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
Politico Pro: 'Telehealth cliff' spurs lobbying explosion, drawing in Land O'Lakes, Boeing (2/10) – The Alliance for Connected Care is among several organizations that had pushed to permanently fix telehealth coverage but has shifted to asking for a temporary extension that would allow time to collect more data on telehealth usage and its impact on the cost and quality of health care, potentially outside of the pandemic as well. They think it could quiet skeptics who fear expanded telehealth could drive up costs and invite fraud. "We're able to tell … Capitol Hill and the Biden administration … if we can get agreement across this diverse of a membership, it must be good public policy,” said Krista Drobac, executive director of the Alliance for Connected Care.
mHealth Intelligence: New Senate Bill Aims to Extend Medicare Telehealth Waivers By 2 Years (2/10) – The Telehealth Extension and Evaluation Act, introduced by Sens. Catherine Cortez Masto (D-NV) and Todd Young (R-IN), aims to extend access to telehealth for Medicare beneficiaries after the COVID-19 pandemic has ended. "This legislation will provide certainty to beneficiaries and health care providers alike while ensuring sufficient time is taken to analyze the impact of telehealth on patient care throughout the pandemic to inform permanent telehealth reform," said Krista Drobac, executive director of the Alliance for Connected Care.
The Alliance for Connected Care: Alliance Statement on the Introduction of the Telehealth Extension and Evaluation Act (2/7) – The Alliance for Connected Care is pleased to support the introduction of the bipartisan Telehealth Extension and Evaluation Act (S. 3593) and applauds Senators Cortez Masto (D-NV) and Young (R-IN) for their leadership in drafting this crucial legislation to ensure predictable patient access to telehealth following the end of the public health emergency. “We call on Congress to take up and pass the Telehealth Extension and Evaluation Act this spring,” said Alliance for Connected Care executive director, Krista Drobac.
Additional coverage on Alliance mentions following the introduction of the Telehealth Extension and Evaluation Act can be found through Fierce Healthcare and PYMNTS.
Alliance for Connected Care: Alliance submits comments to House Ways & Means Committee on America’s Mental Health (2/4) – The Alliance for Connected Care submitted a letter
to the House Ways & Means Committee, providing input following the Committee’s hearing on “America’s Mental Health Crisis.” The letter provides several recommendations to the Committee, including that Congress should permanently remove obstructive in-person requirements on mental health through telehealth, move to fully remove outdated originating site requirements on telehealth, and ensure continued access to audio-only mental health care, among other recommendations.
Alliance for Connected Care: Alliance submits letter of support for Maryland HB 670 – Study on Expansion of Interstate Telehealth (2/8) – The Alliance for Connected Care submitted a letter of support for Maryland House Bill 670, which would require the Maryland Health Care Commission (MHCC) to study the ways that interstate telehealth can be expanded to allow Maryland residents to use telehealth to receive health services from out-of-state practitioners. The Alliance believes that one of the biggest barriers to telehealth becoming a regular patient and provider choice is the administrative burden caused by the variation in licensure requirements from state to state. This bill would allow the state to evaluate the role interstate telehealth can play in addressing health care needs, and show the value expanding interstate telehealth practice can have on increasing access to care and ensuring continuity of care, particularly for rural and underserved areas and areas experiencing provider shortages.
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Administration
Health Care Innovation: DOD’s Lessons Learned Applying Telehealth to Mental Health Care (2/9) – A recent Government Accountability Office (GAO) report to Congress highlighted the expansion in telehealth use for mental health care for military service members during the pandemic. The Department of Defense's (DOD) Military Health System told GAO that telehealth was a valuable tool in providing mental health care during the COVID-19 pandemic, noting that telehealth facilitated continuity of care. DOD officials noted that telehealth may not be the best fit for some high-risk patients, but it is a valuable tool that will likely remain in use for some mental health care services after the pandemic ends.
CMS: American Rescue Plan Act of 2021 Section 9817 Overview (2/4) – The Centers for Medicare & Medicaid Services (CMS) released an overview of states’ planned activities for American Rescue Plan Act funding based on spending plans reviewed by CMS as of November 30, 2021. The most commonly proposed activities included strengthening the provider workforce, expanding beneficiary services, enhancing use of technology and telehealth, improving quality and impacting social determinants of health. The most common activities for enhancing the use of telehealth included providing equipment to enable telehealth visits, expanding beneficiary access to assistive technology, and more.
