AXIOS: Telehealth Isn't Causing Extra Medicare Visits - Pandemic-era policies to expand telehealth haven't increased the number of patient services that Medicare pays for, a new claims analysis from consulting group Teus Health suggests. The findings from the study, commissioned by Alliance for Connected Care, could counter concerns that continuing telehealth flexibilities beyond the COVID-19 public health emergency is too expensive. In-person and virtual care had almost identical rates of repeat visits for the same medical issue, at just over 20 percent. The study also found consistent rates between chronic and emergent conditions. See the analysis here.
Inside Health Policy: Sens. Sanders (I-VT) and Paul (R-KY) Likely to Lead Senate Health Committees Next Congress (10/26) – Sens. Sanders (I-VT) and Paul (R-KY) are next in line to lead the Senate HELP Committee as Chair and Ranking Member, depending on which party controls the chamber after the midterm elections next Congress. This shift could be good for telehealth as Sen. Sanders (I-VT) supports expanding access to telehealth. He and more than a dozen other Democratic Senators recently wrote to HHS expressing support for the agency’s proposed prohibition on discrimination in telehealth, which was included in HHS’ proposed rule on the Affordable Care Act’s section 1557 non-discrimination provision.
Department of Veterans Affairs: Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) Audio-Only (10/24) – The Department of Veterans Affairs (VA) published a proposed rule to amend its medical regulations regarding the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) coverage. This rulemaking would remove the exclusion from CHAMPVA coverage for audio-only telehealth. In addition, the VA proposed removing limitations on outpatient mental health visits as well as removing cost sharing requirements for certain contraceptive services and contraceptive products approved, cleared, or granted by the U.S. Food and Drug Administration (FDA). Comments are due by November 23, 2022.
Telehealth Research, Reports and Surveys
Journal of the American Board of Family Medicine: The Impact of Telehealth on Primary Care Physician Panel Sizes: A Modeling Study (10/26) – This study explores the potential for telehealth to significantly increase physician capacity by reducing nonvalue adding activities and patient no-shows. The study found that tele-visits reduce the nonvalue-added time physicians spend with patients as well as patient no-shows. At current levels of tele-visit utilization, the use of tele-visits may translate into more than a 10 percent increase in patient panel sizes assuming a modest reduction in visit durations and no-shows, and as much as a 30 percent increase assuming that half of all visits could be effectively conducted virtually and result in a greater reduction in visit durations and no-shows. The findings suggest that using telehealth for many routine encounters is a reduction in wasted physician time and a substantial increase in the number of patients that a primary care physician can care for without jeopardizing access to care.
Medscape: Do PAs Think Telemedicine Was Helpful During Early COVID and Now? (10/26) – The Medscape Physician Assistant (PA) Career Satisfaction Report 2022 found that two-thirds of PAs have used telehealth since the pandemic began. PAs in suburban (68 percent) and rural (70 percent) areas were more likely to use telehealth than PAs in urban areas (61 percent).
Hypertension: Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial (10/25) – A study published in the Alliance for Connected Care advisory board member American Heart Association’s journal Hypertension found that telehealth care by pharmacists is an effective alternative to clinic-based care for managing high blood pressure. For the new study, researchers compared two types of care for moderately severe, uncontrolled high blood pressure: traditional clinic-based care, using face-to face visits with doctors and medical assistants, and telehealth care, with home blood pressure telemonitoring and home-based care coordinated via telephone by a pharmacist or in some cases, a nurse. The telehealth and the clinic-based care were both successful in lowering blood pressure on average. The findings suggest that telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension. For additional coverage, see the American Heart Association press release and mHealth Intelligence.
Cureus: Telemedicine Patient Satisfaction and Cost: A Comparative Study in the COVID-19 Era (10/25) – Telemedicine has the potential to enhance access to health care services across distances, which was of great value during the COVID-19 pandemic. However, concerns about user satisfaction in comparison to face-to-face (FTF) interaction remain inadequately addressed. This study demonstrated that the telemedicine group had patient satisfaction levels similar to those of the FTF clinical visit group, having a lower cost of care. Factors associated with patient satisfaction with telemedicine clinical care are identified and discussed. Both groups showed similar results in overall satisfaction with substantial cost savings for telemedicine patients.
JAMA Network Open: Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department (10/25) – This cohort study evaluates whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care. Telehealth follow-up visits after ED encounters were associated with higher rates of repeated ED hospital visits, however the patients with telehealth follow-up who return to the ED might have greater illness severity when they arrive or possibly other medical or social circumstances that prevent ED physicians from being able to discharge them home. It is important to note that ED patients tend to have higher use of health services in general. This finding of higher ED revisits is not just limited to telehealth, but is a characteristic of this population.
