White House Office of Science & Technology Policy: Community Connected Health Stakeholder Engagement Summary Report (5/3) – The White House Office of Science & Technology Policy (OSTP) published a Community Connected Health Stakeholder Engagement Summary Report, which was informed by comment letters received in response to the agency’s request for information (RFI) earlier this year on how digital health technologies can be used to transform community health. Key takeaways included that audio-only telehealth enabled many community health providers to reach their patients when they may not have been able to have a video connection, and the Alliance for Connected Care recommended priority that provider licensing be re-envisioned to better meet the needs of patients and providers. In order to fully take advantage of the advances in telehealth. The White House OSTP will now pivot to developing a more concrete set of actions and policy recommendations based on this feedback.
Inside Telehealth: Biden Administration Pursues Interstate Licensing for Behavioral Practitioners (5/2) – The White House is exploring multiple pathways to address barriers to interstate licensing for mental health practitioners, which includes plans the Administration could enact on its own and others that would be in conjunction with Congress. The Administration is considering removing interstate licensing barriers for decentralized clinical trials, among other strategies. Although interstate licensing has recently caught the attention of federal legislators with the rapid expansion of telehealth, Congress is limited in what it can do to remove licensing barriers for practitioners because state licensing boards have primary jurisdiction over the issue. Increased interstate licensing would make specialized care more accessible to a wider population, like behavioral health care, especially for patients in rural and underserved areas.
Food and Drug Administration: Digital Health Policies and Public Health Solutions for COVID-19
(4/28) - The Food and Drug Administration (FDA) issued updated guidance reminding the public that many health-related software applications, including some for telehealth, used during the pandemic are not considered medical devices and are not regulated by the agency.
U.S. Department of Commerce: Biden Administration Awards Nearly $77 Million to Expand Internet Access for Dozens of Tribes (5/4) – The U.S. Department of Commerce’s National Telecommunications and Information Administration (NTIA) announced it has awarded 19 grants as part of the Tribal Broadband Connectivity Program. The grants, totaling nearly $77 million, are being awarded in 10 states and will fund internet use and adoption projects to improve health care, workforce development education, housing, social services and more in tribal communities. This includes assisting with telehealth expansion to ensure more patients in these tribal communities can access telehealth services.
Energy and Commerce Committee Leaders Introduce Mental Health and Substance Disorder Legislation (5/6):Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Cathy McMorris Rodgers (R-WA) introduced legislation to reauthorize key Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) programs to address the national mental health and substance use disorder crises. Among other provisions, this legislation reauthorizes the Pediatric Mental Health Care Access grant program to improve the integration of pediatric primary care providers with behavioral health providers via telehealth. The Health Subcommittee will vote on the package next week. Legislative Text. Press Release.
The Alliance maintains a chart of telehealth-specific legislation on its website.
Telehealth Research, Reports and Surveys
Federation of State Medical Boards: The Appropriate Use of Telemedicine Technologies in the Practice of Medicine (5/6) – The Federation of State Medical Boards (FSMB) updated its guidance
to state medical boards for regulating the use of telemedicine technologies in the practice of medicine, while raising awareness for licensees and patients alike as to the appropriate standards of care in the delivery of medical telehealth services via telemedicine technologies. The guidance offers a model policy for use by state medical boards and lawmakers to expand regulatory opportunities and enable wider, appropriate adoption of telemedicine technologies for care delivery. In February, the Alliance submitted comments in response to the draft report for this guidance, which focused on the inclusion of audio-only telehealth, reforming licensure laws, ensuring equitable access to telehealth and removing restrictive in-person requirements. The FSMB adopted the Alliance’s recommendation on making an exception on licensure for providers conducting and recruiting patients for multi-state clinical trials. Coverage on this development, including an Alliance statement, can be found here.
Kaiser Family Foundation: PrEP Access in the United States: The Role of Telehealth (5/3) – Telehealth to provide pre-exposure prophylaxis (PrEP) and associated services (“tele-PrEP”) has been a trend that began before the COVID-19 pandemic. This issue brief provided an overview of the tele-PrEP landscape, including how PrEP services (e.g., initial consults, lab work, prescribing, and ongoing monitoring) are provided and factors that facilitate its provision as well as barriers that remain. The brief also highlights two-state run programs – California and Iowa – and four community-based clinics that offer tele-PrEP programs.
