February 27, 2023

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

Alliance for Connected Care: Amend the RPM/RTM Medicare Administrative Contractor (MAC) Meeting Procedures (2/22) - The Alliance for Connected Care and the American Telemedicine Association sent a letter expressing disappointment in the process for evaluating Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) scheduled for Tuesday, February 28. The letter states that the time allotted to subject matter experts is not adequate and expresses concern about the bibliography provided to meeting participants last week, which is missing at least 45 studies by known clinical experts. For additional coverage, see Politico Pro and Inside Telehealth.

“We are concerned that advice rendered by the CAC in this instance will not be the result of a full scientific inquiry, nor will it help ensure unbiased or contemporary consideration of state of the art technology and science"

Read the full letter here.  Watch the MAC meeting here.

Administration

Drug Enforcement Administration: DEA Announces Proposed Rules for Permanent Telemedicine Prescribing of Controlled Substances (2/24) - On Friday night DEA released two major proposed rules around telehealth prescribing. Comments for both are due in 30 days. 

The first rule is on the expansion of the induction of buprenorphine via telehealth. It expands the circumstances under which individual practitioners are authorized to prescribe schedule III-V narcotic drugs to manage withdrawal treatment via telemedicine, including audio-only telemedicine.

The second is the broader special rule on prescribing of controlled substances through telemedicine. This is the rule required by the Ryan Haight Act of 2008 that allows for a telehealth provider to prescribe without an in-person visit first.  The Alliance has aggressively pushed for the release of this rule. 

Unfortunately, the draft rule as written is very restrictive and would likely lead to many patients losing access to virtual care. It would 

• Curtail any practitioner practicing telemedicine to offering a 30-day supply of a controlled substance to a patient. After 30 days, an in-person visit is required, by either that practitioner or an eligible referring practitioner.
• Restrict prescriptions to non-narcotic schedule III-V controlled medications (not allowing schedule II or IIN substances like stimulants used for mental health) without a prior in-person visit by either that practitioner or an eligible referring practitioner.
• Creates a 180-day grace period for patient-provider relationships established during the public health emergency.
  
• Require practitioners to keep additional detailed records regarding prescriptions issued as a result of a telemedicine encounter.

Please watch for upcoming Alliance advocacy opportunities on the proposed rule. 

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Health Resources and Services Administration (HRSA): Office for the Advancement of Telehealth Outcome Measures (2/24) - HRSA requested to extend the approval of the Office for Advancement of Telehealth outcome measures that are currently set to expire on October 31, 2023. The performance measures help evaluate the effectiveness of the Telehealth Network Grant Program services and monitor their progress using performance reporting data. Measures for the Telehealth Network Grant Program capture awardee-level and aggregate data that illustrate the impact and scope of federal funding along with assessing these efforts.

Centers for Medicare and Medicaid Services (CMS): Updated COVID-19 Medicaid & CHIP Service Utilization Data Snapshot (2/23) - CMS released an updated snapshot, which provides information on COVID-19 related service utilization by beneficiaries, including data on COVID-19 testing, treatment, services delivered via telehealth, and services for mental health and substance use disorders. Preliminary data suggest that, during the public health emergency (PHE), among all age groups, the rate of services delivered through telehealth during the PHE remain high, but have generally declined since April 2020. 

CMS: Updated Guidance for Providers on PHE 1135 Waivers (2/23) - CMS released updated guidance for providers on the PHE 1135 waivers and flexibilities. During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries. To ensure a smooth transition, CMS continues to release guidance in response to the PHE ending May 11, 2023. 

Fact sheets with notable telehealth provisions for:

HRSA Office for Advancement of Telehealth: Health Equity in Telehealth (2/21) - The HRSA Office for Advancement of Telehealth released a web page on health equity in telehealth. Specifically, the page provides resources with best practices on how telehealth can improve health care for underserved patients.  

Department of Veterans Affair (VA): Telehealth is "a Godsend" for a Veteran in Need (2/17) - The Wilmington VA uses the Remote Patient Monitoring – Home Telehealth (RPM – HT) program to monitor Veterans’ vital signs and health status and provide health education. Veterans enrolled in the RPM – HT program send key vital signs and other health information to their care team who can monitor the data and intervene if something seems wrong. The Wilmington RPM – HT team also has regular check-ins with Veterans using VA Video Connect, VA’s secure videoconferencing tool. During these video visits, the care team can review the Veterans’ vital signs with them and assess their condition. Recently, the team successfully intervened to assist a Veteran in need, demonstrating the success of RPM-HT program. 

