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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This will be the last newsletter of 2022. Our next newsletter will be sent on January 3, 2023. Wishing you a happy holiday season!
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All Eyes on Congress This Week
All eyes on end-of-year! The Alliance is closely tracking Congress as it moves to finalize its year-end legislative package. Last week, House and Senate Appropriators reached a deal on a bipartisan, bicameral government funding framework which will allow Congress to move to finalize the year-end appropriations package. We may see the text of the omnibus spending package as soon as today.
We are watching for the inclusion of an extension of Medicare telehealth flexibilities through the end of 2023 and extension of HDHP telehealth flexibilities (our latest advocacy mentioned in the Congress section), as well as a few other telehealth provisions including in House
and Senate draft appropriations language from earlier this year. Stay tuned for more developments!
Alliance in the News
Axios Pro: Omnibus Movement Could Mean Bigger Health Care Package
(12/13) – Telehealth is one of the priorities being considered for the end-of-year funding package. “If telehealth ends up being in the omnibus, it is likely to be only a one-year extension of the PHE flexibilities that end on December 31,” said Krista Drobac, executive director of the Alliance for Connected Care. The Congressional Budget Office (CBO) score would be favorable for one year and then could give more time for data and evidence to inform whether it should be extended further. In addition to pushing for continued Medicare telehealth flexibility, providers and some lawmakers are looking to extend a waiver that lets people with high-deductible health plans continue to access coverage of telehealth services before their minimum deductible is met.
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Administration
HHS: Medications for the Treatment of Opioid Use Disorder Proposed Rule (12/13) – The Substance Abuse and Mental Health Services Administration (SAMHSA) issued a proposed rule which would update the federal regulations that oversee OUD treatment standards. Specifically, the proposed rule change would allow Americans to access the treatment by allowing take home doses of methadone and the use of telehealth in initiating buprenorphine at opioid treatment programs (OTPs). It is important to note that this proposed rule does not address health care providers outside of OTPs – providers outside of OTPs who prescribe narcotics such as buprenorphine must have a Drug Enforcement Administration (DEA) waiver. The DEA has yet to finalize the special registration for prescribing of controlled substances via telehealth. Public comment on the proposed regulatory changes may be made until February 14, 2023. For additional coverage, see Fierce Healthcare, and PoliticoPro.
"While we appreciate SAMHSA's leadership on opioid treatment programs, we want to make very clear -- the continuation of telehealth prescribing of controlled substances after the PHE requires DEA to act very soon. DEA regulations must also capture all of the patient's needs met by telehealth -- not just opioid treatment," Krista Drobac, executive director of the Alliance for Connected Care told Inside TeleHealth.
AHRQ: Notice of Intention to Request OMB Approve the AHRQ Safety Program for Telemedicine (12/15)
- HHS issued a notice announcing the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the White House Office of Management and Budget (OMB) approve the proposed information collection project “The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use.” This program aims to improve two at-risk areas among telemedicine practices by implementing the AHRQ- and Johns Hopkins Armstrong Institute for Patient Safety and Quality (JHAI)-developed Comprehensive Unit-based Safety Program (CUSP) approach: (1) the diagnostic process for breast, colorectal, and lung cancer; and (2) antibiotic stewardship (AS).
Department of Health and Human Services (HHS): Letter to U.S. Governors from HHS Secretary Xavier Becerra on COVID-19 Resources (12/15) – HHS Secretary Becerra sent a letter to all U.S. Governors on COVID-19 resources available to states. Specifically, he highlights the Test to Treat model to expand access to life-saving treatments, including through telehealth and mobile Test to Treat options. Additionally, the Secretary Becerra encourages providers to utilize telehealth if practices are experiencing strains with medical personnel availability.
Centers for Medicare and Medicaid Services (CMS): HHS Proposes Rule to Strengthen Beneficiary Protections, Improve Access to Behavioral Health Care, and Promote Equity for Millions of Americans with Medicare Advantage and Medicare Part D (12/14) – CMS issued a proposed rule to strengthen Medicare Advantage (MA) and Medicare Part D prescription drug coverage. Notably, CMS proposes requiring MA organizations to develop and maintain procedures to offer digital health education to enrollees to improve access to medically necessary covered telehealth benefits. CMS also proposes policies to strengthen network adequacy requirements and reaffirm MA organizations’ responsibilities to provide behavioral health services, including allowing licensed clinical social workers and those who prescribe medication for opioid use disorder (OUD) to become eligible for a ten-percentage point telehealth credit. Read the fact sheet here. Read this perspective
to the rule.
