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
Inside Health Policy: Lawmakers Praise CMS Proposal For Permanent Behavioral Telehealth (9/19) – The Alliance for Connected Care commented on the CMS CY2023 Outpatient Prospective Payment System (OPPS) proposed rule, noting that the policies proposed within the rule would allow both rural residents and older patients to access a broader range of behavioral health services in their homes. “As more Medicare patients seek care from home and the behavioral health demands in rural areas exceed capacity, this provision allows older adults to access the mental health care they need at home,” said executive director Krista Drobac
in the comment letter. A spokesperson for the Alliance for Connected Care says if the rule is finalized, Congress would not need to pass legislation to allow CMS to pay for mental health telehealth services, including hybrid telehealth and in-person services that previously would have been difficult to bill for.
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Administration
Military Times: VA Telehealth Appointments May Complicate Vet’s Community Care Options (9/22) – Veterans Affairs officials will look at including patients’ access to telehealth services as part of its eligibility for outside care programs, a move that could dramatically change what community care options are available for veterans in coming years. Under current program rules, veterans who are enrolled in VA health care plan can visit a private sector physician with VA picking up the cost if they meet certain criteria. This includes facing lengthy wait or travel times for care at a VA facility, or if VA does not provide a specific type of medical service. The idea is to ensure that veterans receive medical care as soon as possible, even if VA physicians aren’t directly providing it.
U.S. Preventive Services Task Force: Draft Statements on Depression and Anxiety for Adults (9/20) – The U.S. Preventive Services Task Force (USPSTF), an independent panel of medical experts from the fields of primary and preventative care, released draft recommendations on depression and anxiety screening for adults. Specifically, the recommendations highlight the importance of telemedicine for integrated care within rural and low resourced care settings. The USPSTF is accepting public comments on the draft recommendations, which will close on October 17, 2022.
Health Resources & Services Administration: Scope of Project and Telehealth PIN Public Comments (9/20) – The Health Resources & Services Administration (HRSA) is requesting public comment on the Draft Scope of Project and Telehealth Policy Information Notice (PIN). The purpose of the Health Center Program Scope of Project and Telehealth PIN is to establish policy guidance for health centers that provide telehealth within the HRSA-approved scope of project. The PIN also describes considerations as well as criteria health centers must meet for providing services to patients via telehealth within the Health Center Program scope of project. Comments are due by November 14, 2022.
Department of Veterans’ Affairs Office of Connected Care: With Telehealth, Veterans Can Access Care When and Where They Need It (9/19) – Last year, more than 2.3 million Veterans used telehealth to access care through the U.S. Department of Veterans’ Affairs (VA). Veterans are able to use telehealth to access primary care, instant care for non-urgent needs, mental health care, and care closer to home. The VA continues to make it easier for Veterans to connect with their VA care team from home, or a VA facility.
Politico: Biden on ‘60 Minutes’: ‘The Pandemic is Over’ (9/18) – HHS Assistant Secretary for Public Affairs Sarah Lovenheim released a FAQ, which clarifies that a public health emergency declaration exists at the discretion of the HHS Secretary and can last as long as the Secretary determines the emergency does, provided it is renewed every 90 days. The President does not play a formal role in declaring or ending PHEs. The estimated time of when the PHE ends influences when the 151-day extension of telehealth waivers will take effect and expire.
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Congress
The Hill: Congress Must Ensure Continued Access To Telehealth Services (9/23) –Reps. Steel (D-CA) and Lee (D-NV) penned an op-ed highlighting the Telehealth Expansion Act of 2021 (H.R. 5981/S. 1704), which would provide certainty to patients who have high-deductible health plans coupled with a health savings account (HDHP-HSA) and are seeking to have their telehealth services covered without first reaching a deductible. This provision was originally included in the bipartisan CARES Act and was not tied to the Public Health Emergency (PHE). This first-dollar coverage of telehealth services initially expired on Dec. 31, 2021 and was notably the first telehealth flexibility to expire before the end of the PHE, meaning employees who had such plans were no longer able to receive telehealth services beginning January 1, 2022 unless they reached an expensive deductible. While Congress was able to get an extension of this policy in the March 2022 Omnibus for the duration of 2022, it is set to expire again at the end of the year. Reps. Steel and Lee urge their colleagues in Congress to support the Telehealth Expansion Act and increase access and affordability for patients. For additional background on this issue, visit the Alliance for Connected Care website.
