December 5, 2022

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: Alliance Statement on Pandemic Response Accountability Committee Report on Telehealth Use and Program Integrity Risks During COVID-19 (12/1) – The Pandemic Response Accountability Committee issued a report on telehealth use and program integrity risks across selected health care programs during the first year of the COVID-19 pandemic. The Alliance for Connected Care released a statement responding to the potential areas of program integrity concern noted within the report. While there will always be program integrity risks in federal programs, we urge policymakers to keep it in perspective. There is no evidence of a need for widespread concern related to telehealth in the Medicare program.

Administration

Pandemic Response Accountability Committee (PRAC) Health Care Subgroup: Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic (11/30) – The PRAC Health Care Subgroup released a report focusing on telehealth across selected health care programs in six Federal agencies during the first year of the COVID-19 pandemic. The PRAC's Health Care Subgroup developed this report to provide policymakers and stakeholders with information about the nature of telehealth and its use across selected health care programs in six Federal agencies during the first year of the pandemic. The report also provides insights into the program integrity risks associated with telehealth and safeguards that could strengthen oversight in these programs. For additional coverage, see PoliticoPro.

Congress

Senate Finance Committee: Mental Health Parity Discussion Draft (12/1) – Senate Finance Committee Chair Wyden (D-OR), Ranking Member Crapo (R-ID), and Sens. Bennet (D-CO) and Burr (R-NC) released the fifth and final legislative discussion draft as part of the Committee’s bipartisan mental health initiative. This discussion draft included policies aimed at improving mental health parity in Medicare and Medicaid and helping to put access to mental health and substance use disorder (SUD) services on par with physical health care. The discussion draft requires the Medicaid provider directory to denote whether a provider offers covered services via telehealth.

Inside Telehealth: Dems Treat Telehealth HDHP Coverage As GOP ‘Ask’ In Year-End Talks (12/1) – Democrats are treating calls to extend pre-deductible telehealth coverage under high deductible plans (HDHP) linked to health savings accounts (HSA) as a GOP ask, which they plan to use as a leverage to get Democratic priorities into the year-end spending package. Without action from Congress, pre-deductible coverage of telehealth services for individuals with HDHP-HSAs will end at the end of 2022, potentially cutting off access to vital telehealth services for millions of Americans. According to telehealth lobbyists, permanent extension of HDHP telehealth coverage is not likely to make it into the year-end package. But a one- or two-year extension of a broad array of Medicare telehealth waivers will likely include the HDHP Telehealth policy affecting private plans.

Telehealth Research, Reports and Surveys

America’s Health Insurance Plans (AHIP): Survey of Telehealth Use by Commercial Insurance Enrollees (12/1) – AHIP released a survey, fielded by NORC at the University of Chicago, which found that 73 percent of commercially-insured telehealth users think that Congress should make permanent the provisions that allowed for coverage of telehealth services before paying their full deductible. Notable findings include:

• The majority of respondents said they use telehealth because it is more convenient than an in-person appointment (69 percent).
• Nearly four in five (78 percent) said telehealth made it easier for them to seek out health care when they need it.
• A strong majority (85 percent) said there are an adequate number of medical providers available to them via telehealth for the health needs they have.
• More than half (53 percent) used telehealth between two and five times over the past year.
• Nearly three in four (73 percent) said Congress should make permanent the provisions that allowed for coverage of telehealth services before paying their full deductible.

For additional coverage, see MedCity News, HealthLeaders.

JAMA Ophthalmology: Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care (12/1) – A quality improvement study published in JAMA Ophthalmology demonstrated the potential to enhance ophthalmic telehealth using asynchronous testing, which was effective in subspecialty-level care. The volume of in-person outpatient visits dropped by 83.3 percent across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic. The research suggests that combining teleophthalmic visits with asynchronous testing may be a feasible approach to expand teleophthalmic subspecialty care. For additional coverage, see HCPLive.

Center for Connected Medicine (CCM): Top of Mind for Top Health Systems 2023 (12/1) – Though health care leaders see telehealth as critical to boosting patient access, they believe that reimbursement and patient technology issues are hindering more widespread telehealth use. This study, conducted in consultation with KLAS Research and CCM partners, surveyed leaders from 59 health systems who answered quantitative and qualitative questions on their technology priorities. Overall, 30 percent of executives who responded to the first survey cited telehealth as the area of health care technology that has seen the most significant progress or improvement in the past two years. The survey found several barriers to telehealth use as well, including reimbursement challenges (26 percent), patient technology barriers (21 percent), and the lack of provider adoption (13 percent). For additional coverage, see mHealth Intelligence.

