November 13, 2023

Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on virtual care. 

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Congress

Senate Finance Committee: Health Subcommittee Hearing "Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency" On November 14 (11/14) - The Senate Finance Committee Health Subcommittee will hold a subcommittee hearing on telehealth permanency. 

Witnesses: 

• Nicki Perisho, BSN, RN, Principal Investigator & Program Director, Northwest Regional Telehealth Resource Center
• Eric Wallace, MD, FASN, Professor of Medicine, University of Alabama at Birmingham EMedicine
• Chad Ellimoottil, MD, MS, Associate Professor, Medical Director of Virtual Care, University of Michigan
• Ateev Mehrotra, MD, MPH, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School

Organizations can submit statement for the record to Statementsfortherecord@finance.senate.gov.

Senate Finance Committee: Passage of Legislation to Improve Mental Health Care, Lower Drug Costs and Extend Essential Medicaid and Medicare Programs (11/8) - The Senate Finance Committee advanced the Better Mental Health Care, Lower Drug Cost, and Extenders Act by a vote of 26-0. The legislation expands mental health care and substance use disorder services under Medicaid and Medicare, reduces prescription drug costs for seniors at the pharmacy counter, extends essential Medicaid and Medicare provisions that will expire this year, and increases Medicare payments to support physicians and other providers. Of note, several telehealth provisions were part of the legislative package: 

• Section 105. Establishment of Medicare Incident to Modifier for Mental Health Services Furnished through Telehealth
• Section 106. Guidance on Furnishing Behavioral Health Services via Telehealth to Individuals with Limited English Proficiency under Medicare Program
• Section 107. Ensuring Timely Communication Regarding Telehealth and Interstate Licensure Requirements
• Section 108. Facilitating Accessibility for Behavioral Health Services Furnished Through Telehealth

See a section-by-section here. 

Sen. Whitehouse (D-RI): Reintroduction of the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (11/3) -Sens. Whitehouse (D-RI), Cortez Masto (D-NV), Murkowski (R-AK), Warner (D-VA), and Blackburn (R-TN) reintroduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (S. 3193/H.R. 5163). The legislation would allow for the use of telehealth in substance use disorder treatment. 

Administration

Centers for Medicare and Medicaid Services (CMS): Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program (11/6) - On November 6, 2023, CMS issued a proposed rule that would revise the Medicare Advantage Program (MA), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. The proposed policies build on existing Biden-Harris policies to strengthen beneficiary protections and guardrails to promote healthy competition and ensure Medicare Advantage plans best meet the needs of beneficiaries. Specifically, CMS is proposing to add this Outpatient Behavioral Health facility specialty to the list of the specialty types that will receive a 10% credit if the Medicare Advantage plan organization’s contracted network of providers includes one or more telehealth providers of that specialty type who provide additional telehealth benefits for covered services.

Department of Health and Human Services (HHS): The Biden-Harris Administration is Taking Actions to Improve Health of Rural Communities and Help Rural Health Care Providers Stay Open (11/3) - The Biden-Harris Administration is taking actions to improve the health of rural communities and help rural health care providers stay open, including supporting access to needed care such as behavioral health and through telehealth services. The President’s FY 2024 budget put forth several policies to support rural providers, including $45 million for services provided via telehealth.

CMS: Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule (11/2) - On November 2, 2023, CMS issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024. Telehealth-specific provisions that the Alliance advocated around include:

• New Alliance WIN - CMS will continue to permit a distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home through CY 2024.
  
• CMS will continue to pay the higher, non-facility rate for telehealth in CY2024.
  
• CMS will continue to permit direct supervision via virtual means using audio/video real-time communications technology through the end of CY 2024. However, CMS is not extending its proposed policy on supervision of residents in teaching settings to include in-person services furnished by residents.
  
• CMS finalized to include RPM and RTM services in the general care management HCPCS code G0511 when these services are provided by RHCs and FQHCs. CMS clarified that these services can be billed alongside other care management activities (Another new win for the Alliance).
  
• CMS finalized its procedural refinements to the review process for addition, or removal, of the Medicare Telehealth Services List.
  
• CMS added marriage and family therapist and mental health counselors as Medicare distant site practitioners for purposes of furnishing telehealth services.

Telehealth Research, Reports and Surveys 

American Heart Association: Health Disparities Among the Many Unique Challenges for People in Rural America (11/7) - According to data reported in the Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association, people living in rural parts of the U.S. are 40% more likely to develop heart disease and have a 30% higher risk of stroke than people who live in urban areas. Unique health challenges related to individual risk factors, social determinants of health and lack of access to health care drive these disparities. Telehealth and digitally enabled health care is leveraged for patients in communities with broadband, though technology is lagging in the most remote areas.

Annals of Internal Medicine: Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension (11/7) - Remote patient monitoring (RPM) is a promising tool for improving chronic disease management. A study in the Annals of Internal Medicine showed that patients with high blood pressure who frequently tested themselves at home filled their prescriptions more regularly and needed fewer hospitalizations and emergency department visits for their hypertension. 

JAMA Internal Medicine: Changes in Physician Electronic Health Record Use With the Expansion of Telemedicine (10/30) - Telehealth use during the COVID-19 pandemic was associated with an increase in the time physicians spent working in the EHR, though this work was largely related to documenting visits rather than messaging patients. Physicians who provided care both through telehealth and in person in a week had 0.43 additional hours of EHR time per eight patient scheduled hours and 0.38 additional hours outside of scheduled hours compared with those providing care entirely in person. Health systems should consider the burden of EHR time for physicians who deliver care via telemedicine, when considering scheduling, number of patients under care (ie, panel size), and productivity expectations. 

