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.
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Alliance News
Alliance, Along with 15 Other Organizations, Launches New Campaign to Permanently Protect Access to Telehealth – The Alliance has joined the Telehealth Access for America (TAFA); a public education campaign, to advise actions and strategies to protect access to critical telehealth services. TAFA will encourage Congress to meet the moment and act now to permanently protect access to telehealth services for every person in America.
Representative Steel: What They’re Saying: Healthcare Community Applauds Telehealth Expansion Act (11/30) – Reps. Steel (R-CA) and Lee (D-NV) recently introduced the Telehealth Expansion Act (H.R. 5981), which would make permanent a CARES Act provision that allowed pre-deductible coverage of telehealth services for individuals with HDHP-HSAs. This provision is set to expire on December 31, 2021 if Congress does not take action. Several groups were quoted in support of this legislation, including Alliance for Connected Care Executive Director Krista Drobac: “During the COVID-19 pandemic, Congress enabled employers to offer pre-deductible coverage for telehealth services, expanding access to care and reducing out-of-pocket costs for millions of Americans. The bipartisan Telehealth Expansion Act of 2021 will ensure individuals with HDHP-HSAs continue to have ready access to virtual-care services while remaining eligible to make and receive contributions to an HSA.”
NPR: Voice-only telehealth may go away with pandemic rules expiring (11/23) – As lawmakers and insurers debate whether to continue allowing this sort of audio-only care to continue, the crux of the debate is whether this low-tech way of reaching more people is also safe and effective. "Prior to the pandemic, I thought of audio-only as a quality issue; now I think of it as an equity issue," says Drobac, executive director of the advocacy group Alliance for Connected Care. "It really does expand access for patients to providers that they would otherwise not be able to see."
Advisory Board: ‘Left behind to get worse’: Amid telehealth rollbacks, some patients feel abandoned (11/23) – According to the Alliance for Connected Care, all 50 states and DC implemented emergency declarations to waive certain licensing requirements for out-of-state providers conducting telehealth appointments. However, many of these flexibilities are being rolled back, leaving patients who relied on care from their providers in another state via telemedicine throughout the pandemic to make difficult decisions about their care. In this article, Advisory Board offers four key considerations for health care leaders looking to advocate for patients’ continued access to telehealth services.
Wall Street Journal: Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say (11/22) – States are curbing access to certain telehealth services that were expanded during the pandemic to ensure patients could continue to access care. Hospitals, doctors, telehealth providers and advocacy groups, including the Alliance for Connected Care and its members, have been advocating to make various flexibilities permanent, including many of the licensure flexibilities that were put in place. This article highlights patients who sought providers out-of-state for their rare medical conditions or other health care needs and are now being told their visits would no longer be covered unless they take place in person. This has the potential to impact patient access, including due to foregone or cancelled telehealth appointments.
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New Federal Telehealth Data
HHS released new CMS data
and an Assistant Secretary for Planning and Evaluation (ASPE) report
of Medicare telehealth utilization in 2020 and early 2021. Overall, nearly 53 million virtual visits occurred in traditional Medicare in 2020, compared to about 840,000 in 2019. Of those, nearly all (92%) of visits occurred in patients’ homes, which was not permissible prior to the pandemic. Furthermore, 44% of Medicare visits were in rural areas and 55% were in urban areas, demonstrating beneficiaries, regardless of location, utilized telemedicine for access to health care services during the pandemic.
- HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE): Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location (12/3) – HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released
a report
of Medicare Part B visits and use of telehealth in 2020 during the COVID-19 PHE, including by beneficiary characteristics, provider specialty and location. The analysis found that the share of Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million. The report also found insightful trends on the kinds of services Medicare beneficiaries sought through telehealth. In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8 percent of visits to primary care providers and 3 percent of visits to other specialists.
