A staffing expert shows how telehealth is stepping in to fill the staffing shortage Bill Siwicki December 19, 2022 "As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience," he says. The staffing shortage is a huge challenge in healthcare today. Another challenge is finding a solution to this vexing problem. But telehealth may be becoming an emerging strategy to help fill in gaps within hospitals and health systems, contended Chris Franklin, president of LocumTenens.com, a self-service job board and a full-service physician and advanced practice recruitment agency working in high-demand medical specialties. Healthcare IT News sat down with Franklin to discuss changes occurring in healthcare staffing, what he calls hybrid staffing strategies, and the results of a new LocumTenens.com survey. Q. Overall, what changes are you seeing occurring in healthcare staffing? A. The changes we've seen in the broader economy regarding contingent employment over the past three years are incredibly impactful on healthcare staffing. There are a few key numbers that tell the story. There currently are 3.5 million fewer workers in the U.S. than there were two years ago. Since February 2020, job openings have gone up by 50%, while total employment in the U.S. has gone slightly down. Because demand is outpacing the available supply, workers are demanding not just increases in pay, but also more choice and control over when, how and where they work. This is incredibly true in healthcare, based on every indicator we watch. New data shows more than 300,000 healthcare workers dropped out of the workforce in the last two years. Physicians report they are choosing early retirement or leaving the full-time practice of medicine for other kinds of work, in and outside of our industry. Nurses on the frontline have made the news due to the difficulties they have experienced, and also because of the freedoms they are newly experiencing due to the uptick in travel nursing. According to a 2021 study from Health Affairs, nearly 100,000 nurses exited the profession last year – most of them under the age of 50. Another 32% of nurses have said they may leave the profession. The Bureau of Labor Statistics estimates we'll need to fill nearly 200,000 nurse vacancies a year until 2030. Patients are sicker than they have ever been. Over the past year, nearly every hospital has seen increases in patient acuity, largely driven by care that was delayed during the [COVID-19] pandemic. And chronic disease and obesity continue to be primary drivers of healthcare consumption in the U.S. Even though it's been on the horizon for years, the impact of a big population of aging baby boomers – the oldest turned 75 this year – is finally here, and demand for healthcare is about to increase dramatically as a result. Burnout also is at an all-time high. A recent survey from MGMA and Jackson Physician Search highlights a sobering pair of statistics: Nearly two-thirds of physicians (65%) report they are experiencing burnout in 2022, up four percentage points from the 2021 study. Of those experiencing burnout, more than one in three physicians (35%) said their levels of burnout significantly increased in 2022. All of this points to a big, industrywide shake-up, and we are seeing first-hand that traditional workforce staffing models are no longer working, especially in healthcare. What's emerging is something very different – hybrid models that anticipate both permanent and contingent workers, an uptick in models that combine site-based care with a robust telehealth presence, an increase in APP staffing overall, and in general, a growing commitment to giving providers access to the kind of work-life balance they are desperately seeking. Q. You say you are seeing a hybrid staffing strategy that includes elements of locum tenens, more advanced practice providers and more telehealth coverage. Please elaborate on this. A. Healthcare leaders are looking for new and creative solutions now more than ever – and all amidst this backdrop of healthcare workforce shortages. We have seen first-hand the impact the gig economy is directly having on the healthcare workforce and know the biggest concerns for healthcare facilities are attracting talent, retaining talent, and avoiding or mitigating burnout. To help clinicians' desire to achieve a more viable work-life balance, healthcare leaders are evolving their hiring models to reflect a new appreciation for the flexibility that hybrid staffing models represent. Solely relying on traditional staffing models and solutions just won't work anymore. Through staffing innovation, hospitals and healthcare organizations are actively seeking options to improve access to care with more sustainable models. Healthcare staffing is complex and there's never a one-size-fits-all solution, but we are seeing an increase in interest in alternative models of staffing, including a growing use of locum tenens staff and improving patient access to care with advanced practice providers (APPs) and telehealth expansion. Awareness of and interest in locum tenens are at an all-time high for both healthcare organizations and clinicians. People are actually taking their own well-being into account in terms of their employment, opting into contingent work as a way to manage their levels of stress and burnout. We had a locum tenens physician tell an audience at a recent conference: "If you have burnout in locums, you are not doing it right." There's no doubt flexibility of locum tenens offers a desirable outcome on what physicians are wanting out of life. According to the recent survey: Nearly 90% of healthcare facilities already use locum tenens staffing. Nearly 57% of facilities that have not used locum tenens staffing in the past are planning to use it in the next year. According to a recent survey we conducted on innovation and flexibility in staffing, when most administrators consider locum tenens, they most commonly think about onsite physician care. Data shows hospitals utilize onsite locum tenens more than three times as often as telehealth, but that is starting to change. Facilities that were previously reliant on onsite are now embracing telehealth. COVID-19 expedited this adoption, as hospitals looked beyond traditional models to meet their patients' needs. In some cases, hospitals are taking a flexible, hybrid approach that integrates telehealth and onsite care, providing the best of both worlds and delivering value to patients. Additionally, the use of APPs in combination with physicians as a strategy is growing, with 73.9% affirmatively responding to the question, "Do you plan to expand APP coverage?" Q. Your company recently did a survey of hospital administrators to get a clearer view of the challenges in today's landscape. What did you learn as it relates to telehealth? A. Our recent survey results – which are detailed in the Innovation & Flexibility: Journey to Sustainable Healthcare Report – revealed that hospital administrators have strong feedback when it comes to managing today's challenging landscape. With regard to how it relates to telehealth, more facilities are using telehealth than ever before. COVID-19 expedited this adoption, but over the coming year, most hospitals expect to expand their use of telehealth even further – there is no turning back. Patients across the board now are more comfortable using telehealth as the COVID-19 pandemic drove a surge in virtual visits, including those who have historically hesitated to use technology. Traditionally, psychiatric services dominated locum tenens telehealth services, with behavioral health accounting for 79% of telehealth services for LocumTenens.com. However, utilization has started to shift as hospitals look at other specialties, including oncology, cardiology and physiatry. By expanding telehealth offerings, facilities can expand access to care and reach more patients in new locations. Over the past year, many facilities have been able to deliver a higher level of specialty care to satellite or remote locations through telehealth. Going forward, better reconciling reimbursements to align with the level of care provided in a telehealth setting will lead to broader adoption. Q. Where do you see the telehealth component of staffing in five years? A. The feedback we have gotten shows that more than half (60%) of those surveyed plan to expand telehealth. Through innovation, healthcare providers will continue to adapt to flexibility and improved access to care. These flexible solutions create a more sustainable model to provide quality care to patients and their communities. As clinicians are passionate about patients receiving quality healthcare delivered in a timely manner, I see telehealth programs being the key to improving patient outcomes and the overall healthcare experience. The beauty of telehealth is that it provides access to a qualified provider at any time. For example, we have a client that provides psychiatric services across the country. During a busy day, a patient presented who was experiencing domestic violence trauma, and she wasn't comfortable talking with a male doctor. The problem was there were only male psychiatrists on call at her presenting hospital. The hospital contacted our team, and we in turn reached out to two privileged and credentialed female providers that weren't on-call that day. Although one was heading out to attend a wedding, she accepted the assignment to immediately provide care for this patient. So, even though this psychiatrist worked five states away from the hospital, she was able to provide care because of the access to telehealth. The result: The patient received the "right care" that she needed at the right time with an experienced provider. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/staffing-expert-shows-how-telehealth-stepping-fill-staffing-shortage < 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 >