AHIP: Survey Says Voters Want Federal Government to Extend Telehealth Flexibilities (11/29) – A survey conducted by AHIP found that a majority of respondents are requesting that the government sustain the telehealth flexibilities enacted during the COVID-19 pandemic. The survey polled 818 voters with employer health insurance between Nov. 11 and 13. The survey shows that 65 percent of those with employer-provided coverage reported being likely to consider seeing a doctor or receiving treatment through telehealth. This finding was consistent across age, income, and ethnicity groups. Further, 49 percent claimed that interest in telehealth is mainly backed by convenience, and 35 percent stated that it saves time as it eliminates the need for travel. Considering the survey results, AHIP concluded that respondents would advocate for the government to continue telehealth flexibilities. For additional coverage, see mHealth Intelligence.

Massachusetts Association of Health Plans: Bridging the Digital Divide Advancing Telehealth Equity (11/28) – A report, funded by the Massachusetts Association of Health Plans, describes how telehealth has proven to be widely beneficial for state residents and provides recommendations to optimize virtual care delivery within the Commonwealth. Researchers found that there were many apparent health care disparities resulting from the digital divide. Barriers to telehealth access and utilization included the lack of a usual source of primary care, lack of internet connectivity and devices, andlack of understanding of how to use technology. Based on these insights, researchers created a set of recommendations: create federal and state policies to operationalize telehealth infrastructure, establish national standards for health care access portals, and support families who adopt new care modalities. For additional coverage, see mHealth Intelligence.

Managed Healthcare Executive: Investments in Telehealth are Expected to Decrease (11/28) – Health care industry leaders around the globe expect to see a decrease in the amount of money invested in emerging technologies over the next 12 months due to current economic conditions. According to a GlobalData survey, 39 percent of the health care leaders surveyed expect the decrease because of inflation and rising costs. Additionally, 24 percent of health care industry leaders believed there would be a minor decrease in investment in emerging technologies during the next 12 months, while 15 percent of them are prepared to see a moderate to significant decrease in investment.

Cureus: Bridging the Gap in Graduate Medical Education: A Longitudinal Analysis of Medical and Fellowship Director Experiences in Telehealth (11/27) – This five-year longitudinal survey analysis found that the overall utilization of telehealth by graduate medical education (GME) programs has increased along with the continued need for training to prepare residents for current and future practice. Results show that while telehealth knowledge and use increased among program director faculty, systemic concerns about the feasibility of telehealth from a time and cost perspective remain high. Program directors remain committed to telehealth resident education, with over 60 percent stating that it is "essential to future practice". The qualitative thematic analysis highlighted the need for additional resources and support to conduct telehealth and the variability within disciplines of the use, therefore modeling, of telehealth in clinical settings.

Telehealth News and Market Developments

American Hospital Association (AHA): AHA Urges the Drug Enforcement Administration (DEA) to Release Regulation for Prescribing Controlled Substances via Telehealth After COVID-19 PHE (12/1) – AHA urged the DEA to release its proposed rule outlining a special registration process for prescribing medically necessary controlled substances via telehealth after the COVID-19 PHE. Additionally, the AHA requested DEA to provide an interim plan to support continuity of care if the PHE expires before the rules are finalized and grant a permanent exception for separate registrations for practitioners in states that have medical licensing reciprocity requirements.

Healthcare IT News: Franciscan Health Expands Its Epic-Linked Telemedicine Offerings (12/1) – Franciscan Health uses telehealth technology in multiple ways to help provide high-quality care to patients across the organization. The pandemic allowed teams to think differently and change care delivery to better support patients. Franciscan Health conducted training in phases for its operations team, the providers and staff, technology, and patients. In addition to safely providing patient care, the ability to capture revenue growth was necessary.

Healthcare IT News: Sweetwater Medical Reduces Patients’ Blood Pressure and Weight with Remote Patient Monitoring (11/30) – Sweetwater Medical Associates, a single-clinic family practice in Texas, perpetually faced staffing shortages. The team always seemed strapped for time, finding it challenging to monitor at-risk patients with hypertension and obesity to help manage their chronic conditions and look for signs of impending problems. In 2021, Sweetwater partnered with 100Plus to enable an AI-assisted remote patient monitoring (RPM) platform, which allowed health care providers to remotely monitor and manage their patients' health conditions. Patients enrolled in the RPM program achieved average systolic blood pressure reduction of 5.80 mmHg for those with hypertension and mean weight loss of 3.45 pounds for those with obesity.

HIT Consultant: Addressing the Mental Health Crisis in Kids with Telehealth (11/30) – Children in America were increasingly struggling with mental health before COVID-19, but the pandemic compounded an already growing crisis. Today, nearly one in five children experience a mental health disorder. Expanding access to telehealth will be a key component to addressing the pediatric mental health crisis for two main reasons: it breaks down geographic barriers and it helps distribute mental health professionals across a larger area to maximize the dwindling supply of providers. Teletherapy will play a crucial role in closing the gap and providing equitable care between patients and therapists, making sure resources are maximized to help children in need.

