The Alliance for Connected Care is leading a sign-on letter alongside several other telehealth groups urging Senate leaders to act this fall to ensure certainty for telehealth services by passing a two-year extension of important telehealth policies enacted at the start of the COVID-19 pandemic. Without action, such policies will expire 151 days after the end of the public health emergency. As demonstrated by the House – which passed the Advancing Telehealth Beyond COVID-19 Act (H.R. 4040) by a vote of 416-12 – telehealth is an overwhelmingly bipartisan issue. The Senate should act to pass legislation that would extend critical telehealth flexibilities, including provisions to lift provider and patient location limitations, remove in-person requirements for telemental health, ensure continued access to clinically appropriate controlled substances without in-person requirements, and increase access to telehealth services in the commercial market. Join the more than 330 organizations that have already signed on to the letter - the deadline is COB TODAY, Monday, September 12.
On September 7, the HHS Office of Inspector General (OIG) released two new telehealth reports that add to the growing body of evidence showing that telehealth meaningfully expands access to care, and that long-term telehealth expansion is feasible with some limited steps to ensure continued oversight and evaluation. The Alliance for Connected Care wrote a statement in response to the reports, and was pleased to see the continued evaluation of beneficiary access through telehealth show that that dually-eligible beneficiaries, and some minority populations, were more likely than others to use telehealth to ensure access to care. The Alliance also appreciated OIG’s evaluation of program integrity risks related to telehealth during the COVID-19 pandemic.
Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks – In this report, OIG examined a selected group of providers believed to pose a higher risk of fraudulent billing to the Medicare program. The report did not draw any conclusions around the use of telehealth and if there is any relation to fraud. The report examined claims from 742,000 providers whose billing for telehealth services posed a high risk to Medicare and found that 0.2 percent posed a high risk to Medicare for fraud, waste or abuse.
The Hill: State Lines Should No Longer Be Barriers to Health Care (9/9) – Former U.S. Department of Veterans Affairs (VA) Secretary David Shulkin wrote an op-ed on how state borders present arbitrary barriers in accessing care. The op-ed highlights how Veterans are able to receive care from licensed health care providers via telehealth nationwide, regardless of where they are located. During the pandemic, all 50 states used emergency authority to amend their licensing requirements for out-of-state practitioners, according to a tracker by the Alliance for Connected Care. The pandemic proved that providing the flexibility to practice care across state lines improves access to care while maintaining patient safety. The VA has shown the way forward in modernizing licensing in this respect, and the same should be done for all Americans.
Stat News: A New Report Brings Telehealth Fraud Risk Into Focus (9/8) – A new report by HHS OIG offered early evidence that only a small portion of providers are billing for virtual care in a potentially fraudulent way, suggesting that targeted interventions could crack down on abuse. “Congress and CMS have to look at what the future of telehealth looks like holistically,” said Andrew VanLandingham, a senior counselor for policy at OIG. The office’s goal, he said, is to “make sure we maximize the benefits and minimize the risks.” “These reports add to the growing body of evidence showing that telehealth meaningfully expands access to care, and that long-term telehealth expansion is feasible with some limited steps to ensure continued oversight and evaluation,” the Alliance for Connected Caresaid in a statement.
Politico: HHS Inspector General Finds Telehealth Fraud Was Rare During the Pandemic (9/7) – HHS OIG released a report that found only a small fraction of Medicare claims for telehealth during the COVID-19 pandemic were at high risk of being fraudulent. The HHS OIG called for more oversight from CMS to identify telehealth companies billing Medicare to bolster oversight, saying that some providers that were flagged seem to be associated with telehealth companies. The move drew some criticism from the Alliance for Connected Care “We don’t believe there is clear justification for singling out virtual-only providers,” said Krista Drobac, the executive director of the Alliance for Connected Care, though she added that some “limited steps” to bolster oversight might be logical.
Alliance for Connected Care: Comment Letter on CY 2023 Physician Fee Schedule Proposed Rule (9/6) – The Alliance for Connected Care submitted comments
on the CMS Medicare Physician Fee Schedule (PFS) Proposed Rule for calendar year (CY) 2023, which includes several important reforms with respect to telehealth. The Alliance:
Appreciates and supports the effort from CMS to create more temporary Category 3 codes (and its proposal to retain these codes through the end of CY 2023). However, we were disappointed CMS did not find sufficient clinical benefit to add any of the proposed Category 1 or Category 2 codes.
Remains concerned with steps taken by CMS around in-person visit requirements and we encourage CMS to apply these requirements to the minimum extent required by law.
Believes limiting non-facility providers to a lower facility payment rate for telehealth would have the effect of disincentivizing telehealth usage by a patient’s existing in-person provider and undermining opportunities to increase patient access.