Senate Finance Committee: Mental Health Workforce Enhancement Discussion Draft (9/22) – The Senate Finance Committee released a discussion draft of legislation aimed at expanding the mental health workforce. Notably, the discussion draft includes policies that would reimburse marriage and family therapist services and mental health counselor services under Part B of the Medicare program. This expansion will help address behavioral health workforce shortages. This would have implications for telehealth reimbursement and expands qualified providers that can be reimbursed by Medicare for telehealth services. The Alliance for Connected Care applauds this work, as it highlighted the importance of addressing workforce shortages in a survey
released earlier this year which found telehealth can support and retain the health care workforce.
House Republican Leader McCarthy: Commitment to America (9/22) – House Republicans released their policy platform titled “Commitment to America”. The policy agenda is a result of feedback and stakeholder comments from the Republicans’ Healthy Future Task Force work. The policy agenda includes various health care priorities to achieve healthier lives for Americans, including improving access to telehealth.
The Ripon Forum: We Will Commit to a Healthier Future (9/22) – Reps. Buchanan (R-FL) and Guthrie (R-KY), the co-leads of the House Republicans’ Healthy Future Task Force, published an op-ed in anticipation of the release of the House Republican party’s Commitment to America policy platform. The Task Force has collected stakeholder comments over the past year to inform solutions on expanding choices, lowering costs, and modernizing treatment options to improve health care. In addition to expanding access to innovative health care technologies, the Task Force wants to safeguard and maintain expanded telehealth access that patients, especially seniors, benefitted greatly from during the pandemic.
House Ways & Means Committee: Health Care and the Climate Crisis Report (9/19) – The House Ways & Means Committee released a report
which found that the health care sector causes ten percent of greenhouse gas emissions, which cause extreme weather events and contribute to worse health outcomes. The report proposes increasing access to and use of telehealth to address this issue, along with recommendations for federal, state and local action to reduce emissions from health care facilities. For additional coverage, please see Inside Telehealth.
Senator Burr: Burr Demands Clarity on Admin’s Contradictory COVID-19 Policies After President Declares ‘the Pandemic is Over’ (9/19) –Senator Burr (R-NC) wrote
a letter to President Biden following his declaration the pandemic has ended during a recent CBS interview, stating this contradicts the current COVID-19 policies of the Administration. This includes vaccine mandates for some federal employees and military personnel, the continued federal public health emergency declaration, and the recent request for billions of dollars in additional COVID funding.
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Telehealth Research, Reports and Surveys
mHealth Intelligence: Out-of-State Telehealth Aided Rural Residents Amid the Pandemic (9/22) –A study
published in JAMA Health Forum found that many Medicare beneficiaries benefitted from the elimination of restrictions on out-of-state telehealth services during the COVID-19 pandemic, primarily those with cancer, rural residents, and those residing nearby state borders. The study results imply that these populations are highly affected by restrictions that limit out-of-state telehealth.
Picasso MD: Case Study: How Real-Time, Virtual Access to Specialists Produces Better, More Equitable Health Care (9/22) – In a case study of two clinics that serve patient populations at opposite ends of the Social Determinants of Health (SDOH) spectrum, PicassoMD demonstrated how its on-demand virtual specialists service can improve health outcomes. PicassoMD’s Curbside consult platform was deployed simultaneously to primary care providers in a more affluent clinic and a more socially disadvantaged clinic. In 20 percent of the PicassoMD Curbside interactions, the provider was able to avoid an unnecessary patient visit to the specialist as a result of the encounter. These results indicate PicassoMD’s ability to provide better and more equitable health outcomes for patients and sustainable value for systems, payers, and at-risk providers.