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Congress
Telehealth Extension and Evaluation Act
(2/8) – Sens. Cortez Masto (D-NV) and Young (R-IN) introduced the Telehealth Extension and Evaluation Act (S. 3593), which would extend certain telehealth services covered by Medicare and evaluate the impact of telehealth services on Medicare beneficiaries. View the bill text, press release, and section-by-section. Key provisions of this bill include:
- Extend Medicare telehealth services implemented under 1135 waiver authority for an additional two years following the last day of the public health emergency (PHE);
- Require a clinician to see a patient for an in-person visit within 12 months prior to the prescribing of high-cost lab tests and high-cost durable medical equipment (DME) products during the two-year extension period;
- Require telehealth providers to bill with a national provider identifier (NPI) for Medicare for telehealth services during the two-year extension period;
- Allow Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) to serve as distant site providers for an additional two years after the expiration of the PHE, and ensure Critical Access Hospitals (CAHs) are able to provide telehealth services for two years post-PHE;
- Continuation of DEA flexibility for prescribing of controlled substances for medication assisted treatment (MAT) via telehealth for two years following the PHE; and
- Require an HHS study on the effects of changes to telehealth under the Medicare and Medicaid programs during the PHE, specifically looking at the impact of pandemic telehealth flexibilities on utilization, cost, fraud, privacy and equitable access over the course of the extension.
Inside Health Policy: Wyden Taps Cardin, Thune to Draft Telehealth Piece of Mental Health Bill (2/8) – In a recent hearing, Senate Finance Committee Chair Ron Wyden (D-OR) tapped Sens. Ben Cardin (D-MD) and John Thune (R-SD) to draft the telehealth piece of a broad bipartisan legislative package he plans to unveil this summer to tackle the nation’s mental health crisis. Sens. Cardin and Thune sponsored the Telemental Health Care Access Act of 2021. “Telehealth has been essential for maintaining and expanding access to health care services during the COVID-19 pandemic. This is especially true for those seeking mental health counseling and medical management, as we have seen spikes in anxiety, depression, substance abuse, domestic violence and suicide resulting from social isolation,” Cardin said in a press release for this bill.
Connect Unserved Americans Act (2/7) - Sens. Thune (R-SD), Smith (D-MN), Wicker (R-MS), and Casey (D-PA) introduced the Connect Unserved Americans Act (S. 3587), which would modify conditions of funding for the distance learning, telemedicine, and broadband program of the Rural Utilities Service. The legislation would ensure the USDA targets funding through the ReConnect Program to areas most in need of reliable broadband services and would enhance the coordination between federal agencies that are disbursing broadband funding to prevent the overbuilding of existing broadband networks. See bill text and press release for more information.
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Telehealth Research, Reports and Surveys
mHealth Intelligence: Even Before COVID-19, Telehealth Supported Timely Access to Primary Care (2/11) – A new Emory Healthcare study reveals telehealth helped patients gain more timely access to primary care compared to the barriers associated with in-person office visits. The study results revealed that telephone-enabled care was higher than both video (56.6 percent) and in-person (46.5 percent) appointments. This demonstrates telemedicine's ability to ensure that patients get timely access to care and makes a compelling case for telehealth's effect on care access.
Peterson-KFF: Outpatient telehealth use soared early in the COVID-19 pandemic but has since receded (2/10) – A recent brief by Kaiser Family Foundation found services delivered through telehealth may improve access for people with certain conditions. The analysis found that from March through August 2021, eight percent of all outpatient visits were conducted via telehealth, down from 13 percent in the first six months of the pandemic, but still above pre-pandemic levels. It also found that adults age 65 and older relied on telehealth for a smaller share (five percent) of outpatient visits during this time than younger adults (eight percent) and children (11 percent). Patients in rural and urban areas used telehealth at similar rates during this period (10 percent and eight percent, respectively). Researchers concluded that regulatory and coverage policies, in addition to clinical guidelines and recommendations, will determine telehealth use in the future.
HIT Consultant: With No End in Sight for COVID, Why Is Congress Not Acting on Telehealth? (2/9) – A survey
conducted by the Digestive Health Physicians Association found that more than 80 percent of patients and 90 percent of physicians surveyed were either satisfied or highly satisfied with telehealth. Research suggests that telehealth promotes the triple aim of improving health care by improving the care experience, reducing cost, and improving patient and population health outcomes. Telehealth also increased access to care by decreasing travel time, limiting missed workdays, and reducing the need to find alternative caregivers.
