Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on the use of virtual care.
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Alliance News
Alliance for Connected Care: Study by Alliance Board Members Found that Telehealth Did Not Increase Primary Care Utilization (9/29) – Three Alliance for Connected Care Board Members conducted a government-funded study to determine whether there was an increase in primary care utilization with the expanded availability of telehealth. Using a grant from the Agency for Healthcare Research and Quality (AHRQ), data was collected by MedStar Health, Stanford Health Care, and Intermountain Healthcare across the three health systems. Results suggest the availability of telehealth is not resulting in additional primary care visits, rather, telehealth is serving as a substitute for certain in-person encounters resulting in no overall increase in primary care utilization. The health systems will continue to work under the Connected CARE (Care Access Research Equity) & Safety Consortium, expanding their initial focus on primary care.
Modern Healthcare: Telehealth Better Than In-Person Visits on Some Quality Measures (9/27) – A recent study published in JAMA Network Open found that telehealth visits for primary care can be comparable in quality to in-person visits, suggesting remote testing and screenings are valuable tools to augment patient care. The results are examples of clinical domains where telemedicine could be used as an alternative to in-office care. Prioritizing telehealth visits for chronic disease management and preventive care could lead to better quality outcomes as well as more affordable care. The data in this report should spur more research to find out why telehealth allows for higher quality in some instances, said Krista Drobac, executive director of the Alliance for Connected Care. “We’ve always said that telemedicine is medicine,” Drobac said. “It's just a different modality and so the quality should be comparable.”
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Administration
Government Accountability Office Blog: Telehealth in the Pandemic—How Has It Changed Health Care Delivery in Medicaid and Medicare? (9/29) – The Government Accountability Office (GAO) posted a blog that looks at how telehealth use has grown within Medicaid and Medicare—the government’s health insurance programs.
Congressional Budget Office: The Opioid Crisis and Recent Federal Policy Responses (9/28) – The Congressional Budget Office (CBO) released a report which described the effects and evolution of the opioid crisis in the United States, the factors that have contributed to it, the laws enacted to address it, and the effects of the COVID-19 pandemic on the crisis. In particular, the report mentioned the impact of telehealth flexibilities during the pandemic.
Food and Drug Administration: Streamlining Emerging Technology Medical Device Development Through Regulatory Tools Between Food and Drug Administration, Department of Health and Human Services and Veterans Health Administration (9/27) – The Food and Drug Administration (FDA) and the Veterans Health Administration announced they will collaborate to develop and disseminate new tools to test the safety and effectiveness of medical devices and emerging technologies, with an initial focus on interoperable systems that can help advance automation, telemedicine and personalized health care. The collaboration, established through a memorandum of understanding, is expected to spur development of “off-the-shelf” testing tools that can provide innovators with straightforward, reproducible and cost-effective testing methods throughout the product development cycle.
Department of Health and Human Services: Joint Statement by the Chief Public Health Officer of Canada, Dr. Theresa Tam, and Assistant Secretary for Health Admiral Rachel Levine, MD, on Substance Use and Harms During COVID-19 (9/27) – The Chief Public Health Officer of Canada, Dr. Theresa Tam, and the United States Assistant Secretary for Health, Admiral Rachel Levine, MD released a white paper on substance use and harms. The white paper examines rapid and innovative approaches used by both countries to monitor substance use trends during the pandemic. Notably, the report examined prescribing for controlled substances via telehealth and calls for continued evaluation of these policies to determine if it should become permanent.
Health Resources & Services Administration: Telehealth for School-Based Services (9/27) – The Health Resources & Services Administration (HRSA) released a best practice guide, which outlines how to build a school telehealth program, prepare students and guardians for school-based telehealth, billing for telehealth, and more. School-based telehealth improves and expands a student’s ability to access health care providers. Increased access to health care helps students stay or become healthy and focus on learning.
