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
Inside Telehealth: Telehealth Lobbyists Say New OIG Study Will Boost Push for Permanent Legislation (3/18) – Telehealth lobbyists say a new study from the HHS Office of the Inspector General (OIG), which found telehealth access was critical for Medicare beneficiaries during the first year of the pandemic, will boost prospects for permanent telehealth reforms. Krista Drobac, executive director of the Alliance for Connected Care, said the new OIG report reinforces the benefits of telehealth utilization to increase access to health care services. “This is exactly the kind of analysis we have been waiting for,” Drobac said. “While we have data from the providers and payers, nothing beats analysis from a government entity whose entire job it is to ensure good stewardship of public programs. When OIG says telehealth is essential to delivering Medicare services, it’s very powerful."
Medical Economics: Congress Extends Medicare Telehealth Waivers (3/14) – This week, President Biden signed into law the Consolidated Appropriations Act, 2022, which included several key telehealth provisions such as extending Medicare telehealth flexibilities for 151 days after the public health emergency ends. The Alliance for Connected Care and 337 other organizations had previously written to House and Senate leadership urging them to keep telehealth waivers in place through the end of 2024, and then enact legislation making the waivers permanent. While the $1.5 trillion omnibus spending bill contains language extending the telehealth waivers, Congress needs to find a way to keep telehealth waivers permanent.
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Administration
HHS Office of the Inspector General: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic (3/17) – The HHS Office of the Inspector General (OIG) released a new report examining the use of telehealth services in the Medicare program during the first year of the pandemic, declaring that telehealth was critical for providing health care services during this time period for Medicare beneficiaries. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis. The Alliance for Connected Care developed a summary of key findings from the report, which can be found here.
White House: President Biden Signed the Consolidated Appropriations Act, 2022 Into Law (3/15) – President Biden signed into law the Consolidated Appropriations Act, 2022 (H.R. 2471), which provides full-year funding through September 30, 2022 for projects and activities of the Federal Government. More specifically, it includes major telehealth provisions, including an extension of Medicare telehealth flexibilities for 151 days once the public health emergency ends. A summary of telehealth provisions included in this package can be found here.
Congressional Budget Office: CBO releases score for Consolidated Appropriations Act, 2022, including for telehealth provisions (3/14) – The Congressional Budget Office (CBO) released its score of H.R. 2471, Consolidated Appropriations Act, 2022.
- Notably, CBO estimated that the Medicare telehealth extension included as part of this package will cost $663 million for the 151 day continuation of these flexibilities.
- The CBO estimated that the extension of the telehealth exemption for high-deductible health plans coupled with a health savings account (HDHP-HSAs) would result in a “cost” of $44 million to the federal government for the remainder of 2022. This cost comes in the form of decreased revenues since it is a tax benefit.
Both of these scores are lower than expected and strengthen advocacy efforts to retain telehealth authorities long-term.
Federal Communications Commission: Promoting Telehealth in Rural America (3/14) – The Federal Communications Commission (FCC) seeks comment on revisions to the Rural Health Care Telecommunications (Telecom) Program rules to ensure that rural health care providers receive funding necessary to access the broadband and telecommunications services needed to provide vital health care services. The FCC also seeks comments on proposals to modify the applicability of the internal funding cap on upfront costs and multi-year commitments in the Rural Health Care Healthcare Connect Fund Program, proposals to streamline the invoice process in the Telecom Program, and on ways to further increase the speed of funding commitments. Comments are due by April 14, 2022.
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Congress
Telehealth Treatment and Technology (3T) Act: (3/18) – Representatives Cawthorn (R-NC) and Gosar (R-AZ) introduced the Telehealth Treatment and Technology (3T) Act of 2022 (H.R. 7097), which would facilitate the provision of telehealth services through interstate recognition of health care professionals' licenses. The bill would provide millions of Americans with unprecedented opportunities to nurture strong relationships with their medical providers, receive treatment, and consult medical professionals without leaving their home. The legislation would also allow doctors, nurses, and specialists to interact with an increased number of patients quicker and more efficiently.
House Energy & Commerce Committee: Pallone Opening Remarks at Hearing on America’s Wireless Future Frontier (3/16) – House Energy & Commerce Committee Chairman Pallone (D-NJ) delivered opening remarks at the recent Communications and Technology Subcommittee hearing titled, “5G and Beyond: Exploring the Next Wireless Frontier.” In his remarks, he noted that it is more important than ever to lay the foundation for the US to continue to lead the world in critical technological advancements. On mid-band spectrum airwaves and broadband, Pallone noted these airwaves are critical to fuel advancements in telehealth services.
