“More than 400 members of the House voted to extend telehealth flexibilities in July, and it’s time for the Senate to follow. Without more policy certainty around telehealth, beneficiary access could be compromised,” said Krista Drobac, Executive Director, Alliance for Connected Care. “The House created the momentum, we hope the Senate will seize it and enact comprehensive telehealth legislation this fall.”
Inside Telehealth: Telehealth Stakeholders Push For Greater Use Of Virtual Care In Value-Based Purchasing (9/14) – Telehealth stakeholders and experts agree that virtual health care services are essential to incorporate in value-based purchasing (VBP) systems and other alternative payment models, arguing telehealth improves health care and saves money by strengthening the patient-provider relationship, improving management of chronic diseases that disproportionately affect minorities, and averting expensive care by expanding access to preventative care. The Alliance for Connected Care said that if correctly designed the greatest opportunity for savings and profits within a VBP system are often the people with limited access to care and related social needs who can most benefit from virtual care. The Alliance believes that the greatest opportunity for telehealth is within existing VBP models, like Medicare Advantage and Accountable Care Organizations. Those using VBP models do not have the same concerns around increasing patient access to services that exist in Medicare FFS systems.
Alliance for Connected Care: Alliance Submits Comments to the Proposed CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) (9/13) – The Alliance for Connected Care submitted comments
in response to CMS Calendar Year (CY) 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. The Alliance applauded the proposal to ensure the continuation of patient access to mental health services via telehealth from hospital-based providers after the conclusion of the COVID-19 public health emergency (PHE).
Centers for Medicare and Medicaid Services: Medicare Telehealth Trends (9/15) – The Centers for Medicare & Medicaid Services (CMS) released
new data that highlights trends in the use of telehealth services between January 1, 2020 and March 31, 2022. The data allows for analysis of telehealth utilization by quarter, state, and various demographic characteristics. The data showed that approximately 10 million Medicare beneficiaries used telehealth during 2021.
HRSA Office for the Advancement of Telehealth: Telehealth and Cancer Care (9/13) – The HRSA Office for the Advancement of Telehealth released best practice guides for telehealth and cancer care. The guide highlights the needs and procedures for a successful telehealth cancer care program. Tele-oncology may offer patients, their family members, and caregivers convenience (i.e., time and travel), lower costs, and flexible scheduling. Telehealth also reduces germ exposure for immunocompromised individuals.
Office of the Assistant Secretary for Planning and Evaluation: Flexibilities in Controlled Substances Prescribing and Dispensing During the COVID-19 Pandemic (9/8) – The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report on flexibilities in controlled substances prescribing, including via telehealth, during the pandemic. The federal government issued a range of flexibilities around telehealth, medications for opioid use disorder, licensing, and emergency prescribing to improve access to controlled substances and medications for opioid use disorder during the COVID-19 pandemic. Flexibilities allowing for the use of telehealth for controlled substance prescribing and medications for opioid use disorder were the most common flexibilities implemented by states.
Inside Telehealth: Telemedicine Is One Of Three Health Items On GOP’s November Agenda (9/12) – The GOP’s “Commitment to America” agenda outlines the Republican party’s priorities in advance of the midterm elections this November. , which includes expanding access to affordable telehealth.. This priority was previously part of the Modernization Subcommittee of the House GOP Healthy Future Taskforce, which announced a plan to continue telehealth access beyond the pandemic by adjusting Medicare originating site requirements and maximizing employer-sponsored telehealth coverage through the use of health savings accounts, priorities the Alliance for Connected Care
previously submitted comments on in support.
Digital Equity Foundation Act: Reps. Matsui and Lujan Introduced Legislation to Increase Digital Equity, Inclusion, and Literacy (9/15) – On September 15, Reps. Matsui (D-CA), Grijalva (D-AZ), Eshoo (D-CA), and Smith (D-WA) introduced the Digital Equity Foundation Act (H.R. 8858), which would establish the Foundation for Digital Equity. The Foundation will supplement the National Telecommunications and Information Administration (NTIA) and the Federal Communication Commission’s (FCC) work to award grants to improve digital equity outcomes, such as telehealth, among others. Sens. Lujan (D-NM), Merkley (D-OR), Heinrich (D-NM), Markey (D-MA), Blumenthal (D-CT), and Klobuchar (D-MN) introduced companion legislation in the Senate (S. 4865).
This study analyzed out-of-state telemedicine use among Medicare beneficiaries during the first half of 2021. The study found that nearly 40 percent of out-of-state visits were for primary care, while 25 percent were for mental health. Researchers found that most visits across state lines are part of an established provider-patient relationship, and that restrictions on out-of-state care may disrupt many existing patient-clinician relationships in primary care and mental health treatment. The findings suggest that licensure restrictions of out-of-state telemedicine would have had the largest effect on patients who lived near a state border, those in rural locales, and those who received primary care or mental health treatment.