- CMS: Medicare Telemedicine Data Snapshot Overview (12/3) – CMS released a new data snapshot of Medicare fee-for-service and Medicare Advantage telehealth utilization from March 1, 2020 through February 28, 2021. Overall, more than 28 million beneficiaries used telemedicine – representing a more than 3,000% increase over the previous pre-pandemic period. In addition, 44 percent of rural beneficiaries and 55 percent of urban beneficiaries used telemedicine.
Below are additional key findings and discussions from the agency.
- Overall utilization: 52.7 million or 5% of Medicare FFS clinician visits, were provided via telehealth in 2020 – a 63-fold increase from 2019.
- Overall total health care utilization in 2020 was 11.4% below levels from 2019, reflecting 179 million fewer visits, even after accounting for the increased use of telehealth services in 2020.
- CMS found 53 percent of beneficiaries in traditional Medicare and private Medicare Advantage plans used telehealth between March 2020 and the end of February 2021.
- Visits by specialty: Prior to the pandemic, telehealth made up less than 1% of visits across all visit specialties but increased substantially in 2020.
- Telehealth increased to 8% of primary care visits, while specialty care had the smallest shift towards telehealth (3% of specialist visits).
- Visits to behavioral health specialists showed the largest increase in telehealth in 2020. Telehealth comprised a third of total visits to behavioral health specialists, with up to 70% of these telehealth visits during 2020 potentially reimbursable for audio-only services.
- Visits broke down by race: Black people had slightly lower telehealth use than White people, while Asian people and Hispanic people had higher use. However, all groups had a similar overall decrease in health care services in 2020.
- White beneficiaries had more telehealth visits overall, but the percentage of beneficiaries who had at least one telehealth visit was higher among Black beneficiaries.
- Telehealth made up 6.4 percent of Asian beneficiaries' visits, 6.2 percent of Hispanic beneficiaries' visits, 5.3 percent of white beneficiaries' visits, 4.7 percent of Black beneficiaries' visits and 5.6 percent of American Indian/Alaska Native beneficiaries' visits.
- HHS suggested that barriers to internet access could be behind racial and geographic disparities, as well as patients’ preferences and comfort with using digital technology.
- Telemedicine use by Geography:
Telehealth use varied by state, with higher use in the Northeast and West, and lower in the Midwest and South.
Discussion of health outcomes and costs findings:
- HHS indicates that more research is needed on the impact of telehealth on health outcomes and costs, as well as the role of value-based purchasing in supporting telehealth.
- HHS acknowledged the difficulty predicting how much virtual visits will substitute for in-person care in a post-pandemic world and states that “extending telehealth flexibilities in a post-pandemic world could lead to higher health care utilization, especially if providers are paid the same rates for telehealth as in-person visits.”
- Note that overall total health care utilization in 2020 was 11.4% below levels from 2019, reflecting 179 million fewer visits, even after accounting for the increased use of telehealth services.
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Administration
Centers for Medicare & Medicaid Services (CMS): HHS Seeks Public Comments to Advance Equity and Reduce Disparities in Home Dialysis (12/1) - CMS issued a Request for Information (RFI) to solicit stakeholder and public feedback that will be used to inform potential changes and future rulemaking to improve the organ transplantation system and seek to enhance the quality of life of those living with organ failure. In addition to these topics, the RFI seeks feedback on home dialysis, for example:
- What are patient barriers to dialysis modality choice?
- What are reasons for differing rates of home dialysis by race/ethnicity?
- With regard to home dialysis, how can CMS ensure adequate safety standards such as appropriate infection control behaviors and techniques are enforced?
- What can CMS do to increase availability and use of home support resources with regard to home dialysis?
- If more patients choose home dialysis, would there be systems and infrastructure in place to support this?
- To what degree does telehealth and remote monitoring technology impact decisions of home dialysis use?
HHS: HHS Announces $35 Million for Telehealth in the Title X Family Planning Program (11/23) – HHS announced the availability of $35 million in American Rescue Plan (ARP) funding to enhance and expand the telehealth infrastructure and capacity of Title X family planning providers.
