-provider relationships – except in rural areas and for alternative payment methodology (APM) providers) Continue audio-only coverage and incorporate audio-only into telehealth definition (post-PHE audio-only restrictions should limit coverage to established patients and at patient request) Permanently expand asynchronous services beyond virtual check-ins and Alaska and Hawaii demonstration projects for both new and established patients Make Health and Human Services (HHS) 1135 temporary waiver authority permanent for future PHEs Eliminate the requirement for in-person visits for telemental health services (BPC states this is an undue burden on those who cannot access behavioral health providers in-person) Require evaluation of controlled substance prescribing via telehealth and for non-hospice, non-cancer patients, first require an in-person exam prior to prescribing substances prone to abuse (BPC additionally recommends the Department of Justice (DOJ) follow through on its requirement to create a special telemedicine registration process to allow for certain in-person requirement exemptions) Refine reimbursement rates and end broad payment parity between telehealth and in-person care to offset any cost/utilization increases, including implementing different rates for audio-only and video visits In regard to transparency and consumer protections in particular, the report also recommends clear information to beneficiaries be provided regarding benefits appropriately delivered by telehealth and ensuring that beneficiaries consent to the use of telehealth. BPC additionally recommends the ability to distinguish between traditional and fully virtual providers be determined, and that enforcement resume related to HIPAA. In regard to fraud, waste, and abuse protections, the report calls for sufficient funding to the HHS Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) to modernize and track telehealth use, the requiring of outlier provider audits, and that high-cost durable medical equipment (DME) and laboratory tests be limited to established patients, unless providers are part of APMs. To improve data quality, the BPC suggests CMS simplify telehealth billing and develop additional guidance for providers to ensure uniformity and coding accuracy. Lastly, the BPC recommends requiring MedPAC complete a formal evaluation of post-PHE telehealth impacts on access, quality, patient outcomes, and cost to truly determine long-term trends and policies. BPC’s report is extremely thorough and highlights the many issues policymakers are facing in contemplating permanent telehealth policies. Some of BPC’s attempts to balance recommendations and exceptions to address concerns raise additional complexities behind the considerations further showcasing where policymakers and future research should focus. For instance, in terms of audio-only, BPC notes that continued coverage is critical for beneficiaries lacking broadband and technology access, although additional restrictions should be adopted to address concerns related to quality and potential for overuse. However, policymakers should consider whether these additional restrictions may ultimately limit the access the report describes as critical. In terms of payment parity, BPC notes that it has been an important tool to increase access to care and ensure that practitioners provide telehealth services. However, given payer and policymaker concerns, BPC recommends that perhaps the best post-PHE policy would be to cover certain telehealth services at higher rates than pre-PHE rates, but not necessarily equivalent to in-person rates. That may go against other recommendations in the BPC report to simplify telehealth billing, although ultimately BPC does state that CMS should look carefully at cost differentials when determining appropriate rates. Since many providers state that the cost and time of providing services via telehealth and in-person are equivalent it is important that researchers and policymakers look carefully at that issue. In addition, BPC suggests that different reimbursement rates may ensure access to in-person services, yet also states that parity in rates ensures access to telehealth services, showing the difficulty in sufficiently balancing these various considerations. Researchers and policymakers must pay careful attention to all perspectives and data around these issues in order to truly ensure telehealth’s ability to increase access to necessary health care. For additional details on BPC’s findings and recommendations, please view the report in its entirety. See original article: https://mailchi.mp/cchpca/bipartisanpolicycenter-report-highlights-telehealth-policy-considerations-recommends-2-year-extension-of-federal-flexibilities-further-research < Previous News Next News >

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

ATA: What's ahead for telehealth policy after the pandemic Andrea Fox September 23, 2022 Federal and state advocacy team members discussed the status of telehealth policy as the public health emergency deadline looms and the industry questions, 'Is the pandemic over?' The American Telehealth Association is working with Congress and several federal agencies to shape the fate of policies and payments for telehealth services that experienced a rapid uptake during the COVID-19 pandemic. WHY IT MATTERS Now that President Joe Biden has declared the COVID-19 pandemic over, the ATA's Telehealth Awareness Week policy update webinar explored how federal and state telehealth policies may be affected as Congress decides whether or not to end the public health emergency (PHE). Federal priorities for telehealth have evolved with the pandemic with restrictions lifted by a Congress deciding if the limiting of certain restrictions should be lifted permanently. The PHE must be reviewed every 90 days, so Congress will have to revisit the renewal by mid-October, according to policy experts presenting during Wednesday's online event. "As we know, [President] Biden has said in recent days that the pandemic is over, so it's possible that the technical public health emergency might expire sometime in the very near future," said Megan Herber, director at Faegre Drinker who advises ATA and ATA Action on all things Federal policy. Telehealth payments and provider practices are highly regulated on the Federal level, said Quinn Shean, strategic advisor at Tusk Ventures and the state policy advisor for ATA and ATA Action. But even if providers do not serve Medicare populations, "Medicare policy trickles down," added Herber. For example, before the pandemic, patients had to be in a rural area in a hospital or clinical setting to receive reimbursement for telehealth. "That is the current status quo right now – as long as the COVID-19 public health emergency is in place," Herber explained. But in about five months, "all of those waivers go away automatically unless Congress does something." Approaches to policy can be different in different contexts, noted moderator Alexis Gilroy, co-leader of the healthcare and life sciences practice at Jones Day. "Where do you come at it based on the particular lane it sits in?" In terms of state-level telehealth policy, there are multiple state priorities because states differ in their approaches to telehealth coverage requirements for public and private health plans, reimbursement for services provided via telehealth, and eligibility to deliver reimbursable services. States also differ in how they regulate synchronous and asynchronous telehealth and remote patient monitoring. They vary on which types of providers can deliver telehealth, what establishes a valid patient/provider relationship and if out-of-state practitioners can treat patients in the state remotely without a license, explained Shean. "We have a patchwork of 50 different state requirements here," she said. The ATA has been focused on developing a consistent regulatory framework so telehealth can be deployed across states and fully leveraged. "The ATA is committed to modality-neutral policies," instead of dictating which tools clinicians choose to use to deliver telehealth, she said. ATA is pushing for fair payment for telehealth and home health as well as licensure flexibility across state lines. "It's really aligning our state frameworks with the 21st Century care model," and the states are moving quickly, she said. There have been hundreds of pieces of legislation to update state telehealth policies. The organization is also working with the U.S. Drug Enforcement Agency and Congress to address the future of online prescribing of controlled substances. Many of the barriers to telehealth policy have been based on perceptions that telehealth is somehow substandard and that romanticizes in-patient care, but telehealth has often delivered care where there was no prior access to healthcare, said Shean. "We need to recognize the access gaps that telehealth can fill" and recognize the guardrails that are in place with telehealth as they are with other care settings, said Shean. As more retail providers like CVS, Amazon and others enter the space through mergers and acquisitions, they will also have an impact on the direction of telehealth policy, including how to protect the patient data these companies will have more access to. But with more stakeholders pushing for telehealth on the state level, "having a broader tent now helps show the different patient populations that can be served here and brings more focus," Shean pointed out. THE LARGER TREND Under the CARES Act, Congress granted the Centers for Medicare & Medicaid Services authority to waive certain restrictions for Medicare coverage of telehealth. The agency was able to remove geographic restrictions, expand care at home, increase the amount of Medicare-covered services via telehealth and more. Additional legislative proposals, including the Telehealth Benefit Expnasion for Workers Act, Telehealth Extension Act and others, suggest broadening access to telehealth. "Throughout the pandemic, telehealth has proven to be a vital tool for Americans to receive timely and quality care from their own home," said Tim Walberg, R-Mich, during the bill's introduction at the Capitol in March. "For rural communities in particular, telemedicine has helped remove barriers to care, expand access to specialists and improve health outcomes." ON THE RECORD "There is urgency [for Congress] to act – don't wait until four months and 20 days after the pandemic ends; we need some stability," said Herber. "We'd love to make it permanent, and a lot of these policies we have been asking for since before the pandemic, so it's not really new," she concluded. 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/ata-whats-ahead-telehealth-policy-after-pandemic < Previous News Next News >