Teletherapy Aimed to Make Mental Health Care More Inclusive. The Data Show a Different Story Jamie Ducharme June 14, 2021 Case studies suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For years, teletherapy has been pitched as the next frontier in mental-health care. Unlike medical disciplines requiring a more hands-on approach—say, physical therapy or surgery—talk therapy has long seemed a natural and effective fit for telehealth. And by taking appointments off the therapist’s couch and into patients’ homes via their devices, advocates argued, telehealth could make counseling more accessible and convenient for everyone, with particular benefits for those who lived in health care deserts or who couldn’t regularly drive back and forth to see a clinician. The hope was that virtual therapy could help democratize a system that allowed almost 20% of white Americans to receive mental-health care in 2019, but fewer than 10% of people identifying as Black/African American, Hispanic/Latino, Asian or Pacific Islander. Then, of course, the pandemic hit, sending the U.S. health care system into a panic and shuttering clinics and private practices nationwide. Telehealth, once psychiatry’s up-and-comer, was suddenly its lifeline. With impressive speed, a system built around face-to-face visits shifted almost exclusively online. By May 2020, 85% of the American Psychiatric Association’s (APA) surveyed clinician members said they were conducting the majority of their sessions virtually, up from just 2% prior to the pandemic. It was the perfect pressure test for the promise of virtual mental-health care. If there was ever a time for teletherapy to shine, it was during the pandemic. But the data aren’t so shiny. Telehealth has indisputably improved mental-health care access—but not to such an extent that it delivers on promises of revolutionizing the mental-health system. The same problems that kept many people—particularly those who are lower-income or of color—from seeking care before the pandemic still exist, even with the expansion of telehealth. As a result, mental-health usage in the U.S. hasn’t changed as drastically as many advocates would have liked. In a series of TIME/Harris Poll national surveys conducted this winter and spring, about half of respondents reported using telehealth since the pandemic began, compared with about 25% who said they had beforehand. Increases in telehealth usage during the pandemic, broken down by demographic groups But only about 5% said they’d gotten mental-health care for the first time during the COVID-19 crisis. That suggests the expansion of telehealth didn’t bring in an influx of new patients to the mental-health system. Government data show a similar picture: about a quarter of U.S. adults received mental-health care in the winter of 2021, according to the U.S. Centers for Disease Control and Prevention (CDC), up from about 19% in 2019. That’s an improvement, but not an enormous one. The number of U.S. adults reporting mental health problems grew significantly during the pandemic, but the number of those getting treatment did not Similarly, a March 2021 study from California’s Kaiser Permanente health system found that telehealth allowed clinicians to conduct 7% more psychiatric visits in spring 2020 than 2019—but most of those were with patients who already had a psychiatric diagnosis. Among people without a pre-existing diagnosis, volume declined by more than 40%, suggesting that virtual appointments were more helpful for people already served by the mental-health system than those outside it. On the opposite U.S. coast, telehealth allowed McLean Hospital, a psychiatric institution near Boston, to increase outpatient volume by about 15%, counting both new and existing patients, but psychiatrist-in-chief Dr. Scott Rauch says there’s “absolutely the recognition that there are some populations,” like certain older adults, “that are having difficulty accessing the technology.” In fact, despite the increased availability of telehealth, the share of American adults with an unmet mental-health need increased from August 2020 to February 2021, from 9% to almost 12%, according to CDC data. That’s understandable, given elevated levels of anxiety, depression and stress during the pandemic, but it also suggests teletherapy is not a panacea. And that means the harder work is still ahead. There are lots of ways to think about access to care. The most obvious—making it easy for a patient to speak directly with a clinician, either in person or via a device—is only one. There are also financial barriers. A single therapy session can easily top $100 (without insurance) in many parts of the country, and telehealth has done little to change that. Rightly so, argues Dr. Joe Kvedar, a former president of the American Telemedicine Association, since there’s no evidence to suggest virtual therapy is lower quality than face-to-face. Be that as it may, high price tags mean both therapy and teletherapy remain unattainable for many. Another limitation: there are simply not enough therapists to go around. More than 125 million people in the U.S. live in an area with a shortage of mental-health practitioners, according to U.S. Health Resources and Services Administration estimates. Whether they’re seeing patients virtually or in the flesh, there are a finite number of mental-health professionals with a finite number of hours in their days. Rauch, from McLean Hospital, says telehealth can increase appointment capacity somewhat, mainly because patients are less likely to cancel or no-show, but “as long as it requires an hour of clinician time to deliver an hour of clinical service, expanded access won’t be drastically enhanced.” To meet demand, the U.S. needs not only more therapists generally, but also more therapists from diverse backgrounds. A 2020 study concluded that just 10% of U.S. psychiatrists identify as Black, Hispanic, American Indian, Alaska Native, Native Hawaiian or Pacific Islander. That means many patients of color can’t find a therapist whom they trust and with whom they can form a close rapport, a barrier that dissuades many people from getting the help they need or prevents them from reaping the full benefits of therapy, says Dr. Amanda Calhoun, a psychiatry resident at Yale and a fellow on the APA’s Council on Minority Mental Health and Health Disparities. “There are many patients who want a Black therapist and they can’t get it,” Calhoun says. “If we truly want to reduce the gap [in mental-health care usage] we need to make it a trustworthy system where people feel they can connect with their therapist or psychiatrist.” Patients who do not speak fluent English, or who feel more comfortable using another language, may also struggle to find a therapist with whom they can communicate freely. Increased use of language interpretation could be an essential tool for expanding access, Calhoun says. It seems naive, or at least wildly optimistic, to think telehealth could overcome some of these entrenched structural issues. And in some cases, virtual care actually worsens disparities. Some people don’t have a reliable Internet connection or a smart device, for example. About 7% of American adults don’t use the Internet at all, according to Pew Research Center, and those without advanced education and people of color—i.e., those already often underserved by the mental-health system—are least likely to be “digitally literate,” according to a 2020 Health Affairs article. Further, elderly adults, an estimated 20% of whom have some sort of mental-health condition, may struggle to navigate virtual platforms even if they have quality Internet access. And online platforms aren’t perfect. Some people feel uncomfortable sharing their most intimate thoughts through a screen, and any digital system runs the risk of malfunctioning or being hacked. That recently happened in Finland, when a data breach led thousands of patients’ sensitive appointment notes to land in hackers’ hands. Plus, teletherapy is only convenient if you’re able to step away from work and other responsibilities to conduct the call in a private place. While the pandemic has many white collar workers drowning in time at home, surrounded by devices, that’s far from a universal experience. For essential workers, a disproportionate number of whom are people of color, it may be only slightly easier to steal away for a teletherapy appointment than it would have been to schedule an in-person visit with a clinician. Perversely, teletherapy may be making it easier than ever for people who already had access to mental-health care to get it, while leaving behind the people who arguably need it most. If teletherapy isn’t doing the trick, the question then becomes how to better serve those still not getting the mental-health care they need. Calhoun says any real solution needs to take a step backward and investigate why many people either cannot or choose not to seek help. For people of color, centuries of neglect and mistreatment by the medical institution are not easily forgotten. In the 1700 and 1800s, influential American doctors coined since-discredited diagnoses like “drapetomania” (psychosis or madness causing an enslaved person to run away) and “negritude” (essentially, the “disease” of not being white). Many contemporary providers aren’t aware of those offensive diagnostic frameworks, Calhoun says, but the cultural legacy of that racism is still widely felt in communities of color. Training more clinicians from underserved backgrounds is the single most impactful way to encourage people of color to get help, Calhoun says. But that process takes time. In the interim, she says, all clinicians need to be educated about psychiatry’s problematic past so they can acknowledge and understand why some patients may not feel comfortable seeking help, and then hopefully address those issues in their own practices. Looking beyond telehealth and focusing on community-based programs—like church-run mental-health groups or the Confess Project, a nationwide initiative that trains barbers to be mental-health advocates—may also help build that trust. Case studies also suggest teletherapy can work well when it’s integrated into the traditional, in-person medical system. For the past decade-plus, Massachusetts has run a program that allows participating primary-care providers to teleconference in a psychiatrist during a child’s checkup, for example. Such programs don’t eliminate mistrust of the medical system, but they can at least make it easier to introduce people to the mental-health system. Mental-health apps—while not appropriate for patients with serious diagnoses, and clearly not an option for those without a smartphone—can also provide a cheap (or even free) stopgap measure for people struggling to find or afford an appointment with a clinician, Rauch says. And in some cases, adds Dr. Adrienne Robertson, a family medicine physician who works with the online medical startup Nurx, through which people can request prescription medicines and diagnostic tests simply by filling out a form, eliminating face-to-face interactions with providers can actually put patients of color at ease, because they can “just [be] a patient like everyone else.” Policy also plays a role. Nordic countries, like Sweden, have among the most robust and widely used telemedicine programs in the world, boosted by affordable, state-sponsored medical networks. Unlike in the U.S., where insurance limitations and out-of-pocket costs are roadblocks for some patients regardless of platform, many people in Nordic countries have a public option for virtual care. Last year, the Centers for Medicare and Medicaid Services made it easier for Medicare holders to use telehealth services, a policy that allowed more than a quarter of Medicare beneficiaries (and more than 30% of Black and Hispanic beneficiaries) to use telehealth during the fall and summer of 2020, but it’s not clear what will happen after the pandemic ends. Permanent federal action for Medicare and Medicaid holders—many of whom are low-income or elderly adults—could open up therapy to millions of people who can’t currently afford it. And changing federal policies that currently limit clinicians to treating patients located in the state where they are licensed could help even out distribution of the mental-health workforce. All of these fixes are considerably more complex than bringing appointments online; they require rebuilding the system, rather than simply shifting it to a new platform. That work needs to happen sooner rather than later, Calhoun says. Already, according to TIME/Harris Poll data, many people are returning to in-person medical appointments, both psychological and physical. In May, more than half of respondents who’d received mental-health care said they’d had an in-person appointment since the start of the pandemic, up from 37% in February. While some patients and clinicians are sure to stick with teletherapy after the pandemic, much of the system will seemingly revert back to how it was—and without concerted effort, the same problems may persist for years to come. This article can be found at https://time.com/6071580/teletheraphy-mental-health/. < Previous News Next News >