Disability and Rehabilitation Assistive Technology: Telehealth in Speech and Language Therapy During The COVID-19 Pandemic: A Systematic Review (9/21) – This systematic review found that patients and therapists were more inclined to use telehealth for speech and language therapy. Beyond infection control, eliminating travel time, incorporating other health care advocates, and convenience delivering care in familiar environments to pediatric patients are all benefits that will be durable outside pandemic times. Given the need for continuous therapy sessions in order to treat speech-language disorders, the application of tele-practice may eliminate problems in this area to some extent while preventing the transmission of COVID-19.
MGMA: Improving Access to Specialty Care: Analyzing the Effects Of A Telehealth Intervention On Timely Access, Patient Loyalty, And Provider Productivity In A Rural Vascular Practice (9/21) –This study found that telehealth interventions can positively affect patient access, patient satisfaction, and provider productivity in the rural specialty care setting. A small, specialty vascular clinic with offices in the Mountain States region faced increasing wait times for new patient evaluation at one location. They used telehealth and found that the telehealth intervention improved the productivity of the clinic and reduced patient wait times.
American Journal of Managed Care: Sustaining the “New Normal”—The Future Is Still Bright for Telehealth in the Wake of COVID-19 (9/21) – One of the positive outcomes of the COVID-19 pandemic was the fast-forwarding of telehealth scaling, innovation, and uptake by providers, consumers, and payers. As the pandemic wanes and society moves towards a “new normal,” health care organizations must now harness the powerful lessons of this experience and reframe their strategy of how to meet consumers where they are to deliver affordable and high-quality care. The Women’s Health Service Line at UPMC Magee-Womens developed a postpartum remote blood pressure monitoring program for women with hypertensive disorders of pregnancy (HDP) for home monitoring and management of hypertension from the time of hospital discharge through the first six weeks after delivery. UPMC Health Plan believes that consumers want telehealth and that telehealth can help achieve organizational goals of avoiding unplanned care, closing care gaps, and achieving care targets.
University of Colorado: University of Colorado Research Reveals That Telehealth Follow-Up After Gall Bladder Surgery Is Just As Effective As In-Person (9/21) – A research study by the University of Colorado Department of Surgery shows that telehealth, which started as a necessity during the COVID-19 pandemic, has evolved into a time-saving step for patients recovering from surgery. The study showed that a telehealth appointment to follow up after a cholecystectomy (gall bladder removal) is just as effective as an in-clinic visit to detect and address postoperative complications including wound infections and cardiopulmonary complications such as pneumonia and pulmonary embolism. The research is an important finding in the world of surgery, which hasn’t been as quick as other specialties to embrace telehealth.
NEJM Catalyst: Busting Three Myths About the Impact of Telemedicine Parity (9/21) – The University of Rochester Medical Center (URMC) published research demonstrating the success of URMC’s effort to provide mental health services to nursing homes via a hybrid model that includes telemedicine. This study looked at a program URMC physicians developed to bring psychiatric and psychotherapeutic resources to nursing home patients through a combination of telehealth, on-site visits and staff education. The researchers concluded that the program improved access to care and reduced the number of residents requiring anti-psychotic medication. The paper is one of two studies on telemedicine by URMC researchers.
Medical, Marketing, and Media: Consumers Continue to See Value in Telehealth (9/21) – According to this industry survey, health care consumers continue to see opportunities to expand care options through telehealth services. Consumers view telehealth as a convenient way to receive care from specialists that are not in their geographic area, with nearly 80 percent of respondents indicating that they are comfortable with using telemedicine. Additionally, consumers are increasingly embracing remote patient monitoring as a way for their trusted physicians to conveniently track their care journey. The report shows that consumers are more than willing to use telehealth services than before.