Healthcare Finance News: Telehealth especially important in areas where mental health care is scarce (2/9) – A recent study
found that when the nearest psychiatrist's office is dozens or even hundreds of miles away, a virtual connection may be enough to help people living with serious mental health conditions get effective care through their local primary care clinic. Most patients with post-traumatic stress disorder, bipolar disorder or both conditions were engaged with either of two types of telehealth – Telepsychiatry Collaborative Care, where the psychiatrist makes the initial diagnosis via video and the local clinic team provides brief psychotherapy while the local primary care physician handles medication prescriptions with consultation from the telepsychiatrist; or Telepsychiatry/Telepsychology Enhanced Referral, where a psychiatrist makes the initial diagnosis and handles medication prescriptions, and a psychologist provides psychotherapy via telehealth. The study gives insights into which patients might need additional support when getting such care.
mHealth Intelligence: Remote Monitoring, Telehealth Use Linked to Tighter Blood Pressure Control (2/9) – According to a recent study, telehealth services, combined with remote patient monitoring, helped boost engagement and blood pressure control among stroke survivors living in under-resourced communities. The group that received care through the Telehealth After Stroke Care strategy had higher patient engagement rates, with 91 percent of patients in that group completing a video visit with primary care providers and specialists, compared with 75 percent of patients in the usual care group. Notably, the telehealth intervention group had better blood pressure control, with 76 percent of participants having their blood pressure under control at the end of the study, compared to 25 percent in the usual care group.
Fierce Healthcare: Rural residents face racial inequities in accessing hospital care, study finds. Telehealth, policy changes help close the gaps (2/8) – According to a recent study, rural residents who are Black, American Indian or Alaska Native are more likely to live further from a hospital than white rural residents. The researchers suggested multi-pronged approaches to equity, including addressing and preventing gaps in care created by hospital closure or relocation and the use of telehealth services. In the short run, access to selected services associated with hospital presence can perhaps be enhanced through expanded use of telehealth options.
JACC Heart Failure: Assessing Telehealth for the Outpatient Management of Heart Failure (2/8) – A recent study found that telehealth for outpatients with heart failure allowed for distanced encounters without increases in subsequent acute care or death. Researchers recommend using standardized assessments before outpatient visits to help triage patients with heart failure to telehealth or in-person visits. They also advise clinicians to consider patient preferences because many people with heart failure are frail or live far away from the clinic, making telehealth visits more appealing. Telehealth may be especially useful in the outpatient management of patients with heart failure who have stable symptoms.
Health Leaders: Virtual Care Helps Improve Hypertension Management (2/8) – A study
conducted by Stanford Medical found that hypertension patients who shifted from in-person care to virtual visits during the height of the pandemic were better able to manage their blood pressure. More than three-quarters of hypertension patients who accessed a virtual care platform during the pandemic saw an improvement in blood pressure management. The results of this study suggest that a holistic approach to hypertension management, attending to lifestyle changes and appropriate medications is effective through virtual video primary care visits nationwide.
CirrusMD: 7 statistics on how women have used telehealth during the pandemic (2/7) – According to a survey conducted by CirrusMD, women were more inclined to use telemedicine than men during the pandemic. Additionally, most women found telemedicine care comparable to in-person appointments, and would use telehealth in between routine appointments. The survey demonstrates that telemedicine is transforming health care for some groups more than others.
mHealth Intelligence: 77 percent of Infectious Disease Patients Open to Telehealth (2/7) – According to a survey
conducted by Washington University, more than three quarters of infectious disease (ID) patients said they would try telehealth after being told the time and money they spend on in-person care. The researchers also noticed a strong correlation between time and money, and telehealth interest level. As travel expenses and time rose, so did the willingness to participate in virtual care. Researchers concluded that providing the option of telemedicine alongside in-person care within ID clinics appears to spark interest for patients.
WESA: Study shows rise in telemedicine during the pandemic eliminated a historic racial health gap (2/7) – A recent study from the University of Pennsylvania shows that the sharp rise in telemedicine appointments during the pandemic appears to have eliminated a historical racial health gap in appointment show rates between Black and white patients in a Philadelphia health system. Researchers hypothesized that one of the reasons telemedicine may be closing some of these racial health gaps is because it makes appointments more convenient and brings care closer to where a patient is. Additional coverage on this study can be found here.