Telehealth May Be Rural Healthcare’s Lifeline Corey Scurlock December 28, 2022 As a new year dawns, it seems like a stock-taking time in U.S. healthcare. Skyrocketing costs, underwater margins, a depleted workforce and sicker patients have most hospitals and systems thinking existential thoughts about 2023, none more so than rural facilities. According to a report by the Bipartisan Policy Center (BPC), a Washington, D.C.-based think tank, 116 rural hospitals across 31 states closed between 2010 and 2019. Many of them were small critical access hospitals. Federal Covid-19 relief funding is believed to have prevented additional closures—only two rural hospitals closed in 2021. Now, though, 631 rural hospitals are threatened with possible closure within the next few years, according to the Center for Healthcare Quality and Payment Reform. As the CEO and founder of an acute care telehealth company, I’ve observed firsthand that workforce needs are one of the primary drivers of telehealth adoption. What was once a staff shortage is now a crisis, particularly in nursing, but also among physicians. From 2020 to 2021, the total supply of registered nurses decreased by over 100,000, the largest drop in four decades. By 2025, there could be a shortage of 200,000 to 450,000 nurses in the U.S. Rural hospitals are at a particular disadvantage since they tend to have worse workforce shortages than urban hospitals. According to the BPC, “urban areas have 30.8 physicians per 10,000 residents; rural ones have 10.9 physicians per 10,000.” There are also often fewer specialists—such as cardiologists, psychiatrists, radiologists and obstetricians—in rural areas. Opportunities To Improve Care Rural hospitals have for years contracted with academic medical centers for remote episodic help with patients with clinically complex conditions, such as stroke and sepsis. To make care more affordable, we’re seeing more rural healthcare leaders embracing telehealth for supplemental care, filling in coverage gaps or for specialized consultations on complex cases so that people get the right care at the right time in the right setting. In previous articles, I wrote about how telehealth can provide clinical expertise, how telehealth specialists target “hot spots” along the patient care journey and about virtual nursing, in which veteran RNs with specialty expertise guide bedside staff and patients through the care process. Rural hospitals are in dire need of expert care at patient transition points. Virtual care often starts in what is now the front door of a hospital: the emergency room. Rural and critical access hospitals often have to park patients in the hallway as they triage. A remote intensivist steeped in critical care medicine can track the vital signs of patients and do the intake, often guiding inexperienced staff to the right site of care and helping them through tests, diagnoses and procedures. Inappropriate patient transfers are a source of inefficiencies and poor-quality care. Patients may be sent to intensive care who don’t need to be. Some can be easily treated in the ER and sent home. Others may need a complex operation, for which a transfer to a level 1 trauma center is needed. Outcomes for ER patients with delayed care are, not surprisingly, poorer. Maximizing A Stretched Workforce The BPC examined three evidence-based programs that involve using digital technology—one of which was tele-ICU—to see how they could optimize a stretched healthcare workforce and ensure that patients receive quality care in their local hospitals. Tele-ICU programs can be episodic, such as enabling two-way audiovisual communication between telehealth providers and local ICUs to get answers to questions, or they can be continuous, where a remote physician has complete access to electronic medical records, imaging systems and other databases to get timely information that informs decisions about a patient’s care. According to the BPC, “studies have demonstrated that tele-ICU programs enhanced care plans, improved clinical outcomes, reduced hospital transfers, and were associated with increased best-practice adherence.” Telehealth also facilitates the mentoring of young nurses and assesses where there are gaps in current knowledge. The BPC report mentions a study that found that 27% of hospitals with ICUs have tele-ICU capabilities. Such capabilities can potentially lead to substantial savings: The report cites a 2019 cost-benefit analysis that found that a telehealth ICU program saved $3.14 million over six months by “reducing ICU variable costs per case, decreasing length of stays and decreasing ICU mortality.” It’s a fairly straightforward story: Remote intensivists can monitor dozens of patients remotely at a time, while tele-ICU nurses can keep track of 30 to 50 patients simultaneously, compared with just three for a bedside RN. Bedside clinicians typically can deal with only one emergency at a time, while remote intensivists can handle up to four codes at once. A Path Forward Pretty soon, the pressures of the workforce shortage will likely compel many, if not most, acute care providers to adopt some virtual care across the enterprise. So it’s crucial for rural hospitals to take steps now to ingrain telehealth into their operations and make it part of the fabric of care—that way, it’s there when they need it. Here are some things for rural hospitals to think about when choosing a telehealth partner. • There are many entities offering telehealth services, ranging from large academic medical centers to consortiums of providers to vendors large and small. Make sure you have complete trust in your chosen partner. • Ensure that all of the entity’s physicians are licensed to practice medicine in your state(s). If not, they cannot order tests, prescribe medications or do anything but recommend a course of action. • Does the telehealth provider have a network of specialists in every area? For example, many vendors lack psychiatrists, who are in short supply nationally amid the explosion in demand for mental health services. • Make sure your telehealth partner understands patient flow optimization techniques that support level-loading and optimized bed utilization. Final Thoughts Through my travels and in conversations with executives across the nation, I’ve found that the word “telehealth” doesn’t sound techy anymore and that the understanding of the benefits delivered by digitally enabled care is more mature. Telehealth is now recognized as a tool that, as part of a strategic process to remedy gaps in care delivery, can be combined with change management to drive real value. Soon, in fact, “telehealth” may be replaced by “health” when we look at the evolution of care through technology. Dr. Corey Scurlock MD, MBA is the CEO & founder of Equum Medical. See original article: https://www.forbes.com/sites/forbesbusinesscouncil/2022/12/28/telehealth-may-be-rural-healthcares-lifeline/?sh=1f7657be3e9d < Previous News Next News >