Nation's 1st telehealth chair on changing culture Georgina Gonzalez February 17, 2022 Sarah Rush, MD, serves as the chief medical information officer of Akron (Ohio) Children's Hospital, and in May 2020, she became what is believed to be the first endowed chair of telehealth in the nation. She spoke to Becker's about the creation of the role and what it has meant for the hospital. The chair position, made possible by a $1 million donation from philanthropist Marci Matthews, was spurred by the telehealth boom brought on by the pandemic. In 2019, Akron Children's had just 275 telehealth appointments, but in 2020 had completed over 55,000 virtual visits. Also, in spite of the general national decline in telehealth usage, Akron completed around 45,000 telehealth visits in 2021. Despite the hospital's previous efforts to integrate telehealth into behavioral and emergency department care, Dr. Rush said it was the pandemic that caused the change. "I think, conceptually, people had not been able to really wrap their brains around what telehealth could do," she said. "I think organically through the process of doing and seeing and both sides of it, the providers learning how to do it, the patient learning how to do it, it just sort of naturally happened. Now I think it's become really ingrained in a way that I don't think it would have had we not been put into that situation of having to do it." Read full article here: https://www.beckershospitalreview.com/telehealth/nation-s-1st-telehealth-chair-on-changing-culture.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >

Rural Providers Weigh Telehealth Investment Against Regulatory Uncertainty Holly Vossel June 8, 2022 Hospices are leveraging expanded telehealth options to maximize access for hard-to-reach rural patients despite lingering regulatory uncertainties. Case in point, the Providence Institute for Human Caring last year launched a tele-palliative care program aimed at addressing rural patients’ unmet needs. Thus far, the initiative has yielded positive results, but the process hasn’t always been easy, according to Dr. Gregg VandeKieft, executive medical director of the institute’s Palliative Practice Group. Snags along the way included dairy cows blocking staff from reaching patients. “For the first time we’re able to offer equitable access to specialty palliative care services for patients who need and want them in this rural setting,” VandeKieft told local news. “But we often have to balance providing health care with the time schedules and welfare of livestock, crops and other realities of rural living.” Washington-based Providence Health System provides a range of facility- and home-based care, including senior services and hospice. The company has more than 119,000 employees serving communities in six states. The TelePC program has increased care collaboration between Providence and the patients’ other providers, including family caregivers. It has also reduced travel time for the palliative care team and curbed unnecessary patient transfers and recurring hospitalizations. Hospice and palliative care providers have wrangled for decades with obstacles that complicate access to rural patients and make their care more expensive. For starters, rural regions are less likely to have a Medicare-certified hospice than urban counties. The service areas of the nearest hospices may not extend far enough to reach some of the people in those zones. When rural patients do have a provider in range, those hospices do their best to deliver care while contending with lower patient volumes, a smaller labor pool, long-travel times between home visits and the resulting travel costs. Some of the challenges are very unique to rural areas, like livestock schedules, lack of nearby caregiver support and limited internet bandwidth capacity. Telehealth has been an important part of improving providers’ ability to reach rural patient populations, according to Dr. Michael Fratkin, chief medical officer for ResolutionCare, a Vynca company. Fratkin founded palliative care provider ResolutionCare in 2015. Advanced care planning technology company Vynca acquired the company last year in its first move into the clinical care space. The pressures on rural providers go beyond the logistical. A successful tele-palliative care program requires not only greater access to high-speed internet in those areas, but also the confidence of the people they serve. Many rural residents place a lower value on telehealth services compared to the in-person care they are used to, said Fratkin. “The advantages of telehealth are the gain of seeing people at home and instantaneously sharing space with them,” Fratkin told Hospice News. “We are not physically entering their private space, not requiring them or staff to drive. What’s most important is creating that safe space to share. There are biases that virtual care is second rate. We have to blast through these biases. They are a bigger barrier to palliative and hospice care than dairy cows.” Then came the pandemic, and with it broad expansion of how providers can use telehealth — at least for the time being. Rapid deployment of telemedicine during the COVID-19 public health emergency (PHE) has created “a new pathway” for bringing palliative and hospice care specialists to rural areas, according to authors of a recent report published in the JAMA Health Forum. Additional studies further support the claim that changes to telehealth policy improved access. But without further regulatory or legislative action, those pathways will close when the federally declared emergency ends. The U.S. Department of Health & Human Services (HHS) most recently extended the PHE period to expire in July. The agency has not indicated whether or not they will renew it. As hospices navigate how they will use telehealth in the long-term, these uncertainties put them in a bind. Many are trying to weigh the benefits of telehealth investments against the possibility that they may soon have to shut down or cut back those programs. One factor policymakers might need to consider is that people may now expect that these services will remain available to them. The events of the past two years have opened the eyes of many patients to telehealth’s potential , according to Fratkin. “The pandemic telehealth experiment is unmeasured, but what we’ve discovered by being thrust into this experiment is that I don’t think patients want to give it up,” Fratkin told Hospice News. “They discovered the value of communications technology allowing them to stay in their lives and not interrupt care. Some of these providers are running back to the status quo as if it was working, but we’re going forward, not backward in this.” < 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

