April 17, 2024

Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on virtual care. 

This is the public update of the Alliance, issued quarterly. The biweekly Alliance newsletter is now members-only. Was this email forwarded to you? Subscribe here or feel free to contact us about membership. 

Alliance News

Alliance for Connected Care: Alliance Submits Statement for the Record for House Energy & Commerce Hearing on Telehealth Legislation (4/10) - The Alliance for Connected Care submitted a statement for the record to the House Energy & Commerce Committee, Health Subcommittee for the legislative hearing, “Legislative Proposals to Support Patient Access to Telehealth Services.” The Alliance focused its comments on the need for urgent actions in extending Medicare telehealth provisions through December 31, 2024 to provide certainty around the future of telehealth. 

Alliance for Connected Care: Alliance Co-Leads Letter to DEA Urging Action on Telehealth Rule Crucial for Mental Health, Substance Use Disorders (4/2) - The Alliance co-led a letter to the U.S. Drug Enforcement Administration (DEA) requesting the expedited release of a revised proposed rule to permit and regulate the prescribing of controlled substances through telehealth. The letter was signed by 214 stakeholders. The Alliance also sent the letter to key Congressional staffers, Leaders in the Biden Administration, and .

Selected Coverage:

• Healthcare Dive: Telehealth Groups Urge DEA to Release Controlled Substance Prescribing Proposal
• Healthcare IT News: Telehealth Groups Urge DEA to Release Virtual E-Prescribing Rules
• MedCity News: 200 Stakeholders Push DEA for Updated Proposed Rule on Virtual Prescribing of Controlled Substances

Alliance for Connected Care: Correcting the Record for House Ways & Means Hearing on Care in the Home (3/14) - During the March 12 House Ways and Means Committee Hearing on Expanding Access to Care at Home in Rural and Underserved Communities, a number of already disproven myths about telehealth were publicly repeated. While broader understanding of the benefits and use of telehealth have come a long way, these outdated misconceptions continue to undermine policymaking and must be corrected. Importantly, the Alliance and its members believe that an in-person visit requirement is never the right guardrail for a telehealth service – because these requirements harm patients with access challenges, such those who are frail or homebound, have transportation issues, or live in rural or underserved areas. Similarly, the Alliance believes that a clinician’s time has the same value, no matter if they are supporting a patient virtually or in-person.

Alliance for Connected Care: Alliance Submits Statement for the Record for House Ways & Means Hearing on Care in the Home (3/12) - The Alliance for Connected Care submitted a statement for the record to the House Ways & Means Committee for the hearing, “Enhancing Access to Care at Home in Rural and Underserved Communities.” 

Alliance for Connected Care: Alliance Leads Over 200 Organizations in a Letter Urging Congress to Act on Telehealth (2/22) - The Alliance for Connected Care convened well over 200 organizations on a letter, urging congressional leaders to act on telehealth earlier this year, to allow for implementation time prior to the expiration of statutory restriction on December 31, 2024. Without timely and decisive action from Congress, many Americans risk losing access to telehealth services they rely upon due to challenges with 2024 timelines needed to ensure 2025 benefits – such as federal payment rules, employer and health plan benefit decisions, and health provider workforce decisions.

OTHER TOP ALLIANCE NEWS

Alliance Joins Statement to DEA on Geographic Red Flags in Telemedicine - The Alliance for Connected Care joined over 45 organizations in a statement to the Drug Enforcement Administration (DEA), requesting explicit guidance to the pharmacy community that the geography of a prescriber in relation to the patient or the pharmacy should not be a “red flag” when a prescription is a result of a telehealth visit.

Alliance Joins Letter In Support of the States Handling Access to Reciprocity for Employment (SHARE) Act - The Alliance for Connected Care joined over 20 organizations in a stakeholder letter supporting the States Handling Access to Reciprocity for Employment (SHARE) Act (H.R. 1310). The bill would authorize the use of FBI background checks for the administration of interstate compacts.