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State Telehealth News and Activity
NBC News: ‘A real crisis’: License backlogs in some states are preventing health care workers from seeing patients (2/12) – As the pandemic wears on, therapists and other providers face unusually long wait times for licenses in some states, preventing them from entering the workforce. The delays are putting further strain on the country’s battered health care system, hurting workers’ ability to make a living and patient’s ability to receive care. COVID-19 forced every licensing agency to adapt. Emergency rules to bring in temporary health care workers and allow a wave of new telehealth providers, along with a surge in people moving across state lines, meant an increased volume of applications and sometimes required creating a whole new emergency licensing system.
Maryland Matters: Patients and Doctors Love Telehealth, But Law Needs Updating, Lawmaker Says (2/11) – At the start of the pandemic, Maryland took steps to expand the use of telehealth and relax state licensing laws to allow patients to access their providers in another state. With those licensure flexibilities now expired, and a pending sunset of the Interstate Medical Licensure Compact (IMLC) fast approaching, advocates and physicians are urging the state legislature to take action on two bills (SB 386
and HB 180) that would ensure the state remains a member of the compact. While the compact does not create licensure portability, without an extension, Maryland’s ability to remain part of the IMLC would expire in September and out-of-state providers would no longer be able to conduct telehealth visits with Maryland patients.
The Office of Governor Ned Lamont: Governor Lamont Introduces Comprehensive Package of Legislative Proposals on Healthcare (2/10) – Connecticut Governor Ned Lamont announced a legislative package to improve health outcomes and reduce health care costs for families and small businesses across the state. The package would invest more than $72 million in expanding access to care and addressing the workforce shortage, including through making it easier for patients to access primary and preventive care services in-person or via telehealth by putting contact information for primary care providers and telehealth services on insurance cards. The Governor also has plans to encourage the state to adopt two interstate licensure compacts that cuts red tape for doctors and psychologists.
JD Supra: Telehealth in Idaho: Regulations Withdrawn (2/9) – Idaho licensing boards have withdrawn their rules implementing the Idaho Telehealth Access Act for health care providers, including physicians, physician assistants, dentists and psychologists, as part of Governor Little’s initiative to reduce nonessential regulations. Consequently, physicians and most other health care providers need only comply with the Act, which requires several provisions such as acting within a provider’s scope of practice when delivering telehealth services and taking steps to establish a provider-patient relationship by use of two-way audio or audio-visual interaction, among others.
State of Reform: Stakeholders say joining interstate licensure compact would significantly increase access to behavioral health services in Colorado (2/8) – The Colorado Senate Health and Human Services Committee heard testimony on Senate Bill 77 this week, legislation that would increase the workforce pool for behavioral health counselors in the state. The bill would enter Colorado into the new Interstate Licensed Professional Counselor Compact, which was established in 2020 and was enacted by Georgia and Maryland in 2021. The compact would allow mental and behavioral health counselors and providers licensed in Colorado to practice across state lines without having to obtain another license in other compact states. Currently, 12 other states are considering legislation to join this compact, which will go into effect once 10 states join.
State of Reform: Florida bill ensuring behavioral health care across state lines moves forward
(2/8) – Florida legislators discussed the benefits of House Bill 953 this week during a House Health Care Appropriations Subcommittee meeting, which would enter the state into the Psychology Interjurisdictional Compact (PSYPACT). February 2021 data from the National Alliance on Mental Illness Florida found that out of the 40.8 percent of Florida adults who reported symptoms of anxiety or depression, nearly a quarter were unable to access counseling or therapy. This bill would address this gap, and was unanimously passed by both the Professions and Public Health and Health Care Appropriations Subcommittees. It now goes to the House Health and Human Services Committee.
Alliance for Connected Care: Alliance submits letter of support for Maryland HB 670 – Study on Expansion of Interstate Telehealth (2/8) – The Alliance for Connected Care submitted a letter of support for Maryland House Bill 670, which would require the Maryland Health Care Commission (MHCC) to study the ways that interstate telehealth can be expanded to allow Maryland residents to use telehealth to receive health services from out-of-state practitioners. (Details in the Alliance update section above.)
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Interested in tracking where states are with their COVID-19 emergency declarations and licensure flexibilities? The Alliance created a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state. For regular updates, visit this link.