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Telehealth Research, Reports and Surveys
JAMA: Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care (12/1) – According to a new study, 66.5 percent of participants surveyed wanted at least some video visits in the future, but when they had a choice between an in-person and a video visit when out-of-pocket costs weren’t a factor, 53% preferred an in-person visit. Exposure to video telehealth video visits affected participants’ views. The survey found 45% of participants reported having at least one video visit with providers since the COVID-19 pandemic began in March 2020. Among that group, 44.2% preferred in-person, and 31.4% would rather use video. But for those who didn’t have experience with video visits, 60.2% preferred an in-person visit, and only 12.2% preferred video.
Kaspersky: Nine out of ten healthcare organizations provide telehealth services, yet almost half face patients’ mistrust towards privacy (11/29) – New global research from Kaspersky reveals that 91% of medical organizations have already implemented telehealth capabilities, with 44% starting to use them after the pandemic. At the same time, 52% of respondents have experienced cases where patients refused telehealth services due to security concerns. Medical organizations have adapted to the new conditions, and today, 56% of healthcare institutions are planning to increase their investment in telehealth and virtual care solutions. Kaspersky surveyed healthcare decision-makers to learn how the digital transformation of the industry is going and which problems they believe should be solved to create a world in which everyone can gain access to affordable, fast, and quality care.
JAMA: Attitudes and Perceptions of Multidisciplinary Cancer Care Clinicians Toward Telehealth and Secure Messages (11/24) – A new study finds that the majority of cancer care clinicians were satisfied with telehealth and expressed intent to continue to use the care modality in the future. Just over 75 percent of respondents said they were somewhat or very satisfied with telehealth. Additionally, 84 percent of clinicians said that they thought their patients were somewhat or highly satisfied as well. Around three-fourths of the participants reported that they thought patient caregivers, colleagues, and non-clinician staff were satisfied with telehealth—76 percent, 81 percent, and 73 percent, respectively.
National Academy for State Health Policy (NASHP): States Allowing Telehealth Prescriptions for Opioid Use Disorder (11/19) – Early on in the COVID-19 pandemic, the federal government implemented several telehealth flexibilities to allow states to maximize access to medications for opioid use disorder (MOUD). While these flexibilities remain allowable until the end of the federal public health emergency (PHE), state approaches to prescribing MOUD via telehealth currently vary greatly. NASHP produced a map of current telehealth MOUD state policy 18 months into the COVID-19 pandemic. Currently, roughly 50 percent of states explicitly allow MOUD via telehealth, and three have ended provisions for MOUD via telehealth.
Journal of Evaluation in Clinical Practice: Medicare and telehealth: The impact of COVID-19 pandemic (11/16) – A new study shows Medicare beneficiaries living in metropolitan areas were more likely to report that they used telehealth services. Researchers assessed the responses of 9,686 beneficiaries to the CMS Medicare Current Beneficiary Survey Fall 2020 COVID-19 Supplement. More than half (58.3 percent) of beneficiaries reported that their primary care physicians have offered telehealth appointments since July 2020. The study also revealed differences in telehealth access and usage among Medicare beneficiaries based on age, sex, location and internet access. For example, compared to people who were older 75 years, younger Medicare beneficiaries were more likely to have a telehealth appointment with their primary care physician, to report higher rates of specialist telehealth visits and to use video or voice calls with their physicians. In addition, beneficiaries who lived in non-metro areas were less likely to report that their primary care provider offered telehealth appointments and use video or voice calls as compared to their metro-based counterparts.
