Apply Now: $250 M in Telehealth Grants National Council for Behavioral Health April 30, 2021 Telehealth Grants - Apply Now Yesterday, the Federal Communications Commission (FCC) opened its second phase of the COVID-19 Telehealth Program with an additional $250 million available to eligible providers, including community mental health and substance use organizations. Organizations are strongly encouraged to apply for the grants that may be used to fund technology and equipment to bolster service delivery via telehealth. The application will close at 12:00pm ET on May 6, 2021. Read more and reach out here with any specific questions on the application process. COVID-19 Telehealth Program Application Resources: https://www.usac.org/about/covid-19-telehealth-program/covid-19-telehealth-program-application-resources/?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjbshy_rZnI19Utm_szbXLRtL_Em1obbBZMPGjL8UcKptxsAQkufy8_qpLAJ8F7YLbidFX_B4uUKtfjz1Xqfb00kuVsv-2qjkBEx3 COVID-19 Telehealth Program (Invoices & Reimbursements): https://www.fcc.gov/covid-19-telehealth-program-invoices-reimbursements?mkt_tok=NzczLU1KRi0zNzkAAAF8wn-qjeRoIRGRmJOwVOAO8DxtchsnKpit1UbNY_hCbZZVDnK6jxX-VTendryRdaw0BeLxWnFcR90xotZs6ikzMrcjjvHZgcWX3tpv1reh Questions: Round2TelehealthApplicationSupport@usac.org < Previous News Next News >

What you need to know about standing up a virtual nursing unit Bill Siwicki February 15, 2022 Jennifer Ball, RN, director of virtual care at Saint Luke's Health System of Kansas City, describes the workings and many benefits of the telehealth approach. The U.S. nursing shortage has reached critical levels during the pandemic battle, paired with an aging population. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees. To serve its inpatient population and overcome the nursing shortage, St. Luke's Health System of Kansas City has developed an innovative approach leveraging virtual care. The organization created and implemented one of the nation's first virtual nursing units to reduce the burden on bedside nurses and much more. In her HIMSS22 educational session entitled "Lessons Learned from Launching a Virtual Nursing Unit," Jennifer Ball, RN, director of virtual care at Saint Luke's Health System of Kansas City will offer attendees next month a deep dive into the workings of the virtual nursing unit. She has been a nurse for 35 years, with a clinical background in ICU, trauma and ED, and has 25 years of experience in nursing management. To read the full article: https://www.healthcareitnews.com/news/what-you-need-know-about-standing-virtual-nursing-unit < Previous News Next News >

Updated Version of CONNECT for Health Act Introduced in Congress Center for Connected Health Policy May 4, 2021 Last week an updated version of the CONNECT for Health Act was introduced in Congress. Last week an updated version of the CONNECT for Health Act was introduced in Congress. The bill, which was first introduced in 2016 but has been repurposed in this newest version to remove restrictions on telehealth for mental health, stroke care and home dialysis in certain circumstances. It also addresses several of the restrictions in Medicare, including geographic limitations, expanding originating sites to include the home, restrictions on federally qualified health centers (FQHCs) and rural health clinics (RHCs) reimbursement and gives the Secretary of Health and Human Services the ability to waive other telehealth restrictions permanently. For more information, see the press release, or read the bill’s summary published by Senator Schatz office. Stay tuned for a deeper dive and further analysis from CCHP next week. Press Release: https://www.schatz.senate.gov/press-releases/schatz-wicker-lead-bipartisan-group-of-50-senators-in-reintroducing-legislation-to-expand-telehealth-access-make-permanent-telehealth-flexibilities-available-during-covid-19-pandemic Summary: https://www.schatz.senate.gov/imo/media/doc/CONNECT%20for%20Health%20Act%20of%202021_Summary.pdf < Previous News Next News >

Teladoc Reports $133M Net Loss in Second Quarter, but Visit Numbers Are Up Kat Jercich, Healthcare IT News July 2021 Meanwhile, Amwell announces its acquisition of SilverCloud Health and Conversa Health. The virtual care giant Teladoc released its earnings report this week, showing a net loss of $133.8 million for the second quarter of 2021. Total net loss for the first half of 2021 was $333.5 million, compared to $55.3 million for the same time period last year. At the same time, the vendor said its $503 million second-quarter revenue earnings had more than doubled compared with 2020. This change led Teladoc to forecast its total yearly revenue to be in the range of $2 billion to $2.025 billion, with a predicted net loss between $3.35 and $3.60 per share. Its visit numbers were also up, at 3.5 million: 28% higher than the second quarter of 2020, during the first wave of the pandemic. The company expected 13.5 million and 14 million total visits this year. After the earnings report, Teladoc's shares fell more than 7% in the extended session Tuesday, as reported by MarketWatch. Still, execs voiced optimism, driven in part by the launch of myStrengthComplete and what the company described as a "significant new agreement" with the Health Care Service Corporation. "Teladoc Health delivered a strong second quarter, marked by exciting new client wins, product launches, and tremendous progress on our quest to be the category-defining provider of whole person virtual care," said CEO Jason Gorevic in a statement. "We have solid momentum heading into the second half as the market embraces the unified care experience that only Teladoc Health has the breadth and scale to achieve," he added. New Amwell acquisitions Teladoc competitor Amwell was also in the news this week for its $320 million acquisition of SilverCloud Health and Conversa Health. SilverCloud Health delivers a range of digital cognitive behavioral health programs, which the company says are evidence-based and clinically validated. According to SilverCloud, the programs are used by more than 300 organizations, including Kaiser-Permanente, Optum and Providence Health. Amwell will use the platform to enrich its own behavioral health offerings and develop new programs. Conversa Health, meanwhile, uses automated patient interactions to ensure patients stay on track before and after live or virtual visits. It is used, the company says, by organizations including Northwell Health, UCSF Health, UNC Health, University Hospitals and Prisma Health. Amwell says it will use Conversa's technology to advance initiatives aimed at longitudinal care, clinical quality and population health. The acquisitions will also enable Amwell to create new digital workflows and programs and expand its client base to include those of Conversa and SilverCloud – especially in the U.K. "We believe that future care delivery will inevitably blend in-person, virtual and digital care experiences; and as such, we are uniquely building a global platform to support such advanced, coordinated care," said Ido Schoenberg, chairman and co-CEO at Amwell. "By integrating SilverCloud Health and Conversa Health into our platform, we are demonstrating Amwell’s fundamental and repeatable design to continually scale digital healthcare services across the different sites of care," he added. "These acquisitions will amplify the presence and reach of care teams and reaffirm that as the needs of the healthcare marketplace evolve so too will the Amwell platform." < Previous News Next News >