Medicare Payment Advisory Commission (MedPAC): MedPAC March 2022 Report to Congress recommends more mandated telehealth data reporting (3/15)- In its latest March 2022 Report to Congress, MedPAC unanimously recommended to Congress that HHS require health care organizations to report more information on telehealth use to help policymakers weigh the future of virtual care. MedPAC called for physicians and other health professionals, hospice providers, and home health agencies to report virtual care services provided to Medicare beneficiaries to assess the impact of these services on access, quality and costs. MedPAC also recommended CMS mandate that clinicians differentiate between audio-only and video-enabled telehealth visits when reporting the care.
Senate HELP Committee – Senate HELP Committee holds markup, advances PREVENT Pandemics Act (3/15) – This week, the Senate HELP Committee held a markup on and advanced the PREVENT Pandemics Act (S. 3799), which is aimed at strengthening the nation’s public health and medical preparedness and response systems in response to COVID-19 and in preparation for future pandemics. Several amendments were considered as part of this markup, including an amendment from Senator Murphy (D-CT) to include the Alliance for Connected Care-endorsed TREAT ACT (S.168/H.R. 708) as part of the bill to provide temporary licensing reciprocity for telehealth and interstate health care treatment. While this amendment was withdrawn by Sen. Murphy, Chair Murray (D-WA) and Ranking Member Burr (R-NC) voiced support for addressing licensing reciprocity as a Committee in the future. To listen to remarks from the markup, click here.
Representative Steel: Healthcare Community Applauds Telehealth Extension Championed by Rep. Steel (3/14) – Members of the health care community voiced their support for Rep. Michelle Steel (R-CA) and Rep. Susie Lee’s (D-NV) bipartisan Telehealth Expansion Act following the passage of the Consolidated Appropriations Act, 2022, which included an extension of telehealth access. The omnibus funding bill included an extension for plans and employers to cover telehealth services pre-deductible for those who have a High Deductible Health Plan (HDHP) in combination with a Health Savings Account (HSA) through the end of 2022. The Telehealth Expansion Act would make this provision permanent. “This provision was critical to expanding access to care and reducing out-of-pocket costs for millions of Americans, and its expiration in December impacted this access in significant ways. We are pleased to see Congress take steps to reinstate this important flexibility through the end of 2022 and look forward to working with Congress on a permanent fix,” said Krista Drobac, Executive Director of the Alliance for Connected Care.
To keep up to date on current telehealth legislation moving through Congress, the Alliance updates a tracker of major federal telehealth legislation here.
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Telehealth Research, Reports and Surveys
Fierce Healthcare: HIMSS 2022: Health systems see virtual care companies as biggest competitive threat: report (3/16) – A report
from The Chartis Group that was released at the Healthcare Information and Management Systems Society (HIMSS) Global Conference in Orlando found that while many hospitals and health systems have ramped up their investments in digital technologies, most provider organizations are still stuck in the planning stages for personalized care. Health systems need enterprise coordination and an unwavering focus on implementing digital offerings that are aligned to consumers care experiences across leadership to shift from planning to execution. Provider organizations need to create comprehensive views of their patients’ behaviors and aggregate them directly to improve digitally enabled experiences.
RAND Corporation: Audio-Only Telehealth Remains Common at Safety Net Health Clinics (3/15) – According to a recent RAND Corporation report, rapid adoption of telehealth helped safety net clinics in California to maintain consistent levels of service after the onset of the COVID-19 pandemic, but the use of audio-only care has persisted in the clinics longer than in other types of health care settings. Researchers say the higher rates of audio-only telehealth in safety net settings raises questions about the quality of care and equity for low-income patients, since the quality of care for audio-only telehealth has not been established. The study found that overall visit volumes remained about the same throughout the study period, with the share of audio-only and video visits dramatically increasing during the pandemic, particularly for behavioral health. The researchers emphasized the need to understand the impact of audio-only visits on the quality of medical care, as well as where it fits into a hybrid model of care where patients receive a mix of telehealth and in-person visits.
Health Affairs: Legislation Increased Medicare Telestroke Billing, But Underbilling And Erroneous Billing Remain Common (3/15) – A recent study by Health Affairs found that the Furthering Access to Stroke Telemedicine (FAST) Act, which permanently expanded Medicare payment for telemedicine consultations for acute stroke (“telestroke”) from delivery only in rural areas to delivery in both urban and rural areas, saw an increase in Medicare telestroke billing. However, only a minority of hospitals had ever billed for that service. This study suggests there is consistent confusion among providers regarding payment billing requirements. Researchers highlighted that as Congress considers options for Medicare telemedicine payment after the COVID-19 pandemic, simplified payment rules would help ensure that expanded reimbursement achieves its intended impact.