Congress

House Energy & Commerce (E&C) Committee: Chair McMorris Rodgers (R-WA) Announced Changes to E&C Republican Subcommittee Assignments (4/11) – House Energy and Commerce Committee Chair McMorris Rogers (R-WA) announced updates to Republican Members’ subcommittee assignments. Of note, Rep. Balderson (R-OH) will join the Subcommittee on Health and leave the Subcommittee on Communications and Technology. Rep Balderson has been an active leader on telehealth and remote monitoring, and helps lead the digital health caucus and telehealth caucus.

Medicare Payment Advisory Commission (MedPAC): Telehealth in Medicare: Status Report (4/11) – MedPAC staff presented updated trends in Medicare telehealth and discussed the landscape around in-person requirements for telehealth visits. In particular, staff proposed alternative safeguards to an in-person requirement, including applying additional scrutiny to outlier clinicians, or prohibiting “incident to” billing for telehealth services provided by any clinician who can bill Medicare directly. Commissioners generally supported the removal of in-person requirements, particularly for behavioral health. Several Commissioners emphasized the importance of reframing the conversation from restrictive regulations to address program integrity concerns to increasing health care access and innovation.

House E&C Committee: Legislative Proposals to Support Patient Access to Telehealth Services (4/10) – As noted above, the House Energy & Commerce Committee, Health Subcommittee held a legislative hearing to discuss a range of legislative proposals to support patients’ access to telehealth services and avert the statutory deadline on Medicare telehealth services of December 31, 2024. Members discussed the importance of ensuring certainty around telehealth, guardrails for permanent telehealth, cross-state licensure, and remote patient monitoring. Most notably, there was robust discussion around payment parity, what services are appropriate for virtual care, and safeguards to ensure virtual-only companies did not game the system. Additional coverage can be found on Fierce Healthcare, Healthcare Dive, and Politico.

Rep. Ezell (R-MS): Introduction of DEA Special Registration Legislation (4/9) – On April 9, Rep. Ezell introduced H.R. 7899, which would promulgate the final regulations relating to special registration for telemedicine.

Sen. Tester (D-MT): Letter to Department of Veterans Affairs (VA) For Rural Veteran Mental Health Telehealth Funding (4/4) – On April 4, Sens. Tester (D-MT) and Moran (R-KS) sent a letter to the Department of Veterans Affairs (VA) regarding the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, which provides grant funding for rural veteran mental health telehealth initiatives.

Congress: Labor, Health and Human Services, Education, and Related Agencies Fiscal Year (FY) 2024 Appropriations Bill (3/21) – On March 23, President Biden signed the Further Consolidated Appropriations Act, 2024 (H.R. 2992) into law. The package includes six fiscal year (FY) 2024 appropriations bills, including HHS, providing funding through September 30, 2024. The package includes funding for Telehealth Centers of Excellence, funding for the Health Resources and Services Administration (HRSA) to integrate and implement a robust telementoring initiative, and directs the Administration for Strategic Preparedness & Response (ASPR) to provide a report describing the potential role of a Federally Funded Research and Development Center with an academic partner that has strengths in telehealth and far forward medical response.

On March 20, The House Ways & Means Committee held a hearing, "The President’s Fiscal Year 2025 Budget Request." During the hearing, members questioned HHS Secretary Xavier Becerra on the importance of adequately funding mental health, behavioral health, and telehealth services. Sec Becerra expressed strong support for action on telehealth.

• Q: Rep. Buchanan (R-FL): What is your position on extending the current telehealth flexibilities? 
  • R: Secretary Becerra: We are with you. We can't allow the flexibilities to expire and we need to work with states to ensure telehealth is facilitated across state borders.
• Q: Rep. Thompson (D-CA): How does HHS view the upcoming telehealth deadline? Are telehealth flexibilities important? 
  • R: Secretary Becerra: We need to maintain telehealth flexibilities, which have helped a lot with providing mental health services. We want to ensure Congress can extend these flexibilities.