Digital Health Tools Transforming Pediatric Telemedicine, Teletherapy & Telehealth Dr. Maheu February 24, 2022 The COVID-19 pandemic has led to an unprecedented rise in pediatric telemedicine to alleviate the strain of behavioral health issues. Unprecedented stressors abound. Children are now more often confined to their homes and are less able to socialize. They may be forced to adjust to their parents’ working from home. They may witness economic and emotional fluctuations that leave them more anxious than at any time in recent history. With the increased demand for care with a shortage of available pediatric behavioral professionals, many organizations have shifted to pediatric telemedicine and telehealth or teletherapy tools.. COVID 19 and Challenges for Pediatric Telemedicine for Behavioral Health A meta-analysis published in JAMA Network, pediatrics found that one in every four children suffered depression during the COVID-19 lockdown and the anxiety prevalence rate was 20.5%. According to the Centers for Disease Control and Prevention (CDC), compared to 2019, the number of mental health-related emergency visits in 2020 went up by 24% for children in the 5-11 age group and 31% in the 12-17 age group. The American Association of Pediatrics and the American Association of Child and Adolescent Psychiatry have officially declared an emergency as pediatric behavioral health went through a crisis countrywide. Parents had pretty tough times getting support for pediatric behavioral health following the closure of clinics and shortage of pediatric-trained therapists. Digital health tools primarily developed for adult health care have been adapted to connect parents to trained child therapists to overcome geographical and pandemic-related barriers. Full article here: https://telehealth.org/pediatric-telemedicine-2/?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&smconv=5bc4c379-a4c1-484f-a411-33ec93777504&smlid=12&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Permanent Pay, Originating Site Policies Boost Access to Virtual Addiction Services Victoria Bailey Dec. 29, 2021 By making temporary reimbursement and site-originating policies permanent, legislators could help increase access to virtual opioid use disorder treatment, according to a new report. December 20, 2021 - Lawmakers have the power to solidify access to virtual opioid use disorder treatment by introducing policies that ensure reimbursement parity, solidify audio-only telehealth coverage, and expand the list of eligible originating sites, according to an issue brief from the Pew Charitable Trusts. During the COVID-19 pandemic, telehealth proved to be a successful care modality for delivering opioid use disorder treatment to individuals across the country. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services (SAMHSA) lifted their restrictions and allowed buprenorphine prescribers to initiate medication treatment via telehealth without requiring an in-person visit first. However, these regulations are temporary and are set to expire once the public health emergency ends. In order to ensure access to virtual opioid use disorder treatment, state Medicaid agencies and policymakers should make these and other telehealth regulations permanent, Pew said. Legislatures should require public and private payers to reimburse providers for all opioid use disorder treatment services delivered via telehealth, including clinical assessments, prescriptions, medication management, and counseling sessions. Additionally, ensuring reimbursement for a variety of providers — including physicians, nurse practitioners, physician assistants, and mental health professionals — could help solidify the virtual treatment process. According to Pew, states that offered coverage for buprenorphine prescribing via telehealth saw positive patient outcomes that were similar to in-person services. Policymakers should also establish payment parity between telehealth and in-person opioid use disorder treatment services under public and private payers alike. “Without assurances of sufficient reimbursement rates, providers may be unwilling to invest in telehealth infrastructure for their practices, or they may find it infeasible to increase the use of telehealth for OUD treatment,” researchers wrote in the brief. Medicaid programs can ensure reimbursement parity for telehealth services without submitting a plan amendment to the Centers for Medicare and Medicaid Services (CMS). Thirty-eight states and Washington D.C. have established payment parity for certain telehealth services, but not all programs include opioid use disorder services in their provisions. Originating-site restrictions must also be addressed, Pew researchers said. Some states allow patients to use telehealth but only from certain clinics that can serve as an originating site. By expanding the list of eligible originating sites to include the patient’s home, policymakers could make accessing virtual care more convenient for individuals. Medicare currently allows individuals to receive telehealth-based opioid use disorder treatment from their homes, according to the brief. Past studies have shown that patients can initiate buprenorphine safely and successfully while remaining in their homes. In addition, patients seemed to prefer receiving treatment from home. Further, Medicaid programs should make audio-only telehealth policies permanent to facilitate access to virtual care, Pew researchers recommended. Audio-only coverage is set to expire when the public health emergency ends. Ensuring that providers receive reimbursement for audio-only opioid use disorder services may help address care disparities and benefit underserved communities that tend to use the care modality most often, including Black and Hispanic populations, individuals with limited English proficiency, and communities with inadequate broadband access. At least 15 Medicaid programs offer reimbursement for audio-only telehealth as of February, but some states only provide coverage for certain services, the brief noted. Finally, Pew researchers recommended that policymakers allow correctional settings to offer telehealth-based opioid treatment. Jails and prisons typically allow incarcerated individuals to receive healthcare via telehealth but the option to receive virtual opioid use disorder treatment is far less common, the brief stated. If states allocated funding to these institutions, they could invest in the necessary telehealth resources to establish virtual opioid treatment services. A few correctional facilities, including one in Minnesota and one in Massachusetts, currently offer buprenorphine treatment, counseling sessions, and clinical assessments through telehealth. Even with these policy changes, states may face additional barriers to offering virtual opioid treatment services including a lack of funding for infrastructure and poor broadband access. Pew researchers suggested that states consider partnering with the National Consortium of Telehealth Resource Centers to receive assistance with launching a telehealth program. Additionally, state and local governments can leverage funding from the American Rescue Plan Act to invest in expanding internet access to communities that need it. https://mhealthintelligence.com/news/permanent-pay-originating-site-policies-boost-access-to-virtual-addiction-services < Previous News Next News >