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

NCQA Report: 3 Strategies to Close Telehealth Access Gaps Mark Melchionna May 16, 2022 The National Committee for Quality Assurance released a telehealth report that highlighted care disparities and strategies for improvement. May 16, 2022 - Prioritizing individual preferences and patient needs, breaking down regulatory barriers, and leveraging technology in an equitable manner can go a long way toward addressing the growing disparities in telehealth use, according to a white paper released by the National Committee for Quality Assurance (NCQA). The white paper, titled The Future of Telehealth Roundtable, discusses ways to close gaps in telehealth use and access. The NCQA is a nonprofit organization that focuses on improving the quality of care and certifying various healthcare groups. Dig Deeper Pressure on Congress to Solidify Telehealth Access Builds GOP, Independent Senators Co-Sponsor Medicare Telehealth Access Bill Lawmakers Ask Congress to Create a Rural Telehealth Access Task Force As virtual care grows amid the COVID-19 pandemic, The Future of Telehealth Roundtable highlighted various areas that could be enhanced. The white paper derives from an October 2021 conference consisting of telehealth and technology experts from several prominent healthcare organizations, including MedStar Health. The experts noted that despite the expected benefits associated with telehealth, such as convenience and lower costs, disparities still exist within specific communities. According to the white paper, three strategies could help close care gaps as telehealth is further implemented. The first is creating telehealth services that cater to personal patient preferences and needs, as some individuals may face struggles due to their primary language and socioeconomic status. The second is addressing regulatory barriers to access and changing regulations to allow expanded clinician eligibility for licensure. The final strategy is ensuring that digital technology can be leveraged efficiently. For example, considering patient access levels to technology is critical because it determines how patients can be reached and how to best care for them. “Even prior to the pandemic, a change in healthcare delivery was on the horizon with ever-evolving advancements in technology,” said NCQA President Margaret E. O’Kane, in an accompanying press release. “As virtually based care expands, unique patient needs and preferences must be identified and prioritized so that telehealth can help us close the gaps in healthcare and not widen existing disparities.” The Future of Telehealth Roundtable also emphasized the continuing popularity of telehealth and that it will hold a place in the new normal. But as the implementation process continues with new technology, avoiding the digital divide is necessary to eliminate disparities. Throughout the COVID-19 pandemic, various studies have emphasized pinpointing the potential barriers to telehealth access. One study published in February revealed that Black patients with cardiovascular disease (CVD) prefer recording and sharing blood pressure (BP) via a text-based program rather than an online patient portal. This is likely because the patient portal has higher technical requirements than text-based communication. Further, research published last November shows that patients with limited English proficiency were less likely to use video when accessing virtual services during the pandemic than adults who could speak English comfortably. For full article: https://mhealthintelligence.com/news/ncqa-report-3-strategies-to-close-telehealth-access-gaps < Previous News Next News >

GAO Reports on Telehealth and COVID-19 Flexibility Findings Center for Connected Health Policy June 2021 While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed. The United States Government Accountability Office (GAO) released testimony May 19th regarding their ongoing assessment of COVID-19 flexibilities within the Medicare and Medicaid programs, as required under federal pandemic response oversight provisions included the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Provided before the U.S. Senate Committee on Finance, the GAO focused its summarized findings around the effects of program flexibilities and preliminary observations related to telehealth waivers of certain federal requirements, as well as considerations regarding ongoing use. Telehealth waivers included allowing services to be provided remotely in all areas and settings, as well as expanding the types of providers and technologies that could be used, such as audio-only modalities. While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed. GAO testimony highlighted Centers for Medicare and Medicaid Services (CMS) data on recent telehealth utilization: -Medicare telehealth services increased from 325,000 services in mid-March to 1.9 million in late-April; then decreased to 1.3 million by June as it continued to steadily drop -Nearly 40% of beneficiaries received office visits through telehealth; nearly 60% received mental health services via telehealth -Internists and family practitioners were the primary provider specialties using telehealth, through which they delivered one-quarter of their services -89 of the 146 newly available types of telehealth services could be furnished via landline phones -More beneficiaries under age 65 received services via telehealth than those over age 65 -More beneficiaries in urban areas received services via telehealth than those in rural areas -Similar proportions of beneficiaries across all racial and ethnic groups received services via telehealth When highlighting potential considerations moving forward, the GAO added that preliminary observations show that due to lack of broadband and digital literacy, access to services via live video telehealth continues to be limited among those with low socioeconomic status, those over age 85, and those in communities of color. Given that CMS information indicated that telehealth services have continued as in-person visits have been able to increase, the GAO also suggested considering the potential for increased spending if payment parity requirements related to telehealth are maintained post-pandemic. In relation to fraud and program integrity, the GAO discussed the inability of CMS to determine many aspects of telehealth services, such as type of modality and specific location data, as well as the suspension of security rules that raise potential medical information privacy issues. In regard to quality of care via telehealth considerations, the GAO cited a study specific to Direct-to-Consumer telehealth companies potentially overprescribing antibiotics as their primary example, adding that CMS is still exploring how to measure quality related to services provided via telehealth. GAO information was based upon interviews of federal and state officials and provider and patient groups regarding their telehealth experiences, in addition to reviews of federal laws and CMS guidance. Additional GAO data and reports can be found on their website. < Previous News Next News >