States Expand Medicaid Reimbursement of School-Based Telehealth Services Center for Connected Health Policy June 2021 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. The National Academy for State Health Policy released a report last month on how states are increasing Medicaid coverage of school-based telehealth during COVID-19, as well as assessing which services can be effectively delivered via telehealth and how to best support equitable access to services via telehealth for students. The authors found that 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. As far as services, the brief showed that most states cover audiology and speech-language therapy via telehealth, although behavioral health services had the greatest expansion and providing telemental health they found to be a recognized best practice. Half of all states cover individualized education program (IEP) plan services or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as well. The report also suggests that moving forward states should explore federal funding opportunities to expand technology and broadband access for students facing disparities in access to care. < Previous News Next News >

Emergency telemedicine poised to grow in pandemic’s new phase Tanya Albert Henry, Contributing News Writer May 23, 2022 Emergency medicine is likely not the first specialty that comes to mind when thinking about the clinical areas that can benefit greatly from telehealth. But this digitally enabled mode of health care delivery that took off at the pandemic’s onset was helping in the emergency medicine setting before COVID-19 and will only continue to grow. An AMA Telehealth Immersion Program event co-hosted with the American College of Emergency Physicians (ACEP) provided an overview of the innovative ways telemedicine is being used in emergency settings and discussed how telehealth can continue to help physicians provide better care for patients. Emergency medicine doesn’t take place in one spot in the hospital and emergency physicians are trained to take care of emerging acute care situations in any setting, said Aditi U. Joshi, MD, chair of ACEP’s telehealth section. That includes the kind of asynchronous care that can be part of telehealth. Triage involves determining which kind of care presenting patients require. “Can they stay at home, do they need to go to an urgent care, primary care, or do they need to come into the emergency department?” she said. “We are uniquely skilled in that.” Telestroke was another form of telehealth in use before the COVID-19 pandemic, and telehealth was in use at freestanding emergency departments and urgent care centers. And here are a few ways that virtual care is poised to continue to grow: Triage. This can include, for example, talking to the emergency medical services unit on the way to the hospital, long-term acute care (LTAC) triage, and telemedicine screening exams. Direct, acute unscheduled care. For example, virtual urgent care, ED consults to help with things such as transfer stabilization treatment advice, LTAC, correctional medicine, or skilled nursing facility consults. Virtual (out of ED) observation. For example, post-ED follow-up visits, remote home monitoring, and hospital at home. The AMA helps guide physicians, practices and health systems in optimizing and sustaining telehealth at their organizations through the AMA Telehealth Immersion Program. The program builds on The Telehealth Initiative and is part of the AMA STEPS Forward® Innovation Academy, which enables physicians to learn from peers and experts and discover ways to implement time-saving practice innovation strategies. Benefits in the rural setting Over the past decade, 120 U.S. hospitals closed and 31 states have seen at least one rural hospital among those closures. With 20% of the population living and working in a rural area where hospitals often have limited staff, wait times for EDs in the rural hospitals are higher than the national average that is already at 24 minutes—and that is to see a nonphysician such as a nurse practitioner or physician assistant. It’s not uncommon for a physician to have to be called to come in from home at night because there are not enough doctors to staff the hospital 24/7. Emergency physician Kelly Rhone, MD, interim chief medical officer and vice president of innovation and outreach at Avel eCare, said their virtual health system—started in 1993—works with rural hospitals across the country to provide emergency care. They are hard-wired into EDs where health professionals with the push of a button can connect to their virtual emergency department, staffed with emergency physicians and nurses, to direct those who have their hands on the patients who may be in cardiac arrest, suffering from a stroke or facing other life-threatening injuries. “We are making a difference in rural health and bringing cutting-edge emergency medicine to the bedside,” Dr. Rhone said. Emergency telehealth in big cities too Telemedicine in the ED setting has benefits in large urban areas such as Los Angeles, too. Moshen Saidinejad, MD, directs pediatric emergency medicine at Ronald Reagan UCLA Medical Center, and said many children go to EDs that aren’t set up for pediatric patients and telemedicine allows those trained in pediatric emergency medicine to consult with those treating a child. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. For more information see full article: https://www.ama-assn.org/practice-management/digital/emergency-telemedicine-poised-grow-pandemic-s-new-phase?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