Alliance -Supported Legislative Introduction - On March 19, Sen. Scott (R-SC) and seven bipartisan cosponsors introduced the Telehealth Modernization Act (S. 3967), which would make permanent certain telehealth flexibilities under the Medicare program. Rep. Carter (R-GA) and seven bipartisan cosponsors introduced the companion legislation (H.R. 7623) in the House on March 12. Bill Text Press Release

Administration

Government Accountability Office (GAO): Telehealth Usage by the Coast Guard (4/10) – GAO released a report on telehealth usage by the Coast Guard. The report describes how the Coast Guard uses telehealth to provide medical care to its active-duty personnel, as well as describes telehealth benefits and challenges identified by Coast Guard officials and documents.

Centers for Medicare and Medicaid Services (CMS): Rhode Island Comprehensive Demonstration Includes Remote Monitoring (3/21) – CMS approved an amendment to Rhode Island's section 1115 demonstration, “Rhode Island Comprehensive Demonstration.” The amendment provides authority for the state to add remote supports and monitoring as a home and community-based service (HCBS) among others. The demonstration amendment is effective through December 31, 2024.

White House: President’s Budget for Fiscal Year (FY) 2025 (3/11) – President Biden released his FY 2025 budget request, which proposes $130.7 billion in discretionary funding and $1.7 trillion in mandatory proposed budget authority for the Department of Health and Human Services (HHS) in FY 2025. The White House calls or expanding access to telehealth in rural areas through broadband programs, and the Medicare rural hospital flexibility grants program. Most notably, the budget includes a proposal to prohibit hospitals from billing unwarranted facility fees for telehealth services and for certain other outpatient services.

CMS: P.O. Box Allowed on Provider Enrollment Forms (3/4) - Alliance Advocacy on Provider Location/Home Address – PARTIAL WIN. CMS has amended the “description of the provider first line location address and second line location address data elements to permit a provider that does not have a physical location other than their home address to enter a post office box or personal mailbox offered by a private delivery service as their provider location address.” While this change is a huge win for home address reporting on provider enrollment documents, we believe a similar change would be required related to billing.

CMS: Rural Health Clinic (RHC) Billing Guidance for Care Management and Remote Patient Monitoring (RPM) (3/1) - CMS released RHC billing guidance which clarifies that HCPCS code G0511 can be billed multiple times in a calendar month for the codes, including RPM. The Alliance commented on this issue in its Physician Fee Schedule comments, particularly on the health equity concerns as it may lead to providers choosing only one type of care management service under G0511. CMS clarified in the PFS final rule that G0511 can be billed multiple times, but there was still confusion from the community. CMS released additional guidance clarifying this.

Office of Inspector General (OIG): Medicare Generally Paid for Evaluation and Management Services Provided via Telehealth During the First 9 Months of the COVID-19 Public Health Emergency That Met Medicare Requirements (2/13) - The Department of Health and Human Services (HHS) OIG released a report which found that telehealth provided to Medicare beneficiaries did not result in fraud. This is notable due to the timeframe reviewed: March 2020 through November 2020, which was when telehealth utilization was at the highest.

Telehealth Research, Reports and Surveys 

JAMA Internal Medicine: Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation (4/7) – In this heart failure trial in Navajo Nation, a telephone-based strategy of remote initiation and titration for outpatients with heart failure with reduced ejection fraction led to improved rates of guideline-directed medical therapy at 30 days compared with usual care. This low-cost strategy could be expanded to other rural settings where access to care is limited. Underutilization of guideline-directed medical therapy for heart failure with reduced ejection fraction is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service, access to care, especially cardiology care, is limited, contributing to poor uptake of recommended therapy.

Harvard Medical School: For Controlling Blood Pressure, Telemedicine May Beat Clinic Visits (4/1) – Telemedicine visits combined with self-measured blood pressure readings may help people control high blood pressure better than traditional office visits. Researchers reviewed data from 31 trials lasting between six and 12 months that compared telemedicine to clinic visits for managing blood pressure. The telemedicine visits relied on blood pressure readings taken by patients at home, along with remote contact with health care providers via phone, video, or email.