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Telehealth News and Market Developments
Healthcare IT News: How Harvard’s telehealth program can be a guide toward success (2/10) – In a preview of their HIMSS22 panel, Harvard leaders described how Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center (BIDMC) spun up a “virtual hospital” in response to the COVID-19 pandemic. After considering numerous external vendors, the health system designed and built its own homegrown telehealth platform hosted on BIDMC’s Amazon Web Services cloud, through which it currently conducts about 4,200 weekly patient visits.
mHealth Intelligence: Keeping Health Equity Top-of-Mind in Remote Patient Monitoring Programs (2/10) – Interest in remote patient monitoring (RPM) is on the rise. Racial minorities and people living in rural areas face numerous hurdles to care, including lack of insurance, lack of stable internet connectivity, lower incomes, no transportation, or extended travel distances to see their providers. While these communities are most likely to benefit from virtual care services, like RPM, they are also the ones who may have the most trouble accessing it. As health care stakeholders are waiting for broadband expansion efforts to come to fruition, providers can work to democratize the devices used to support RPM — which tend to be low-cost, like scales and blood pressure cuffs — and make them more widely available.
General Surgery News: The State of Telemedicine in Surgery (2/8) – At the 2021 virtual annual American College of Surgeons Clinical Congress, three surgeons shared how telehealth has impacted the field of surgery. Among topics discussed included the benefits of lifting originating-site restrictions for telehealth, providing telehealth outcomes data to third-party payors, and the need for more value-based payments strategies to incentivize use of telehealth services.
CNBC: Amazon rolls out its telehealth service nationwide (2/8) – Amazon launched their telehealth program, known as Amazon Care, nationwide this week. The program provides virtual-care visits, as well as free telehealth consultations and in-home visits for a fee from nurses for testing and vaccinations. It has since expanded into more of a primary care service. Amazon said it’s capitalizing on the surge in demand for in-home care, both virtually and in-person, generated by the COVID-19 pandemic.
American College of Physicians: Extending Telehealth Measures Important Step for Care Delivery Say Internists (2/8) – The American College of Physicians (ACP) called for extending regulatory flexibilities for telehealth that have been put into place during the COVID-19 pandemic, such as the recently introduced Telehealth Extension and Evaluation Act. ACP noted this bill as a promising step in care delivery for physicians and their patients. ACP believes that the opportunities provided by the increased use of telehealth will continue to be an important piece of health care delivery beyond the pandemic.
Pharmacy Times: RPM is Effective for Patients with Cancer During the Pandemic
(2/7) – According to a presentation at the Association of Community Cancer Centers 38th National Oncology Conference, a pilot program evaluating remote patient monitoring for patients with cancer who were either persons under investigation for COVID-19 infections or COVID-19 positive with mild or no symptoms found that participants effectively engaged with the program’s data reporting system at least once a day 97.2 percent of the time. The RPM pilot program, conducted at Inova Health System, saw high overall compliance and engagement, and on-demand access to patient information helped patients.
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Upcoming Events
February 17 – HHS Health Resources and Services Administration (HRSA) Center for Innovation, “Community Connected Health Initiative Roundtable – Innovation in the Community Health Workforce.”
February 22 – National Rural Health Association, “Lessons Learned Implementing Tele-behavioral Health Programs in Rural Indiana.”
March 3 – HHS Health Resources and Services Administration (HRSA) Center for Innovation, “Community Connected Health Initiative Roundtable – International Models of Innovation in Community Health.”
March 16 – HIMSS, “Digital Connectivity as a Social Determinant of Health.”
March 22-23 – xtelligent Healthcare Media, “Telehealth22 Virtual Summit: Creating a Hybrid Healthcare Strategy with Virtual Care.”
April 21 – National Consortium of Telehealth Resource Centers, “Innovation & Integration of Telehealth into Population Health.”
Previous Events, Videos and Podcasts
Healthcare IT News, “Telehealth can boost outcomes for chronic conditions.” In this episode of HIMSS TV, Stacy Hurt, a patient engagement consultant and HIMSS Digital Influencer, discusses the importance of continuing telehealth post-pandemic, especially for disabled and immunocompromised patients.
Healthcare IT News, “HIMSSCast: Addressing the digital accessibility gap.” Many health IT experts, innovators and vendors have touted digital health as a mechanism to overcome hurdles to care. But at the same time, digital health tools can exacerbate difficulties, especially for people with disabilities. Josh Basile, community relations manager for accessiBe, joins Kat Jercich, senior editor of Healthcare IT News, in this episode of HIMSSCast to discuss how organizations can ensure websites and other software are accessible for everyone.
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