CONNECT for Health Act Recently Reintroduced Center for Connected Health Policy May 2021 CCHP Breaks Down Key Elements in New Fact Sheet * < Previous News Next News >

CHOP Study Explores the Use of Telemedicine in Child Neurology in Largest Study to Date Children's Hospital of Philadelphia September 16, 2022 -- Certain patients were more likely to use telemedicine even with the reopening of in-person appointments, while barriers to telemedicine remained for some families -- PHILADELPHIA, Sept. 16, 2022 /PRNewswire/ -- Researchers from the Epilepsy Neurogenetics Initiative (ENGIN) at Children's Hospital of Philadelphia (CHOP) found that across nearly 50,000 visits, patients continued to use telemedicine effectively even with the reopening of outpatient clinics a year after the onset of the COVID-19 pandemic. However, prominent barriers for socially vulnerable families and racial and ethnic minorities persist, suggesting more work is required to reach a wider population with telemedicine. The findings, which represent the largest study of telemedicine in child neurology to date, were published today by the journal Developmental Medicine & Child Neurology. The COVID-19 pandemic prompted a rapid and unprecedented conversion of outpatient clinical care from in-person visits to remote telehealth visits. While telemedicine had been used to deliver care for specific adult patient populations prior to the pandemic, the effectiveness of telemedicine in child neurology as a novel method of care had not been systematically explored. In a prior study published by Neurology in 2020, CHOP researchers found that patients and clinicians had a high rate of satisfaction with telemedicine and many on both sides were interested in using telemedicine for future visits. To that end, the study team wanted to determine the long-term impact of telemedicine on child neurology care during the COVID-19 pandemic, factoring in the reopening of outpatient clinics. The observational study was based on a cohort of 34,837 in-person visits and 14,820 telemedicine outpatient visits between October 2019 and April 2021 across a total of 26,399 child neurology patients. "In 2020, the COVID-19 pandemic necessitated the use of telemedicine visits, but now that telemedicine visits have been established as part of the care we are able to deliver, we had the opportunity to compare them more thoroughly to in-person visits," said the study's first author Michael Kaufman, MS, a data scientist with ENGIN at CHOP. "With data on nearly 15,000 telemedicine visits, we were able to identify trends in how telemedicine was being used by individuals of different demographic backgrounds, neurological conditions and other variables." The researchers found that telemedicine was a viable option for many patients and was utilized more often than in-person visits for certain patients, such as those with epilepsy and attention-deficit hyperactivity disorder. Other patients, such as those with certain neuromuscular and movement disorders, younger patients, and those needing specific procedures were less likely to receive care by telemedicine. Additionally, the researchers found that self-reported racial and ethnic minority populations in the study as well as those with the highest social vulnerability – a measure of community resilience to stressors on human health – were less likely to participate in telemedicine visits. Two novel metrics were developed to determine access to telemedicine and track delayed care, which revealed further disparities. Some of the most vulnerable individuals were less likely to activate their online patient portals and were more likely to receive delayed care, compared to less vulnerable individuals. "Our group has studied telemedicine extensively, and our findings demonstrate how telemedicine has become a standard component of child neurology care for many patients," said Ingo Helbig, MD, a pediatric neurologist at CHOP, director of the genomic and data science core of CHOP's Epilepsy Neurogenetics Initiative (ENGIN) and senior author on this study. "Increased use of telemedicine was prompted by a public health emergency, and so we need to make sure, as these new tools for patient care remain prevalent, that we're continuing to learn about and address disparities in care and optimize access for socially vulnerable families, so that they have the tools necessary should another similar public health crisis occur." This study was supported by The Hartwell Foundation through an Individual Biomedical Research Award; the National Institute for Neurological Disorders and Stroke grants K02 NS112600 and K23 NS102521; the Center Without Walls on ion channel function in epilepsy "Channelopathy-associated Research Center" grant U54 NS108874; the Eunice Kennedy Shriver National Institute of Child Health and Human Development through the Intellectual and Developmental Disabilities Research Center (IDDRC) at Children's Hospital of Philadelphia and the University of Pennsylvania grant U54 HD086984; intramural funds of Children's Hospital of Philadelphia through the Epilepsy NeuroGenetics Initiative (ENGIN); and the National Center for Advancing Translational Sciences of the National Institutes of Health through the Institute for Translational Medicine and Therapeutics' (ITMAT) Transdisciplinary Program in Translational Medicine and Therapeutics at the Perelman School of Medicine of the University of Pennsylvania grant UL1TR001878. Kaufman et al, "Child neurology telemedicine: analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic." Dev Med Child Neurol. Online September 16, 2022. DOI: 10.1111/dmcn.15406. About Children's Hospital of Philadelphia: A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as a new inpatient hospital with a dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu . Contact: Ben Leach Children's Hospital of Philadelphia (609) 634-7906 Leachb@email.chop.edu See original article: https://finance.yahoo.com/news/chop-study-explores-telemedicine-child-154000001.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr < Previous News Next News >