What an eventual end to the PHE would mean for telehealth Andrea Fox October 17, 2022 Among other impacts, ending the PHE would represent access challenges and a loss of Medicaid coverage for millions, and would end medication-assisted treatment for opioid use disorder without an in-person exam. Since the COVID-19 public health emergency was declared in 2020, the Department of Health and Human Services has renewed the legislation every 90 days. Close to the end of the most recent expiration date, October 13, HHS Secretary Xavier Becerra again signed a renewal determination and it was posted without announcement late in the day. There had been no official news, but a lot of hearsay that the PHE would be renewed once more, because the Biden Administration indicated it would give two months' notice before its expiration. There is also the matter that open enrollment begins on November 1, and without the relaxed enrollment provisions for Medicaid that the PHE provides, the national uninsured rate along with health premium costs would certainly rise. But by definition an "emergency" can't last forever. The inevitable end of the PHE could result in the loss of Medicaid to millions when states review enrollee eligibility and in other impacts to healthcare operations. Questions regarding what will happen to telehealth benefits and the continuum of care in the absence of the PHE loom large. There has been extensive support for making the changes that have launched telehealth and provided the opportunity to serve more patients, but some people want to halt the prescribing of controlled substances via telehealth for mental health and substance abuse disorders and see the Ryan Haight Act – the online pharmacy consumer protection act of 2008 – reinstated. What's at stake Despite the Consolidated Appropriations Act of 2022, which provides a 151-day extension on some flexibilities granted during the COVID-19 public health emergency once the PHE ends, providers and other healthcare professionals engaged in telehealth are eager to prepare for the expiration date. There has been mounting pressure from the Republican Party, including a September 19 letter from Sen. Richard Burr, R-N.C., with numerous questions about ending emergency powers after President Joe Biden remarked during his September 60 Minutes appearance that "the pandemic is over." "Without a clear plan to wind down pandemic-era policies, the deficit will continue to balloon and the effectiveness of public health measures will wane as the American people continue to be confused by mixed messages and distrust of federal officials," wrote Burr. Despite economic concerns, ending the legal waivers afforded under the PHE could ricochet, hammering against gains made in increased patient access. Dr. Adrienne Boissy, Qualtrics chief medical officer (and former Cleveland Clinic chief experience officer), notes that patients continue to rely on expanded digital access as mental health effects from the pandemic linger. She says that a reversal would limit digital health access, which an overly burdened and understaffed industry has come to rely on. "The ease and convenience telehealth provides are consistent sources of positive patient experiences, as well as decreased total costs of care and less time away from the workplace," she said in a statement to Healthcare IT News. "Comparing 2016 to 2022, clinicians also report better health outcomes for patients, efficiency and less stress/burnout as major drivers for adopting digital tools, including telehealth," she said. "With the PHE, we saw the industry put patients and their access to care first – no longer hindered by location or demographics. "To revert back to reimbursement models that only support in-person care unravels the gains of meeting people where they are – physically and emotionally," said Boissy. "We can’t turn back now," Boissy said. Brad Kittredge, CEO and cofounder of Brightside Health, adds that the country will be short of psychiatrists – by 14,280 to 31,109 – in just a few years. Ending the PHE presents a reduced ability to serve the growing number of patients in need of or seeking mental healthcare, he said. "While there’s no silver bullet solution, telehealth offers the best and most immediate solution to this growing challenge by increasing patient access to mental health specialists without being limited to geographic regions or facilities," Kittredge explained in a statement sent to HITN. "More significantly, telehealth enables us to use technology and data to help clinicians be more efficient and effective at treating their patients, maximizing the impact they can make," he said. Telehealth in legislative limbo During a recent American Telemedicine Association policy update, the ATA's federal and state-level telehealth policy experts described efforts to develop a consistent regulatory framework so telehealth can be deployed across states, be fully leveraged and address the patchwork of 50 different state requirements. Legislators have also proposed broadening access to telehealth through the Telehealth Benefit Expansion for Workers Act, the Telehealth Extension Act and the Advancing Telehealth Beyond COVID-19 Act of 2021, which was passed by the House of Representatives in July, received in the Senate and referred to the Committee on Finance, where it sits. Also at play are a number of loosened restrictions that opened the gateway to online treatment of certain conditions when uptake surged and access to in-person medical care was restricted. Healthcare organizations and retailers entering the space through mergers and acquisitions with healthcare providers have urged the U.S. Justice Department and the Drug Enforcement Agency to revise telehealth controlled substance rules. The bill H.R. 7666 – the Restoring Hope for Mental Health and Well-Being Act of 2022 – introduced by Rep. Frank Pallone Jr., D-N.J., which was passed in the House, aims to address this hot-button issue for mental telehealth providers. The bill would permanently eliminate the X waiver, currently not required under the PHE. To qualify for the waiver to dispense buprenorphine for maintenance or detoxification treatment, the practitioner must take an eight-hour training and may only treat up to 30 opioid use disorder patients. Dr. Kristin Mack, a physician in Ticonderoga, N.Y., told MedPage Today that she would like to see the X waiver eliminated permanently. According to the story, rural communities are some of the hardest hit by the opiate epidemic. "We work really hard with community resources to provide counseling and things like that. But if I were to tell somebody, 'Oh, you have to go an hour away to a city to get care for this,' and then they need to be seen monthly, it's just not an option," she said. The Restoring Hope for Mental Health and Well-Being Act of 2022 was received in the Senate and was referred to its Committee on Health, Education, Labor and Pensions at the time of reporting. Treating opioid use disorders via telehealth It has been more than 10 years since the Ryan Haight Act mandated that DEA establish a rule ensuring that healthcare providers can successfully prescribe controlled substances via telehealth, but there has been no rule set forward. The SUPPORT Act again mandated the DEA issue rulemaking by October 2019 and the fiscal year 2021 final appropriations report requested that the agency establish these rules, according to the website of Sen. Mark Warner, D-Va. This past year he urged the Biden Administration to finalize regulations that allow doctors to prescribe controlled substances through telehealth. "In practice, the DEA’s failure to address this issue means that a vast majority of healthcare providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need. These restrictions have been temporarily waived during the COVID-19 public health emergency, and I welcome that, but patients and providers need a more permanent and long-term solution to this long-delayed rulemaking," Warner wrote in May 2021. Under the PHE, several virtual behavioral health startups focused on medication-assisted treatment for substance abuse disorder received investment rounds, according to Chris Larson at Behavioral Health Business. According to the story, Doug Nemecek, the chief medical officer of behavioral health for Evernorth, said that not enough people are accessing MAT, and that overdose rates have reached historic highs. "If regulations come back that prevent those companies from being able to deliver care in that way, we’re concerned that it’s going to have a negative impact on patients and our ability to make sure that people have access to the MAT that we want them to have access to," Nemecek said. Evernorth, part of Cigna Corp., is connected to digital MAT companies like Quit Genius. The cofounder of Quit Genius, Dr. Maroof Ahmed, explained in an email to Healthcare IT News that telehealth has filled a void that existed before the PHE. "Telehealth flexibilities and ePrescribing waivers have been crucial in enabling providers to care for patients during the pandemic and have greatly expanded access to care in situations where patients were unable or unwilling to travel to a physical location," he insists. Reinstating Ryan Haight Act requirements also has support Amending the Ryan Haight Act law is an effort largely supported in the healthcare and mental health space. However, Dr. Mimi Winsberg, CMO and the other cofounder of Brightside Health, shared another point of view regarding the dubious practice of prescribing controlled substances without an initial in-person visit. "To count on a public health emergency temporary lifting of laws in order to stimulate growth of your business is perhaps a questionable practice," she told Healthcare IT News, noting that Brightside adhered to not prescribing controlled substances over telemedicine despite the legal waivers. "While a lot of medical visits moved to tele during this sort of difficult part of the pandemic, that now in most specialties, they have gone back to in-person, but what we are seeing in mental health is about 80% have stayed remote," she added. "And so patients are continuing to get their mental healthcare largely through telemedicine." Winsberg entertained the question out loud: "Will they be resistant to in-person appointments if they need certain kinds of prescriptions?" "I don't think they will because we have seen that they're willing to go back to the doctor for other reasons," she added. The net growth of prescription drugs issued – stimulants and other controlled substances – grew during the pandemic, and she says she questions if the growth was largely driven by online practices "that were taking advantage of the lifting of the Ryan Haight Act." Winsberg did acknowledge, however, that an inability to prescribe buprenorphine via telehealth for substance abuse disorder, "is potentially an issue," she said. "These laws exist for a reason, and what we have to balance in medicine is the willingness to help people with the do no harm principle." Establishing systematic monitoring of controlled-substance prescribing via telehealth could be achievable, Winsberg said. "But, we'd like to move towards appropriate prescriptions of controlled substances, and if we can find a way to meaningfully regulate that online, then great," she concluded. Equal treatment for mental health disorders In January, Dr. Robert Field and doctoral candidate Kimberly Williams at Drexel University published a commentary on the National Academy of Medicine website on the long overdue policy update needed to prescribe buprenorphine via telehealth. The authors say that those who need treatment for opioid use disorder should have the same level of telehealth access as others who receive treatment for other medical concerns. They also noted that the DEA has not created a registration process through the online pharmacy consumer protection act, despite Congressional requests and statutory actions. "Doing so would not only ensure increased access to treatment but also set the stage for systematic monitoring of telemedicine and telephone services to confirm they meet the same rigorous standards of care as in-person services. "Such quality assurance efforts could promote the development of best practice guidelines and reduce variations in care as usage of these modalities increases," they argue. For the mental telehealth provider community wondering if the ability to prescribe buprenorphine via telehealth fades away in five months – if the Biden Administration does not intervene and extend the PHE, Congress does not pass legislation and the DEA does not create a registration process for prescribing controlled substances for opioid use disorder via telehealth – the U.S. may face even higher overdose rates. 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/what-eventual-end-phe-would-mean-telehealth < Previous News Next News >