Other key findings from the study include:
Of the 8,392,092 patients with a telehealth visit, 422,547 patients (5 percent) had one or more out-of-state telemedicine visits.
In 62.6 percent of all out-of-state visits, a prior in-person visit occurred between the same patient and clinician between March 2019 and the visit, showing that out-of-state telemedicine visits were largely used for continuity of care purposes with an existing provider-patient relationship.
These visits were most common among those who lived near a border (57.2 percent of out-of-state visits).
Visits were largely for primary care and mental health treatment (64.3 percent of out-of-state visits).
People in rural communities were more likely to receive out-of-state telemedicine care (33.8 percent vs 21 percent).
There was high out-of-state telemedicine use for cancer care (9.8 percent of all telemedicine visits for cancer care).
Developmental Medicine & Child Neurology: Child Neurology Telemedicine: Analyzing 14,820 Patient Encounters During the First Year of the COVID-19 Pandemic (9/16) – Researchers from the Epilepsy Neurogenetics Initiative (ENGIN) at Children’s Hospital of Philadelphia (CHOP) found that, across nearly 50,000 visits, patients continued to use telemedicine effectively even with the reopening of outpatient clinics a year after the onset of the COVID-19 pandemic. The researchers found that telemedicine was a viable option for many patients and was utilized more often than in-person visits for certain patients, such as those with epilepsy and attention-deficit hyperactivity disorder. Additionally, the researchers found that self-reported racial and ethnic minority populations and those with the highest measures of social vulnerability were less likely to participate in telemedicine visits. See the Children’s Hospital of Philadelphia press release for more information.
Applied Clinical Trials: How Remote Patient Monitoring Technology Can Impact Decentralized Clinical Trials (9/16) – Remote patient monitoring (RPM) technology, when combined with in-person, can create a hybrid approach that incorporates remote features, convenient locations, and conventional methods for clinical trials. RPM can lower burden for patients and broaden access, create better and more objective data that links clinical research to the real world, and faster recruitment to allow for more attempts to reach the desired goal.
American Journal of Managed Care: Part I: The Promise of Telehealth (9/15) – Telehealth has increased patients’ access to care, supplementing in-person visits for initial diagnosis and follow-up care. However, without proper provider reimbursement and required investments into virtual care solutions, the consistency of care will differ. Opportunities and benefits—such as better medication adherence, convenience for location- or mobility-challenged patients, and greater access to needed care—are notable. Overcoming access and technology challenges, understanding and mitigating risks in clinical care, and achieving consensus among health care stakeholders on a comprehensive approach going forward will be front and center in the coming months and years.
American Medical Association: Physicians’ Motivations and Key Requirements for Adopting Digital Health Adoption and Attitudinal Shifts from 2016 to 2022 (9/13) – The American Medical Association (AMA) conducted a study
of physicians' motivations and requirements for the adoption of digital clinical tools. Physicians are increasingly seeing the advantages of digital health solutions since 2016 when the AMA first investigated the motivations, requirements and uses of digital health technology among physicians. The largest growth in adoption was among digital health tools that aid in remote care. The percentage of physicians using tele-visits/virtual visits grew from 14 percent in 2016 to 80 percent in 2022 while the percentage of physicians using remote monitoring devices grew from 12 percent in 2016 to 30 percent in 2022. These findings highlight the importance of keeping telehealth pandemic flexibilities permanent after the end of the public health emergency.
American Journal of Managed Care: Physician Response to COVID-19–Driven Telehealth Flexibility for Opioid Use Disorder (9/13) – This study aimed to learn how preferences and practices regarding telehealth have evolved during the COVID-19 pandemic for physicians who provide opioid use disorder (OUD) treatment. The primary survey data were collected in July 2020 leveraging administrative contact information for the population of publicly listed buprenorphine-prescribing physicians in the United States. A total of 1,141 physicians received the survey and consented to participate. Findings suggest that the COVID-19 pandemic increased physician use of telehealth technology, and this has positively shifted their perceptions of effectiveness. Respondents overwhelmingly report interest in post–COVID-19 pandemic telehealth use and support for proposed legislation to loosen telehealth restrictions.
FAIR Health: Monthly Telehealth Regional Tracker (9/12) – In June 2022, after two months of growth, national telehealth utilization fell 3.7 percent, from 5.4 percent of medical claim lines in May to 5.2 percent in June. One-hour psychotherapy remained the number one telehealth procedure code nationally, indicating the impact telehealth has on mental health care. For additional coverage, see mHealth Intelligence.