Cureus: Telehealth Transformation: A Mixed-Methods Study on Organizational Change Processes and Outcomes in a Private Medical Practice (3/29) – This mixed-methods case study investigated the impacts, costs, barriers, and facilitators associated with implementing telehealth services across a private pediatric clinic system. The research examined the effects of telehealth on provider engagement and financial performance. Results showed significantly increased costs (44%) and revenues (47%) at clinics following virtual care expansion. The findings suggest catalyzed financial and productivity transformations. Researchers recommended updating coordination protocols, enhancing training and support resources, incentivizing provider usage, and modulating implementation pacing responding to user feedback during large-scale organizational innovation.

JAMA Network Open: Patient Characteristics and Telemedicine Use in the US, 2022 (3/22) – A study found that 43 percent of people opted for telemedicine (also known as telehealth) in 2022, even when in-person visits were available. Of them, 70 percent chose video visits and 30 percent had audio-only, or phone, visits with their doctors. Video visits were less likely among older adults and people without internet access. People who were uninsured, older and didn’t use the internet were more likely to use audio telehealth, or phone calls. Researchers noted that audio-only calls may give people a greater sense of privacy, but clinics and health systems need policies to include audio-only telehealth.

New England Journal of Medicine: Key Issues as Wearable Digital Health Technologies Enter Clinical Care (3/20) – Wearable digital health technologies (DHTs) offer the potential to affect health care by making behavioral and physiological patterns in daily life outside the clinic visible to patients and medical professionals. The evidentiary basis for the broad clinical effect of wearable DHTs in these areas is in its infancy, but there is potential for real-world medical benefits. Well-designed longitudinal trials will show which of these transformative aims can be realized.

National Association of Pediatric Nurse Practitioners: Implementing Pediatric Telemental Health Care has Both Advantages and Challenges (3/20) – Implementing telemental health services in the pediatric primary care setting can help address the growing need for children’s mental health care. However, there are not enough pediatric mental health providers available to address all of the needs of this vulnerable population. Additionally, disparities such as lack of adequate technology or a language barrier may make it more difficult for some patients to benefit from telemental health services.

JAMA Network Open: Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors (3/14) – Research from the University of Pittsburgh and University of Pittsburgh Medical Center (UPMC) found that telemedicine visits conducted for children with primary care providers (PCPs) are associated with fewer antibiotic prescriptions than telemedicine visits with virtual-only direct-to-consumer (DTC) companies. The findings highlight the importance of supporting integrated telemedicine within the primary care setting and the potential challenges and limitations of delivering virtual-only acute care to children. Find the UPMC press release here.

JAMA Network Open: Telehealth Treatment for Opioid Use Disorder During Pregnancy (3/14) – Research found that a majority of pregnant people remained engaged in telehealth-enabled opioid use disorder (OUD) care, with most carrying to term. The researchers conducted a cohort study assessing the efficacy of a low-barrier, multistate, telehealth-based addiction treatment program in the US. They used EHR data to identify pregnant patients, 18 and over, diagnosed with OUD and receiving buprenorphine or buprenorphine and naloxone treatment between January 1, 2018, and December 31, 2022. The study also showed that patients who became pregnant once established in care through telehealth were more likely to continue virtual care.

The Journal of Pediatrics: Impact of Telemedicine on Access to Care for Rural Transgender and Gender-Diverse Youth (1/11) – A study conducted by researchers from University of Virginia, UVA Health, and the University of Southern California found that telehealth was associated with lower no-show rates for healthcare visits among transgender and gender-diverse youth in rural areas. The researchers conducted a retrospective analysis of EMR data from a clinic serving transgender and gender-diverse adolescents and young adults. Overall, the no-show rate for the 17,928 patient encounters was 10.9 percent. However, telehealth visits had a no-show rate of only 5.4 percent. The study aligns with prior research showing that telehealth supports health care access for transgender and gender-diverse youth.

