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: Becerra Calls on Congress to Expand Telehealth Access Across State Lines (3/31) – At the House Appropriations Committee, Subcommittee on Labor, Health and Human Services (HHS), Education, and Related Agencies hearing on the FY2023 Budget Request for HHS, HHS Secretary Xavier Becerra called on Congress to take action on state licensure issues that have been an obstacle for telehealth expansion. Secretary Becerra noted, “We are trying to figure out how we allow that service to cross state lines. Because there are different standards in different states for those medical professionals. Not to let the old way of business get in the way…That’s where we’ll need your help to give us the authorities to go beyond what we’ve gone before.” In response to these remarks, Krista Drobac, the executive director of the Alliance for Connected Care, noted: “The fact that the Secretary of HHS mentioned this issue is huge. This is truly a national issue where federal and state governments both play a role.”
Inside TeleHealth: HHS Chief Seeks Congress’ Help To Allow Interstate Licensing For Telehealth (3/31) – HHS Secretary Becerra is seeking help from lawmakers in allowing interstate licensing of medical professionals so that telehealth can be practiced across state lines when the pandemic ends. During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspects of state licensure requirements to assist patients in getting care, which made it easier for patients to be cared for via telehealth. Over 200 health care organizations sent a letter
to all 50 state governors last November urging them to maintain and expand licensure flexibilities in a letter spearheaded by the Alliance for Connected Care.
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We are trying to figure out how we allow that service to cross state lines … Not to let the old way of business get in the way…That’s where we’ll need your help to give us the authorities to go beyond what we’ve gone before. -HHS Secretary Xavier Becerra, to Congress
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Administration
Centers for Disease Control and Prevention (CDC): CDC Released Data From National Ambulatory Medical Care Survey Showing Percentage of Office-Based Physicians Who Had Telephone or Internet Consults (4/1) – The CDC released data from the National Center for Health Statistics, National Ambulatory Medical Care Survey 2018 and 2020, outlining how many encounters physicians made with patients via telephone consults or internet/email consults. The survey found that the percentage of office-based physicians who reported having telephone consults with patients during their last normal week of practice increased from 35.8 percent in 2018 to 57.4 percent in 2020. The percentage who reported having Internet/email consults with patients also increased from 13.9 percent in 2018 to 26.8 percent in 2020.
Inside TeleHealth: Telehealth Investments, Studies Scattered Throughout Biden’s 2023 Budget (4/1) – Investments in telehealth are scattered across the Biden Administration’s fiscal year 2023 budget request, with funding requests sought by CMS, the HHS Office of Inspector General, Federal Communications Commission and Health Resources and Services Administration signaling federal interest in telehealth’s role in the future given the increase in telehealth during the COVID-19 pandemic. Notably, the Administration is committed to supporting a temporary extension of broader telehealth coverage under Medicare beyond the Public Health Emergency (PHE) to study its ability to promote proper use and access to care.
U.S. Government Accountability Office (GAO): Report on Medicaid - CMS Should Assess Effect of Increased Telehealth Use on Beneficiaries' Quality of Care
(3/31) – The GAO released a report on an analysis of state-reported CMS data on telehealth use in five selected states. GAO found that the number and percentage of services delivered via telehealth and the number of Medicaid beneficiaries receiving telehealth increased exponentially at the beginning of the COVID-19 pandemic in March 2020. For example, from March 2020 through February 2021, 32.5 million services were delivered via telehealth to 4.9 million beneficiaries, compared with 2.1 million services to about 455,000 beneficiaries the prior year. The GAO recommends that CMS: 1) Collect and analyze information about the effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive; and 2) Determine any next steps based on the results of the analysis.
Healthcare IT News: Interview with OIG analyst John Gordon on OIG study showing virtual care use among Medicare beneficiaries (3/30) – The HHS Office of Inspector General (OIG) recently released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic, finding that telehealth was critical for providing services for such beneficiaries during this time period. Healthcare IT News interviewed OIG analyst John Gordon to discuss the takeaways of the study and how the information OIG found may help decision makers in shaping future telehealth policies.
Health Resources and Services Administration (HRSA): Telehealth Resource Center Performance Measurement Tool (3/28) – HRSA submitted an Information Collection Request (ICR) to the Office of Management and Budget (OMB) on their Telehealth Resource Center (TRC) Performance Measurement Tool. HRSA is requesting an extension of two types of HRSA TRC programs: Two National Telehealth Resource Center Programs focused on policy and technology; and 12 Regional Telehealth Resource Center Programs to host activities and provide resources to rural and underserved areas. HRSA is seeking comment on: 1) the necessity and utility of the proposed information collection for the proper performance of the agency's functions; 2) the accuracy of the estimated burden; 3) ways to enhance the quality, utility, and clarity of the information to be collected; and 4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments are due by April 27, 2022.
