Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.
Telemental Health Care Access Act: (6/15) – Senators Cassidy (R-LA), Smith (D-MN), Cardin (D-MD), and Thune (R-SD) introduced the Telemental Health Care Access Act of 2021 (S.2061), which would ensure coverage of mental health services furnished through telehealth. The Alliance for Connected Care has endorsed this bill because it repeals the in-person visit requirement that was placed on tele-mental health in the end-of-year 2020 legislative package. View the bill text and press release.
Expanding Access to Mental Health Services Act: (6/17) – Representative Rosendale (R-MT) introduced the Expanding Access to Mental Health Services Act (H.R.4012), which would permanently include certain HCPCS codes as telehealth services under such title and broaden mental health options, including intake examinations and therapy, via telehealth for Americans on Medicare. View the press release. Bill text has not yet been released. Check the Alliance’s federal legislation tracker for updates.
Audio-Only Telehealth for Emergencies Act would allow physicians delivering care during a public health emergency or a major disaster declaration to receive the same compensation for audio-only telehealth visits as they would receive for in-person appointments. View the bill text. Note – this is a new bill; this bill was not introduced in the 116th
Telehealth Health Savings Account (HSA) Act would allow employers to offer high-deductible health plans that include telehealth services without limiting employees’ ability to use health savings accounts. A current IRS regulation stops employees from making or receiving contributions to HSAs if they hold a high-deductible health plan that waives the deductible for telehealth services. This means that employees holding such high-deductible health plans will often need to pay out of pocket for telehealth services. The Coronavirus Aid, Relief and Economic Security Act temporarily waived this regulation, and the Telehealth HSA Act would make this waiver permanent. View the bill text. Note – Sen. Loeffler (R-GA) previously introduced this bill in the 116th Congress.
Enhance Access to Support Essential (EASE) Behavioral Health Services Act would allow mental health professionals providing telehealth services through Medicare and Medicaid to be reimbursed at the same levels as mental health professionals conducting in-person visits. This would allow patients to receive care in the comfort of their own homes and reduce the stigma associated with seeking mental health treatment. View the bill text. Note – Reps. Bilirakis (R-FL) introduced the House version of the EASE Behavioral Health Services Act in the 116th Congress. A House companion has not yet been introduced in the 117th Congress.
Increasing Rural Telehealth Access Act would expand access to health care by improving remote patient monitoring technology for individuals in rural areas. Remote patient monitoring is a form of telehealth that uses digital technologies and mobile medical devices to gather health data from patients at home and send it to their health care providers. This technology allows health care providers to continuously monitor patients with chronic health problems. View the bill text. Note – this is a new bill; this bill was not introduced in the 116th
State Telehealth Activity
ITN Technology: California Physicians Weigh In On Telemedicine (6/18) – A recent survey of independent physicians across California, indicates that telehealth and other technologies played a significant role in helping physicians and patients navigate the pandemic, and they appear to be a permanent part of healthcare’s future. Respondents confirmed this shift as follows:
30% responded that the past year “made me want to use technology more to see my patients.”
47% had not previously used telehealth to see patients.
39% responded that telehealth “played a crucial role in my ability to continue to care for patients.”
46% see telehealth as “a staple” of future practice.
4% reported that telehealth “did not work for my practice”
JD Supra: Tracking Telehealth Changes State-by-State in Response to COVID-19 (6/18) – States, payers, and providers are looking for ways to expand access to telehealth services post-pandemic, as it has become an essential tool to ensure access to care. Manatt Health developed a federal and comprehensive 50-state tracker for policy, regulatory, and legal changes related to telehealth during the COVID-19 pandemic. This article provides an executive summary, outlining federal developments from the past two weeks, new state-level developments, and older federal developments on telehealth policy. Among new state-level developments include that Connecticut, Hawaii, Nevada, and Texas all passed bills related to telehealth, ranging on topics from audio-only to expanding the types of providers who can practice telehealth.
NCSL: Treasury Releases Guidance on State Broadband Spending (6/17) – States are investing in broadband at an unprecedented rate, and many see the need for further efforts to increase deployment and adoption. Following its release of the interim final rule governing the Coronavirus State and Local Fiscal Recovery Fund, the Department of the Treasury provided FAQ to guide states on spending for broadband. The update clarifies that states and localities may invest in areas where not all households or businesses are unserved or underserved as long as an objective of the project is to provide service to unserved or underserved households or businesses. It also clarifies that the use of “reliably” in the broadband provision of the interim final rule provides states and localities with significant discretion to assess the experience of users on the ground. States may also use the funds for “middle-mile” projects but encourages partnership with “last-mile” networks to encourage adoption.