Health Affairs: Medicare Beneficiaries in Disadvantaged Neighborhoods Increased Telemedicine Use During The COVID-19 Pandemic (5/2) – This study examined Medicare fee-for-service claims to quantify outpatient telemedicine use before and after Medicare telehealth coverage waivers were implemented that expanded coverage for virtual care services during the COVID-19 pandemic. The study also examined the association of telemedicine use with the Area Deprivation Index, a comprehensive measure of neighborhood socioeconomic disadvantage. The data showed that as telemedicine use increased, the highest odds of utilization were seen for people living in the most disadvantaged neighborhoods. The study suggests that the coverage waiver increased access to telemedicine for all Medicare populations, including people residing in the most disadvantaged neighborhoods, although the odds of use were persistently lower with increasing age.
Healthcare IT News: Telehealth can play a vital role in reducing carbon emissions (5/2) – The Ohio State University Wexner Medical Center built a dashboard to estimate the environmental impact of the medical facility's telehealth offerings. Researchers found that telehealth appointments saved 2.2 million gallons of gas for patients since the start of the pandemic. Since the onset of the pandemic in March 2020, the medical center has delivered 768,970 telehealth visits, which has avoided an estimated 50 million miles of travel. Telehealth provides an opportunity to reduce the health sector’s environmental impact.
State Telehealth News and Activity
Inside Telehealth: More Work Needed to Achieve Telehealth Equity, NC Providers Say (5/6) – At a recent webinar on telehealth access in North Carolina, providers noted that telehealth availability helped maintain continuity of care for Medicaid beneficiaries in the state during COVID-19 but did not necessarily overcome disparities in access to services. A study
by the Duke University Margolis Center for Health Policy found that people who are eligible for Medicaid due to income were less likely to use telemedicine services than those who were eligible because of disability, and that audio-only telehealth services were more likely to be used by rural patients than urban ones, and by Black patients compared to other racial groups. Speakers noted that the goal many providers and policymakers are working toward is digital equity, and that audio-only telehealth availability was a key option for patients to ensure access to health care.
JD Supra: State Policy Levers to Improve Access to Telebehavioral Health (5/5) – States are utilizing a variety of policy levers to maintain access to telebehavioral health services once the public health emergency ends. Commonly used levers include: creating allowances for out-of-state behavioral health providers; enabling coverage for audio-only telebehavioral health services; expanding telehealth-eligible provider types to include a broad range of behavioral health providers; and requiring payment parity for telebehavioral health visits. This article provides a roundup of legislation being considered at the state-level around these policy approaches.
Inside Telehealth: Alaska Considering Bill on Telehealth Flexibility, Payment Parity (5/5) – The Alaska Legislature is advancing a bill that would permanently extend telehealth flexibilities in the state past the end of the federal public health emergency and establish payment parity for services provided digitally. House Bill 265
would permanently allow all health care providers licensed in Alaska to treat patients via telehealth without a requirement for an initial in-person visit, reduce barriers to prescribing controlled substance medications via telehealth, expand Medicaid coverage for telemedicine, and ensure payment parity for those services. The bill would also allow physicians not licensed in Alaska to conduct follow-up care via telehealth with patients in the state, if an initial physical examination has taken place in person.
Boston.com: Bake Administration launches free telehealth program for COVID treatment
(5/4) – The Baker-Polito Administration in Massachusetts launched a new free telehealth program to help people more easily access treatment for COVID-19. The program is available to residents who are 18 years of age or older that have tested positive for COVID-19 and are experiencing mild to moderate symptoms. These patients will be able to schedule a video consultation with a health care provider to determine if they are eligible for Paxlovid, a COVID-19 treatment pill, and whether that is the right treatment to meet their needs.
mHealth Intelligence: NY Health System Strikes Partnership to Provide Remote Physical Exams (5/3) – Rochester Regional Health and TytoCare have partnered to leverage TytoCare’s artificial intelligence-powered tools available to the health system’s clinicians to provide remote physical examinations to patients in Western New York. Rochester Regional Health will use multiple tools and services provided by TytoCare, including the TytoHome kit which provides consumers with various remote monitoring devices.
Becker’s Hospital Review: Idaho health system creates telehealth program to treat patients with burn injuries (5/2) – Teton Valley Health Hospital in Idaho created a telehealth program designed to treat patients with burn injuries. TeleBurn was developed in partnership with the Burn & Reconstructive Center at Eastern Idaho Regional Medical Center to allow physicians and other clinicians at Teton Valley’s emergency room to connect to burn specialists at Eastern Idaho Regional Medical Center via video.
