Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.
HRSA Reorganization. This week, the Health Resources and Services Administration (HRSA) announced a reorganization of its bureaus and offices
to accommodate changing needs in the agency’s mission to improve health care for people who are geographically isolated and/or medically underserved. Among the changes, the Office for the Advancement of Telehealth has moved from its longtime home in the Federal Office of Rural Health Policy to become an operational focal point for telehealth across all of HRSA’s programs.
State Telehealth News and Activity
Alaska Public Media: Dunleavy adds nursing, telehealth issues to Legislature’s agenda (9/2) – Alaska Governor Mike Dunleavy expanded the state legislature’s special session agenda to include bills that address nursing and telehealth amid the ongoing pandemic and spike in COVID cases across the state. One bill to be considered would expand telehealth and provide tools to expand the health care workforce and capacity. The second bill would call for allowing Alaska to participate in the Nurse Licensure Compact.
Foley & Lardner LLP: New Jersey’s Telemedicine Business Registry: What You Need to Know (9/1) – New Jersey recently finalized regulations requiring all telemedicine or telehealth organizations providing telemedicine services to patients located in New Jersey to register with New Jersey’s Department of Health before October 15, 2021. The regulations apply to all telemedicine or telehealth organizations providing services in the state, however “health care facilities that simply utilize telemedicine or telehealth services in addition to in-person evaluation and care services are not required to register or pay registration fees.”
State of Reform: Analysis illustrates California safety net facilities’ experience implementing telehealth (8/30) – The California Health Care Foundation (CHCF), through its Connected Care Accelerator Innovation Learning Collaborative, collected clinical utilization data from 23 state safety net health centers between February 2019 and February 2021 to asses their experience with the shift to widespread telehealth use and to identify where they had success. The data revealed four key themes: 1) telehealth replaced a large volume of care during COVID-19; 2) the rate of adoption of video visits varied and was supported by a few key implementation practices; 3) health centers developed unique telehealth models and incorporated needs of patients, staffing models, and tech infrastructure; and 4) health centers implemented and continue to seek solutions to address digital barriers.
Telehealth Research, Reports and Surveys
Chief Healthcare Executive: Telehealth Increased Healthcare Access for Hispanic, Low-Income Populations During COVID-19 (9/2) – A recent study published in the Journal of Medical Internet Research found that Hispanic and low-income communities had the largest percentage increase in telehealth use in response to the pandemic. Of the more than 4.5 million members of Kaiser Permanente Southern California that were part of the study cohort and enrolled in January 2020, 15 percent were at least 65 years old, 51.5 percent were female, 39.4 percent were Hispanic, and 7.7 percent lived in census tract areas with a median household income less than $40,000. Hispanic patients had the largest increase in telehealth visits at 295.5 percent, and visits for patients in the low-income group increased the most at 313.5 percent.
STAT Opinion: 3 surprising trends in seniors’ telemedicine use during the pandemic (8/30) – This article highlights three findings about how telemedicine is used by Medicare beneficiaries, according to an analysis of 30 million Medicare claims:
One in 10 telehealth-using Medicare beneficiaries accessed care through the telephone alone, suggesting that eliminating reimbursement for telephone-only calls could meaningfully restrict access.
Telemedicine use decreased sharply after peaking in May 2020, demonstrating that telehealth will certainly play a role in health care, but future use depends on both government and private health plans’ policies around how — and how much — clinicians are reimbursed for providing this type of care.
Telemedicine use has not varied substantially by race and ethnicity. Through the end of 2020, there were no substantive differences found in the proportion of beneficiaries using telemedicine by race and ethnicity: 51 percent of non-Latino white beneficiaries, 55 percent of Black beneficiaries, and 56 percent for both Latino and Asian beneficiaries.
Telehealth News and Market Developments
Modern Healthcare: CMS should collect home health telehealth data, experts say (9/3) – At the September Medicare Payment Advisory Commission (MedPAC) meeting, MedPAC commissioners discussed how CMS should collect data about telehealth use in home health to guide policymakers in setting reimbursement rates for providers. CMS adjusted how Medicare pays providers under the home health prospective payment system in 2020 after Congress mandated changes to those payments in the Bipartisan Budget Act of 2018. MedPAC tried to examine the impact of those changes on home health, finding a 20 percent decline in in-person visits last year, however it is unclear whether this was from the pandemic or the payment changes. While MedPAC will not recommend that CMS require home health providers to report their telehealth use, the commission may describe the benefits of such a requirement in its March 2022 report.
mHealth Intelligence: American Academy of Pediatrics Targets Parity in Telehealth Policy Statement (9/2) – The American Academy of Pediatrics issued a policy statement in the September issue of Pediatrics, calling for payment parity for telehealth and more efforts to address social determinants. The document, titled “Telehealth: Improving Access to and Quality of Pediatric Health Care,” contains eight recommendations, focusing primarily on ensuring equitable, quality care, payment reform and addressing barriers to access.
American Medical Association (AMA): Telehealth virtual visits can be a tool to fight climate change (9/1) – Researchers with Northwest Permanente (NWP) calculated telehealth’s impact on reducing patients’ vehicle traffic and the corresponding reduction in emissions. Ambulatory visit carbon intensity, a new metric that measures the total greenhouse gas emissions associated with a given outpatient visit, dropped by 51 percent. The article stated that, “Fewer miles driven, for example, also mean less wear and tear on public streets and fewer in-person patient visits allows for a reduction in health care’s footprint.”
Business Insider: Here’s how a Cleveland hospital is implementing a hybrid telehealth model during the ongoing pandemic (9/1) – MetroHealth, a community hospital in Cleveland, Ohio, quickly pivoted to telehealth during the pandemic to care for its diverse patient population, as well as a Hospital at Home program to free up inpatient beds. The health system has expanded these services to better reach for and care for its patient population, offering training and support to providers to help with the transition to a model that relied heavily on virtual care. Providers conducted about 480,000 telehealth visits in 2020 and 217,000 thus far in 2021.
JAMIA: Health management via telemedicine: Learning from the COVID-19 experience (8/30) – In a new Journal of the American Medical Informatics Association article, Stanford-affiliated researchers highlight the gaps they still see in telemedicine and the opportunities for growth beyond the COVID-19 crisis. “To optimize patient and provider experience through telemedicine, stakeholders need to focus on enhancing technology interoperability and usability and providing sufficient training for efficient telemedicine use. While in-person visits are essential in many conditions, telemedicine may be a viable alternative for certain patient populations and care needs.”
Home Health Care News: How CommonSpirit Reduced Medicare Spending by $136M (8/30) – As a MSSP participant, CommonSpirit has saved Medicare more than $200 million over the past three years. CommonSpirit has pulled it off by increasing annual wellness visits, improving the management of hypertension, enhancing care coordination and innovating its home-based care offerings, according to the press release.
JAMA Health Forum: Paying for Telemedicine in Smaller Rural Hospitals (8/27) – Researchers from Harvard Medical School penned a piece in JAMA about the limitations of financial gain from telehealth in rural hospitals. "While EDs can bill on behalf of clinicians, which would defray subscription costs, few do so because the administrative barriers of credentialing and licensure are prohibitive across multiple insurers, especially given the low volume of consultations and the amount of reimbursement per visit," the analysis said.
HIMSSCast, “Telehealth and Value-based Care.” UPMC’s Dr. Andrew Watson joined this episode of HIMSSCast to discuss two major trends in health care – telehealth and value-based care – and how they intersect.