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

Telehealth, physical therapy and the pandemic: Lessons for all Bill Siwicki February 14, 2022 A University of Washington clinical instructor explains the benefits and challenges of therapy and technology. For vulnerable patient populations – and for those who just prefer the convenience of care at home – telemedicine has been a success. But it still has its limitations. For example, the precise movements and exercises involved in physical therapy rehab are hard for a patient to accomplish remotely. A provider on a video call may seem about as valuable as a YouTube video. But there are new technologies and strategies that link patients, safely, to at-home physical therapy care that balances telemedicine with in-person visits. Many experts say this is the future of telemedicine: a hybrid of in-person and virtual care. To read the entire article: https://www.healthcareitnews.com/news/telehealth-physical-therapy-and-pandemic-lessons-all < Previous News Next News >

AMA survey shows widespread enthusiasm for telehealth American Medical Association March 23, 2022 CHICAGO — An American Medical Association (AMA) survey released today shows physicians have enthusiastically embraced telehealth and expect to use it even more in the future. Nearly 85% of physician respondents indicated they are currently using telehealth to care for patients, and nearly 70% report their organization is motivated to continue using telehealth in their practice. Many physicians foresee providing telehealth services for chronic disease management and ongoing medical management, care coordination, mental/behavioral health, and specialty care. The survey comes as Congress recently extended the availability of telehealth for Medicare patients beyond the current COVID-19 public health emergency. Additional action by Congress will be needed to permanently provide access to Medicare telehealth services. As physicians and practices plan to expand telehealth services, they say widespread adoption hinges on preventing a return to the previous lack of insurance coverage and little to no payer reimbursement. Payers, both public and private, should continue to evaluate and improve policies, coverage, and payment rates for services provided via telehealth. “Physicians view telehealth as providing quality care to their patients, and policymakers and payers have come to the same conclusion. Patients will benefit immensely from this new era of improved access to care,” said AMA President Gerald E. Harmon, M.D. “This survey shows adoption of the technology is widespread as is the demand for continued access. It is critical that Congress takes action and makes permanent telehealth access for Medicare patients.” Physicians strongly support that telehealth via audio-only/telephone remains covered in the future to ensure equitable access. That coverage has been permitted during the public health emergency and extended for several months afterward. According to the survey, 95% of physicians report patients are primarily located at their home at the time of the virtual visit. Allowing patients to be in their home is a key component of making telehealth more accessible. Before the pandemic, Medicare patients needed to be physically located in a rural area to access telehealth services, shutting out urban and suburban patients from receiving the same benefits of virtual care. Before the pandemic, rural patients needed to travel to an “originating site,” essentially another health care facility, outside of their home to access telehealth services. The temporary extension in the omnibus will allow patients with Medicare to receive telehealth services anywhere they are located, including in their home. The AMA will continue to urge Congress to make permanent this and other policies that have offered coverage and convenience to patients. Fewer than half of respondents report being able to access all of their telehealth platforms via their electronic health records, and more than 75% report that their support technology does not automatically collect and deliver patient-reported data. Improving interoperability between platforms and support technology would improve and streamline telehealth services. Physicians perceive technology, digital literacy, and broadband internet access to be the top three patient barriers to using telehealth. In addition, only 8% of physician respondents said they were using remote patient monitoring at this time. The AMA will advocate for patient populations and communities with limited access to telehealth service, including but not limited to, supporting increased funding and planning for telehealth infrastructure such as broadband and internet-connected devices. Read the survey here. To learn more about the results, register for an AMA Telehealth Immersion Program webinar at 10 a.m. ET March 31. Media Contact: Jack Deutsch ph: (202) 789-7442 jack.deutsch@ama-assn.org About the American Medical Association The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care. < Previous News Next News >