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Congress
Telehealth Benefit Expansion for Workers Act (3/31) - Reps. DelBene (D-WA), Walorski (R-IN), Walberg (R-MI), and Craig (D-MN) introduced the bipartisan Telehealth Benefit Expansion for Workers Act (H.R. 7353), which would expand Americans’ access to employer-sponsored health benefits by classifying telehealth as an excepted benefit. The bill would amend the Health Insurance Portability and Accountability Act and the Affordable Care Act to allow all employees—including part-time and seasonal workers—to receive this excepted benefit. Under the legislation, any stand-alone telehealth service would remain separate from traditional medical plans and would not serve as a replacement. The Alliance for Connected Care and other stakeholders called on Congress to take up this important issue last fall. For additional coverage, see articles from Healthcare IT News and Inside TeleHealth.
Senate Finance Committee: Bipartisan Finance Report Supports Boosting Tele-mental Health Access (3/29) - The Senate Finance Committee released a report
that lays out a case for federal action to solve the nation’s mental health crisis and lends strong support to lawmakers’ efforts to boost tele-mental health access beyond the pandemic. The report concludes tele-behavioral health services have been vital during the pandemic and more work is needed to eliminate impediments to tele-behavioral health and innovative technologies. Pointing to the pivotal use of tele-behavioral health during the pandemic, telehealth services may increase access to behavioral health care by reducing stigma associated with accessing mental health and substance use disorder (SUD) services, and easing difficulties attending appointments due to issues with transportation or child care. The research may help Sens. Cardin (D-MD) and Thune (R-SD) draft the telehealth legislation expected this summer.
Home-Based Telemental Health Care Act of 2022 (3/28) – Sens. Rounds (R-SD), Smith (D-MN), Thune (R-SD), and Boozman (R-AR) introduced the bipartisan Home-Based Telemental Health Care Act of 2022 (S. 3937), which would establish a home-based telemental health care demonstration program for purposes of increasing mental health services in rural medically underserved populations and for individuals in farming, fishing, and forestry occupations.
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
PR Newswire: Fifth Annual FAIR Health Report Captures Impact of COVID-19 Pandemic on Healthcare System (3/31) – According to a recent FAIR Health report, telehealth utilization grew nationally by 7,060 percent from 2019 to 2020, an increase driven by the COVID-19 pandemic and the limits imposed on certain in-office services, coupled with the greater risk of infection from in-person encounters. Telehealth held the highest percentage of medical claim lines in 2020, with 15.41 percent of all medical claim lines nationally. This demonstrates telehealth’s impact from the COVID-19 pandemic on the nation’s health care system.
mHealth Intelligence: Remote Patient Monitoring Program Effective in Treating COVID-19 (3/29) – According to a recent study
published in the Journal of Telemedicine and Telecare, a home monitoring program developed by the University of Iowa Hospitals and Clinics helped keep a majority of patients out of the hospital and effectively monitored and treated COVID-19 patients. Researchers analyzed 1,128 COVID-19 patients treated as part of the home monitoring program between March 9, 2020, and June 30, 2020. The researchers found that more than 92 percent of patients did not need hospitalization and concluded that the home monitoring program can help clinicians effectively identify and treat high-risk COVID-19 patients.
mHealth Intelligence: Telehealth Supported Opioid Use Disorder Treatment at Safety-Net Clinic (3/28) – According to a recent study published in the Journal of Rural Mental Health, as health care became increasingly virtual during the COVID-19 pandemic, telehealth helped safety-net facilities provide opioid use disorder (OUD) patients, particularly those involved in buprenorphine treatment programs, high levels of care. The study took place at a south-central Pennsylvania-based federally qualified health center (FQHC), which provides a Medications for OUD (MOUD) with buprenorphine program at various clinics. Treatment retention rates for the groups in all four time periods fell within the 90 percent range, implying that each program was effective, whether it was conducted through telehealth or in-person. Researchers concluded that telehealth was efficacious in retaining patients in MOUD with buprenorphine treatment programs during the COVID-19 pandemic.