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State Telehealth News and Activity
The Hill: States shouldn't push Americans off the telehealth cliff (12/2) – Naomi Lopez, director of Healthcare Policy at the Goldwater Institute, which developed Arizona’s telehealth reform issued an op-ed in The Hill reflecting on states’ deployment of telehealth during the pandemic and the urgent need to ensure patients can continue to access and use these services once the PHE ends. “[W]ith several of those states on the verge of sunsetting these regulation relaxations, and the federal reforms set to expire once the public health emergency ends, we’re now standing on the precipice of a “telehealth cliff.” That’s terrible news for any American seeking medical care — but it doesn’t have to be this way,” she said.
mHealth Intelligence: Washington State Solidifies Audio-Only Telehealth Regulations (12/2) – The Office of the Insurance Commissioner in Washington State has finalized regulations to implement the audio-only telehealth law that passed earlier this year in the state. The law requires payers to reimburse providers for audio-only telemedicine services at the same rate as in-person care. Starting January 1, 2023, payers are required to ensure telehealth payment parity only if the provider and patient have established a relationship through an in-person exam within the past year. The finalized regulations also require patient consent to be documented in a patient’s medical record.
Clarion Ledger: Mississippi health insurers to cover telehealth visits at same rate as in-person (12/2) – Mike Chaney, the Mississippi Insurance Commissioner, secured support from Blue Cross & Blue Shield of Mississippi to continue covering telehealth visits at parity with in-person visits. As a result of Governor Reeves’ decision to end the state of emergency in the state on November 20, the Insurance Department would have to withdraw emergency authorization of insurance coverage of telemedicine during the COVID-19 pandemic. As such, Commissioner Chaney appealed to the insurance companies to continue the coverage of this issue until the State Legislature could address it.
State of Reform: Leaders want long-term telehealth and workforce support in Maryland (12/1) – Four Maryland health care leaders were featured on a panel where telehealth was a central topic of discussion. The panelists agreed on the success of telehealth during the pandemic, and how to ensure that such access to care remains viable long-term. The panelists also noted concern over the flexibilities that are starting to be rolled back and jeopardizing access to patient care. Notably, Bob Atlas, president and CEO of the Maryland Hospital Association (MHA), highlighted the Medical Excellence Zone initiative in the DMV region, which would allow health care professionals licensed and in good standing in one jurisdiction in the Zone to practice in the other jurisdictions without having to obtain another license.
mHealth Intelligence: 5 New Telehealth Training Sites to Open in Arkansas, Tennessee (12/1) – The University of Arkansas for Medical Sciences (UAMS) is looking to advance telehealth training through the opening of five satellite locations of its South Central Telehealth Resource Center. This resource center is staffed with telehealth professionals who provide education and training for health care organizations and educational facilities interested in using telehealth as a care delivery modality. UAMS will open four satellite sites in Arkansas and one in Tennessee.
WTVR News: Expiring waivers could leave telehealth patients in a bind (11/30) – Many states are beginning to roll back pandemic flexibilities that allowed providers to treat patients in a state where they were not licensed. This has posed an issue for many health systems, including Stanford Health Care. Dr. Christopher Sharp of Stanford Medicine and Stanford Health Care stated, “The way we currently do it, we have to ask patients at the time of their visit, where are you right now because if at the time of your visit you are not in one of these approved states we have to tell you we can’t proceed with your care,” something that can be awkward for patients and caregivers.
Health Leaders Media: New York Invests $3 Million in Telehealth Technology Purchases (11/29) – New York is planning to invest $3 million in a program aimed at helping community health providers purchase new telehealth technology to expand access to care in underserved communities. Governor Hochul announced that the state will issue $150,000 grants to community health providers across the state for the technology, and that the program will spur public-private support for technology platforms that enable more residents to access virtual care services.
State of Reform: Op-Ed: Access to internet and telehealth: Key to health equity for older Californians enrolled in Medi-Cal
(11/23) – Telehealth has been a lifeline for many throughout the pandemic, however it has sparked discussion on the digital divide, as some individuals cannot afford to pay for internet service or a device to utilize telehealth services. This was true for the age 65+ population in California, as many seniors had limited access to the internet and devices required for robust telehealth services. A recent survey found that 44 percent of California seniors had used telehealth using a computer or smartphone, and 24 percent had consulted health professionals on a landline phone. Additionally, over half of Asian and Latino respondents and 44 percent of Black respondents noted they had not used any telehealth services.