The National Law Review: Oregon Looks to Provide Parity for Telehealth (6/15) – Oregon passed a bill (House Bill 2508A) into law earlier this month which requires parity for health care services delivered through telehealth. The bill, which went into effect on June 1, expands coverage of and reimbursement for telehealth services in the state to promote equitable and safe access to care. Oregon, like many other states, has recognized the value of telehealth services, and has begun to take steps to ensure permanency for the temporary mandates issued during the pandemic. HB2508A encourages the continued use of telehealth by requiring the Oregon Health Authority to reimburse health services delivered via telehealth if specified criteria are met including reimbursing a provider at the same rate for a health service delivered in person or through telehealth.
Government Technology: States Weigh Telehealth Costs as Appointments Shift Offline (6/14) – As doctors and patients return to in-person appointments, state lawmakers are divided over how much taxpayer money to keep spending on audio-only telehealth appointments. Audio-only visits have been a lifeline for those who did not have technology for video visits throughout the pandemic, however those critical of making such a policy permanent say such visits do not meet the same level of quality as video or in-person care. The California legislature, for example, wants Medi-Cal to continue paying the same rate for audio-only visits as video and in-person visits, but the state budget reduces the rate for the upcoming year. This article provides an overview of considerations going into this issue across states.
Telehealth Research, Reports and Surveys
American Journal of Managed Care (AJMC): Telemedicine Effective at Care Retention Among Rural Patients Living With HIV (6/19) – Researchers have found that when put up against traditional, or face-to-face (F2F), care, telemedicine (TM) produced comparable results among persons living with HIV in rural Georgia, thereby presenting itself as a potential way to increase access to specialty HIV care for these individuals. Noting the difficulty persons living with HIV have at being retained in care, especially when presented with social, geographical, health system, and economic barriers, researchers from Medical College of Georgia, Massachusetts General Hospital, and Harvard Medical School investigated telemedicine’s impact in the space.
National Library of Medicine: Reducing Hospital Visit Rates in Hospice Patients Using Telemedicine (6/19) – The purpose of this project was to examine the impact of accessibility to a provider via telemedicine on emergency department visit rates in adults, 35 years and older, on home hospice and palliative care. Researchers found that among the intervention group, the number of emergency department visits and the number of 911 calls decreased from 12 (54.5%) to one (4.5%) postintervention. In conclusion, the researchers determined that a telemedicine hospice care application may benefit a palliative and hospice organization by enhancing patient clinical outcomes and decreasing emergency department visit rates.
Mobihealth News: Patients are looking to go back to brick-and-mortar post pandemic (6/15) – New data from HIMSS' State of Healthcare survey reveals that the bulk of patients are looking to return to in-person care. However, younger generations are more likely to continue on telehealth. While half of patients have experienced a telehealth visit in the last year, the bulk of them say they want to get back to normal in-person visits, according to new research conducted by HIMSS. In fact, HIMSS' State of Healthcare report found that 60% of patients want to return to their pre-pandemic experiences.
Journal of the American Medical Directors Association: COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey (6/8) – The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic. Seventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%). The most common challenges were as follows:
patient lack of familiarity with telemedicine (81.9%)
patient anxiety (77.8%)
clinician anxiety (69.4%)
technical difficulties reaching patients (66.7%)
supply shortages including masks, gown, and disinfecting materials (55.6%).
Top adaptive strategies included:
using telemedicine (95.8%)
reducing in-person visits (81.9%)
providing resources for patients (52.8%)
staff training in PPE use and COVID testing (52.8%).
In conclusion, the authors note that an increased recognition of the need for in-home care by health systems who observed its critical role in caring for fragile older adults may serve as a silver lining to the otherwise dark sky of the COVID-19 pandemic.
The adoption of live, video conferencing, remote patient monitoring, and asynchronous telehealth solutions
Provider needs for reimbursement and licensing to succeed in telehealth
Infrastructure and tech investments required to meet patient needs
Currently, about 35 percent of provider organizations are using remote patient monitoring technologies, according to the Insights report. But the difference between use in hospitals and physician practices is stark–59 percent at hospitals and 21 percent at physician practices. The report finds that remote patient monitoring solutions can play a critical role in chronic care management and home health programs that work to drive down care costs and improve patient outcomes.
Telehealth News and Market Developments
Forbes: Transforming Telehealth Access in The Post-Pandemic Era (6/18) – Telehealth has emerged as a viable delivery model of care and in the process has helped to transform the digital patient journey and redefined what the "digital touch" looks like, said Anita Gupta, Forbes Council Member and an Anesthesiologist. To make telemedicine more sustainable and lasting in the post-COVID era, we need fewer regulations and better payment systems.