Fierce Healthcare: Optum survey: Providers see telehealth as convenient, but frustrations remain (3/15) – A recent survey
by Optum found that while providers often find telehealth as convenient as their patients do, a number of frustrations with virtual care linger. The survey highlighted that 58 percent of providers were concerned with the quality of care they can provide in a virtual setting and 55 percent said managing patient expectations of what the visit can do is challenging. Telehealth has proven to be a valuable and convenient asset for patients accessing care, so providers and technology vendors need to continue improving on the technology itself as well as virtual care processes.
KFF: Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic (3/15) – A new analysis from Kaiser Family Foundation (KFF) and Epic Research found that telehealth visits for outpatient mental health and substance use services went from virtually zero percent in 2019 prior to the COVID-19 pandemic to a peak of 40 percent in mid-2020, and continued to account for more than a third (36 percent) of such visits in the six months ending in August 2021. The telehealth boom for mental health and substance use services far exceeds the increase recorded over the same period for other outpatient services. As a result, mental health and substance use services accounted for 39 percent of all telehealth outpatient visits in the six-month period between March and August 2021, about five times the share of all other outpatient visits. This reflects the tremendous increase in need for mental health services as a result of the pandemic, social distancing and ensuing economic turmoil, as well as a return to in-person visits for other outpatient care.
mHealth Intelligence: Clinicians need new approaches to delivering empathy through telehealth services (3/15) – A new report by Elsevier Health and Ipsos revealed that although a majority (63 percent) of clinicians worldwide expect most of their consultations to be remote within the next decade, 51 percent believe that telehealth will negatively impact their ability to demonstrate empathy with their patients. A vast majority of clinicians (82 percent) surveyed said that soft skills like listening and displaying empathy have become more critical in the last decade. There will need to be changes in clinical education to prepare clinicians with soft skills in digital environments.
Journal of the American Heart Association: Effectiveness of Telemedicine Visits in Reducing 30‐Day Readmissions Among Patients With Heart Failure During the COVID‐19 Pandemic (3/1) – A recent study published in the Journal of the American Heart Association found that telehealth follow-up appointments can boost care for heart failure patients. The study found that patients who received telehealth follow-up had a lower 30-day readmission rate for hospitalization (15 percent) than patients with no follow-up care. The researchers concluded that telemedicine may provide a sustainable, cost-effective, and patient-centered approach for helping to reduce rehospitalization in patients with heart failure.
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State Telehealth News and Activity
National Law Review: State Law Telehealth Considerations – State Licensure Requirements Persist, Permissible Telehealth Modalities Generally Expand, and Insurance Parity Laws Ensure Reimbursement (3/17) – This article explored various state law approaches to the establishment of the patient-provider relationship and permissible modalities for the delivery of care via telehealth. Telehealth regulations will continue to evolve on a state-by-state basis based on results of this review, and health care providers engaged in cross-border telehealth services must remain vigilant as a result. An emerging trend among states has been to clarify, and in some cases broaden, the applicable standard or modalities available to practitioners for the provision of a telehealth encounter, generally allowing greater flexibility and convenience for both patients and providers.
WAFF 48: House, Senate bills to regulate telehealth if approved (3/16) – State lawmakers in Alabama introduced two bills to regulate telehealth services, saying there are no guidelines for the practice in Alabama. House Bill 423 and Senate Bill 272 would allow the Alabama Board of Medical Examiners and the Medical Licensure Commission to adopt rules for using technology to deliver remote care. The bills would also regulate the issuance of controlled substances.
Mass.gov: Baker-Polito Administration Files Health Care Legislation Aimed at Expanding Access to Care (3/15) – The Baker-Polito Administration in Massachusetts filed comprehensive health care legislation that would increase access to care and control costs. The bill would modernize licensure and scope of practice standards, which would strengthen the health care workforce in the state and expand capacity through measures that allow providers to practice at the top of their license and remove barriers to licensure. The bill would also authorize Massachusetts to enter the Interstate Medical Licensure Compact, and reduce barriers and advance adoption of telehealth by providing increased flexibility for providers delivering telehealth services by removing limitations to location or settings for providers.
Dinsmore: State Medical Board of Ohio Proposes New Telehealth Rules in Response to HB 122 (3/16) – Following the passage of House Bill 122 in Ohio and its corresponding expansion of telehealth services, the State Medical Board of Ohio released proposed administrative rules to provide further guidance to licensed health care professionals regarding applicable standards of care and regulatory expectations relative to informed consent, record keeping, and remote prescribing. The proposed rule also outlines what services are considered telehealth services.