American Journal of Preventive Medicine: Before and During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics (9/9) – Research found that rural residents had lower telehealth engagement rates during the COVID-19 pandemic than their urban counterparts, showing the need for geographic targeting and the provision of additional resources. This study aimed to determine whether the location of residence had an influence on care quality by comparing data on rural and urban residents from before and during the pandemic. Researchers noted that prior to the COVID-19 pandemic, there was no noticeable correlation between the type of visit —in-person or virtual — and residence. However, during the pandemic, telehealth visits increased by 27.2 percent among those living in isolated rural areas and by 52.3 percent among those living in urban areas. Researchers noted that the future of telehealth equity will be influenced by reimbursement.
Telehealth News and Market Developments
National Hospice and Palliative Care Organization: NHPCO Urges CMS to Implement More Telehealth Data Collection and Oversight (9/14) – The National Hospice and Palliative Care Organization (NHPCO) and its affiliate group, the Hospice Action Network (HAN), recently led a letter on behalf of organizations representing a broad coalition of the hospice, palliative care, and telehealth communities urging Congress to require CMS to develop and implement Healthcare Common Procedure Coding System (HCPCS) codes or modifiers for telehealth visits and add them to the hospice claim form. Better collection of information about telehealth is vital to making long-term legislative decisions about how the practice should be continued once the COVID-19 PHE ends.
Fierce Healthcare: Doximity Expands Access to Telehealth Service Free of Charge to Thousands of Clinics (9/14) – Doximity, is expanding access to its telehealth service, Dialer Pro, to free medical clinics across the U.S. at no cost, which are estimated to support a total of 1.8 million patients nationwide. The platform’s pilot program was utilized by 48 clinics and roughly 1,000 clinicians in various communities throughout the country. Through these collaborations, Doximity has been able to improve Dialer Pro to uniquely support free clinics through tools like automatic language detection, the ability to add supplementary parties to a call and easy transition between voice and video calls if broadband internet is not available.
Forbes: The Punctuated Equilibrium Of Telemedicine: Digital Health Solutions And Government’s Role (9/14) – Lack of access to laboratory diagnostics for patients has wide-ranging effects, including implications for medication nonadherence that will continue to grow as the burden of chronic diseases grows. The value of telehealth is compromised if the patient must travel to a distant site for lab testing in support of the telehealth intervention. There are ways for businesses and the government to collaborate that can improve the telemedicine landscape that benefits patients and consumers, as the clear, quantifiable health outcomes speak for themselves and can help influence further adoption and integration.
Fierce Biotech: Tasso Earns FDA Clearance for Its Home Blood Collection Device for Telehealth Tests (9/14) – Tasso, a telemedicine company that specializes in remote, self-sampled blood collection, received a Food and Drug Administration (FDA) clearance for its home blood collection device. The Tasso+ lancet can be placed by the user themselves on their upper arm to fill up a small tube of blood drawn from the capillaries through a push-button suction method the company describes as virtually painless. Single-use kits can be mailed directly to the patient’s home for self-collection, with samples mailed back to the lab with a prepaid label. This could help provide clinical-grade testing for remote clinical studies run by pharmaceutical companies as well as personal telemedicine appointments.
Forbes: Roy Schoenberg, CEO of Amwell Thoughts on Telehealth (9/14) – At the HLTH ViVe conference earlier this year, Roy Schoenberg, CEO of Alliance for Connected Care board member Amwell, shared that telehealth is an access mechanism and a relationship point between clinicians and patients. Telehealth is not just about convenience – it’s a care setting. Telehealth allows providers to catch symptoms early, intervene, and prevent readmissions. “If you are a payer in ‘the room where it happens’ – if you are present there – you, for once, have the ability to influence what happens next,” says Schoenberg, of the potential for telehealth to drive early interventions and control costs for payers.
Healthcare IT News: How Telehealth Can Keep People With Disabilities Out of the Emergency Room (9/13) – Emergency departments (ED) should be a last-stop medical option, but for people with disabilities who visit EDs at a disproportionate rate compared with those without disabilities, this last stop becomes more commonplace. Virtual care has inherent advantages that help prevent excess visits to the ED for all populations, including people with disabilities. Telehealth catches medical problems earlier, which is vital to cut the flow of people into the ED. Offering individuals with disabilities quality care from their homes can help prevent avoidable visits.