Government Accountability Office: Medicare Telehealth: Actions Needed to Strengthen Oversight and Help Providers Educate Patients on Privacy and Security Risks (9/26) – GAO released a report on Medicare telehealth. The report describes the utilization of telehealth services, the Centers for Medicare and Medicaid Services (CMS) efforts to identify and monitor risks posed by Medicare telehealth waivers, and a change the HHS Office for Civil Rights (OCR) made to its enforcement of regulations governing patients’ protected health information during the COVID-19 public health emergency. GAO recommended three recommendations for CMS to strengthen its telehealth oversight, and one for OCR to provide additional direction to providers to explain privacy and security risks to patients.
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Congress
Representative Murphy: Introduction of the Better Interoperability for Devices (BID) Act (9/29) – Reps. Murphy (R-NC), Miller-Meeks (R-IA), and O’Halleran (D-AZ) introduced the Better Interoperability for Devices (BID) Act (H.R.9067), which would require the Department of Health and Human Services (HHS) to review the interoperability, safety, and effectiveness of medical devices. The bill would also ensure medical device standards for home-based care, telemedicine, clinical care, and data sharing.
Medicare Payment Advisory Commission: Mandated Report: Study on the Expansion of Telehealth (9/29) – During its October Public Meeting, the Medicare Payment Advisory Commission (MedPAC) outlined a Congressionally mandated study, due in June 2023, on the expansion of telehealth as a result of the Consolidated Appropriations Act of 2022. MedPAC staff provided an overview of potential policy options for the mandated report, which will analyze changes in telehealth volume and spending during the PHE, assess the impact of telehealth on access and quality, use population-based outcome measures to assess the impact of telehealth expansion on access and quality, and consider alternative approaches to paying for telehealth services under the physician fee schedule (PFS). A notable inclusion was staff-led discussion of a bundled payment model for telehealth services. Commissioners disagreed about the merit of a bundled payment model for telehealth, referencing different use cases. Some Commissioners supported a bundled payment model, while some asked for alternative methods.
Senator Wicker: Resolution Will Help More Americans Learn About Accessing Care Through Telehealth (9/29) – The Senate unanimously passed a bipartisan resolution authored by Sens. Wicker (R-MS) and Schatz (D-HI) designating September 18-24 as “Telehealth Awareness Week.” The resolution recognized the bipartisan support in Congress for telehealth and encouraged expanded access to telehealth services for all people, including members of rural and underserved communities.
Senator Sullivan: Sen. Sullivan Introduces Bill to Remove Obstacle to Mental Telehealth Services for Seniors (9/27) – Sen. Sullivan (R-AK) introduced legislation
(S. 4965) to permanently waive a federal provision requiring seniors who are seeking mental health services to have an in-person visit before receiving services virtually. Reps. Hern (R-OK), Curtis (R-UT), and Bacon (R-NE) introduced companion legislation in the House (H.R. 8497) on July 26.
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Telehealth Research, Reports and Surveys
JD Power: Survey Shows Consumers Embrace Telehealth (9/29) – The J.D. Power 2022 U.S. Telehealth Satisfaction Study found that 67 percent of 4,306 consumers surveyed in June and July reported using telehealth within the past year, up from 37 percent in 2019. Nearly two-thirds of consumers (61 percent) say that convenience is the top reason why they use telehealth, along with faster access to care (49 percent) and ease of access to health information (28 percent). These findings are similar to an Alliance for Connected Care survey
conducted earlier this year.
The Milbank Quarterly: How Emerging Telehealth Models Challenge Policymaking (9/28) – This study describes policy challenges across a range of alternative telehealth offerings in four groups, ranging from those that support the current system to those that compete with it. It also outlines key policy considerations, such as how to pay for telehealth, how much to pay for it, and how to ensure quality of the services. Current telehealth policy discussions are focused on synchronous video and audio telehealth visits delivered by traditional providers and have neglected the growing number of alternative telehealth offerings. These alternative telehealth offerings range from simply supporting traditional brick-and-mortar providers to telehealth-only companies that directly compete with them.