AHIP: Telehealth Coverage During the COVID-19 Pandemic (3/28) – AHIP published a report demonstrating the extent to which health insurance providers modified the benefit design of their Consumer-Directed Health Plan (CDHP) product offerings to cover more telehealth services pre-deductible, how those services were made available, and for which medical specialties the services were most utilized. Nearly all Health Savings Account (HSA)-eligible CDHPs modified their benefit design to cover telehealth services on a pre-deductible basis, with 83 percent of issuers offering fully insured products and 81 percent of plans offering self-insured products. Among specific telehealth services covered pre-deductible, the most common types were primary care (95 percent), mental health (95 percent), chronic care (89 percent), and acute/urgent care (89 percent). The findings suggest the urgent need for an extension of the telehealth safe harbor to allow millions to continue to access affordable and convenient health care.
mHealth Intelligence: A Project ECHO Telementoring Program Cut Hospital Admissions Among Diabetics by 44 Percent (3/28) – According to a recent study published in Medical Care, a Project ECHO telementoring program that involved primary care providers resulted in a decrease in hospitalizations among Medicaid patients with diabetes. The study evaluated one of the Project ECHO programs operated by Rutgers Robert Wood Johnson Medical School (RWJMS) that focuses on diabetes and other endocrine diseases, known as EndoECHO. Researchers found a 44.3 percent drop in inpatient admissions among Medicaid patients with Project ECHO providers compared with their counterparts, and a 61.9 percent reduction in inpatient spending among Medicaid patients whose providers participated in Project ECHO compared with the control group. The researchers concluded that Project ECHO participation was associated with large and statistically significant reductions in inpatient hospitalization and spending.
ONC Live: Analysis Reveals Racial Disparities in Telemedicine Use During COVID-19 Pandemic Among Patients with Hematologic Malignancies (3/27) – Data from a retrospective observational study revealed that White patients with hematologic malignancies in the United States had significantly higher uptake of telemedicine compared to Black patients, reflecting disparities that require further exploration. From March 2020 to February 2021, disparate uptake of telemedicine among Black patients compared to White patients was observed, which proved to be true across all diseases and treatments combined, including acute myeloid leukemia (AML) inpatient treatments, multiple myeloma oral treatment, and in multiple myeloma inpatient treatments. Researchers highlighted that the patterns in documented visits reflect potential telemedicine use disparities.
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State Telehealth News and Activity
The Center Square: PA may make it easier to offer telehealth for mental health care (3/31) – Telehealth in Pennsylvania continues to make strides as temporary waivers approved during COVID-19 are made permanent. House Bill 2419 would allow psychiatrists to offer mental health services virtually like they do with in-person services. This past week, Governor Tom Wolf also signed Act 14 into law, which would extend regulatory waivers related to COVID to June 30th.
The Office of Governor Tony Evers: Gov. Evers. Announces $5 million investment to expand access to telehealth services (3/30) – Wisconsin Governor Tony Evers announced a $5 million investment to make telehealth services, including mental and behavioral health services, more accessible by bolstering child psychiatry telehealth services and establishing neighborhood telehealth access points. Funded by the American Rescue Plan, the Wisconsin Department of Health Services (DHS) will use $2.5 million of the funds to create a new grant program for hospitals and health systems to expand and enhance child psychiatry telehealth services. The remaining $2.5 million will be used for a grant program for providers to partner with community organizations to establish neighborhood telehealth access points at food pantries, homeless shelters, libraries, long-term care facilities, community centers, and schools for people with limited access to technology and reliable internet service.
Alabama Daily News: Senate advances telehealth regulation bill (3/29) – The Alabama Senate approved a bill to create rules and requirements for state doctors who see patients virtually using telehealth. Alabama is one of the few states that doesn’t already have telehealth regulations, and Senate Bill 272 aims to put standards of care of in-person visits into remote visits. The bill would authorize the Alabama Board of Medical Examiners and the Medical Licensure Commission to adopt rules for using technology to deliver remote care.
Becker’s Hospital Review: Arizona extends temporary licenses for health care workers (3/28) – Arizona Governor Doug Ducey signed
legislation on March 25 that extends temporary professional licenses of physicians, nurses, and other professionals who have worked in the state during the pandemic. Health care workers will still have a valid license if Arizona ends its public health emergency, which was originally issued in March 2020 and relaxed licensing requirements. The legislation extends temporary licenses until January 1, 2023.
California Health Care Foundation: Report details health centers implementation of telehealth visits for underserved Californians during COVID-19 (3/28) – The California Health Care Foundation released a report
looking at the Connected Care Accelerator, which was launched in July 2020 to support 45 safety-net organizations in California move toward telehealth and expand telehealth capabilities. The report looks at the health centers participating in the Innovation Learning Collaborative, which helped 23 organizations rapidly design, test, and share telehealth implementation solutions, and assesses changes in the health centers’ capacity to implement virtual care, the experience of health care staff in delivering telehealth, and the impact of the collaborative. One major finding is that audio-only visits were the leading telehealth modality for primary care and behavioral health throughout the pandemic study period, but by the end of the study period, audio-only visits were eclipsed by in-person visits for primary care but not behavioral health.