NASHP: States Focus on Behavioral Health as They Consider the Future of Telehealth (3/14) – With increased access to, demand for, and utilization of behavioral health via telehealth, states are grappling with a number of challenges to ensure adequate yet quality access to remote behavioral health services. NASHP convened a call series with state health officials representing diverse agencies and programs, including Medicaid, CHIP, State Employee Health Plans, State-Based Exchanges, and Departments of Insurance, to discuss telehealth. Throughout these conversations, behavioral health emerged as a persistent theme and area of focus, as states seek to maintain robust yet appropriate access to these critical services.
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Telehealth News and Market Developments
Fast Company: Data Show Telehealth is More of a Luxury Good Right Now (3/18) – National utilization trends suggest telehealth appears to have expanded broader health care access in a small number of people in a certain segment. The largest cohort of telehealth users is women, ages 21 to 40, who are commercially insured and are from more affluent geographies. Without addressing the misalignment of policies, still-evolving payment structure, wide-ranging consumer preferences, and health literacy challenges, the US health care system will not be able to realize the full potential of telehealth.
Inside Health Policy’s Inside TeleHealth: Telehealth, Expanding Scope of Practitioners Key For Behavioral Health (3/17) – Experts at the recent AHIP national conference noted improving behavioral health care requires addressing staff shortages through increased reliance on telehealth post-pandemic, expanding scope of practice for certain practitioners, integrating primary care and behavioral health services, and differentiating between crisis and less-urgent conditions. One major component that needs to be resolved is payment parity for telehealth services, especially as telehealth has been critical for addressing behavioral health needs throughout the pandemic.
STAT News: COVID-19 and telehealth: Holding on to the gains of remote care (3/15) – Telehealth made big strides during the pandemic, both from a technological standpoint and from patients’ perspectives. Telehealth use during the initial COVID-19 peak (March to April 2020) increased from less than one percent of visits to as much as 80 percent in places where pandemic prevalence was high. Telehealth also became a backbone for mental health care. Access to technology, especially broadband internet access, has become a key determinant of a person’s health.
Inside Health Policy’s Inside TeleHealth: Experts Say Telehealth Could Stem Nurse Shortage, Augment Training (3/15) – Experts at a Bipartisan Policy Center panel this week noted that increased reliance on telehealth could help solve some of the national staff shortages for nurses. Telehealth could provide solutions to several parts of the workforce crisis, allowing nurses to do more with fewer staffers. Maureen Chadwick, senior vice president for nursing and clinical operations at Alliance member Ascension, said that for some nursing students, telehealth with retired nurses could provide an outlet to ask questions and seek support when nurse faculty are otherwise engaged.
Aspen Daily News: Doctor Says Telehealth is ‘Not Going Anywhere’ (3/15) – Dr. Andrew Gisleson, a family medicine physician at Roaring Fork Family Practice, said that telehealth is not going to go anywhere. Even as COVID-19 case counts plummeted, several of Dr. Gisleson’s patients have still preferred logging in for their doctor’s visit as opposed to showing up for it in person. Although many health care appointments must be conducted in person, services like mental health services can be carried out via the web or over the phone. Telehealth makes it easier for people who may not have access to reliable public transportation or who have to work long hours to be able to access the mental health services many desperately need.
Forbes: Is Telehealth Here to Stay, Or Just a Mirage? (3/14) – While COVID-19 has demonstrated many benefits of telehealth, the misalignment of underlying incentives may prevent it from becoming a permanent practice. While providers see telehealth as an add-on for key visits, commercial payers don’t see the same value and reimburse less for telehealth visits than in-office visits. As a result, providers who viewed telehealth as a temporary emergency measure are returning to more remunerative visits. To ensure telehealth stays after the pandemic, alignment of incentives, reimbursement based on patient outcomes, and price transparency need to be addressed.
Fast Company: There’s a big caveat in the telehealth expansion that Congress just passed (3/12) – Some experts warn that as more telehealth services become covered by insurers, the government may lose interest in health care initiatives that get patients the most care for their dollar. The telehealth provisions in the 2022 omnibus spending bill are a positive sign that Congress is starting to realize the value of telehealth services, however, Congress could inadvertently prompt health care providers to abandon the value-based care model in favor of a more lucrative pay-per-service approach. Senator Warner (D-VA) is doubtful that reimbursing for telehealth is necessarily the demise of value-based care.
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