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

COVID-19 Policy Playbook Recommends Removal of Telehealth Restrictions for OUD Treatment Center for Connected Health Policy May 2021 Legal recommendations for a safer more equitable future Researchers from the Network for Public Health Law have published a COVID-19 Policy Playbook, that outlines legal recommendations for a safer more equitable future. Chapter 18 of the playbook features access issues to treat individuals with opioid use disorder (OUD). The chapter outlines several of the federal concessions made for telehealth during the PHE, including the ability to utilize non-public facing audio-visual communication technology regardless of their level of HIPAA compliance, and the ability to prescribe controlled substances, particularly buprenorphine via telemedicine. They also note that states have made similar flexibilities available at the state level in many cases. The chapter concludes with a list of recommendations, including the following: *The Secretary of Health and Human Services (HHS) should permit treatment to be initiated via telehealth *Restrictions should be removed on who can receive treatment via telehealth. *States should authorize provision of buprenorphine via telehealth where applicable. COVID-19 Policy Playbook: https://static1.squarespace.com/static/5956e16e6b8f5b8c45f1c216/t/6064ad386b6e756cabb56f96/1617210684660/COVIDPolicyPlaybook-March2021.pdf < Previous News Next News >

The Future of Telehealth: Informatics, Scalability and Interoperability Bill Siwicki, Healthcare IT News July 2021 A Philips executive describes what's happening now with virtual care – and what needs to happen to ensure a solid future for telemedicine and remote patient monitoring. The COVID-19 pandemic pushed telehealth into the spotlight with exponential adoption, helping to prove its value. The healthcare industry learned that, with the right solutions, care can extend outside hospital walls and be conducted anywhere. Further, CIOs and other health IT leaders reinvented systems and processes, and clinicians gained an improved understanding of the invaluable impact of integrated informatics on digital transformations and the quality and efficiency of care. Even while the pandemic continues, healthcare provider organizations have begun to stabilize these infrastructures and revisit the technologies and workflows deployed earlier in the crisis and turn them into standard practices. On this note, Karsten Russell-Wood, portfolio leader for post-acute and home at Philips, shares his viewpoints with Healthcare IT News on the biggest priorities to ensure telehealth is sustained long term. Q. How can telehealth and remote patient monitoring technologies help support chronic and acute care anywhere? A. With the right tools, extending care outside the hospital is not only feasible, but in many cases preferred. The Philips Future Health Index 2021 Report, which surveyed nearly 3,000 healthcare leaders across 14 countries, found that healthcare leaders expect an average of 23% of routine care to take place outside of the hospital walls within three years. This new frontier will undoubtedly include extending real-time care to those with both acute needs and chronic conditions who benefit from consistent communication with doctors. For these patient populations in particular, COVID-19 spurred an interest in becoming a more active participant in care plans, bringing them new levels of convenience and personalization. To meet these needs, providers must continuously work to tailor care toward the consumer, just as we're seeing happen in the banking and retail industries, and [to] advance care models from brick and mortar to "clicks and mortar." Even if the home can't be the hospital, community spaces and retail locations can fill in as connected care stations for underserved communities or patients [who] don't have an ideal setup at home. This is only possible through the use of data-driven, connected care solutions that feed into cloud-based software and allow clinicians to maintain visibility into their patients' conditions from afar. Beyond wellness checks, remote patient monitoring enables doctors to view critical patient data on a consistent basis, helping them cater care to a patient's unique needs, as well as activate timely interventions before health deteriorates. Traditionally, acute patients need an inpatient admission to the hospital and require continuous rounding by a physician. Approaching this patient population with a 360-degree model – monitoring them at home from pre-admission through post-discharge – could help track the different phases of acute care from outside the hospital. The benefits here include freeing clinicians from the bedside, helping them better allocate hospital resources according to risk, and, above all, keeping patients in a more convenient, lower-cost setting. Hospital-grade wearables equipped with secure data integration, for example, can help guide relevant, timely decisions from care teams regarding whether a patient needs to be hospitalized immediately, or can receive treatment elsewhere and remain outside the hospital for the time being. Care teams can view daily and weekly trends via continuous biometric devices, showing everything from skin temperature, respiratory rate at rest and coughing frequency, and be notified if symptoms are worsening. There are similar advantages of using connected devices when managing patients with chronic conditions. In the comfort of their own home, patients can remain connected to their providers in a convenient, passive manner, which can motivate them to adhere to their treatments. Until recently, patients have traveled to their doctors to receive care. However, that doesn't mean hospitals have always been the most accessible means of delivering that care, people just didn't have a choice. The industry now has the means to deliver that same level of care in a much more accessible way, bringing it to patients wherever they may be. For example, those with diabetes or congestive heart failure who may wish to avoid in-person visits can potentially avoid an unnecessary hospitalization if their doctors detect a change in their condition in time. Patients with cardiac arrhythmias can remain home while being continuously monitored. Doctors can detect arrhythmias such as atrial fibrillation as they occur and intervene if necessary. Telehealth solutions can also help clinicians monitor whether a chronic condition is becoming acute. Q. With telehealth and remote patient monitoring comes the need for interoperability and security. How does a healthcare provider organization ensure data can be accessed and shared seamlessly across settings, and that solutions are interoperable? A. As hospitals evolve to extend care beyond their walls, telehealth and remote patient monitoring enable a hybrid continuum of care that brings an increased amount of health data. This requires secure, robust data-sharing infrastructures and a standard for technologies to work together across platforms and locations. The Future Health Index 2021 report found that two of the biggest barriers to the adoption of digital health technologies were difficulties with data management (44%) and lack of interoperability and data standards across technology platforms (37%). Providers need to rely on a longitudinal health record to activate the right care anytime and anywhere. For example, for remote care for patients in ICU settings, known as tele-ICUs, where integrated systems are particularly important: Without a strong backbone for smooth data integration, intensivists can only see what is happening in front of them, instead of making informed decisions based on a holistic view of a patient's health. To ensure data can be accessed and that solutions are interoperable, secure flows of data must be activated. Solutions that are designed to work in tandem are better organized and more secure from malicious attacks. By safeguarding technologies to make sure they're interoperable across platforms and geographic locations, health systems can better protect the data that flows throughout their system and provide increased security. Using a cloud-based platform approach will help achieve this, as well as standardize the current disparate IT landscape and allow data to be accessed anywhere. Leveraging open APIs and approved standards like IHE-HL7 can help facilitate data exchange across multiple sources and vendors across the continuum of care with minimal friction. With the rise in cloud-based applications, software-as-a-service and virtual care solutions enabling data sharing, organizations must work to ensure systems and processes mature at the rate they are evolving. Providers should assess their current infrastructure and their performance metrics such as ROI, quality, scalability and satisfaction, which will help them develop IT models accordingly that support these emerging care pathways. New types of executive roles will also grow in necessity to support building beyond hospital walls, such as chief digital officer and virtual health leadership supporting the informatics department. Further, to ensure confidentiality, integrity and availability of critical data and the systems that house that data, security plans should span across organizations and industries. While updating IT systems all at once may not be realistic, health systems can start by rigorously assessing third-party vendor capabilities, only using 510k cleared medical devices and implementing policies for data protection. Hospitals should prioritize partnerships with organizations that take a proactive approach to protecting health information across devices, systems and settings, so administrators, healthcare providers and patients have confidence about how care is delivered. By connecting devices, unlocking data and fostering collaboration, we will empower new forms of engagement, actionable insights and better health outcomes. Q. You have said that virtual care strategies cannot be a bandage on top of existing or new piecemeal solutions that work in silos, that a much-needed technology infrastructure must be established that not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. Please elaborate. A. Implementing telehealth solutions during the pandemic to supplement in-person care was like building a plane while flying it. Now healthcare organizations can be strategic, stabilize these infrastructures and revisit the technologies deployed in times of crisis and transform them into standard practices. Our world moving forward is one that embraces the best solutions available, leveraging both traditional care models as well as virtualization to provide quality care. This change isn't one that any one organization can do alone, and relies on partnerships with technology companies that enable and foster clinical creativity through co-creation and embrace the subscription economy. Healthcare organizations are increasingly partnering with those with proven track records in implementing foundational technology infrastructures and who can serve as consultants to drive their digital transformation. The ability to co-create has never been more important in driving outcomes. Working side by side with partners in the technology sector will help hospitals and health systems develop solutions from the ground up. There is value in disintermediated partners in this case, as they allow providers, vendors and patients to take collaboration to the next level. And health systems should be given flexibility when it comes to implementing and exploring virtual tools that are right for them. Rather than making a big capital investment upfront, they should be able to adopt solutions in a stepwise fashion, and scale up or down in real time. Today's healthcare organizations care more about access than they do about ownership. They want customized experiences and flexible payment options. That's why healthcare organizations are increasingly turning to subscription services, with a shift from buying a physical product to leveraging a holistic solution that provides ongoing value and engagement. By adopting these new business models, it not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. We've seen success with software-as-a-service models as a predictive, usage-based model that allows for faster innovation, but also reduces the demand for IT maintenance, standardizes service levels and usage, and helps providers quickly scale according to need. < Previous News Next News >