Inside Telehealth: The Federal Communications Commission (FCC) Maps Need Significant Correction To Expand Telehealth Access (12/14) – Telehealth stakeholders, lawmakers and community members are sounding the alarm that the new broadband maps from the FCC, which will dictate Jobs Act funding for internet expansion, need to be significantly revamped, as some communities are entirely missing from the maps. Doing so will help ensure the unserved and underserved are accurately represented. Increasing broadband access is viewed as pivotal to further expansion of virtual care.
HHS: Letter to U.S. Governors from HHS Secretary Xavier Becerra on COVID-19, Flu, and RSV Resources (12/12) – HHS Secretary Becerra sent a letter to U.S. Governors indicating that waivers intended for the COVID-19 public health emergency (PHE) can be used to address surges in respiratory syncytial virus (RSV) and influenza as long as the COVID pandemic is contributing to health systems’ difficulties in responding to the other respiratory illnesses. Those waivers include telehealth flexibilities, along with hospital triage options. Specifically, Secretary Becerra encourages Medicaid agencies to maximize telehealth flexibilities during and after the COVID-19 PHE, including by creating a dedicated website and toolkit to support states’ implementation of telehealth technologies.
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Congress
Rep. Schneider: Schneider, Steel, Lee Lead Bipartisan Push for an Extension of Expiring Telehealth Flexibilities in an End-of-Year Package (12/12) – Reps. Schneider (D-IL), Steel (R-CA) and Lee (D-NV) led a bipartisan group of 30 House Members in a letter asking House leadership to extend critical telehealth flexibilities in the year-end appropriations package. The Alliance for Connected Care worked closely with the Congressional offices on this advocacy effort. The letter called on Congress to include the extension of the flexibility that allowed health plans and employers to provide pre-deductible coverage of telehealth services for individuals with a high deductible health plan coupled with a health savings account (HDHP-HSA). This provision was included in both the Primary and Virtual Care Affordability Act (H.R. 5541) and the Telehealth Expansion Act (H.R. 5981) For additional coverage, see PoliticoPro, mHealth Intelligence and Inside Telehealth.
House Energy & Commerce Committee: Telehealth Access has been a Game Changer for America’s Seniors (12/14) – House Energy & Commerce Committee Ranking Member McMorris Rodgers (R-WA) joined Axios for a discussion titled “The Future of Telehealth” as Congress considers extending telehealth flexibilities for seniors beyond the COVID-19 PHE. Ranking Member McMorris Rodgers (R-WA) highlighted priorities for telehealth extension, which included delinking telehealth flexibilities from the COVID-19 PHE, considering guardrails, and urging the Senate to consider the telehealth bill that passed the House this summer (H.R. 4040).
Sen. Rosen (D-NV): Senate Passes the Data Mapping to Save Moms' Lives Act (12/14) – On December 14, the Data Mapping to Save Moms’ Lives Act (S. 198) passed the Senate by unanimous consent. The bill would require the Federal Communications Commission to incorporate data on maternal health outcomes into its broadband health maps. The bill now heads to the President to sign into law. Sen. Rosen (D-MV), one of the bill’s cosponsors, told POLITICO
that she sees the legislation as a template that could be used to tackle other issues like heart disease or diabetes via telehealth. She sees virtual care as a way to better reach mothers to check in on their health and ultimately save lives.
Medicaid and CHIP Access to Prescription Digital Therapeutics Act: (12/12) – Sens. Capito (R-WV) and Shaheen (D-NH) introduced the Medicaid and CHIP Access to Prescription Digital Therapeutics Act (S. 5238), which would require the CMS Administrator to provide guidance regarding coverage of prescription digital therapeutics under Medicaid and CHIP. The bill would make it easier for clinicians to prescribe innovative new technologies, such as digital health devices and mHealth apps.
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Telehealth Research, Reports and Surveys
Epic Research: Telehealth Visits Unlikely to Require In-Person Follow-Up Within 90 Days (12/13) – Epic Research released a study which found that most patients who had a telehealth visit did not require an in-person follow-up appointment in that specialty in the next three months. For specialties that required follow-up, the additional visits were likely related to needing additional care, not duplicative care (for example, obstetrics, geriatrics). Mental health and psychiatry had the largest volumes of telehealth utilization and some of the lowest rates of needing in-person follow-up. These findings suggest that, for many specialties, telehealth visits are typically an efficient use of resources and are unlikely to require in-person follow-up care. If telehealth is not duplicative of in-person visits for those specialties, it can be an effective tool to help expand access to care.