Update on Risks of Payments in Arrangements With Telemedicine Companies: OIG Warns of Prosecution Risks and Identifies Seven Criteria for Caution When Entering Into Telemedicine Payment Arrangements, and the Advancing Telehealth Beyond COVID-19 Act Passes Andrea M. Ferrari, Nadia de la Houssaye August 26, 2022 On July 20, 2022, the Office of Inspector General of the US Department of Health & Human Services (OIG) issued a Special Fraud Alert urging healthcare practitioners to exercise caution when entering into arrangements with telemedicine companies. OIG issued this Special Fraud Alert the same day the US Department of Justice (DOJ) announced criminal charges against 36 defendants in 13 federal districts as part of the DOJ’s Nationwide Coordinated Law Enforcement Effort to Combat Telemedicine, Clinical Laboratory, and Durable Medical Equipment Fraud.[1] The Special Fraud Alert notes that OIG has recently conducted dozens of investigations of alleged fraud schemes involving companies that provide telehealth, telemedicine, or telemarketing services (collectively, Telemedicine Companies). It also notes that in many of these investigations, OIG found evidence that the Telemedicine Companies intentionally paid physicians and non-physician practitioners (collectively, Practitioners) kickbacks to generate orders or prescriptions for medically unnecessary durable medical equipment, genetic testing, wound care items, or prescription medications. The Special Fraud Alert warns that such kickback schemes implicate the federal Anti-Kickback Statute and can lead to Practitioners, Telemedicine Companies, and others that participate in the schemes being held liable criminally, civilly, and administratively. Liability may arise from (1) paying or receiving payment in violation of the federal Anti-Kickback Statute; and (2) causing submission of fraudulent claims to federal healthcare programs such as Medicare, Medicaid, and Tricare, which may constitute a violation of the federal False Claims Act and other federal laws. As a cautionary guide, the Special Fraud Alert identifies seven arrangement characteristics that may raise OIG scrutiny: 1. The patients for whom a Practitioner orders or prescribes items or services are identified or recruited by a Telemedicine Company, sales agent, recruiter, call center, or health fair, and/or through internet, television, or social media advertising for free or low-cost out-of-pocket items or services. 2. A Practitioner does not have sufficient contact with or information from the purported patient to meaningfully assess the medical necessity of the items or services ordered or prescribed. 3. A Telemedicine Company compensates a Practitioner based on the volume of items or services ordered or prescribed, which may be characterized to the Practitioner as compensation based on the number of medical records that the Practitioner reviewed. 4. A Telemedicine Company furnishes items and services only to federal healthcare program beneficiaries and does not accept insurance from any other payor. 5. A Telemedicine Company claims to furnish items and services only to individuals who are not federal healthcare program beneficiaries but may, in fact, bill federal healthcare programs. 6. A Telemedicine Company only furnishes one product or a single class of products (e.g., durable medical equipment, genetic testing, diabetic supplies, or various prescription creams), potentially restricting a Practitioner’s treatment options to a predetermined course of treatment. 7. A Telemedicine Company does not expect Practitioners to follow up with patients, nor does it provide Practitioners with the information required to follow up with patients (e.g., the Telemedicine Company does not require Practitioners to discuss genetic testing results with each purported patient). OIG advises in the Special Fraud Alert that this list of suspect criteria is illustrative and not exhaustive. Therefore, even arrangements that do not specifically fit one or more of these suspect criteria may still be suspect. However, OIG also indicates that it recognizes there are many legitimate telemedicine and telehealth arrangements, and explicitly states that the Special Fraud Alert is not intended to discourage those legitimate arrangements. Rather, OIG is using the Special Fraud Alert to encourage Practitioners (and, by extension, their advisors) to use heightened scrutiny, exercise caution, and consider the above list of suspect criteria before entering into arrangements with Telemedicine Companies. Telehealth Expansion Legislation Significantly, a week after OIG issued the Special Fraud Alert, the US House of Representatives overwhelmingly (416-12) passed the Advancing Telehealth Beyond COVID-19 Act of 2022 (HR 4040), which encourages broad use of telehealth by expanding and extending for at least an additional two years — through December 2024 — the Medicare telemedicine payment policies that were introduced for the COVID-19 public health emergency. The House bill removes geographic restrictions and expands originating sites for telehealth services, continues expansion of the practitioners eligible to provide telehealth services, allows mental health services to be provided via telehealth and telecommunications, and continues certain COVID-19 allowances for audio-only telehealth services. The bill is now pending in the Senate. [1] Press Release, US Department of Justice, Justice Department Charges Dozens for $1.2 Billion in Health Care Fraud (July 20, 2020), https://www.justice.gov/opa/pr/justice-department-charges-dozens-12-billion-health-care-fraud. © 2022 Jones Walker LLP National Law Review, Volume XII, Number 238 See Original article: https://www.natlawreview.com/article/update-risks-payments-arrangements-telemedicine-companies-oig-warns-prosecution < Previous News Next News >

HHS-OIG Reports on Pandemic Medicare Telehealth Trends to Inform Permanent Policies Center for Connected Health Policy Nov. 2, 2021 The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. The Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a telehealth report on October 18th that looked at the relationship between providers and Medicare patients utilizing telehealth between March and December 2020. Specifically, HHS-OIG examined encounter claims data to determine the presence of pre-existing relationships, dates of any prior visits, and the types of services provided. Interestingly, it was found that though pre-pandemic requirements limiting telehealth visits to established patients were waived, 84% of visits still occurred within those parameters. In addition, as policymakers consider making some telehealth pandemic policies permanent, some stakeholders have suggested a need to require an in-person visit within a certain period of time in order to be eligible for a telehealth visit. However, the data collected by HHS-OIG shows such requirements may not be necessary, as Medicare patients were found to already have had an in-person visit on average within four months prior to the telehealth visit without such a requirement. Additional findings included: Beneficiaries most commonly received e-visits, virtual check-ins, and telephone evaluation and management services via telehealth from providers with whom they had an established relationship Beneficiaries received about 45.5 million office visits delivered via telehealth, which accounted for nearly half of all telehealth services 86% of traditional Medicare beneficiaries received a telehealth service from providers with whom they had an established relationship, compared to 81% of Medicare Advantage Beneficiaries who received home visits via telehealth, which represented only 1% of all services provided via telehealth, were the least likely to have an established relationship with their providers The average amount of time between beneficiaries’ in-person visits and their first telehealth services varied by type of service Beneficiaries who received home visits via telehealth had an in-person visit with their providers at an average of around 9 months prior to first telehealth service Beneficiaries who received nursing home visits and assisted living visits via telehealth had an in-person visit at an average of 2 months prior to their first telehealth service HHS-OIG notes that the provision of this data seeks to inform policymakers looking at long-term telehealth policy and making certain pandemic expansions permanent, especially in light of concerns around telehealth fraud and abuse. For instance, it could help in examining the necessity of one of the most controversial, and confusing, permanent federal changes made thus far as part of the Consolidated Appropriations Act, which post-PHE will require an initial in-person visit within 6-months of a tele-behavioral health visit for purposes of Medicare reimbursement. However, the requirement only applies if the service is not provided in a geographically rural area and at a qualifying medical facility. There is also an exception for treatment of substance use disorder and co-occurring mental health treatment. In addition, CMS is proposing to make the 6-month in-person visit a requirement for subsequent visits in the proposed calendar year 2022 physician fee schedule. For non-behavioral health visits, the 6-month requirement wouldn’t apply, however patients would need to be located in a rural area and eligible facility type to qualify for Medicare reimbursement. Some Medicaid programs are considering limiting telehealth use to established patients, occasionally also applying restrictions to specific modalities and services. However, the HHS-OIG findings may suggest that it is unnecessary to limit telehealth to certain patients and services to prevent fraud and abuse as standard practice may already be providing sufficient guardrails in those respects. In addition, the study findings could indicate that the issue may be more related to general standard of care concerns that apply across all services, not just those delivered via telehealth. The balance may then include looking at how to manage health care fraud generally, which elsewhere HHS-OIG has clarified that most fraud is not telehealth specific. The issue could then boil down to how much autonomy to provide clinicians when making medical determinations, including when a telehealth visit is appropriate. Typically oversight in that respect has been under the purview of clinical licensing boards, not governed by general laws, but as we shift outside of the pandemic it is possible we may see additional shifts in terms of these policy approaches. As policymakers balance these multiple findings, perspectives and concerns, it remains to be seen how such data will be applied or used to justify permanent policies. It will also be important to continue to weigh these factors against general access to care issues so as to not inadvertently limit telehealth as a means of ensuring patients can receive necessary medical services. Additional information on the HHS-OIG study can be found by viewing the brief and complete report. < Previous News Next News >