Legislators Throughout the Southwest are Moving Towards Institutionalizing Telehealth Services Kirin Goff, Southwest Telehealth Resource Center July 2021 Legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services As the COVID-19 pandemic becomes increasingly under control and more states are ending their public health emergency declarations, legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services. At the forefront of this new legislation is Arizona’s HB 2454 that Governor Doug Ducey signed into law on March 5, 2021 to provide comprehensive amendments to the state's laws governing telehealth. In Arizona and other southwest states’ new telehealth laws, entities are generally prohibited from denying coverage for telehealth services and are required to cover remotely provided services at the same rate as equivalent in-person services. Exceptions to these requirements may be developed by an advisory committee of government officials, practitioners, and other stakeholders, who will determine, among other things, circumstances in which telehealth services are inappropriate. Even in the absence of a rule prohibiting telehealth services, healthcare providers must use good faith in determining whether telehealth services are appropriate, and if so, which communication modalities are appropriate. Communication Modalities Prior to the public health emergency response to the pandemic, audio-only services were generally permissible only if the healthcare provider had an existing relationship with the patient and audio-visual communication was not reasonably available. Voicemail was specifically excluded. Going forward, telehealth services in Arizona may be provided, when appropriate, through interactive audio/video, asynchronous store-and-forward technology (i.e., digitally stored medical imaging, multimedia files, other information that can be reviewed remotely), and remote patient monitoring technology. Legislation in other states throughout the southwest also includes measures that govern the types of communications by which telehealth services can be provided. In many cases, telehealth can be provided by means other than real-time, audio-visual communication. Nevada SB 5, for example, amends an existing definition of telehealth to include audio-only interactions. Utah's SB 161, which was enacted, allows providers to use HIPAA-compliant asynchronous audiovisual technology for certain treatments. Amendments to New Mexico's Cannabis Regulation Act (HB 2, also enacted) provide a patient to be diagnosed as a qualified patient via telemedicine, which includes store-and-forward and remote patient monitoring technologies as options. Collection and Reporting of Telehealth Data to Form Policy Decisions Legislators in Nevada, like those in Arizona, seek to collect and use data on telehealth services to aid in forming policy. Nevada SB 5 requires the state's Department of Health and Human Services to establish (if funding permits) a data dashboard allowing analysis of access to telehealth by different groups and populations. The bill goes further to include behavioral health boards, the Patient Protection Commission, and the Legislative Committee on Health Care to use the dashboard in formulating policy. Another Nevada bill (ACR 5) establishes a legislative committee to address the shortage of behavioral health professionals in the state. This committee will study the provision of behavioral health services through telehealth and consider ways to expand the use of telehealth to provide such services. Expansion of Services Various bills explicitly expand telehealth services in particular fields such as dentistry (Colorado SB 21-139, New Mexico SB 200), audiology and speech pathology (Colorado SB 21-021, New Mexico HB 210), occupational therapy (Colorado HB 21-1279), and dietetics and nutrition (New Mexico HB 147). Other measures are aimed at expanding broadband access:(Nevada AB 388; Colorado HB 21-1109), including efforts specifically directed at underserved communities (Arizona HB 2885, Nevada AB 388), seniors (Colorado SB 21-210, New Mexico SM 6), and children (New Mexico SM 15). In-Person Medical Examination Requirements In-person requirements have long been a contentious topic in the provision of initial telehealth services in certain contexts. For example, Arizona’s HB 2454 prohibits providers from prescribing Schedule II drugs after an audio-only communication with the patient, but generally allows other drugs to be prescribed after audio-only telehealth communications. In another context, Nevada’s SB 266 provides for in-person medical examinations for workers' compensation claims, but only if initial examinations were performed through telehealth services and only if a party requests an in-person examination. Interestingly, some bills seek to relax restrictions. For example, New Mexico’s HB 12 seeks to eliminate a previous requirement that a practitioner could only certify a patient for medical cannabis use if the practitioner had previously examined the patient in-person. Overall, the surge of bills moves us towards institutionalizing telehealth. Importantly, the latest round of legislation also exposes how much more there is to learn about optimizing telehealth and identifying best practices as uptake continues to increase across the southwest. New Mexico HB 147: https://track.govhawk.com/public/bills/1414538 New Mexico SM 6: https://track.govhawk.com/public/bills/1425880 New Mexico SM 15: https://track.govhawk.com/public/bills/1443803 New Mexico’s HB 12: https://track.govhawk.com/public/bills/1428580 Source: https://southwesttrc.org/blog/2021/legislators-throughout-southwest-are-moving-towards-institutionalizing-telehealth < Previous News Next News >