Business Wire: Research Finds that Telehealth Fills Care Gaps for Patients (9/28) – Research from athenahealth found that use of telehealth, which increased dramatically during the COVID-19 pandemic, not only remains substantially above pre-pandemic levels but has also emerged as both a key diagnostic tool and treatment vehicle. The findings suggest telehealth is now integrated across the care continuum. Additionally, the findings indicate telehealth is playing a larger role in care delivery and may be filling crucial care gaps for patients as it has evolved past its early pandemic function of simply substituting in-person visits.
AHIP: Policies to Support Future Telehealth Innovation (9/28) – Telehealth provides new opportunities for care to be delivered more cost-effectively, which helps make coverage and care more affordable and accessible for everyone. This report lays out policies for telehealth after the public health emergency. Telehealth has the opportunity to permanently change the standard of care by retaining the policies that enabled recent telehealth advancements for patients and consumers. AHIP also published an article on how health insurance providers are pushing to expand and strengthen telehealth beyond COVID-19, which can be found here.
Aging and Disability Business Institute: Policy Spotlight: Telehealth and the Role of the Aging Network (9/28) – In recent years telehealth has played a growing role in ensuring that older adults receive medical care. A new Policy Spotlight, Telehealth and the Role of the Aging Network, developed in partnership with the National Council on Aging, provides an overview of changes to telehealth that have occurred due to the pandemic, outlines the current challenges related to access, and identifies opportunities for expanding telehealth.
JAMA Network Open: Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System (9/26) – A study found that virtual care methods can expand health care capabilities, performing on par or better than in-person care on most quality measures evaluated. Patients with telemedicine exposure in primary care had comparably better performance in 11 of 16 quality measures with statistically significant differences. The study examined whether quality of care among patients exposed to telemedicine differs from patients with only in-person office-based care. Researchers concluded that telehealth could augment care for various conditions, especially chronic diseases. The study also supplies information that could assist providers in determining an ideal ratio of in-person and telehealth visits.
Annals of Family Medicine: Facing the Digital Divide: Increasing Video Visits Among Veterans Experiencing Homelessness (9/26) –In response to concerns around the digital divide, an interdisciplinary team of primary care clinicians implemented a quality improvement project to increase video visits for veterans experiencing homelessness (VEH). The proportion of video visits among telehealth visits doubled from baseline by the conclusion of the 16-week intervention period. The study found that standardized video visit workflows, sustained education, and maximizing resources available at the VA proved essential to increasing video visit use. Researchers recommend future studies exploring the impact of programs providing persons experiencing homelessness with digital access devices and identifying factors affecting differential video visit use in emergency shelter, transitional, and permanent housing program participants.
Inside Telehealth: Telehealth Popularization Shouldn’t Leave Non-Tech Savvy Patients Behind, Execs Say (9/26) – Parks Associates released a report, which found that 40 percent of patients had participated in a remote patient monitoring program, with common uses including monitoring a chronic condition, diagnosing a potential heart condition or sleep issue, and monitoring illness recovery. Two-thirds of family caregivers said they wanted support for online medical appointments and the ability to monitor the vital signs of their loved ones. Fifty-five percent of all households reported using telehealth in the last year. Patients are becoming more interested in sharing the data from their wearable devices with doctors and integrating the data they collect into medical treatment.
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Telehealth News and Market Developments
Health Leaders: MedStar Health, Intermountain, and Stanford Medicine Expand AHRQ-Funded Telehealth Study (9/28) – Three Alliance for Connected Care Board Members, MedStar Health, Stanford Medicine, and Intermountain Healthcare are expanding an ongoing digital health partnership to create a patient safety learning laboratory aimed at improving telehealth access for those with chronic care needs and other vulnerable populations. With support from AHRQ, the project will focus on patient safety and health equity of telehealth.