Telehealth News and Market Developments
PR Newswire: Hazel Health Accelerates Growth to Over 3,000 Schools in 14 States, Secures Series C1 Funding (10/27) – Hazel Health, a school-based telehealth program, has expanded to 14 states, reaching nearly 2.5 million students in more than 3,000 schools. This expansion means that more than 10 percent of K-12 students in the states where Hazel Health currently operates now have access to physical and mental health care at school and at home. Hazel Health partners with school districts to provide mental and physical health care services to K-12 students where they are–at school or home. For additional coverage, see Becker’s Hospital Review.
Becker’s Hospital Review: Where Telehealth is Going Next at Kaiser Permanente (10/26) – Kaiser Permanente is creating a "hybrid" or "fluid" model of health care, mixing video visits, remote monitoring and "telesitting" — along with in-person treatment — to give patients care where and how they need it. Becker’s Hospital Review interviews Dr. Edward Lee, executive vice president of IT and CIO of the Permanente Federation, to see how the health system is taking the lessons it learned from telehealth's skyrocketing use during the pandemic to shape its care now.
Fierce Healthcare: Hospitals Share Their Telehealth and Other Priorities for Lame Duck Session in Congress (10/26) – Hospital groups are seeking more financial relief from Congress in the short lame duck session next month, as well as passage of reforms to prior authorization and extensions of rural hospital programs. The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) sent separate letters to congressional leadership this week seeking several priorities, including telehealth. The FAH’s letter emphasizes that telehealth has proven to be a critical and value-added component of the health care delivery system.
News10: EMS agencies Use Telehealth to Avoid Unnecessary Hospital Visits for Patients (10/26) – New York emergency medical services (EMS) uses telehealth to avoid unnecessary hospital visits for patients. The New York EMS partnered with UCM Digital Health, which allows emergency medical technicians (EMTs) and paramedics to assess the situation before connecting the patient with a doctor. The usage of telehealth has cut down wait time at the hospital.
Politico: Why Medicaid is Blocking Patient Home Monitoring (10/26) – Many state Medicaid offices are stymieing the use of remote patient care, refusing coverage for low-income residents who suffer from chronic diseases at higher rates than Americans with private insurance. While the Centers for Medicare and Medicaid Services (CMS) has some reimbursement codes for remote monitoring, states have broad discretion to set their own rules. Around 20 state Medicaid programs don’t reimburse for remote patient monitoring, according to data from the Center for Connected Health Policy. Several states that pay for remote monitoring have stringent restrictions around its use.
The Harvard Crimson: Hundreds of Students Have Registered for New Telehealth Counseling Platform, CAMHS Director Says (10/26) – Roughly two weeks after Harvard introduced a new telehealth counseling program, nearly 400 students have registered for the online platform. More than half of students who registered for the service are between the ages of 23 and 29. Thirty-seven percent of the students registered for TimelyCare are Asian or Asian American students, while 29 percent are White, and 10 percent are Black.
Politico Pro: Critical Intervention Needed for Remote Care (10/26) – Large health systems are investing big money to provide more health services at home — everything from post-operative care to treatments for chronic disease. But even as successive administrations have touted remote patient monitoring programs as a key to improving health and reducing unnecessary government spending, state Medicaid offices remain an impediment to scaling them nationally, refusing coverage for low-income residents who suffer from chronic diseases at higher rates than Americans with private insurance. Many states have declined to pay for them, in part because the upfront legwork and bureaucratic headaches can be stifling to officials who deal in yearly budget cycles and rarely get credit for savings decades down the road.
Healthcare IT News: HIMSS Promotes Key Policies on Telehealth Expansion (10/25) – HIMSS called on health care stakeholders to get involved in two initiatives to help expand access to quality care for underserved and at-risk populations. The first is focused on protecting access to care via the telehealth flexibilities that have enabled broad expansion and uptake of virtual care since the start of the COVID-19 pandemic. Specifically, HIMSS is in support of the Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040), which was passed by the House of Representatives by a wide margin this past July but has stalled in the Senate.
Forbes: Diabetes and Remote Patient Monitoring: Challenges and Solutions (10/25) – Diabetes management has always been a challenge, not just for the patients but also for the physicians and health care staff who offer remote patient monitoring (RPM) for individuals. Prabhat Sharma, cofounder and CEO of FitPeo Inc, a remote care platform, shares solutions to common challenges patients face when using home monitoring devices for diabetes.