Zoom's Head of Healthcare Talks the Future of Telemedicine Bill Siwicki, Healthcare IT News August 2021 Heidi West discusses telehealth/hybrid in-person care, the communities that could suffer without virtual care and the remaining obstacles to mainstreaming telemedicine. Telehealth continues to be a priority for the healthcare industry. It has proven itself throughout the ongoing COVID-19 pandemic. Recent Zoom research found that in the U.S., 72% of survey respondents want to attend healthcare appointments both virtually and in-person post-pandemic, demonstrating the clear need for telehealth as an option for this hybrid approach to healthcare. Despite the success of telehealth during the last year and a half, some have questioned its broader use as healthcare returns to in-person office visits. However, this reversal could put certain communities and demographic populations at a disadvantage, such as those in rural areas or ones without reliable transportation. Healthcare IT News sat down with Heidi West, head of healthcare at Zoom, to discuss telemedicine's future, hybrid in-person/telehealth care, communities that could be hurt without virtual care, and challenges to telemedicine becoming fully mainstream. Q. Telemedicine visits have tapered off some since their pandemic peak in 2020. Will telemedicine remain popular? If so, what will drive its continued popularity? A. During a year full of stay-at-home mandates and concerns about public safety, it makes sense as to why we saw such a sharp increase in the use of telemedicine solutions – virtual care offerings made it possible for us to get the help we needed while largely staying out of harm's way, and protecting ourselves and loved ones. Yes, there will always be a need to provide in-person care – surgical procedures, imaging and specific hands-on care still will require actual office visits. However, the opportunity for telemedicine is tremendous, and physicians should consider a virtual-first mentality to support the convenience and safety of the patient. Some forms of medical care can easily be managed over virtual platforms, and by continuing to be available virtually, providers can reach new audiences, regularly track existing ones and even grow stronger patient-provider relationships than before. One area that is particularly well-suited for this is psychiatry and psychotherapy. With online therapy, providers can meet with patients far from their physical office space, opening up opportunities to take on new business outside of the immediate neighborhood, as well as meet with patients at different times, since travelling will not need to be taken into consideration. There also is untapped potential for video communications and telehealth platforms to help aid and enhance group therapy experiences. Studies have already shown higher demand for online group therapy and fewer no-shows among the participants who sign up for sessions. We also will see some medical practitioners such as nutritionists and dermatologists continue to use telehealth solutions in their practices. There are many cases in which doctors in these fields can provide expertise and recommendations to patients via video conferencing in the same way they would in person. Telemedicine will continue to bring a level of flexibility and accessibility to the patients that need it in these realms, and it will only continue to grow as we become an even more digitally connected society. Q. In your recent study, the clear majority of consumers want both virtual and in-person care. This seems to show a need for telehealth as an option for a hybrid approach to healthcare. What will this hybrid look like, more specifically? A. We will see this hybrid approach combine the best of both the physical and digital worlds to offer an incredible experience. Generally, we'll see more primary consultations conducted via virtual platforms, with providers then asking patients to come in or engage with a specialist either remotely or in person as needed. This provides a greater number of patients with a greater level of convenience. Because of the pandemic, there also has been a heightened awareness and preference to manage post-acute care and chronic conditions at home. Providing accessibility to care in the home will be one of the greatest growth areas for telehealth. We'll likely see more outpatient care or physical rehab programs conducted over video calls for patients who have recently undergone surgery and are resting at home. New hybrid experiences also will improve information sharing and precision among doctors in their respective fields. Rather than waiting for hours across time zones for emails to be read and sent about a specific case, videoconferencing can allow doctors that are physically in a room examining a patient to digitally share information with consultants or experienced professionals outside of the room – or even in other parts of the world – in real time. Additionally, no longer do smaller hospitals or doctor's offices have to solely rely on experts in or near the local community – the talent pool for a given procedure or evaluation vastly expands when video conferencing is a part of the equation. Q. While telehealth has indeed been very successful amid the pandemic, some experts have questioned its broader use as the industry returns to in-person care. You've said this reversal could put certain communities and demographic populations at a disadvantage, such as patients in rural areas or without reliable transportation. Please elaborate. A. Yes, a great deal of the population lacks the accessibility to healthcare in the same ways that people in affluent and urban areas often have. Urban dwellers generally come across a greater number of doctors' offices, specialized care facilities and treatment options, whereas those on the outskirts or those without reliable transportation have limited choices in when and who they see as medical issues arise. The evolution of telehealth and its swift adoption during the pandemic gave many communities access to doctors and other medical professionals that they normally wouldn't be able to see. As an example, before committing to buying an expensive plane ticket and hotel room in order to see a specialist in a city far away, a patient in a more rural area can join a video conference to discuss any issues with the specialist ahead of time and determine if the trip is truly needed. This saves both parties time, money and peace of mind. Certain demographic populations also have seen the positive effects of virtual care in a way that wasn't as prevalent before the pandemic. For example, minority race groups and people of color oftentimes have difficulty finding therapists or psychiatrists that understand or align with their cultural beliefs. However, the proliferation of online therapy sessions during the pandemic has drastically changed this. Virtual health services have allowed patients to find and connect with the mental health professionals that have academic, personal and professional backgrounds that align with their existing values and beliefs, even if the practitioner lives outside the immediate region of the patient. For the first time, many marginalized groups are getting the care they need from people they trust and connect with on a deeper level. Removing telehealth as an option for care also removes a great deal of accessibility for people in similar situations to the above, or those who previously were not able to nor offered an opportunity to get the care they needed. Losing these options could mean driving a greater divide between socioeconomic groups and regions throughout the U.S. Lastly, and conversely, many physicians need to consider the increased competition threatening their patient population by not prioritizing digital health solutions. Between direct-to-consumer telehealth apps being developed daily, and retail health becoming more prevalent, there is a significant risk to not offering virtual care. Doctors and other providers could lose their patients to other companies and practices that are ahead of the curve. Q. What are remaining challenges to telemedicine being fully mainstream, including permanent reimbursement? How will healthcare provider organizations overcome these challenges? A. There are a couple of challenges that come to mind. The first that inhibits a large portion of the global population from widely leveraging telemedicine is lack of Internet connection. Without broadband and easy access to the web, telemedicine is nearly impossible. In time and with strong partnerships with Internet service providers and telecommunications organizations, the two industries will be able to offer greater accessibility to consumers and potential new patients. The second is the issue of reimbursement. There still is a lengthy discussion to be had about if payers should be required to reimburse for a telehealth appointment or service the same as they would for an in-office one. Some view a virtual care experience as less valuable and therefore, financially, worth less, as well. Providers and payers must work with legislators to combat this notion, and instead recognize the importance of telehealth, focusing on the needs of the consumer and potential to actualize value-based care. Virtual healthcare services will only continue to proliferate due to consumer demand and market competition. Regardless of reimbursement structure, the requirements and advancements in telehealth will dictate continued interest and opportunities. < Previous News Next News >