Acoustical Society of America: Telehealth Makes Hearing Health Care More Equitable (9/15) – The Acoustical Society of America published a report promoting the use of telehealth to help diagnose and treat hearing loss, especially for those in rural areas who lack access to hearing specialists. The report said virtual audiology assessments would allow patients to access care in their home or at a local clinic from a specialist hundreds of miles away. The hearing tests could be administered through wireless headsets controlled by a mobile phone or laptop.
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Telehealth News and Market Developments
Medical University of South Carolina: MUSC Receives Grant That Combines Need for Telehealth Support And Rural Health Care Workforce Pipeline Network (9/22) – The MUSC Center for Telehealth has received a three-year $1.545 million grant from HRSA that seeks to enhance local capacity to support telehealth while also fostering a workforce development pipeline to address rural health workforce disparities. The funding supports the establishment of a South Carolina Rural Telehealth Workforce Pipeline Network (RTWPN) and brings together statewide collaborations.
Chief Healthcare Executive: How Boston Medical Center Used Remote Patient Monitoring to Track Vulnerable Patients (9/20) – Boston Medical Center teamed up with Rimidi, a remote patient monitoring program, to track postpartum patients and identify those at higher risk for stroke or other complications. Boston Medical Center gave patients cellular-connected blood pressure cuffs to monitor patients and see if some needed intervention. The program proved to be very successful. Virtually all of the patients checked their blood pressure, and they were able to identify some patients that needed treatment before suffering a stroke or heart attack.
mHealth Intelligence: Intermountain Healthcare Launches Pediatric Telehealth Services (9/20) – Alliance board member Intermountain Healthcare has added pediatric telehealth services, allowing for 24/7 video consult communication between the Primary Children’s Hospital emergency department (ED) and ED physicians systemwide. The telehealth service added by Intermountain Healthcare targets pediatric patients, aiming to expand access to care for this population. It enables ED providers across Intermountain to communicate virtually with clinicians in the Primary Children’s Hospital ED. Through virtually enabled care, Intermountain aims to provide patients with the ability to remain in their home and eliminate transfers to Primary Children’s Hospital as much as possible.
Becker’s Hospital Review: Texas Hospital to Use Telehealth for Pre-Surgical Physicals (9/20) – Dallas-based White Rock Medical Center has partnered with telemedicine developer SHL Telemedicine to use its technology to conduct pre-surgery physicals in remote locations. The technology, dubbed SmartHeart, is a portable lead ECG tool that allows clinicians to conduct diagnostic testing in and outside of the hospital. White Rock Medical Center will use the technology in its bariatrics program.
Healthcare IT News: An Academic’s Perspective on Direct-to-Consumer Telehealth Services (9/20) – Direct-to-consumer telemedicine services offer many benefits, including convenience. Consumer-facing telehealth services may be less expensive than using telehealth through a patient’s provider if they have a high deductible. Direct-to-consumer telemedicine services will continue to grow as more insurance companies reimburse for these services.
Newswise: Johns Hopkins Medicine Surpasses 1.5 Million Telemedicine Visits Since Start of Pandemic (9/19) – Alliance board member Johns Hopkins Medicine’s physicians and clinicians have conducted more than 1.5 million telemedicine visits with over 420,000 patients in Maryland, Washington, D.C., Florida and across the country since the start of the COVID-19 pandemic. While some medical visits must be in person, approximately 60 percent of Johns Hopkins’ physicians and clinical providers have used telemedicine at least once since March 2020, according to the health system’s Office of Telemedicine. Looking ahead, the Office of Telemedicine hopes to grow its remote patient monitoring capabilities into the ambulatory and complex care space, allowing for more proactive care of patients at home. As an example, a pilot project run by the Office of Telemedicine is remotely connecting patients at Johns Hopkins Bayview Medical Center’s neonatal intensive care unit with pediatric specialists at The Johns Hopkins Hospital.