Nature: Has Increased Telehealth Access During COVID-19 Led to Over-Utilization of Primary Care? (12/13) – Over two years into the pandemic, the question of whether telehealth will lead to an increase in primary care utilization and spending has been met with contradictory answers. One study sought to examine whether there was a change in primary care utilization with the expanded availability of telehealth and found that that the average number of primary care visits per patient remained stable across patients on commercial insurance, Medicare, and Medicaid. This suggests that the availability of telehealth did not result in additional primary care visits. Instead, telehealth may have served as a substitute for certain in-person encounters. They also found that telehealth use occurred more by patients with multiple primary care visits, suggesting that telehealth was mostly utilized by patients with complex medical needs.
AJMC: Telemedicine Care Quality, Social Vulnerability Index Barriers Measured for Patients with Epilepsy (12/12) – Abstracts from the American Epilepsy Society annual meeting show that telemedicine is capable of meeting the needs of patients with epilepsy, and that the patient portal accessibility for patients experiencing high social vulnerability index needs further research. The survey asked questions about patient demographics, preference of telemedicine, views on quality of care, and effects on finances. The majority of patients surveyed preferred telemedicine instead of in-person visits (64 percent). If the travel distance consisted of ten miles or less, 77 percent of patients stated that they’d rather participate in in-person visits, while there was no difference found between 11 to 50 miles or over 50 miles in telemedicine preferences.
Cureus: Patient Satisfaction with Medical and Social Concerns Addressed During Telemedicine Visits (12/14) – Assessing patient satisfaction with this mode of health care delivery is an important metric of success as it is broadly implemented across various settings. This study assesses patient satisfaction with the medical and social aspects of the care they receive via telemedicine at a university-affiliated primary care training clinic in Detroit, Michigan. Telemedicine was well received, with high satisfaction for addressing medical and social concerns. The results of this study support the use of telemedicine to assess social determinants of health in an underserved minoritized patient population and will help physicians optimize future interactions with patients through telemedicine.
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Telehealth News and Market Developments
UC Davis Health: Chronic Obstructive Pulmonary Disease (COPD) Clinic Creates Remote Patient Monitoring Program to Reduce Hospital Readmission (12/14) – Aiming to improve health outcomes and reduce hospital readmissions, the Comprehensive COPD Clinic at UC Davis Health has created the first remote patient monitoring program in the Sacramento region for high-risk patients with COPD. The program enrolls up to 12 patients with COPD at any time, all of whom are given a pulse oximeter, an electronic device that measures the patient's heart rate and saturation of oxygen carried in their red blood cells. The data collected is uploaded to a dashboard on the patient's electronic health record and is monitored daily by respiratory therapists in the Reversible Obstructive Airway Disease program. The team set up alarms that are triggered when a patient’s symptoms are concerning. Respiratory therapists then reach out to provide care and guidance.
Chief Healthcare Executive: Inside Intermountain Healthcare’s $600M Campaign to Reimagine Pediatric Care (12/13) – Alliance board member Intermountain Healthcare is aiming to expand options at its children's hospital and provide more care for kids in their communities. Intermountain’s aggressive philanthropic effort, dubbed Primary Promise, appears to be resonating with donors. So far, the effort has raised more than $500 million. With expanded telehealth services, Intermountain can support other hospitals and enable them to keep kids in their own facilities without needing to transfer them to the children’s hospital. Nurses and physicians can call and get added support from Primary Children’s regarding children in the emergency department.
HIT Consultant: Brightside Health Launches Telehealth Program to Combat Suicide Epidemic (12/12) – Brightside Health announced the launch of Crisis Care, a telehealth program treating individuals with elevated suicide risk. With the addition of Crisis Care, the company will expand its services to individuals experiencing acute suicidal thoughts and behaviors. While telehealth has improved access to mental health care, the majority of virtual mental health services only treat patients with low-to-moderately severe conditions. This critical gap in care leaves lives at risk and increases health care costs due to avoidable ER visits and hospitalizations. Crisis Care was developed to fill this widening gap, providing timely access to specialized care for individuals with acute suicide risk.