Policy & Legislation New Mexico: A Leader in Telehealth Laws New Mexico has one of the most progressive telehealth statutes in the entire U.S. New Mexico Legislation Federal Resources NEW MEXICO LEGISLATION Telehealth NMSA § 13-7-14 "Healthcare Purchasing Act" NMSA § 59A-22-49.3 "Health Insurance Contracts " NMSA § 59A-23-7.12 "Group and Blanket Health Insurance Contracts " NMSA § 59A-46-50.3 "Health Maintenance Organizations " NMSA § 59A-47-45.3 "Nonprofit Healthcare Plans " (see also S.B.354 (2019) "Coverage for Telemedicine Services" ) Broadband NMSA § 63-9J-1 thru 63-9J-4 "The Broadband Access and Expansion Act" ( see also S.B.93 (2021) "Broadband Access and Expansion Act" ) New Mexico Federal FEDERAL RESOURCES Center for Connected Health Policy (CCHP) Find up-to-date information for Medicare, Medicaid, Federal Employee Plans, and more... CCHP, a nonprofit, nonpartisan organization, has been the federally designated National Telehealth Policy Resource Center since 2012. CCHP provides technical assistance to twelve regional Telehealth Resource Centers (TRCs), state and federal policy makers, national organizations, health systems, providers, and the public. CCHP - Federa l CCHP - New Mexico

Southwest Telehealth News

The value of telehealth and the move to digitally enabled care — 3 insights Becker's Hospital Review In Collaboration with American Medical Association Nov. 1, 2021 During the pandemic, healthcare organizations embraced telehealth to ensure they could provide access and high quality care to their patients. Now, nearly two years later, organizations are contemplating how best to move forward, including how to safeguard and optimize opportunities to move towards digitally enabled care. During the pandemic, healthcare organizations embraced telehealth to ensure they could provide access and high quality care to their patients. Now, nearly two years later, organizations are contemplating how best to move forward, including how to safeguard and optimize opportunities to move towards digitally enabled care. During Becker's 6th Annual Health IT + Revenue Cycle Virtual Conference, the American Medical Association sponsored a roundtable discussion on this topic. The AMA's Lori Prestesater, Vice President of Health Solutions, and Meg Barron, Vice President of Digital Health Innovations, talked with healthcare executives from around the country about their digital health successes and challenges. Three insights: 1. Providers want virtual care to continue as long as their key concerns are addressed. "Physicians are enthusiastic about digital health technologies," Ms. Barron said. "However, that enthusiasm is directly tied to a solution's ability to help them take better care of patients or reduce their administrative burdens." Four key concerns consistently expressed by physicians when evaluating digital solutions are whether a solution works and has an evidence base, how providers will be compensated, what liability and privacy issues exist, and how implementation and change management will occur. 2. One of the major advantages of telehealth is improved access. Access can be widely defined; virtual technology has made significant inroads in improving access in multiple ways: COVID-19 access. The department chair of a hospital in the Northeast noted that telehealth helped them provide quick access and treatment to patients during the pandemic. "It worked extremely well in this emergency situation," he said. "Patients would call in and report symptoms, and we could make decisions about their care. We provided pulse oximeters and followed up via telehealth." Specialty access. A CMO from a Midwestern health network — who is the father of a daughter with a chronic illness — shared his personal experience with specialty care from multiple systems. "I can't imagine how my daughter could receive specialty care without telehealth. Care that was previously siloed can now be accessed nationally, if not internationally." Behavioral health access. A chief population health officer from a health system in the Midwest said telehealth access to mental health services was a big success. "Patients found the pandemic very rough, and many needed some behavioral health services, but they didn't necessarily want to try to see somebody because of the stigma associated with it," she said. "Being able to offer telebehavioral health services to our patients, and frankly, even to our employees, was a great success." 3. Challenges such as patient hesitancy, bandwidth issues and measurement of value remain. Although patients are generally positive about telehealth, some have found it difficult to onboard to telehealth platforms. One provider in the Northeast said younger patients love the ability to text and connect virtually, but elderly patients often prefer in-person visits for the human connection. Also, many healthcare organizations have faced connection issues. A West Coast CMO explained, "We have 24 hospitals, and many of them are in rural areas. We really struggled with bandwidth." Finally, measuring the value of these technologies remains a challenge. Ms. Prestesater pointed out that it can be a "many-year equation to evaluate the value for a chronically ill patient." AMA has a recently released Return on Health value framework that can help an organization quantify the comprehensive value of virtual care. Although some participants warned that virtual care may not be less expensive, it can be hard to quantify savings from things like avoiding emergency care. A Midwest hospital executive said, "Home-based care has led to a substantial reduction in visits to the emergency room and days in the hospital for us. The problem in the whole equation is it's hard to measure something that doesn't happen." < Previous News Next News >

Frequently Asked Questions Regarding Licensure & Telehealth Mei Wa Kwong, JD September 12, 2022 This video addresses the most frequently asked questions CCHP receives regarding licensure and telehealth for example: (1) What does the law says if your patient is going on vacation to another state, but still needs your services? (2) Do you really need a license in another state if you’re just consulting with a provider who is already licensed in that state? (3) ….and many more! View the PPT for this video here. See original video: https://www.cchpca.org/resources/frequently-asked-questions-regarding-licensure-telehealth/ < Previous News Next News >

Audio-Only Telemedicine Services Special Announcement NMTHA's communication with the New Mexico Office of the Superintendent of Insurance about billing for AUDIO-ONLY telemedicine services February 2022 Update: New Mexico Audio-Only Telemedicine Services The New Mexico Telehealth Alliance (NMTHA) works hard to ensure telehealth is sustainable and meets healthcare needs in our State. The NMTHA has been instrumental in ensuring New Mexico has one of the leading telehealth laws in the country. Looking at the NM Telehealth Act, last amended in 2019, the New Mexico Office of Superintendent of Insurance (OSI) has put out the following information around the continued ability to bill for telephonic services. What you need to know: The telemedicine definition allows the use of audio-only telemedicine services. The NM Telehealth Act: The New Mexico Telehealth Act, which was last amended in 2007, defines telehealth as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store-and-forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education.” § 24-25-3(C) NMSA. This definition clearly incorporates audio-only services, particularly as “the purpose of the New Mexico Telehealth Act is to provide a framework for health care providers to follow in providing telehealth services to New Mexico citizens in a manner that provides efficient and effective access to quality health services.” § 24-25-2(B) NMSA. What insurance this affects: This is only for fully-insured health plans regulated by the NM OSI, and for NM State employee, public school, and retiree health plans. It does not apply to Medicaid, Medicare, other federal health plans, or self-insured health plans. Access the final text of S.B.354 (2019) and chaptered statutes HERE . See the email communication from the NM OSI HERE . Sincerely, New Mexico Telehealth Alliance