PR Newswire: Kettering Health Partners with Nest Collaborative to Provide Virtual Breastfeeding Support for New Parents (11/29) – Nest Collaborative and Kettering Health have teamed to provide telehealth breastfeeding support to families giving birth at the health system's maternity centers in Ohio. Nest Collaborative's International Board Certified Lactation Consultants (IBCLCs) will augment Kettering Health's own lactation program by providing virtual prenatal and postpartum support for new parents 7 days a week.

Politico Pro: COVID Forced Rural Health Care to go Virtual – Providers Don’t Want to go Back (11/29) – When COVID-19 arrived in early 2020, rural Medicare providers and doctors staffing government-funded rural clinics took advantage of HHS rules allowing them to have virtual visits with their patients by phone or video call. Nearly three years later, what started as a COVID precaution has transformed the way they do business. Patients, initially reluctant to engage with doctors virtually, now appreciate the convenience. Providers like it, too, and have retooled their operations for telehealth.

Goodside Health: Goodside Health Empowers Students with Same-Day Mental Health Services (11/29) – School-based health care service provider Goodside Health announced a new program offering mental health care access to youth, adolescents, and young adults through a variety of services, including telehealth. Goodside Health will partner with SchoolMed: Mental Health to give students access to an expanded suite of services to detect signs of mental illness and provide timely intervention. Following the mental health care screenings, school counselors will meet with a Goodside Health provider and view the student screening results. If needed, the student will be provided with access to teletherapy visits from school or home through Goodside Health’s mental health program. For additional coverage, see HIT Infrastructure.

Bassett Healthcare Network: Columbia University and Bassett Healthcare Network Advance Collaboration with Cardiovascular Digital Medicine and Clinical Services (11/28) – The Columbia University Vagelos College of Physicians and Surgeons and Bassett Healthcare Network have teamed up to provide central New York residents with access to New York City-based clinical cardiovascular services to address the common difficulties in accessing care in rural areas. Specifically, Columbia physicians will use telehealth technology to examine and consult with patients at Basset Healthcare locations downstate, with assistance from Bassett nurses. The Columbia physicians will be able to conduct physical examinations using live video, along with an electronic stethoscope that allow the physicians to remotely monitor heart and lung sounds. For additional coverage, see mHealth Intelligence.

2KUTV: Virtual and Convenient Instant Care (11/28) – Alliance board member Intermountain Healthcare’s Connect Care telehealth service provides urgent care services to patients of all ages from the comfort of their home or on the go. With cold and flu season approaching, there will be unwanted delays in wait times to receive care. The Connect Care telehealth service will be helpful for families who need immediate attention for their children.

State Telehealth Activity

Idaho County Free Press: Prairie River Library District (PRLD) Telehealth Opportunities (11/30) – The PRLD has partnered with the Idaho Commission for Libraries and the Idaho Department of Health and Welfare (IDHW) to create Telehealth, which is an online service where an individual can video call with their health care provider and receive services without having to travel for an appointment. With funding being provided by the IDHW, Telehealth spaces will be fully ADA-compliant, and any individual would be able to use Telehealth, at no cost to them.

The Cheyenne Post: Telehealth: A Prescription for Wyoming’s Mental Health Crisis (11/28) – In this letter to the editor, the author urges Wyoming readers to reach out to Sens. Barrasso (R-WY) and Lummis (R-WY) to vote for the Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040). The author noted that Wyoming was ranked 50^th in the nation on mental health by Mental Health America’s 2022 rankings. The use of telehealth can help improve access to mental health screening, treatment, crisis support, and medication management in Wyoming.

Lubbock Online: Modernizing Rural Health Care, Reforms Needed to Boost Rural Health (11/27) – The Texas Tech Health Sciences Center and Covenant Health is connecting rural areas to broadband infrastructure for telehealth. The academic health systems were able to creatively provide broadband access to communities, such as integrating telehealth services within buses in parking lots. The systems note that the telehealth system isn’t viable to sustain itself at this point. On average, a rural hospital will make a profit of $40,000 to $50,000 per year and telehealth equipment costs over $100,000. Covenant is looking into using the foundation's money to create a subsidized model to create a way to curve the cost of the equipment for rural hospitals, but additional support from the Texas or the federal government is needed.

Upcoming Events and Hearings 

December 8 – American Medical Association, “Panel Discussion: 2022 Telehealth Retrospective & 2023 Predictions.”

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

Previous Events, Videos and Podcasts

Alliance for Health Policy, “Implications of the Midterm Elections for Health Care Policy.” With big pieces of COVID-19 legislation mostly in Congress' rearview mirror, legislators will be turning their attention to other health-related matters, including substance abuse, telehealth, and lots of regulatory oversight.

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