Telehealth Elements in American Rescue Plan COVID Relief Bill Center for Connected Health Policy April 2021 $50 million in grants for local behavioral health services, including via telehealth, and $140 million for information technology, telehealth and electronic health records at the Indian Health Service. March marked the passage of the third major COVID-9 relief bill (HR 1319), titled the American Rescue Plan. While the bill didn’t include significant changes in telehealth policy as past relief legislation has, it did have some nuggets for telehealth. For example, it establishes an Emergency Rural Development for Rural Healthcare Grant pilot that would, among other things, support telehealth programs. The bill also allots $50 million in grants for local behavioral health services, including via telehealth, and sets aside $140 million for information technology, telehealth and electronic health records at the Indian Health Service. To learn more, see the full text of the bill. American Rescue Plan: https://www.congress.gov/117/bills/hr1319/BILLS-117hr1319enr.pdf Indian Health Services: https://www.ihs.gov/ < Previous News Next News >

Trends in Telehealth Prescription Laws Kirin Goff, Southwest Telehealth Resource Center July 2021 New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. States across the country are proposing or enacting legislation that supports making the increased access to telehealth that occurred during the pandemic permanent. However, many states seem to struggle with how to appropriately regulate remote prescribing requirements as there is wide variation in approaches and priorities emerging in these proposed and new laws. The most common approach is to carve separate requirements for controlled substances, and then clarify if and under what circumstances they can be prescribed via telehealth. Notably, concerns about addiction and access to mental healthcare are becoming increasing prevalent in telehealth legislation. Some states are attempting to address the latter by specifically expanding telehealth to meet these needs, including allowances for remote prescriptions. The Worsening Drug Epidemic As the COVID-19 pandemic took center stage, substance use also increased. Preliminary estimates indicate that in the first eight months of 2020, drug overdose deaths increased by 48.1% in Arizona and 46.8% in Colorado, compared to same period in 2019. In the U.S. as a whole, drug overdoses increased by 27% between September 2019 and August 2020, compared to the previous twelve months (all data are based on Commonwealth Fund examination of provisional data from CDC’s National Vital Statistics System). As more Americans become personally impacted by the opioid epidemic, opinions about drug policy seem to be shifting. In lieu of strict regulatory measures, harm reduction is becoming more mainstream, and approaches seem to increasingly favor policies that improve access to care for substance use disorders. For example, the American Medical Association put out an issue brief supporting policies that employ evidence-based harm reduction policies and “remove existing barriers for patients with pain to obtain necessary medications…[including] arbitrary dose, quantity and refill restrictions on controlled substances.” Controlled Substance Prescription Arizona has addressed this issue most directly and comprehensively by enacting HB 2454. This law allows providers to prescribe Schedule II drugs, which are defined as drugs with high potential for abuse, such as Vicodin, methadone, and OxyContin, via audio-visual examination and delegates review for more detailed requirements to a newly created Telehealth Advisory Committee. The committee will “review national and other standards for telehealth best practices and relevant peer-reviewed literature” and establish best practices for providers to follow. This committee must include several experts in behavioral health and substance use, indicating that optimal ways to regulate prescribing controlled substances are a high priority. In other Southwestern states, the majority of recent bills on the topic focus on cannabis. For example, New Mexico’s medical marijuana law (HB 2) allows providers to determine medical marijuana qualification via telehealth. Likewise, Utah recently passed a bill (SB 170) allowing for medical marijuana renewal via telehealth examination, although it still requires in-person exams for initial recommendations. Research and Access to Care Healthcare access issues are also of primary concern, and telehealth is seen as a potential solution, particularly in rural areas. For example, New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. Likewise, Utah attempted (HB 36) to extend the term of a grant for research about how telehealth can improve access to mental health care, particularly for underserved populations. The range of proposed and enacted laws reflects a lack of evidence as well as differing ideologies among legislators. It is unusual for such substantial changes to the legal framework to occur so quickly – without more incremental steps and without a significant body of experience and precedent to glean from other jurisdictions. Arizona’s HB 2454 provides an innovative approach to remote prescribing by providing both access and data, which will be key to watch as states continue to pass telehealth legislation. < Previous News Next News >