American Medical Association (AMA): Henry Ford moves telehealth forward with virtual exam kit (6/18) – Telehealth boomed during the early stages of the COVID-19 pandemic as patients avoided in-person medical office visits, but the tactic has become more than an emergency accommodation. New remote-examination technology is making telehealth more effective than ever, according to Diane L. George, DO, chief medical officer of Henry Ford Medical Group Primary Care in Sterling Heights, Michigan. Dr. George discussed her practice’s experience with expanded telehealth during a recent episode of "AMA COVID-19 Update." As she notes, self-examination tools help close the gap between telehealth and in-person.
The Hill: Sen. Manchin paves way for a telehealth revolution (6/16) – On Wednesday, Sen. Joe Manchin (D-W.V.) and a bipartisan group of senators introduced the Protecting Rural Telehealth Access Act to permanently expand patient access to telehealth. The measure would authorize health providers to deliver virtual care to Medicare enrollees located in any ZIP code in the country. It also would allow patients to receive telehealth care from the comfort of their home. The Alliance for Connected Care has endorsed this bill because of its strong provisions on audio-only telehealth, remote patient monitoring, and rural telehealth through critical access hospitals and other rural providers. View the bill text, press release and summary. For years, telehealth remained at the margins of America’s health care system because of outdated and harmful government barriers, says Charlie Katebi a health policy analyst at Americans for Prosperity. “However, health professionals proved throughout the pandemic this technology saves lives. Manchin’s proposal would ensure Americans can access these important services on a permanent basis.”
Healthcare IT News: How telehealth overcomes barriers to cleft palate care and speech therapy (6/16) – Dr. Cate Crowley, a professor at Columbia University and cleft palate care medical advisor, explains telemedicine's reach and ability to reduce stigma. Dr. Cate Crowley works as part of Smile Train’s Global Medical Advisory Board developing the Cleft Palate Speech Training Project, which provides workshops in Spanish and English for parents and colleagues who work with children with repaired clefts. By focusing on building capacity in low- and middle-income countries, and always considering those children who live in the more rural areas, the Smile Train model reduces the inequities of distance, education and resources, she said. Children born with cleft palate can receive quality services no matter where they are born. “Today, reaching remote regions is so much easier thanks to significant improvements and advancements in tele-therapy – and overall internet access. If the next 10 years see as much improvement as the last 10 years, telehealth will be a seamless and significant tool used virtually everywhere.”
Thomas Jefferson University: Why Telehealth is Not Meeting the Needs of African Americans with Diabetes (6/15) – The COVID pandemic has revealed racial disparities, including differences in who uses telehealth services. Now Jefferson researchers find that a lack of trust in physicians’ abilities to diagnose and treat COVID-19 via telehealth is a significant factor for why African Americans with diabetes did not use telehealth services during the pandemic. The findings show that mistrust in physicians influences whether African Americans use healthcare services.
AMA: AMA calls for action to help telehealth flourish post-pandemic (6/14) – The AMA House of Delegates (HOD) voted to adopt policies advance telehealth and close the digital divide. To continue the use of telehealth after the COVID-19 public health emergency—not as a replacement for in-person care but as part of a hybrid model in which physicians utilize both in-person and telehealth visits to support optimal care—delegates adopted policy calling on the AMA to “continue supporting state efforts to expand physician-licensure recognition across state lines in accordance with the standards and safeguards outlined” existing AMA policy on telemedicine coverage and payment. Delegates also modified existing policy on state licensure and telehealth. Among other things, this license category should:
Exempt interstate physician-to-physician consultations from state-licensure requirements.
Allow, by exemption or other means, out-of-state physicians providing continuity of care to a patient, where there is an established ongoing relationship and previous in-person visits, for services incident to an ongoing care plan or one that is being modified.
mHealth Intelligence: AMA Launches Telehealth Immersion Program to Promote Sustainability (6/14) – The American Medical Association has launched a new program to help providers craft a long-term strategy for telehealth scalability and sustainability. Meg Barron, the AMA’s vice president of digital health strategy, says the AMA Telehealth Immersion Program was developed in the wake of the coronavirus pandemic to help providers who had jumped on the connected health bandwagon to address COVID-19 concerns and were now looking for looking to set a stable long-term strategy.
Center for Connected Health Policy, “Telehealth & Medicaid: Access and Equity in Medicaid and Telehealth Policy.” This webinar featured presentations on trends in telehealth access and equity including strategies to address these gaps. Attendees heard from administrators from the Minnesota Department of Human Services, New York State Department of Health, and the Washington Health Care Authority.