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 >

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

Using Telemedicine When it Makes Sense Adam Ang October 11, 2022 Patients worldwide prefer a mix of in-person and virtual care moving forward from the pandemic. During the pandemic, organisations across private and public healthcare systems have been rethinking their care delivery models. This is one of the major trends Ronald L. Emerson, Global Healthcare Lead at Zoom, shared virtually in the keynote session, "The Rise of Digital First and Decentralized Healthcare," at the HIMSS22 APAC conference. He was joined by Benjamin Lim, Zoom's APAC Leader for ISV Platform Business, who moderated the discussion in person. Recently commissioned research by Zoom found that patients who have used telehealth once prefer a hybrid mode of care post-COVID-19. This has given rise to digital-first healthcare, which does not mean "digital only." "What it does mean is that many healthcare systems, public and private, are developing virtual care models or hybrid models of care," Emerson said. "They thought to let the interaction or the clinical situation dictate the level of care that is needed… If they can handle [visits] over telemedicine and take care of the patient, the patient doesn't need more expensive care. They don't have to come to the emergency room or the hospital or the physician's office. And so we're seeing a large shift in that area and it's decreasing the entry point into the healthcare system," he noted. Rather than an all-digital model of care, a care model that makes sense to a patient's situation is ideal to bridge the gap in healthcare access. "I think our goal with telemedicine is how we utilise it when it makes sense. I am not for an all-digital care model, an all-video model, an all-virtual care model; I'm all for a model that makes sense based on the actual clinical application that can lower the threshold and increase access when people need the care [so] then we can make a better decision on the clinical disposition of the patient," Emerson shared. Telemedicine adoption Another key trend is the rise of video-assisted virtual visits during the pandemic. Care providers are now getting their money's worth in using cost-efficient virtual care technologies. In taking on a vendor's telemedicine platform, care providers usually consider the following: patient acceptability, clinical efficacy, and cost and sustainability. "We're actually seeing the return on investment and sustainability of the project. Vendors and organizations like Zoom have really lowered the price point where these projects are sustainable," Emerson said. Zoom has found its success in integrating as few workflows as possible in an organisation's existing centralised platform. "Healthcare professionals do not want any more platforms to manage. They wanna use their sort of centralized platform if they have electronic medical records," he mentioned. Decentralised healthcare Finally, Emerson noted how organisations are making efforts to reach out to patients across the continuum of care and work to provide the same levels of care they would receive in an in-hospital setting. This trend of decentralised healthcare is happening, he claimed, because health systems now are not just focusing on sickness but also on the ability to keep people healthy through wellness and prevention, education, and better discharge planning – all of which require virtual technology and communication. "We expect to see more and more of this [in] other places," he quipped. Virtual health as a strategic goal For organisations looking to develop their own digitally-enabled care delivery models, Emerson shared that the way to success is by making virtual health a strategic goal in their care provision. "That means the doctors are on board, it's written in their job descriptions. [It's going to be a] part of the delivery system of how we take care of people," he said. See original article: https://www.healthcareitnews.com/news/asia/using-telemedicine-when-it-makes-sense < Previous News Next News >

Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017–20 Juan J. Andino, Ziwei Zhu, Mihir Surapaneni, Rodney L. Dunn, and Chad Ellimoottil Abstract During the COVID-19 pandemic, all fifty states and Washington, D.C., passed licensure waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (that is, interstate telehealth). Because many of these temporary flexibilities have expired or are set to expire, we analyzed trends in interstate telehealth use by Medicare beneficiaries during 2017–20, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth made up a small share of all outpatient visits (0.8 percent) and of all telehealth visits (5 percent) overall. For individual states, out-of-state telehealth made up between 0.2 percent and 9.3 percent of all outpatient visits. We found that most out-of-state telehealth use was for established patient care and that a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who did not receive care outside of their state (28 percent versus 23 percent). Our collective findings suggest that the elimination of pandemic licensure flexibilities will affect different states to varying degrees and will also affect the delivery of care for both established patients and rural patients. View Full Article: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01825?journalCode=hlthaff < Previous News Next News >

A Decade of Telehealth Policy: A New Report From CCHP Mei Kwong- Center for Connected Health Policy August 2022 Ten years ago, in the early months of 2012, the Center for Connected Health Policy (CCHP) faced a decision of potentially great significance. The U.S. Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORPH) Office for the Advancement of Telehealth (OAT) had released a Funding Opportunity Announcement for their Telehealth Resource Center Grant Program and the incumbent contractor for the National Telehealth Resource Center for Policy (NTRC-P) contract would not be reapplying. After weighing the pros and cons of acting as the NTRC-P, CCHP decided to take the plunge and applied. On September 1, 2012, CCHP officially started its work as the federally designated National Telehealth Policy Resource Center and have been serving that role for the past decade. To mark CCHP’s ten-year anniversary as the NTRC-P, we are releasing a look back on telehealth policy in the United States. For the past decade, CCHP has tracked and followed policy development for all 51 jurisdictions in the United States (District of Columbia included) as well as at the federal level providing us with the unique opportunity to observe and study the development of telehealth policy in the United States on both the state and federal levels. This past decade also happens to be the period that encompasses some of the most significant telehealth policy developments seen thus far in the United States. The report is not intended to be an in-depth study on telehealth policy development and history as that could easily be an entire novel given the complexities and nuances that would need to be considered. The National Telehealth Resource Center for Policy Ten-Year Anniversary Report is intended to capture some of the highlights, significant changes, and environmental factors that have had an impact on telehealth policy development in the nation. Considering the increased interest in telehealth policy, CCHP believes this report also will be useful to provide context on how telehealth policy came to be where it is today, particularly for those who may be newer to the field. Additionally, the report is meant to be a celebration of the time CCHP has spent as the NTRC-P including the contributions the organization has made to the telehealth field. This report is dedicated to the memory of Mario Gutierrez, CCHP Executive Director from 2011-2017. Mario was the original visionary who decided in 2012 that CCHP should apply for the project. A special thank you must also be extended to CCHP staff, both past and present, who have truly been the engine that continues to drive the work of the organization forward. Special acknowledgment must be made of Laura Stanworth, Deputy Director, and Christine Calouro, Senior Policy Associate, both who have been with CCHP from the beginning of its role as the NTRC-P and who, along with myself, have seen this past decade of telehealth policy development, including producing all information and navigating CCHP through those first few months of the COVID-19 pandemic. We hope you will enjoy this report and find the information useful. CCHP looks forward to continuing on the ever evolving telehealth policy journey with all of you. See full report: https://mailchi.mp/cchpca/a-decade-of-telehealth-policy-our-10-year-anniversary-report < Previous News Next News >