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

Telehealth Remains Key Modality for Behavioral Healthcare Delivery eVista December 19, 2022 A Michigan-based provider leveraged a telehealth solution to expand critical access to behavioral healthcare as demand for these services skyrocketed during the COVID-19 pandemic. After reaching new heights during the first year of the COVID-19 pandemic, telehealth use is leveling off in several clinical care areas. But there is one prominent exception: behavioral healthcare. Healthcare stakeholders are continuing to flock to telehealth for behavioral health services. An analysis of data from January 2020 to March 2022 shows that mental health conditions were the most common telehealth diagnoses at the national level. In addition, data shows that amid a drop in overall telehealth use since 2020, telemental healthcare has grown. In the first quarter of 2019, 32.4 percent of all telehealth visits were related to behavioral healthcare, according to a market research report. That figure jumped to 59.9 percent by Q1 2022. This data, along with the ongoing mental health crisis in America, signifies the importance of providing virtual care options for behavioral healthcare. At Michigan-based Easterseals MORC, telehealth has been integral to behavioral healthcare delivery since 2019. Then, amid the pandemic, the organization saw its virtual visit volumes skyrocket, and they continue to show no signs of slowing down. "We went from 25 telehealth users before the pandemic to 300," says Clarissa Hulleza, Chief Information Officer of Easterseals MORC. "Those numbers are still going up. We're not seeing any decrease." WHY THE ORGANIZATION IMPLEMENTED TELEHEALTH Easterseals MORC, an affiliate of the national Easterseals organization, serves over 21,000 individuals annually. It provides a wide array of behavioral health services, including therapy, psychiatric care, and substance abuse treatment, as well as long-term care for those with intellectual and developmental disabilities. In 2019, the organization decided to implement a telehealth solution. One of the key goals of the move was to expand access to behavioral healthcare across the state. “The reason we pursued a telehealth solution was so that people who couldn't get to us regularly or at all, could be provided the opportunity to still receive care," says Hulleza. "We serve all of Michigan, and not all of Michigan has access to transportation, or maybe their closest local provider is 20 miles away. So, it was really creating more opportunities for access." Additionally, telemedicine was already becoming popular as a mode of physical healthcare delivery, prompting behavioral healthcare providers to catch up. "It was one of those, 'well, why aren't we doing the same?'" Hulleza says. Easterseals MORC partnered with eVisit to launch a telehealth pilot program in May 2019. A little under a year later, the COVID-19 pandemic hit, compelling providers across the country to rapidly scale up their telehealth programs. According to Hulleza, already having a telehealth solution and vendor partnership in place enabled Easterseals MORC to expand virtual care use seamlessly. "I would say that the absolute benefit was that we never had to close our doors," she adds. "In a time that people needed behavioral healthcare the most, we were able to provide it." IMPLEMENTATION CHALLENGES AND KEY LESSONS LEARNED Easterseals MORC leverages telehealth for nearly all of its services, including case management, one-on-one and group therapy. The organization even provided Applied Behavior Analysis (ABA) therapy virtually, which aims to improve social behaviors using interventions. But implementing a telehealth solution for behavioral healthcare has its challenges. For Easterseals MORC, those challenges ranged from clinician training to technology issues among those receiving services. Clinicians were not only providing care in a new way, they also had to become tech support in helping those they served navigate the new technology. Training is a critical aspect of telehealth technology implementation. If training is not provided proactively, it can result in clinicians avoiding virtual care use as they might find it difficult and overwhelming. “Pilot testing the solution before a full rollout was critical to ensuring that clinicians had adequate training to use the technology and that workflows were not negatively impacted,” Hulleza says. Partnering with the right vendor was a vital aspect of this effort, as the vendor was able to provide clinician training resources as well as suggest new policies and processes required to promote and support the telehealth program. “Ultimately, we selected our vendor because we were looking for a partnership that would improve the overall behavioral healthcare delivery experience. This meant that we needed a tool that offered more than a two-way video solution — one that integrated with, and empowered, the clinical workflow with value-added technology,” Hulleza shares. “There were multiple tools in the marketplace that solved the video connection challenge, but Easterseals MORC was looking to do more than simply move the clinical interaction to a video screen.” Further, choosing the right partner and then piloting the telehealth solution allowed the organization to test the supporting technology infrastructure before a full rollout. Easterseals MORC tested laptop specifications and made sure the solution worked equally well on different devices, including mobile phones and tablets. "We even went as far as making sure our bandwidth at all of our locations was increased so that if we had 20 people doing telehealth at the same time, there wouldn't be any degradation in services," Hulleza says. On the side of those receiving services, Easterseals MORC had to consider the digital divide facing its population. "[The people we serve] don't always have the newest phones, the best bandwidth," she says. "They don't have the luxury of going to a bedroom and closing the door. They might have shared living arrangements. We had to make sure we were accommodating all of those things." To address individuals' technology access needs, the organization applied for various grants and used those to provide iPads and iPhones with built-in data plans. Another essential aspect of closing the digital divide is identifying the viability of an individual to receive services via telehealth. Easterseals MORC uses a checklist tool provided by the telehealth vendor to identify these individuals and the barriers they face. "Do you have a private place? Do you have a microphone? What model phone do you have or mobile device?" Hulleza adds. "The tool goes through all of these questions and allows providers to evaluate if telehealth is an option." Easterseals MORC plans to solidify telehealth as a key behavioral health delivery mechanism within its business. It is unclear if Congress will make the temporary telehealth flexibilities enacted during the pandemic permanent — but for Hulleza, there is no going back. "I absolutely want to grow telehealth here," she says. "The need amplified because of the pandemic, but telehealth was going to exist for our organization even if the pandemic didn’t happen." ____________________________ About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/telehealth-remains-key-modality-for-behavioral-healthcare-delivery < Previous News Next News >

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

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