MedCity News: Beyond Telehealth: How Tailored Care Can Improve Outcomes for Vulnerable Populations (9/13) – Before telehealth can be considered as part of ongoing, longitudinal health care, there are aspects that needs to be addressed, including integration with traditional health care services, and inequities among patient subgroups that arise out of economic, infrastructure, and technological barriers. The health care system needs to integrate additional capabilities, such as remote patient monitoring, to get more comprehensive patient data and drive specific interventions. The more we view health care holistically, as an ecosystem comprising patients, physicians, caregivers, and technology, the better we will be able to improve patients’ health outcomes and overall quality of life.
Forbes: Widespread Adoption of Telehealth Solved Three Major Barriers to Mental Health Treatment (9/12) – The widespread adoption of telehealth during the pandemic solved three major treatment barriers—geography, insurance and income. More people than ever before are getting mental health treatment. Technology helps patients get to providers via telehealth. Technology also helps providers get to patients for follow-up, support and possible intervention if the patient is at risk.
mHealth Intelligence: Rural Hospital Association Expands Access to Telehealth Resources (9/12) – Aiming to support rural communities in obtaining access to virtual care, Equum Medical has partnered with the National Rural Health Association (NRHA) to add telehealth resources to treatment practices. Equum leverages the telehealth infrastructure of its partner companies or the hospital it works with to deploy video and audio feeds. It also uses a proprietary algorithm to distribute the capacity of its specialist network. The use of telehealth to close existing care gaps in rural America is becoming an increasingly common practice.
The Hill: Ending Telehealth Cuts Off A Vital Tool Against Opioid Addiction (9/11) – At the onset of the COVID-19 pandemic, the U.S. Department of Health and Human Services (HHS) and Drug Enforcement Administration (DEA) loosened restrictions to allow DEA-registered practitioners to issue medication-assisted treatment (MAT) to patients without first conducting an in-person evaluation. This added the advantage of reduced stigma and other barriers to obtaining in-person treatment, especially for vulnerable and hard-to-reach populations that often lack access to quality health care. As the COVID-19 PHE draws to a close, it is imperative policymakers move quickly to make the pandemic telehealth flexibilities permanent so health care professionals can continue to reach those most in need.
State Telehealth News and Activity
University of Hawai’i News: Expanding Telehealth Access in the Pacific (9/15) – Expanding and improving telehealth opportunities across the Pacific was one of the topics at a conference hosted by the University of Hawaiʻi at Mānoa. The 2022 U.S. Affiliated Pacific Island Countries & Territories (USAPICT) Telehealth Workshop was presented by the Pacific Basin Telehealth Resource Center (PBTRC) in the UH Mānoa College of Social Sciences in August. Various success stories were shared, including the Guam Memorial Hospital Authority tele-intensive care unit connecting off-island intensivists for around-the-clock care and provider-to-provider consultation through the Swinfen Telemedicine Network for the Kosrae Community Health Center.
Kansas Office of the Governor: Governor Laura Kelly Announces Five-Year, $9 Million Grant to Improve Student Behavioral Health in Southeast Kansas (9/13) – Kansas Governor Laura Kelly announced that Kansas has received $9 million in funding from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to address the behavioral health needs of nearly 40,000 students in the southeast part of the state. The funding will be spread out over five years and will be administered through the Department of Pediatrics at KU School of Medicine to fund KanAWARE, a coalition of state and nonprofit organizations that works to address student behavioral health needs in the southeast Kansas corridor. With this grant, KanAWARE will integrate school-based community health workers into its behavioral health support system for students and families in need. KanAWARE is an expansion of Telehealth Rural Outreach for the Children of Kansas (Telehealth ROCKS), an internet-based delivery service model to address the health disparities faced by children in rural areas.
Health Affairs, “A Health Podyssey: Michael Barnett on Mental Health Care Delivery.” Health Affairs Editor-in-Chief Alan Weil interviewed Michael Barnett from Harvard University's T.H. Chan School of Public Health to discuss Barnett and coauthors recent research on assessing trends in the supply of mental health care practitioners, including psychiatrists and nurse practitioners serving Medicare enrollees. Barnett highlights the effectiveness of facilitating telemedicine in rural areas when providing mental health care.
Texas Public Radio, “Can Telehealth Solve America’s Mental Health Crisis in Schools?” Bonnie Petrie guest hosted Texas Public Radio’s the Source to talk to experts about the telehealth program in Texas that hopes to help solve the mental health crisis. Experts featured included Dr. Laurel Williams, professor of psychiatry at Baylor College of Medicine and Texas Children's Hospital, Reena Pardiwala, clinical director of the Texas Child Health Access Through Telemedicine at UT Health San Antonio, and Josette Saxton, director of Mental Health Policy at Texans Care for Children.