Teledentistry – Lights. Camera. Open Wide. By Trudy Bearden April 7, 2021 The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. Well… not quite; but it may not be what you think. I’m not here to make the case about the importance of good oral health, the impacts of poor oral health on overall health and chronic disease, the potential to lower health care costs and our countless opportunities to integrate oral health into health care services. Rather I ask that you join me to learn just a bit more about what teledentistry is and how it can be used to expand access, provide education and elevate team-based care. Teledentistry. The American Dental Association (ADA) Policy on Teledentistry notes that services delivered via teledentistry must be consistent with how they would be delivered in-person. According to the ADA, teledentistry includes patient care and patient education delivery using (but not limited to) four modalities: Synchronous (live video) – use of audio and video for real-time communication Asynchronous (store and forward) – secure electronic transmission of radiographs, photos, video, digital impressions or photomicrographs, etc. to evaluate, render an opinion or service or develop a treatment plan Remote physiologic monitoring – electronic transmission of physiologic data (e.g., weight, oxygen saturation, blood glucose levels) Mobile health (mHealth) – sharing of education and/or information by mobile communications or use of apps (e.g., reminds or monitors oral hygiene activities) Store and forward. Dental hygienists can assess the mouths of patients, chart areas of concern, decay or periodontal disease, take high-resolution photographs and x-rays and transmit that information to a dentist who can review the materials and develop a treatment plan for a patient. Expand access. In rural areas with shortages of dentists, primary care clinics can “bring” a dentist or other oral health specialist into the exam room by synchronous (live video) communication to assess and discuss a dental issue and subsequent treatment plan for a patient. This is a far superior option than just prescribing antibiotics and pain medications, which may end with the patient in the emergency department. Education. Using a synchronous modality, there are ample opportunities for providing oral health education to patients and families, those in dentistry, those in the medical field, teams considering oral health integration and more. While there are several teledentistry modalities available, the following are the high leverage applications: Using store and forward technology for dental hygienists and others on dental and medical care teams Including dentists and other oral health and dental specialists (e.g., orthodontist) to join primary care office visits Using synchronous and asynchronous (e.g., secure messaging/email) options for provider-to-provider consults Providing synchronous and broad oral health education What’s in it for us and ours? How do we harness teledentistry to improve oral health? As an individual, it’s reasonable to ask your dentist what they are doing or are planning to do to implement or expand teledentistry to know whether there are additional options for you. If delivering health care services to patients, whether in the outpatient, inpatient, specialist, long-term service supports or elsewhere, we should: Know what the teledentistry options are in our area, especially if we are in a rural area with a shortage of dentists Ensure that all patients have a dental home and are receiving preventive and curative dental services – by teledentistry if necessary and available to them Consider an oral health education program that is delivered virtually or remotely and/or includes mHealth or app-based options If you are particularly passionate about the potential of teledentistry, know the barriers in your state and area and find ways to overcome those barriers, which include parity of coverage, parity of payment, and statutes governing teledentistry in your state. Checking this interactive map from the Center for Connected Health Policy is a good starting place. Adequate and access to bandwidth and provider, patient and family buy-in can be significant factors as well. Either way – let’s get our teeth into teledentistry and do what we can to leverage the full range of options to help individuals optimize their oral health. Interactive map: https://www.cchpca.org/ < Previous News Next News >

Telehealth regulations don't go far enough for some Georgina Gonzalez April 21, 2022 Telehealth protections are fading as pandemic era waivers, which allowed providers to treat patients across state lines, are expiring. Many lobbyists are worried about the future of the industry and believe that the current proposals don't do enough to help secure its future, Politico reported April 20. More than 30 states have signed onto the American Medical Association favored Interstate Medical Licensure Compact, which creates a common application for providers, allowing them to more easily apply for licenses to practice in other states. However, some lobbying groups don't think the compact is enough. "[The compact] streamlines the application process, but it doesn't do a lot to reduce the burdens and costs of maintaining a multistate licensure footprint. That is a source of a lot of frustration for physicians in telemedicine," Nate Lacktman, partner at Foley & Lardner's law firm told Politico. The American Telehealth Association believes states should recognize each other's licenses, but acknowledges that due to the federal nature of the country, more compacts will have to be created to get around the problem. Another advocacy group, the Alliance for Connected Care, has proposed a voluntary national system that would recognize licenses from other states. However, the ATA thinks the federal government could tie federal funding to the proposal to encourage states to sign on. For Full Posting: https://www.beckershospitalreview.com/telehealth/telehealth-regulations-don-t-go-far-enough-for-some.html?origin=CIOE&utm_source=CIOE&utm_medium=email&utm_content=newsletter&oly_enc_id=1372I2146745E8F < Previous News Next News >