Congress

Rep. Balderson (R-OH): Introduction of the Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act (H.R. 1110) (2/21) - Reps. Balderson (R-OH), Lee (D-NV), Hinson (R-IA), and Neguse (D-CO) introduced the KEEP Telehealth Options Act (H.R. 1110). The legislation would direct the Secretary of Health and Human Services (HHS), the Medicare Payment Advisory Commission (MedPAC), and the Medicaid and CHIP Payment and Access Commission (MACPAC) to conduct studies and report to Congress on actions taken to expand access to telehealth services under Medicare, Medicaid, and the Children's Health Insurance Program during the COVID-19 emergency. 

Rep. Rosendale (R-MT): Introduction of H.R. 1144 (2/21) - Reps. Rosendale (R-MT) and Miller-Meeks (R-IA) introduced H.R. 1144, which would direct the Secretary of Veterans Affairs to develop a strategy for telehealth furnished by the Veterans Health Administration and submit a report on end-user devices distributed by the Secretary to veterans to facilitate such telehealth. 

Rep. Bonamici (D-OR): Introduction of the Supporting the Mental Health of Educators and Staff Act of 2023 (H.R. 744) (2/2) - Reps. Bonamici (D-OR), Fitzpatrick (R-PA), and Wild (D-PA) introduced the Supporting the Mental Health of Educators and Staff Act of 2023 (H.R. 744). The legislation would address behavioral health and well-being among education professionals and other school staff, including by means of telehealth. A summary of the legislation can be found here.

Telehealth Research, Reports and Surveys

Rock Health: Consumer Adoption of Digital Health in 2022 (2/21) - Rock Health, in collaboration with Stanford Center of Digital Health, released the 2022 Digital Health Consumer Adoption Survey. The survey found that telemedicine reached the 80 percent adoption mark overall, becoming the preferred channel for prescription care and minor illness. In addition, audio-only and asynchronous telemedicine bear out point-to-point video chats as the most-used telemedicine modalities. The survey data suggests consumers are increasingly turning to telemedicine and will need more support post-PHE. 

AccentCare: Improving Access and Timely Care for Vulnerable Patients Referred to Home Health via Telehealth Physician Support (2/21) - AccentCare and Sound Physicians partnered to develop a scalable, evidence-based program that leveraged the COVID-19 PHE telehealth waivers to speed access to Home Health services for eligible patients. The AccentCare-Sound Transition Program aimed to facilitate telehealth patient contact with a physician to overcome technology barriers, among others. The study also found that when telehealth was offered, there were timely initiations of care for patients that may have otherwise been denied home health services. For additional coverage, see Home Health Care News. 

American Hospital Association: Health Care Disruption (2/21) - An American Hospital Association (AHA) report examines seven of the biggest disruptors to enter the primary care space. Specifically, the report highlights Walmart's telemedicine work, which emphasizes convenience in making care appointments. Additionally, Walmart offers tele-behavioral health services. For additional coverage, see Health Leaders. 

Trilliant Health: Less Than One Percent of All Telehealth Visits Are for Oncology Care (2/12) - Recent market research shows that less than one percent of all telehealth visits between Q1 2020 and Q2 2022 were for oncology-related care. Of these oncology-related telehealth visits, 73 percent were evaluation and management (E&M) for ongoing cancer care. Conducted by market research firm Trilliant Health, the study aimed to assess oncology-related telehealth use and patient demographics. The 65-plus population accounted for just 19.3 percent of overall telehealth volume, but they accounted for 61.1 percent of oncology-related telehealth visits. This study adds to the growing body of research regarding telehealth use in the cancer care arena. For additional coverage, see mHealth Intelligence. 

Telehealth News and Market Developments

Behavioral Health Business: Bicycle Health Teams Up with Wellpath, Federal Bureau of Prisons on Virtual MAT Program (2/23) - Substance use disorder (SUD) startup Bicycle Health has joined forces with medical provider Wellpath and the Federal Bureau of Prisons (FBOP) on a new partnership to treat opioid use disorder (OUD) at reentry centers. As part of the deal, Bicycle Health will provide its virtual medication-assisted treatment (MAT) program to individuals living in FBOP’s Reentry Centers. Wellpath and Bicycle Health will work with formerly incarcerated patients in 42 states to help them get on a treatment plan. Individuals enrolled in the program will have access to Bicycle’s telehealth visits, medication management, peer support groups, psychotherapy and in-home diagnostic testing. 

PR Newswire: Biofourmis and Augusta University Health Partner to Improve Clinical Outcomes and Maximize Hospital Capacity Through Continuum-Wide Care at Home (2/22) - Biofourmis, a technology-enabled care delivery provider, announced a four-year engagement with Augusta University Health (AU Health) to expand its Virtual Care at Home program across the continuum. The collaboration will focus on improving throughput in the emergency department (ED) and inpatient setting, reducing hospital readmissions, enabling optimal clinical outcomes, and improving the experience of patients and their families. AU Health's team will utilize the BiofourmisCare monitoring equipment, virtual care solution and analytics platform to monitor patients who are enrolled into the program. For additional coverage, see mHealth Intelligence. 