Telehealth News and Market Developments

American Heart Association: AHA Announces a Center for Telehealth to Increase Access to Quality Health Care and Improve Delivery (11/11) - AHA announced its Center for Telehealth, which recognizes the critical role telehealth can play as a solution to close gaps in health care access, particularly in rural and underserved areas, and deliver quality care to populations that have little to no access to traditional health care providers or facilities. The AHA Center for Telehealth will create gold-standard telehealth education and resources through collaboration with the telehealth community. The center will provide evidence-based education about telehealth, telehealth certification for health care professionals, and deliver solutions that maximize telehealth access for everyone everywhere, improving clinical quality. 

Stat News: Treating Rural America: The Telehealth Solution (11/2) - There is a persistent shortage of primary care doctors in the rural United States. Specialists, like OB-GYNs and endocrinologists, are even harder to access. These shortages mean that many patients must routinely drive long distances to see their doctors, or simply go without care. This leaves rural populations more vulnerable to developing more serious illnesses. Part three of Stat News short documentary series on rural health focuses on how David Newman, an endocrinologist, and his colleague, OB-GYN Johnna Nynas, are using technology to offset major obstacles to health care access in their region.

American Medical Association- Why DEA’s latest move on telehealth could be a lifesaver (11/1)- In his remarks to the DEA, Dr. Ehrenfeld emphasized that “whether audio-only, audiovisual, or in-person care, physicians provide high-quality, evidence-based care that relies on thorough assessments and sound decision-making.” He also said that safeguards such as state laws and the Controlled Substances Act are already in place to help ensure patient safety and prevent diversion.

Employee Benefit News: Telehealth's Crossroads Will Dictate Whether Access to Care is Widened (11/1) - Telehealth has proven to be not only user-friendly and efficient, but also affordable and private. It started gaining traction before the pandemic, which likely accelerated its growth timeline by about five to seven years. Virtual visits became part of a cultural change that saw more everyday interactions move online, including an explosion in video conferencing. Government officials need to be better educated so that they fully understand the value of telehealth, how it connects so many complex moving parts of healthcare and helps provide better outcomes for working Americans – issues that need to be balanced against consumer protections.

MedCity News: Countering the Growing Physician Shortage with Telemedicine (11/1) - While telemedicine seems to be the ideal solution to this ever-increasing shortage problem, it still has challenges and benefits that need to be considered before deciding to add a telemedicine program of your own. Carefully evaluating the pros and cons will help healthcare providers determine what they value in a telemedicine program and what pain points they might face. It can also help them determine how best to fix these potential issues before adding a telemedicine program, which could smooth the transition.

Stat News: Virtual Care Options Flood the Market as Retailers Take Telehealth Mainstream (10/30) - These new virtual care offerings follow efforts by retail giants like Walmart and CVS to build out their health care businesses with a mix of online and brick-and-mortar clinics, some of which accept insurance. These young competitors grew rapidly as the pandemic made telehealth more appealing to patients, and their success has laid the groundwork for more diverse retailers to take a bet on the direct-to-consumer model. The hope is that virtual care will serve as a valuable triage point for health care systems. If all a patient needs is a medication refill for a chronic condition or a birth control prescription, a quick text exchange or video visit with a medical provider can be efficient and safe, and more complex problems can be referred to other providers, sometimes in person.

Forbes: How Modern Tech Helps Health Systems Accomplish The Quintuple Aim (10/30) - Lyle Berkowitz, MD, a primary care physician and the Founder and CEO of KeyCare, an Epic-based virtual care company, shared their perspective on how virtual care can advance the quintuple aim. Using the right technologies, health systems can increase access to care, which is especially important for patients facing socioeconomic hardships.

KevinMD: Coupling Behavioral Health Prescriptions with Measurement-Based Care (10/29) - During the COVID-19 pandemic, the Drug Enforcement Administration (DEA) relaxed its online prescribing rules to better accommodate what had become “the new normal.” Now, with the pandemic behind us, the DEA is reconsidering rules that will require providers to see their patients at least once in person, before prescribing medication during telehealth visits. This is to ensure that prescription medication is properly administered. As providers adjust their practices to meet these updated regulations, they should consider measurement-based care as a method for showing objective evidence for the efficacy of their care. This offers the best compromise between ensuring all channels for access remain open, while ensuring quality of care does not suffer.

Becker's Health IT: Mayo Clinic Looks to Bring Telehealth Services to Ambulances (10/27) - Mayo Clinic announced a partnership with OPTAC-X, a telehealth company and remote physician company, to use OPTAC-X's hybrid LTE-global SATCOM telehealth tools within ambulances. Through the partnership, emergency clinicians will be able to see and hear what emergency medical services are dealing with on ambulances. OPTAC-X will license its hand-free headsets to Mayo Clinic to enable remote patient monitoring. 

Upcoming Events & Hearings

November 13 - Upper Midwest Telehealth Resource Center, "Closing The Gap: Why People With Disabilities Are (And Aren’t!) Using Telehealth." 

November 14- Senate Finance Health Subcommittee, "Hearing on Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency." 

December 5 - Arizona Telemedicine Program, "Impact of State Medical Licensing On College Student Mental Health." 

February 15-16, 2024 - World Conference Forum, "2024 Remote Patient Monitoring Conference."

February 25-28 - ViVE, "ViVE 2024." 

February 28-29, 2024 - Stanford Healthcare Innovation Lab, "Digital Health 2024." 

March 21-22, 2024 - World Conference Forum, "2024 National Telemedicine Forum." 

April 28-30, 2024 - The Rural Broadband Association, "Legislative + Policy Conference."

Please subscribe to this newsletter and send any news or events to rikki.cheung@connectwithcare.org for inclusion.