2021 National Telemedicine Summit World Conference Forum, LLC Sept. 13, 2021 Key Strategies to Revolutionize & Transform Healthcare Delivery, Optimize Quality Patient Care & Outcomes, Increase Accessibility, Enhance Data Analytics, and Reduce Costs! September 13 – 14, 2021 • The Ritz-Carlton, South Beach • Miami, FL Today, telemedicine is one of the fastest growing sectors in healthcare. Specifically, COVID-19 has enhanced and accelerated the role that telemedicine plays within our healthcare system. It is reshaping the landscape of healthcare delivery in the United States, and is being recognized as the future of global healthcare. Telehealth addresses and achieves the basic tenants of Healthcare Reform: providing the population with access to improved and convenient, high quality patient centric care, enhancing outcomes, while reducing per capita expenditures. Today, more than 70 percent of hospitals throughout the United States are engaged in telehealth programs. Studies have shown that the benefits of telehealth include significantly improved outcomes, efficient care delivery as well as reduction in mortality rates, hospitalizations, length of stay, readmissions and healthcare costs. Telehealth has greatly enhanced access to quality care in rural areas and patient satisfaction has increased due to its convenience and patient centric approach. We have created an exciting, high level forum featuring knowledgeable leaders and executives from the nation's leading Hospitals and Health Systems who will share their perspectives, valuable insights and expertise on how to be best equipped for the rapidly evolving and exciting landscape of telehealth. This exclusive event targets senior level executives in order to maximize educational and networking opportunities. By attending the 2021 National Telemedicine Summit, you will learn what highly regarded Hospitals and Health Systems are doing to be prepared for the challenges that lie ahead in 2021 and beyond! We look forward to greeting you in Miami! Link: https://www.wcforum.com/conferences/telemedicine < Previous News Next News >

AHA Statement Stresses Importance of Telehealth in CVD Care Yael L. Maxwell November 16, 2022 With ongoing challenges related to reimbursement, access, and acceptance, the writing committee offers potential solutions. Stressing the importance of telehealth in cardiovascular care, especially given its increased prevalence during the COVID-19 pandemic, a new scientific statement from the American Heart Association (AHA) outlines the current barriers to this type of care and offers some strategies for continued access. As in-person visits were shut down in the spring of 2020, many clinicians and patients turned to telehealth, with subsequent studies and surveys showing related gains in heart failure and nonemergent cardiovascular care. Other research showed that patients who were more likely to use telehealth tended to be younger and privately insured, have more comorbidities, and be from underrepresented racial/ethnic groups. As the pandemic has waned, however, reimbursement for telephone and video visits has been a larger concern. Earlier this month, the US Centers for Medicare & Medicaid Services (CMS) released its 2023 Physician Fee Schedule, which includes continued coverage for telehealth, but only for 5 months following the end of the public health emergency, which some say is not long enough for clinicians to make long-term plans and invest in necessary infrastructure. “This paper in a way summarizes the importance of telehealth and the benefits of telehealth in patient care,” writing committee chair Edwin A. Takahashi, MD (Mayo Clinic, Rochester, MN), told TCTMD. “Payment parity is so important in sustaining telehealth. So I hope that CMS and insurance companies will see the importance highlighted in this paper and reconsider their reimbursement plans with it.” What Is Telehealth? The statement, published online this week in Circulation, begins by defining the concept of telehealth, breaking it down into clinician-to-patient visits and clinician-to-clinician consults. The former includes real-time virtual visits, either video or audio, as well as digital communication, called eVisits, initiated by either the physician or patient. The latter includes both real-time virtual consults, which may also include the patient, as well as digital exchange of low-complexity medical information between clinicians, called eConsults, or second opinions on more-complex concerns. A final hybrid category includes remote monitoring for patients and predictive analysis for clinicians—both machine initiated. Takahashi and colleagues point out some commonly used telehealth tools for cardiovascular home monitoring, including machines for monitoring risk factors like blood pressure, weight, smoking, and diet; medication tracking apps and smart pillboxes for managing medication adherence; and tools like home EGC, pulse oximeter, and pulmonary artery pressure monitoring devices. While there are an undefined number of ways in which telehealth can be useful within cardiovascular care, Takahashi said it’s most effective in tracking disease progression for heart failure and CAD, improving stroke outcomes by decreasing time to diagnosis, and monitoring PAD progression, as well as preventing ulcers and tracking patients postoperatively. The paper outlines advances in telestroke, teleradiology, and telehealth in PAD management. Challenges and Potential Solutions Many challenges remain in order for telehealth to flourish in a nonpandemic era. In his experience, Takahashi said, the biggest barrier to using telehealth relates to “having patients accept it as a replacement for inpatient visits.” But overall, challenges like infrastructure—including broadband internet and hardware for patients—to complete telehealth visits as well as reimbursement stand in the way of telehealth use more generally, he said. “In order for people to adopt and use telehealth, people need to be able to bill for using it. Otherwise, it just is not sustainable.” The statement also stresses the importance that clinician attitude, biases, and acceptance play in the success of telehealth. Difficult to use technological platforms hindered by HIPAA-compliant encryption can also make it more difficult for clinicians to access telehealth appointments. Beyond increases in reimbursement for telehealth, the authors propose a few strategies for continued success. They advocate for government programs to improve broadband internet access across the country, more research to elucidate the specific benefits telehealth can have across the spectrum of cardiovascular disease care, and increased standardization for methods in assessing telehealth quality. “The COVID-19 pandemic improved the telehealth infrastructure through necessity but also uncovered systemic weakness, limitations, and inequities,” they conclude. “Further research into barriers for telehealth implementation and equitable execution are important to ensure the delivery of high-quality care for patients.” Yael L. Maxwell by Yael L. Maxwell Editor, Fellows Forum Yael L. Maxwell is Senior Medical Journalist for TCTMD and Section Editor of TCTMD's Fellows Forum. She served as the inaugural… Read Full Bio See original article: https://www.tctmd.com/news/aha-statement-stresses-importance-telehealth-cvd-care < Previous News Next News >