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Telehealth News and Market Developments
Center for Health Care Strategies: The Doctor Will Hear You Now: Audio-Only Telehealth and the Promise of Access, Equity, and Engagement in Medicaid (3/31) – As part of the Public Health Emergency, the Centers for Medicare & Medicaid Services allowed broad flexibility to use telehealth, spurring its unprecedented use. Many providers and patients found low-tech phone visits to be high value — resulting in high patient satisfaction and decreased “no show” rates. The Center for Health Care Strategies recommends extending payment parity for telehealth visits, using value-based payment models, and empowering managed care organizations to promote audio-only options and supports for states to support telehealth.
Health Leaders: Intermountain Healthcare Expands Its In-Patient Remote Monitoring Program (3/31) – Alliance member Intermountain Healthcare
is using a $100,000 grant from Alliance member Intel to purchase 70 new cameras and microphones, which will be placed in rooms in hospitals throughout Utah and allow care providers in Salt Lake City to monitor and communicate with patients. The Patient Safety Monitoring (PSM) program was launched in 2017, with a goal of remotely monitoring patients and helping smaller hospitals facing staffing issues. Aside from monitoring for falls and other emergencies, the program enables patients to communicate with care providers on-demand. It proved especially useful during the pandemic, allowing providers to monitor patients in isolation and reducing room visits. Health care leaders are now looking to adapt those platforms for use after the pandemic, with new tools and technology that increase monitoring and communications capabilities and allow providers to keep a better eye on patients in the hospital.
Time: Telehealth Companies Want Congress to Make Pandemic Expansion of Their Services Permanent (3/30) – Telehealth companies and medical groups are pushing to make the pandemic-inspired telehealth changes permanent. While Congress recently extended many telehealth changes for five months, telehealth lobbyists want to go further. Alliance Member Amwell recently published a survey that found patients have experienced what it feels like when health care can work on their own terms in their environment, and pushes for expanding telehealth policies.
HIT Consultant: Why Telemedicine Isn’t a Temporary Fix — It’s The Future (3/30) – Telehealth has demonstrated its benefits throughout the COVID-19 pandemic. However, to make telehealth a truly viable form of care long-term, it needs to move towards offsetting basic care and conducting remote diagnostics. Medical wearables, internet access, and cloud-based collaboration can help push telehealth past COVID-19. Telehealth may also incentivize patients to seek care more often, which would be reason enough to prioritize the field’s advancement.
Managed Healthcare Executive: How Rural Hospitals Are Benefiting from Remote Patient Monitoring (3/30) – For rural hospitals, telehealth services such as remote patient monitoring (RPM) can equate to healthier patients, better patient satisfaction rates, improved quality scores, greater workflow efficiency, and a new revenue stream to help sustain their future operations as they work to meet the evolving needs of the communities they serve. RPM can be the bridge that brings quality health care to vulnerable patients with chronic health conditions. RPM typically requires fairly simple technology for the hospital and its patients, from the system the hospital uses for its RPM program management to the devices patients use, making it easy to adopt in rural health care settings.
MedCity News: How to Incorporate Telemedicine in an Orthopedic Practice (3/29) – Telemedicine has a place in orthopedics. Not only can range of motion measurements be taken virtually as effectively as in-person, but telehealth offers additional advantages including the potential to take 2D measurements. The option for virtual visits really benefits the orthopedic population, such as reducing travel costs, reducing COVID-19 exposure risk, and reducing long wait times.
Home Health Care News: Why the ROI of Telehealth Is Worth It, No Matter the Reimbursement (3/28) – Medicare prohibits payment for telehealth services within the home health payment model. Advocates believe the only way for the home health sector to be reimbursed for telehealth services is through Congress and a pilot program developed through the Center for Medicare & Medicaid Innovation (CMMI). According to a telehealth and remote patient monitoring company, patients are getting more connection than they normally would if a nurse were visiting the patient.
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Upcoming Events
April 7 – National Academy for State Health Policy, “State Strategies to Support Telehealth Infrastructure.”
April 7 – The Leukemia & Lymphoma Society, “Telehealth for Blood Cancer Patients – Patient Education Program.”
April 21 – National Consortium of Telehealth Resource Centers, “Innovation & Integration of Telehealth into Population Health.”
April 21 – Center for Health Care Strategies, “Using Telehealth to Support Equitable Access to Health Care in Medicaid.”
June 1-2 – Becker’s Healthcare, “The Shift to Digital Virtual Event – Telehealth, Home Health and Virtual Care.”
Previous Events, Podcasts, or Videos
House Energy & Commerce Committee, “Hearing: Connecting America – Oversight of the Federal Communications Commission (FCC).” The House Energy & Commerce Committee, Subcommittee on Communications and Technology held a hearing on oversight of the FCC, where the committee examined the agency’s oversight of broadband service, affordability and adoption, Universal Service Fund, broadband mapping, and other areas. In his opening remarks, Chairman Pallone noted that broadband and connectivity have proven essential throughout the pandemic, whether it is for telehealth or other services.
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