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Telehealth News and Market Developments
Fierce Healthcare: Carbon Health launches new program with continuous glucose monitors to assess diabetes risk (12/2) – Primary care provider Carbon Health is launching a metabolic assessment program that uses continuous glucose monitors to help identify patients at high risk for diabetes. The company, which provides virtual care services in addition to brick-and-mortar clinics, will integrate data from CGMs worn for two weeks by their patients into its primary care model to create care plans tailored to the individual.
Patient-Centered Outcomes Research Institute (PCORI): PCORI Board of Governors approves $49.5 million to fund new research studies addressing pain relief, smoking cessation, mental health and other conditions (12/2) – PCORI approved two slates of research funding awards totaling $49.5 million to support nine new comparative clinical effectiveness research (CER) studies aimed at improving care for adults and children across a range of health conditions. Three of these CER studies totaling $23.5 million focus on telehealth and mobile health strategies. “With the explosion of telehealth, especially during the COVID-19 pandemic, studies assessing how well telehealth strategies work in different contexts are highly relevant for many Americans, and we look forward to the insights gleaned from these studies as well as all the other newly approved research projects,” said PCORI Executive Director Nakela L. Cook, M.D., M.P.H.
EHR Intelligence: Zoom Announces Cerner EHR Integration for Telehealth Services (12/2) – Zoom has announced that it is now accepting beta customers for a Cerner EHR integration to support telehealth services. Healthcare organizations that use Cerner EHR systems will be able to launch secure Zoom virtual visits directly within their workflows.
Pew Charitable Trusts: Telehealth May Be Here to Stay (12/1) – Pew issued an article emphasizing the important changes most states made to expand Medicare coverage for virtual appointments and to enact telehealth coverage requirements for private insurers. Mei Wa Kwong, executive director of the Center for Connected Health Policy, a nonpartisan organization widely regarded as an authority on telehealth, estimates that the number of telehealth visits increased by as much as 40% during spring and summer 2020 and remains 30% higher than it was before the pandemic. According to a survey conducted by the National Association of Community Health Centers, the percentage of health centers using telehealth jumped from 43% before the pandemic to 98% during the early months of the crisis. “The telehealth temporary policies helped so many people receive care they otherwise wouldn’t have received or may have put off getting until it became a more serious issue,” Kwong wrote in an email to Stateline. “To suddenly have that access taken away by a policy change could have significant, adverse impacts on many.”
Becker’s Hospital Review: Best Buy buys remote monitoring platform for $400M: 4 details on its healthcare plans (11/29) – Best Buy closed its acquisition of remote care monitoring platform Current Health for about $400 million, company CEO Corie Barry said during its third-quarter earnings call Nov. 23. The remote care monitoring and telehealth company combines patient-reported health data from wearable biosensors to give caregivers insights on patients' conditions in real time.
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Previous Events
House Energy & Commerce Committee, Health Subcommittee: “Hearing on: “The Overdose Crisis: Interagency Proposal to Combat Illicit Fentanyl-Related Substances.” Several members of Congress asked the DEA on the longstanding need for implementation of the Special Registration for Telemedicine Prescribing of Controlled Substances.
American Urological Association, “Perspectives in Telehealth Policy: Where We Are and What Comes Next.” This event featured several panelists, included the Alliance for Connected Care’s Chris Adamec, who provided their insights and opinions on the future of telehealth in 2022 and beyond.
Healthcare IT News, “Telehealth Connection TV: An in-depth look at all things telemedicine.” Federal officials, scholars, chief information officers and two sitting senators weigh in on their experiences with virtual care and their predictions for the future.
NPR, “Voice-only telehealth may go away with pandemic rules expiring.” As lawmakers and insurers debate whether to continue allowing this sort of audio-only care to continue, the crux of the debate is whether this low-tech way of reaching more people is also safe and effective. "Prior to the pandemic, I thought of audio-only as a quality issue; now I think of it as an equity issue," says Drobac, executive director of the advocacy group Alliance for Connected Care. "It really does expand access for patients to providers that they would otherwise not be able to see."
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