Intermountain Health: Intermountain Health Facilities Earn CHIME 2022 Digital Health Most Wired Level 10 Recognition for Excellence in Healthcare Technology Innovation (2/21) - The College of Healthcare Information Management Executives (CHIME) recognized Intermountain Health’s hospitals and clinics in Utah for achieving CHIME’s Level 10 status in its 2022 Digital Health Most Wired survey. Level 10 facilities leverage technology in innovative ways and encourage deep adoption across the entire organization for improved safety, quality of care, patient and caregiver experience, value, and broader patient access to health care services. Intermountain is one of only 19 health systems nationally to achieve level 10 for acute care, and one of only 18 health systems nationally to achieve level 10 for ambulatory care. For additional coverage, see Becker's Health IT. 

Healthcare IT News: Women's Telehealth Program Diminishes Stigma via Technology (2/21) - The Medical University of South Carolina (MUSC) Medical Center has a unique telemedicine program in place to help pregnant and postpartum women. The Listening to Women and Pregnant and Postpartum People (LTWP) is a mid-maturity program and screens for behavioral health needs of pregnant women, and has recently expanded to newborn virtual home visitation for all mothers with births in the hospital. MUSC found that pregnant women enrolled in LTWP were significantly more likely to be screened, screen positive, be referred to treatment, and attend treatment, compared to in‐person screening, brief intervention and referral to treatment.

PR Newswire: Baptist Memorial Health Care Enters Into an Agreement with LookDeep to Expand Inpatient Telehealth Capabilities (2/21) - Baptist Memorial Health Care and LookDeep Health announced a collaboration to expand inpatient telehealth capabilities at Baptist Memorial Health Care. LookDeep's Clinical Action Platform enables health systems to securely tackle inpatient telemedicine needs. LookDeep's advanced AI technology continuously observes patients and prompts hospital staff and aid in supporting patient safety and care. When paired with telemedicine teams, it creates a modern virtual inpatient command center that supports hospital bedside teams and improves patient care. For additional coverage, see Becker's Hospital Review. 

Healthcare IT News: Zoom is Helping MaineGeneral Health Boost Its Telehealth Success (2/20) - MaineGeneral Health, a health system based in Augusta, Maine, had telemedicine technology in place at the beginning of the pandemic, but it was impressed with what others were doing with Zoom and soon turned to the video technology. Healthcare IT News interviewed Laura Mrazik, manager of telehealth at MaineGeneral Health, to discuss best uses and best practices with Zoom so others can learn from MaineGeneral's lessons.

BroadbandOhio: BroadbandOhio Selects OCHIN as State Telehealth Administrator (2/15) - BroadbandOhio, a division of the Ohio Department of Development, selected OCHIN as its statewide telehealth administrator to help expand health care services for Ohio’s K-12 students. The new initiative aims to help administrators in at least ten districts implement school telehealth programs. BroadbandOhio plans to establish a steering committee with other state agencies to oversee OCHIN’s efforts. For additional coverage, see Healthcare IT News. 

Upcoming Events & Hearings 

February 28 - Novitas Solutions, "Multi-Jurisdictional Contractor Advisory Committee (CAC) Meeting on Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) for Non-implantable Devices." 

March 3 – Alliance for Health Policy, "Moving Beyond COVID-19: Considerations for Using PHE Flexibilities to Improve Person-Centered Care."  

March 9 - The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, "Achieving Telehealth's Potential: The Federal Policy Landscape for Interstate Telehealth Practices," featuring Alliance for Connected Care Executive Director Krista Drobac.

March 9 – TeleBehavioral Health Center of Excellence, "Behavioral Health Integration Webinar: Telehealth for Integrated Care." 

March 14 - California Telehealth Resource Center, "Telemedicine Policy Update - The Past, Present, and Future of the Regulation of Telemedicine." 

March 14-15 – MedTech Intelligence, "ConnectedCare Summit East." 

March 15 – Mid-Atlantic Telehealth Resource Center, “2023 Summit.”

March 26-29 – HLTH, "ViVE 2023." 

April 12 - Arizona Telemedicine Program, "Navigating Telehealth Legislative and Policy Changes Beyond The Public Health Emergency." 

April 17-21 – Healthcare Information and Management Systems Society, “HIMSS23 Global Conference & Exhibition.”

June 13-14 – mHealth Intelligence, "3rd Annual Remote Patient Monitoring Virtual Summit: Overcoming Technology Access Hurdles to RPM." 

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