Telehealth News and Market Developments

Modern Healthcare: Defense Health Agency Shifting Toward a Telehealth Culture (4/12) – The Defense Health Agency is partnering with digital health company Amwell on the transformation project, has begun to roll out telehealth and digital wellness tools at five hospitals. The agency's My Military Health is comprised of three offerings for providers and patients: a self-care wellness program, a secure virtual visit platform and a digital companion to improve patient compliance. Current and former service members of the Army, Air Force, Marine Corps and Navy along with their families, have had trouble increasing access to care for its patients despite its size. As a result, the agency is in the middle of a digital transformation initiative with plans to adopt virtual care services across all military hospitals and clinics beginning in October.

Georgia Composite Medical Board: Board Rescinds Decision to End Tele-Prescribing Flexibilities (4/5) – After a sustained outcry from doctors who use telemedicine visits to prescribe controlled drugs such as Ritalin, the Georgia Composite Medical Board reversed its plans to restrict the practice. Instead, Georgia’s rules will remain the same as they have been throughout the pandemic until at least the end of the year. The board plans to write new rules from scratch.

Fierce Healthcare: HCA Healthcare Rolls Out Referrals to Talkiatry’s Telepsychiatrists (4/3) – Primary and urgent care providers within HCA Healthcare’s network now have the option to refer their patients to Talkiatry’s full-time psychiatrists from within their electronic health record thanks to a new integration and partnership between the telepsychiatry provider and major for-profit health system. The integration with HCA is the first large health system partnership Talkiatry has announced publicly.

MedCity News: Revolutionizing ICU Care: The Future of Telemedicine in Smaller Facilities (3/28) – One of the most essential aspects of the widespread telehealth adoption is the emergence of the virtual intensive care unit, which provides critical care to patients experiencing chronic ailments. This is especially true in rural areas, where access to top-quality health care isn’t always available for various geographical and economic reasons. Virtual care fills the gaps and allows healthcare providers to tap into experts who specialize in a broad spectrum of services, which enables patients to receive care within the comforts of home rather than traveling hundreds of miles to a bigger city.

Modern Healthcare: Here’s Where Patients Are Seeking Care Beyond the Doctor’s Office (3/27) – More patients are choosing alternative care sites such as retail clinics and outpatient surgery centers, but those sites have a long way to go in terms of gaining market share. Telehealth accounted for 3.9 percent of procedures in 2022, down from 13.4 percent in 2020, a year marked by the COVID-19 pandemic. However, usage remains well above pre-pandemic levels. Just over 60 percent of telehealth procedures were related to mental health conditions.

American Hospital Association (AHA): CMS Urged to Remove Telehealth Provider Home Address Reporting Requirements (3/20) – AHA sent a letter to CMS, urging CMS to permanently remove the requirement for providers to list home addresses on enrollment forms and pursue other ways to assess and monitor providers administering telehealth services from sites other than a practice setting. AHA outlines concerns regarding privacy, safety risks, administrative burdens, reduced incentive to provide telehealth services, among others as concerns for home address reporting. This builds on the Alliance’s advocacy efforts -- including a public letter last fall and a series of meetings with CMS leaders. 

American College of Surgeons (ACS): ACS Releases Statement, Primer on Telehealth in Surgical Practice (3/19) – During its February meeting, the ACS Board of Regents approved a statement, prepared by the Board of Governors Telehealth & Informatics Workgroup, on the importance of telehealth in surgical practice and to establish standards for its optimal use to benefit patients. The Statement on the Importance and Standards of Telehealth in Surgical Practice called telehealth a “transformative tool in healthcare” that—among other things—helps enhance access, allows multidisciplinary collaboration, offers cost-efficiencies, and empowers patient-centered care. In addition, the ACS released a primer, a comprehensive guide to help ensure telehealth’s ethical and effective utilization.

Upcoming Events & Hearings

April 28-30 - The Rural Broadband Association, "Legislative + Policy Conference."

May 1 – National Institute for Health Care Management Foundation (NIHCM), “Telehealth: A Vital Piece of the Care Access Puzzle.”

May 9-11 – AMA, “May CPT Editorial Meeting.” Digital health issues to be discussed

May 14-15 - Reuters, "Digital Health 2024."

Please subscribe to this newsletter and send any news or events to rikki.cheung@connectwithcare.org for inclusion.