Telehealth News and Market Developments
NBC Washington: MedStar Health to Expand Use of Tech That Monitors Patients from Their Homes (5/4) – Alliance Member MedStar Health is expanding its remote patient monitoring services to serve greater numbers of primary care patients, including those with chronic conditions such as hypertension, congestive heart failure and diabetes. Remote patient monitoring can make room and provide more resources for high-risk patients in the hospital. "The vital signs that are collected by those devices are displayed to that critical care team to create alerts to suggest to that clinical care team, hey, here’s a number that’s problematic. This patient needs your attention. Follow up," Medical Director of the MedStar Telehealth Innovation Center Dr. Ethan Booker said.
Inside Telehealth: PCORnet Plan To Create ASL Category Might Spur Use Of Sign Language In Telehealth (5/4) – The Patient-Center Clinical Outcomes Research Network (PCORnet) plans to change its current designation of American Sign Language (ASL) as an “other” spoken language in its data model and create a specific category for patients who use ASL. With the rapid increase in telehealth utilization since the beginning of the COVID-19 pandemic, the lack of telemedicine accessibility for ASL users has received attention from providers and researchers. Options for making telehealth videoconferencing accessible to deaf patients can include remote interpreting services that translate calls into ASL, real-time captioning by a qualifier captioner, or routing the call through a third-party relay service.
Inside Telehealth: Insurance Coverage Hikes Telehealth Revenue but Takes Time for Approval (5/4) – Telehealth platforms that accept insurance have higher revenue than those that require payment directly from consumers because insurance coverage caters to a larger patient population. Getting coverage approved under government and private plans can take up to a year and the lengthy process can strain new businesses. Participating with government health plans, like Medicare, Medicaid and Medicare Advantage, can be a way for telehealth companies to be adequately reimbursed.
Modern Healthcare: Providers bridge language barriers in telehealth (5/3) – Patients who don't speak English or who have limited English skills can run into challenges when seeking care via telehealth, despite federal protections. Patients can hit roadblocks from the moment they seek care, from scheduling an appointment, to getting onto the telehealth software, to bringing a medical interpreter into the visit. To make telehealth more accessible, telehealth companies are looking to develop information on what telehealth is and instructions for how to access a telehealth platform in patients' preferred languages.
Inside Telehealth: Asynchronous Telemental Health Care Could Help Fix Provider Shortage (5/3) – Telemental health experts said that online care options could be the solution to health care workforce shortages and rising workforce burnout concerns, but policies and reimbursement could be slow to catch up to industry innovation. Asynchronous telemental therapy options could help maximize providers’ capacity to see patients, lighten providers’ workloads by redistributing tasks that do not require qualified mental health providers’ expertise, and help with unmet needs, either because in-person care is inaccessible or because patients prefer to receive care via telehealth. Asynchronous telemental screenings are best used to triage patients’ specific needs and better pair them with providers, which helps patients receive the care they need and helps make the best use of providers’ time and mental energy.
Forbes: How Far Has Telehealth Actually Come? (5/2) – Most measures of telehealth effectiveness today focus on access to care and patient satisfaction, with a significant number of respondents lacking any measures for assessing the value of telehealth. For many organizations that have invested in telehealth, the focus is on sustaining existing telehealth programs and integrating them seamlessly with in-person care for a move toward a hybrid model. The expansion of telehealth to a broader range of health care services or toward more comprehensive enterprise adoption partly depends on the reimbursement landscape and government policy. Telehealth legislation must encourage further investments in telehealth.
Health Affairs: Policy Considerations to Ensure Telemedicine Equity (5/2) – The process of designing permanent, post-pandemic telehealth policies must center on equity. Because of the predominance of fee-for-service models, many ongoing conversations have centered on determining the exact value (and reimbursement) for telemedicine services based on specific details of the interaction, such as the service being provided or the location of the patient or clinician, to design rules that encourage only “appropriate” telemedicine use. Assigning uniform payment levels for these services (thereby implying uniform utility for each patient) makes it difficult to ensure equity, as each patient has unique needs. As more data becomes available, policy makers should reevaluate explicit efforts to improve telehealth equity in permanent telehealth policies.