Federal Times: Telehealth Options to Stay in 2023 Federal Employee Health Plans (10/25) – As federal employees prepare to make their selections for next year’s health insurance benefits, some may wonder whether telehealth services, made especially popular and necessary by the COVID-19 pandemic, will stick around. All federal employee health benefit carriers are continuing initiatives that expanded during the pandemic related to telehealth. Telehealth plays an important role in promoting health equity for working families who may not always be able to leave the office for an appointment.
Employees Benefits News: How Cove is Using Telehealth to Help Employees Manage Migraines (10/25) – Cove, a platform that treats migraine, provides telehealth medications management services and works with patients one-on-one to build a holistic treatment plan. Fifty percent of employees with migraines point to it as the leading cause holding them back in their career, and 30 percent have turned down career opportunities because of their concern around how migraines would impact their performance at work. Telemedicine reduces the gaps in accessing headache specialists or specialty migraine care for employees.
Politico Pro: Medicare Beneficiaries with Disabilities Are Likely to Continue Using Telehealth (10/24) – Advocates for people with disabilities are pushing Congress to extend pandemic rules permitting Medicare beneficiaries to more easily use telehealth. Eased telehealth rules under the COVID-19 public health emergency reduced the burden of traveling to doctors’ offices. However, advocates want policymakers to expand broadband access and strengthen nondiscrimination protections to make sure patients can access telehealth when it is the best option.
Medscape: Can Telemedicine Close the Endocrinology Access Gap? (10/24) – Dr. Richard Plotzker, a retired endocrinologist of Mercy Hospital of Philadelphia Hospital, highlights that physicians have always decided what care was best for their patients. Patients and physicians should discuss telehealth and its appropriateness for the patient's care together as it provides a step toward standardization. Each practitioner should be allowed to pursue telehealth on their own comfort level. To get maximum benefit for these people and many others, an investment needs to be made to identify what the best practices of telemedicine actually are.
Forbes: What’s Next for Telemedicine, And How Do We Get There? (10/24) – The COVID-19 pandemic has shifted the paradigm of health care. Telehealth and remote patient monitoring has the potential to change the health care landscape. This article reviews reports and studies that have found similar things – telehealth and remote patient monitoring can be elements of the full spectrum of care options.
Healthcare IT News: RPM Leads to Early Detection of Stroke-Risk Blood Pressure at Boston Medical Center (10/24) – Dr. Christina Yarrington, Chief of Maternal Fetal Medicine at Boston Medical Center, explains how remote patient monitoring technology improves care during a very sensitive time in a woman's life. Postpartum hypertension is a leading cause of postpartum hospital readmissions and severe maternal morbidity, since it can lead to heart attacks and strokes, which makes it vital to monitor blood pressure closely and then be able to leverage data from blood pressure readings. Remote patient monitoring has allowed the Medical Center to intervene faster and prevent adverse outcomes.
State Telehealth News and Activity
Center for Connected Health Policy: Telehealth Policies and Federally Qualified Health Centers (10/25) – The Center for Connected Health Policy (CCHP) released a fact sheet which reviews telehealth policies in federally qualified health centers (FQHCs). With support from the National Association of Community Health Centers (NACHC) through funding from the Health Resources and Services Administration (HRSA), the Fall 2022 Edition of the Center for Connected Health Policy’s (CCHP) Telehealth summary report and Policy Finder tool highlights how state Medicaid programs address telehealth reimbursement in FQHCs.
MercyOne: MercyOne Clinton Medical Center Provides Neurological Care Through Telehealth (10/25) – MercyOne Clinton (Iowa) Medical Center has created a new service that allows patients to receive neurological care through telehealth. The new tele-neurological services will be available through inpatient rounding, where physicians visit patients' rooms and provide them with remote access to a neurological specialist for an assessment to diagnose, treat or manage conditions affecting the brain. For additional coverage, see Becker’s Hospital Review.
Center for Care Innovations: “Healing the Whole Person”: Telehealth and Addiction Treatment in Orange County (10/17) – Orange County, California has relatively high rates of opioid overdose compared with its surrounding counties and the rest of California. KCS Health Center, a local safety net clinic, used virtual care to reach patients with addiction issues. Patients that have used the program share their experiences and effectiveness of virtual care.
Politico, “Pulse Check: What We Can Learn About Experiments in Remote Care.” Large health systems are investing big money into providing more care at home — everything from post-operative care to treatments for chronic disease. Even as successive administrations have touted remote patient monitoring programs as key to improving health and reducing unnecessary government spending, state Medicaid offices often remain an impediment to scaling them nationally. Ruth Reader talks with Katherine Ellen Foley about why.