Forbes: Health Care Technology Is Enabling Millions Of People To “Age In Place” (9/27) – Many companies are leading “Aging in Place” by spending millions of dollars on new and innovative technology. “Aging in Place” refers to individuals aging in their own homes rather than moving into nursing homes or other types of care facilities. Telehealth has made it easier to connect individuals with physicians and specialists in their own homes.
Healthcare IT News: How One FQHC Uses Telehealth for Primary Care, Behavioral Health, and Addiction Treatment (9/27) – Harbor Care Health and Wellness Center, a federally qualified health center (FQHC) in New Hampshire, provides primary care, behavioral health and dental services to a population that is either homeless or at risk of homelessness. Technology helped keep patients engaged by leveraging mobile and web-based platforms to provide access to patients' care teams. Harbor Care Health and Wellness Center was awarded $801,768 from the Federal Communications Commission (FCC) telehealth grant program to obtain computers and telecommunications devices and add improvements to their network and network security, in order to provide enhanced telehealth services to patients, 75 percent of whom self-identified as homeless.
Forbes: To Be Part Of The Cure To Healthcare Finances, Telehealth Needs To Get Strategic (9/27) – In this op-ed, Dr. Corey Scurlock, founder of Equum Medical, highlights the importance of analyzing the business model of telehealth. Every health care provider should assess what it needs to concentrate on what can be provided more cost-effectively through virtual care. Without a mature telehealth strategy, the implementation of a telehealth service may encounter resistance from all corners—IT, finance, billing, providers, and even patients. Telehealth strategy, like any good business plan, should lay out the staffing model to support the launch of new services.
Health Leaders: Johns Hopkins Medicine Reaches Telehealth Visit Milestone (9/26) – Alliance board member Johns Hopkins Medicine has surpassed 1.5 million telehealth visits, and the health system expects virtual medicine visits to maintain a brisk pace over the next two years. Over the past six months, Johns Hopkins Medicine has conducted about 30,000 to 35,000 outpatient telemedicine visits per month. To support the dramatic increase in telehealth visits during the pandemic, the health system made investments in three primary areas: technical, operational, and training. At the health system, clinician adoption of telemedicine has been greatest in specialties that are less in-person, less physical exam-dependent and less in-person procedural-dependent such as psychiatry.
Memorial Sloan Kettering Cancer Center: Memorial Sloan Kettering Cancer Center Creates Innovative Telemedicine Platform to Provide Patients Greater Access to Care (9/26) – Memorial Sloan Kettering (MSK) Cancer Center collaborated with Accenture, Avanade, and Microsoft to develop and launch a telemedicine platform in August 2021, which has since been used for more than 200,000 virtual appointments. The collaboration allowed MSK to quickly respond to the need for enhanced remote care during the pandemic that left many patients unable to visit doctors and hospitals. The MSK DigITs team leveraged the combined technical resources of Accenture and Microsoft to develop a standardized telemedicine platform that could be used at scale.
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State Telehealth News and Activity
East Idaho News: Idaho State University Receives Grant to Provide Telehealth Services to Rural Idaho Students (9/29) – The College of Arts and Letters of Idaho State University was recently awarded a $30,000 grant to help support the INCLUDE II program. INCLUDE II builds on the infrastructure provided by INCLUDE I to focus on providing clinical mental and physical health care and education to rural students, and opioid and health education to faculty, parents, and community members. Telehealth services will be supported by faculty and students in the health sciences at Idaho State. The Master of Social Work (MSW) Program will educate and train up to four MSW students annually to deliver tele-mental health services to the participating school districts.
South Dakota Public Broadcasting: Telemedicine Can Help Prevent Burnout in Health Care (9/28) – Telemedicine can connect rural health care providers with other health professionals around the country as they work with patients. That added expertise can make the difference between life and death in emergency situations. Dr. Kelly Rhone, a board-certified emergency physician, has seen telemedicine give health care providers access to the mentorship and emotional support they don't have in their own facility.