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

Closing 2022 with New Telehealth G-Codes for HHAs, Uncertainty for Telehealth Startups, Plus State & Federal Telehealth Developments (and much more!) CCHP December 13, 2022 New G-Code Reporting Requirements for HHAs under CY 2023 CMS PPS Rule The Centers for Medicare and Medicaid Services (CMS) has finalized new G-codes to report use of telecommunications technology under the home health benefit for Home Health Agencies (HHAs) under their finalized Calendar Year (CY) 2023 Home Health Prospective Payment System (PPS) Rate Update. HHAs are asked to voluntarily start reporting on January 1, 2023, and the requirement to report would kick in July 2023. CMS notes that in 2020 the home health benefit was temporarily altered due to COVID-19 (and made permanent in 2021) requiring any provision of remote patient monitoring or other services furnished via a telecommunications system to be included in the plan of care. The telecommunication service, however is not allowed to substitute for a home visit ordered by the plan of care or for purposes of eligibility or payment. Reporting of the new G-codes will allow CMS to analyze the characteristics of beneficiaries utilizing services remotely and have a broader understanding of the social determinants that affect who benefits most from these services. The codes HHAs will be asked to submit are detailed in a Medicare Learning Network (MLN) document, and include: G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring) For more details on the G-codes and reporting expectations, see the full MLN Guidance and the full text of the finalized CY 2023 Home Health PPS Rate Rule. Falling Investment for Telehealth Startups A recent article in Politico [subscription required] brings to light the stark decrease in investment in telehealth companies in 2022 (compared to 2021), as the pandemic subsides and a recession likely kicks in. In fact, while telehealth funding for digital health in the US peaked in 2021 with $11 billion dollars, that has fallen to only $3 billion by the third quarter of 2022. The effects of this slow down in capital is bound to ripple across the industry. As a result, many startups are laying off workers and focusing on just a few key offerings. Adding to the uncertainty of the future for these companies is how telehealth policies will impact them moving forward as state and federal governments shift from pandemic era temporary policies to often stricter permanent telehealth requirements with greater oversight. Cerebral, a digital mental health company, for example is currently under federal investigation for over-prescribing ADHD medication. This is the type of occurrence other telehealth companies may take note of and may shape the way they think about the future of their products and services in order to avoid such situations. Additionally, consumer demand has shifted post-pandemic. While consumers were enthusiastic about utilizing telehealth for most forms of healthcare in order to avoid crowded doctors’ offices and hospitals at the height of the pandemic, they now prefer to use it for check-ins with their doctors, mental health visits and addiction treatment, according a survey by the American Medical Association. This necessitates a shift for many telehealth start-ups, and according to Megan Zweig, COO of Rock Health, many companies are struggling with this. For more information, read the full Politico article [subscription required]. World Health Organization Telemedicine Implementation Guidance In November the World Health Organization (WHO) released a telemedicine implementation guide based on knowledge and learnings the WHO has gathered since releasing their first report on telemedicine in 2010. The set of recommendations within the new guide is aimed at optimizing the implementation of telemedicine services by providing an overview of key planning, implementation and maintenance processes to inform an investment plan and support countries across different stages in developing telehealth solutions. The guide contains three phases to developing a successful telehealth program, including (1) a situational assessment; (2) planning the implementation; and (3) monitoring and evaluation, and continuous improvement. There are a total of eleven steps within the three phases, including tasks such as performing a landscape analysis, establishing standard operating procedures, developing a budget and determining monitoring and evaluation goals, as well as an adaptive management plan for improvement. Several case studies from different countries, including India, Cabo Verde, Indonesia, Qatar and Mali are also provided in the annex section of the document. Download the full telemedicine implementation document from the WHO’s website for all the detailed steps outlined in their recommended procedures for telemedicine implementation. See full article: https://mailchi.mp/cchpca/closing-2022-with-new-telehealth-g-codes-for-hhas-uncertainty-for-telehealth-startups-plus-state-federal-telehealth-developments-and-much-more < Previous News Next News >

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

CONGRESS UNVEILS TWO YEAR EXTENSION OF TELEHEALTH FLEXIBILITIES – AS URGED BY THE ATA AND ATA ACTION – AS PART OF OMNIBUS BILL The American Telemedicine Association December 20, 2022 Today, the American Telemedicine Association (ATA) and ATA Action express their gratitude to the U.S. Congress for unveiling a bipartisan, bicameral omnibus appropriations bill that includes a two-year extension for Medicare telehealth provisions put in place during the COVID-19 public health emergency (PHE). The omnibus package also includes a two-year delay in implementing the Medicare telemental health in-person requirement, a two-year extension of the safe harbor to offer telehealth in High Deductible Health Plans (HDHPs) with Health Savings Account (HSAs), and a two-year extension of the Acute Hospital Care at Home Program. Congress is expected to vote on the omnibus bill and send it to President Biden to be signed into law within the next week. The omnibus did not include a comparable extension past the end of the PHE of the Ryan Haight in-person waiver for the remote prescription of controlled substances. However, the legislation does include language directing the Drug Enforcement Administration (DEA) to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued and the procedure for obtaining the registration. “The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients. Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future,” said Kyle Zebley, senior vice president, public policy, American Telemedicine Association, and executive director, ATA Action. “We asked Congress and they listened. We are truly grateful for their staunch support of telehealth. It’s now time to swiftly bring this bill to the President, for passage into law before year-end.” Stakeholder Letter to Congressional Leadership – Urging Extension of Telehealth Flexibilities Stakeholder Letter Urging Congress to Act on the Telehealth High Deductible Health Plan Safe Harbor Tax Provision ATA’s Recommendation’s for Acute Hospital Care at Home Program Stakeholder Letter Urging the DEA to Act on the Prescription of Controlled Substances via Telehealth Before the PHE Expires “We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services. Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction. “The ATA and ATA Action are delivering on our promise, to advocate for permanent access for telehealth services and today marks a significant milestone towards that goal. But the hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff.’ Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.” About ATA Action ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 company and an affiliated trade organization of the ATA. About the ATA As the only organization completely focused on advancing telehealth, theAmerican Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models. See original article: https://www.americantelemed.org/press-releases/congress-unveils-two-year-extension-of-telehealth-flexibilities-as-urged-by-the-ata-and-ata-action-as-part-of-omnibus-bill/ < Previous News Next News >