Telehealth Waivers Wind Down, Restricting Some Providers From Delivering Care Across State Lines Hailey Mensik August 2021 States allowed medical professionals licensed elsewhere to hold virtual visits with their residents during the pandemic. Some are making the rollbacks permanent, but others are reversing again. State lawmakers temporarily scrapped hundreds of regulations early in the COVID-19 pandemic to help businesses and consumers deal with widespread shutdowns, giving patients greater access to telehealth and helping spur an explosion in use of virtual care. A number of states allowed medical professionals licensed elsewhere to hold telehealth visits with residents of their state during the pandemic, and some already have or are looking to make the rollbacks permanent. Exact numbers are difficult to track because some policies overlap and are organized differently in different states, but as of July 28, 17 states and the District of Columbia still had some type of telehealth waivers in place, according to the Federation of State Medical Boards. Other states like New York, Minnesota, Florida and Alaska are among those that have pulled back emergency waivers. Alaska is going back to its old ways after its governor's emergency order ended. Patients there can only visit telehealth providers licensed in the state now after about a year without that rule. The same goes for Florida after its emergency declaration expired on June 26. Meanwhile, Arizona lawmakers passed sweeping legislation in May making the state's pandemic-related telehealth waivers permanent, including requiring insurers to cover audio-only visits and allowing out-of-state medical professionals to conduct telehealth visits with patients in the state. Advocates for allowing providers to permanently deliver virtual care across state lines say it would help ease staffing shortages, help patients and doctors maintain existing relationships and benefit patients in isolated communities by making faraway specialists more accessible. But as long as medical licensing is regulated at the state level, the broad access to services and providers that existed during the pandemic won’t continue for everyone. Patients in rural areas are often far away from a doctor's office, and in states like Alaska where flexibilities expired, can be even further from providers practicing certain specialties, such as a pediatric intensivist or certain oncologists, said Mei Kwong, executive director for the Center for Connected Health Policy. "Maybe there aren't enough of those cases in those particular states to make it worth a provider's while to go and move there, but there's still a need because they may still have people who need those services," Kwong said. The patchwork of red tape could also pose a challenge for providers who have pivoted to delivering more virtual care over the past year. Mia Finkelston, a family medicine physician in Maryland, made the switch to telehealth nearly a decade ago and has been practicing with Amwell ever since. She's currently licensed in 29 states, and said the process to get her licenses varied widely. "It's not standard as far as fees, it's not standard as far as what documents you need to give them. It really is based on those state medical boards and what they decide is important to them," Finkelston said. As more states' waivers expire and others' rules change, one option for providers who want to continue delivering care across state lines is through the Interstate Medical Licensure Compact, which currently includes 30 states, the District of Columbia and Guam. Similar to the nurse licensure compact, it allows eligible physicians to practice in other compact states. It’s worth noting, however, that the Interstate Medical Licensure Compact does not issue a compact license or a nationally recognized medical license for physicians, but rather streamlines the process for them to receive multiple licenses from individual state medical boards. Physicians pay an initial $700 compact fee, then an additional cost for each license in any compact state they want to practice in. States must pass legislation to join the compacts. "No two states are totally alike in their legal and regulatory framework for the practice of medicine, which of course, affects telehealth, which is just one aspect of the overall US healthcare system," Kyle Zebley, director of public policy at the American Telehealth Association, a coalition with a board that includes representatives from hospitals like HCA and payers like CVS, said. "Therefore a way to be consistent with our federal system, consistent with the way that the practice of medicine has been done in this country for so long, we've come up with this great model of compact, which is a way to be consistent with all that while still allowing for care across state lines," Zebley said. As lawmakers try to facilitate continued access to telemedicine for those who need it most, licensure reforms will be key, the authors of a February article in the New England Journal of Medicine argue. "The growth of large national and regional health systems and the increased use of telemedicine have expanded the scope of health care markets beyond state borders," the authors said. They agree that a federal medical licensing system is the loftiest reform option and strengthening existing compacts is the way to go, suggesting Congress pass legislation to encourage holdout states to join the Interstate Medical Compact. Other options include encouraging states to practice reciprocity, where they automatically recognize an out-of-state license, as the Department of Veterans Affairs does with physicians in its system. Source: https://www.healthcaredive.com/news/telehealth-waivers-wind-down-restricting-some-providers-from-delivering-ca/603169/#:~:text=Healthcare%20Dive-,Telehealth%20waivers%20wind%20down%2C%20restricting%20some%20providers%20from%20delivering%20care,but%20others%20are%20reversing%20again. < Previous News Next News >

Geisinger's journey to greatly expanded telehealth Bill Siwicki April 19, 2022 The prolific health system is now able to offer telemedicine appointments to patients for primary care, urgent care and more than 70 specialties. More than 8% of total outpatient visits now are conducted virtually. Rural Pennsylvania is bigger than the states of New Jersey, Massachusetts, New Hampshire and Vermont combined. Some 75%, or 33,394 square miles, of Pennsylvania are considered rural. The geography is diverse, from rugged mountainous terrain to large stretches of farmland. High-profile health system Geisinger and its affiliated entities serve 45 predominantly rural counties throughout central and northeastern Pennsylvania, 31 of which are a part of Appalachia, a unique region of the Appalachian Mountains that cuts through the western part of the state. THE PROBLEM "Access to specialty care for many of our communities is scarce; these communities already are faced with primary care shortages, and for those who need to seek specialists and sub-specialists, long travels often are a costly and time-consuming reality," said Tejal A. Raichura, director of the center for telehealth at Geisinger. "Surveys show that rural Pennsylvanians are not taking care of themselves as well as their urban counterparts," she continued. "Fewer rural residents than their urban counterparts get the recommended exercise. Rural residents have higher rates of obesity, with almost two-thirds at risk for chronic diseases based on their sedentary lifestyle." Rural residents are in poorer physical condition, have more health risks and are more likely to lack health insurance, she added. The wage gap between urban and rural Pennsylvanians is getting wider. In fact, it has doubled in the last 30 years. Improving the quality of healthcare while lowering costs and increasing access in rural Pennsylvania counties is challenging, she said. "In 2018, Geisinger leadership committed to expanding our telehealth program and invested in a platform that could cover various elements of virtual care, including video visits to the home and our clinics, tele-stroke visits at our various inpatient units and emergency rooms, and video visits to non-Geisinger organizations, including other hospitals, skilled nursing facilities, correctional facilities, et cetera," Raichura recalled. PROPOSAL The business plan requested support for an expanded telemedicine program, one that would connect distantly located expert physicians trained in several specialties – including neurology, stroke/intensive care, pediatrics, primary care, geriatrics, psychiatry, endocrinology, rheumatology, podiatry and several others – with rural and underserved communities, allowing residents to access specialty care where they live and work. For Full Article: https://www.healthcareitnews.com/news/geisingers-journey-greatly-expanded-telehealth < Previous News Next News >