North Carolina Governor Roy Cooper: State Office of Digital Equity and Literacy Launches $24M Digital Equity Grant Program (9/27) – Governor Cooper announced the launch of the state’s first digital equity grant program, which will help North Carolinians afford high-speed internet, obtain digital devices and access digital literacy resources. The multi-phased program, administered by the N.C. Department of Information Technology’s Office of Digital Equity and Literacy, will invest up to $24 million of federal American Rescue Plan Act funds for collaborative digital equity projects.
mHealth Intelligence: MUSC Receives $1.5M Grant to Advance Telehealth Training in Rural Areas (9/26) – The Medical University of South Carolina's (MUSC) Center for Telehealth has received a $1.5 million grant to bolster health care training and job placement in rural communities. HRSA awarded the three-year grant, which MUSC will use to establish the South Carolina Rural Telehealth Workforce Pipeline Network. The network aims to create educational opportunities for high school and technical college students to learn about telehealth and gain experience with the virtual care modality in their communities.
Office of Governor California Gavin Newsom: Governor Newsom Issues Legislative Update (9/25) – Governor Gavin Newsom signed AB 32 into law, which makes current telehealth flexibilities permanent under state law. Policy changes outlined in AB 32 include creating payment parity between Medi-Cal managed care plans and commercial plans and allowing virtual enrollment for limited scope Medi-Cal programs. Additionally, the intent of the bill is to continue the provision of telehealth in Medi-Cal programs, including video and audio-only technology, by making the telehealth flexibilities instituted during the public health emergency permanent.
Inside Telehealth: New Mexico Throws Out Proposed Restrictive Telehealth Policies (9/23) – The New Mexico medical board changed course and decided not to enact proposed restrictive telemedicine policies after reviewing public comments. The board will draft new telemedicine guidelines and again seek public comment. The New Mexico medical board’s proposed regulations would have required the establishment of a physician-patient relationship prior to using telehealth and restricted the use of asynchronous telehealth for diagnosis and treatment -- which would have limited the tools available to providers and restricted prescription via telehealth.
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Upcoming Events and Hearings
September 30-October 3, American Academy of Ophthalmology, “AAO 2022.”
October 10-12 – Becker’s Hospital Review, “The Future of Business and Clinical Technologies.”
October 13 – Dickinson Wright, “How Will Telehealth Evolve as the Pandemic (hopefully) Draws to a Close?”
October 17 – Bipartisan Policy Center, “Approaching the Telehealth Cliff: Medicare Policy Post-Pandemic.”
October 19 – Colorado Rural Health Center, “2022 Annual Rural Health Conference.”
November 16-18 – Society for Education and the Advancement of Research in Connected Health, “The National Telehealth Research Symposium.”
December 5 – Center for Telehealth & e-Health Law, “19th CTeL Digital Health Summit.”
December 8 – American Medical Association, “Panel Discussion: 2022 Telehealth Retrospective & 2023 Predictions.”
Previous Events, Videos, and Podcasts
American College of Surgeons, “Surgeon Voices.” In this week’s episode of Surgeon Voices, Steven D. Wexner, MD, PhD(Hon), FACS, FRCSEng, FRCSEd, ACS Communications Consultant and director of the Digestive Disease Institute at Cleveland Clinic Florida, Weston, speaks with Jyotirmay (Joe) Sharma, MD, FACS, Chair of the ACS Board of Governors Telehealth Workgroup, about how the College has been working to find the best ways surgeons can use telehealth to address issues of access, diversity, privacy, and more.
Fierce Healthcare, “‘Podnosis’: Health Equity, Cuts To Medicare Payments And The Future Of Telehealth Flexibilities.” Fierce Healthcare senior editor Paige Minemyer talks with chief health equity officer of Humana, J. Nwando Olayiwola, M.D., about health equity and whether there is a risk the momentum around this issue could slow. They also discuss Medicare and the future of telehealth flexibilities.
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