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State Telehealth Activity
The Big Bend Sentinel: Big Bend Regional Hospital District Discusses Grant Funding for Telehealth, Psychotherapy (12/14) – The Big Bend Regional Hospital District (BBRHD) proposed pursuing grants in expanding access to telehealth options and mental health care services. Executive Director J.D. Newsome is seeking additional funding from the U.S. Department of Agriculture (USDA) this year by applying to a grant specifically targeting telemedicine. For this year’s round of USDA rural medicine funding, the BBRHD has been looking into a telemedicine unit from OnMed that can diagnose — and treat — certain health issues remotely. OnMed describes its products as “self-contained telemedicine kiosks” — patients are seen via videocall by a clinician and then by a pharmacist, who can dispense medication through the ATM-style machine.
The Center Square: Youngkin unveils new plan, announces $230M for behavioral health in Virginia
(12/14) – Virginia Governor Glenn Youngkin announced he will propose $230 million in the state’s upcoming budget amendments to bolster Virginia’s behavioral health system and build crisis care capacity as part of a three-year plan aimed to reshape the state’s strained behavioral health care system. This includes expanding telehealth psychiatric care in schools, increasing the number of crisis receiving centers in underserved communities and providing funding to support and retain the state’s behavioral health workforce.
North Carolina Department of Health and Human Services: Telemedicine Program Launched to Increase Access to Lifesaving COVID-19 Treatments (12/13) – The North Carolina Department of Health and Human Services announced a partnership with StarMed Healthcare to create a time-limited telemedicine program to create better access to treatments for people who test positive for COVID-19, particularly those who are uninsured or don’t have a primary care doctor. Free telemedicine appointments to screen for COVID-19 treatment eligibility will be available, while funding allows, to North Carolinians who have tested positive for COVID-19 with an at-home test or other method. This telemedicine screening service is available regardless of insurance status and IDs are not required
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Upcoming Events & Hearings
December 22 – Upper Midwest Telehealth Resource Center, “Virtual Office Hours.”
January 11 – Mid-Atlantic Telehealth Resource Center, “Questions about School-Based Telehealth.”
January 18 – Center for Connected Health Policy, “Telehealth Policy in 2023.”
February 9 – California Telehealth Resource Center, “Remote Patient Monitoring Event: Learn, Engage, Advance.”
March 15 – Mid-Atlantic Telehealth Resource Center, “2023 Summit.”
April 17-21 – Healthcare Information and Management Systems Society, “HIMSS23 Global Conference & Exhibition.”
Previous Events, Videos & Podcasts
Stat News, “Leaky Health Data, ASH22, & What it Takes to Get Booed by Your Peers.” Katie Palmer, STAT’s health tech correspondent, joins the STAT’s biotech podcast to explain how the explosive popularity of telehealth is putting sensitive patient information into the hands of Facebook, TikTok, and other big tech firms. The podcast also discussed the latest news in the life sciences, including highlights from a big hematology conference, a disastrous biotech IPO, and the downside of being a good quote.
Healthcare IT News, “Telehealth Heavy Hitter Dr. Roy Schoenberg on Virtual Care In 2023.” Dr. Roy Schoenberg, president and CEO of Amwell (an Alliance for Connected Care Board member), shares his views on how his predictions from last year turned out and where virtual care is headed in 2023. The Amwell CEO reviews his successful predictions from last year and looks ahead at clinician-initiated telemedicine and virtual care shifting from transactional to transformational.
Healthcare Finance, “How Telehealth Addresses Behavioral Health's Many Problems.” Dr. Tom Milam, chief medical officer at Iris Telehealth, sees hospitals using virtual care to meet the increasing demand for behavioral health - and help with the shortage of psychiatrists.
Axios, “Vitals Check-Up: The Future of Telehealth Policy.” Creagh Milford, DO, senior vice president of CVS Health (an Alliance for Connected Care Board member),
shares that telehealth is just one of the pillars of an "omni-channel" approach CVS Health is developing toward providing care for people. As for telehealth services, people were showing they still very much wanted to use them as an important way of taking care of their health, adding that 72 percent of people believed they could get as good or better services virtually, a figure he described as "astounding" when compared with just a few years ago. Similarly, about 75 percent of providers believed they could offer as good a service as in-person through telehealth. For additional coverage, see Becker’s Hospital Review.
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