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State Telehealth News and Activity
NBC Washington: Prince George's Public School Students to Have Access to Free Telehealth Care (9/22) – Starting in October, students in Prince George's County can see a doctor, get a prescription or speak to a therapist via Hazel Health. The school system will begin utilizing Hazel Health at 63 schools in October, first at middle schools, academies and high schools. Once the program is underway, the service will expand to elementary schools. Therapy telehealth services will start by early November.
BlueCross BlueShield of North Carolina: Blue Cross NC Releases Data on Telehealth Usage During COVID-19 (9/20) – Based on a review of telehealth data from the past two years, Blue Cross Blue Shield of North Carolina (Blue Cross NC) is launching an expanded telehealth policy that will cover virtual care services for behavioral health, primary care, and outpatient visits for certain plan members. In March 2020, Blue Cross NC implemented parity coverage, providing the same reimbursement for in-person and virtual care, including both video and audio-only visits. The substantial increase of telehealth usage during the pandemic has provided two years of member data that is more informative than the entire 20 years prior when the company first began covering telehealth. The expanded policy will take effect on Jan. 1, 2023. For additional coverage, see mHealth Intelligence.
Argus Leader: Sanford Health Expands Telehealth (9/20) – Sanford Health recently announced that it will build a $350 million virtual health center. Telehealth has long been used in South Dakota as a way to allow for consultation between patients and providers without requiring patients to travel to a hospital or clinic potentially hundreds of miles away. The new initiative will strengthen South Dakota’s leadership in the research, development and implementation of telemedicine services.
Idaho News 6: Telehealth: Improving Access to Behavioral Health Care for Idahoans (9/20) – Telehealth offers real-time audio and video-enabled sessions with behavioral health and medical providers in urban, rural and suburban settings. Because of Idaho’s geography, with 35 rural and nine urban counties, Idahoans often do not have access to behavioral health care providers because of where they live and the lack of behavioral health providers across the state. Optum Idaho, the managed care contractor for the Idaho Behavioral Health Plan through Medicaid, has helped expand access to telehealth throughout the state.
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Upcoming Events and Hearings
September 26-28 – Northwest Regional Telehealth Resource Center, “Annual Conference: Innovation in Telehealth.”
September 28-30 – The Association for Behavioral Health and Wellness, “Behavioral Health and Well-Being Congress.” (Alliance Speaking)
September 29 – Medicare Payment Advisory Commission (MedPAC), “Mandated Report: Study On The Expansion Of Telehealth.”
September 29 – Nashville Entrepreneur Center, “Telehealth Academy 2022.” (Alliance Speaking)
September 29-30 – Northeast Telehealth Resource Center, “8th Annual Regional Conference: Exploring the Telehealth Universe.”
October 10-12 – Becker’s Hospital Review, “The Future of Business and Clinical Technologies.”
October 13 – Dickinson Wright, “How Will Telehealth Evolve as the Pandemic (hopefully) Draws to a Close?”
October 19 – Colorado Rural Health Center, “2022 Annual Rural Health Conference.”
November 16-18 – Society for Education and the Advancement of Research in Connected Health, “The National Telehealth Research Symposium.”
Previous Events, Videos, and Podcasts
Alliance for Connected Care Provides Keynote for the Nashville Telehealth Academy Krista Drobac, Executive Director of the Alliance for Connected Care, provided a keynote address at the Telehealth Academy on navigating the policy barriers to health care transformation. Krista Drobac provided an overview of current telehealth models and the impact of the pandemic on telehealth and the virtual home, and gave a call to action for organizations to speak up about the importance of care transformation. The third day of this hybrid multi-part event will be September 29 for those interested in attending.
AMA, “Why Telehealth Will Be Part of Post-Pandemic Health Care Ecosystem.” While the telehealth surge that COVID-19 generated has tapered off, Baptist Health Kentucky recognizes that—in light of patient enthusiasm for using the technology—it must continue to refine its offerings and ensure that the connecting tools patients use to communicate with their physicians reduce rather than worsen health inequities. In this interview, Dr. Brett Oliver, chief medical information officer for Baptist Health, Kentucky shares the importance of telehealth.
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