Strongly supports the continued availability of direct supervision through telehealth.
White House: Biden Administration Outlines Plan to Get Americans an Updated COVID-19 Vaccine Shot and Manage COVID-19 this Fall (9/8) – The Biden Administration announced it will pilot a telehealth version of its Test to Treat program so that vulnerable communities can get tested for COVID-19 at home and have medication delivered to them at no cost to the patient. The pilot program aims to expand access to COVID-19 testing in underserved communities, coming months after several pharmacy groups raised concerns about patient access under Test to Treat. Through the newly announced pilot program, people in as many as 15 rural and high-risk communities will be able to get tested, consult with a physician, and receive treatment without leaving their homes.
Department of Veterans Affairs Office of Connected Care: Home Telehealth Program for COVID-19 Patients (9/8) – The Northport VA Medical Center in New York created a program which ensured that Veterans who tested positive for COVID-19 at discharge went home with the equipment they needed to watch their symptoms at home. Veterans who needed inpatient or emergency care at Northport VA were given a thermometer and pulse oximeter before leaving the facility. In addition to these remote monitoring devices, Veterans had home telehealth appointments where coordinators would review the Veteran’s daily readings and watch for any alarming changes.
HHS Office of Inspector General: The IHS Telehealth System Was Deployed Without Some Required Cybersecurity Controls (9/7) – The HHS OIG released a report on whether the Indian Health Service (IHS) implemented cybersecurity controls to protect its telehealth system. The report found that although IHS deployed a national telehealth system, which increased the availability of health care services during the pandemic, it did not complete select IT controls as required prior to deploying its telehealth system nationally. OIG recommended that IHS develop a strategy for identifying, implementing, and testing cybersecurity controls for new information systems that are deployed in an expedited fashion to meet an urgent, mission-critical need.
Representative Trahan: Trahan, Kuster, Welch Call for Extension of Critical Audio-Only Telehealth Services (9/8) – Reps. Trahan (D-MA), Kuster (D-NH), and Welch (D-VT), members of the House Energy and Commerce Committee’s Health Subcommittee, sent a letter
to CMS requesting that the agency consider the benefits that pandemic-era audio-only telehealth services have had for patients in need of care who may not have the means to travel to a physician’s office or access a video telehealth appointment. The letter asks CMS to answer several questions, including how the agency is measuring the effectiveness of audio-only telehealth and what data it has about the factors that impact audio-only usage as opposed to other kinds of telehealth. It also asks what CMS believes the impact of ending audio-only telehealth coverage would be on rural beneficiaries and on other groups that are more likely to use the modality, including Black patients.
Telehealth Research, Reports and Surveys
Health Affairs: Rapid Growth Of Remote Patient Monitoring Is Driven By A Small Number Of Primary Care Providers (9/8) – According to a Health Affairs study, a small number of primary care providers have been responsible for most of the recent growth in remote patient monitoring. The study found that remote patient monitoring grew four-fold during the pandemic’s first year. Out of a group of 342 high-volume providers, 0.1 percent accounted for 69 percent of all general remote patient monitoring claims. The study recommends more research to identify which patients and use cases benefit most from remote patient monitoring.
Health Affairs: Telemedicine Platforms Need to be Designed with the Visually Impaired and Others With Disabilities in Mind (9/6) – Visual impairment (VI) ranks among the top 10 leading causes of disability amongst US adults. The impacts of VI are not just exclusive to vision but also affect mental, oral, and physical health. Currently, telemedicine portals lack accessibility customization for persons experiencing blindness. Software designers need to create telemedicine portals that include screen readers, magnification, and high-contrast software. Design flaws that do not promote usability for disabled populations make some platforms relatively inaccessible for independent use.
Mayo Clinic Proceedings: Impact of a High-Risk, Ambulatory COVID-19 Remote Patient Monitoring Program on Utilization, Cost, and Mortality (9/5) – The Mayo Clinic conducted a retrospective analysis that included patients diagnosed with COVID-19 at risk for severe disease who enrolled in the health system’s remote patient monitoring (RPM) program between March 2020 - October 2021. The program included in-home technology for symptom and physiologic data monitoring with centralized care management. High-risk COVID-19 patients enrolled and engaged in an RPM program experienced lower rates of hospitalization, ICU admission, mortality, and cost than those enrolled and not engaged in such programs. These findings translate to improved hospital bed access and patient outcomes.
Telehealth News and Market Developments
Harvard Business Review: Five Steps to Restore Trust in U.S. Health Care (9/8) – The pandemic exposed the weaknesses and undermined public trust in the U.S health care system. In particular, rural residents, along with low-income Americans, have the lowest trust in the health care sector. Physicians and health care organizations can address factors contributing to the erosion of trust in the health care system, including through the adoption of technologies that engage and serve patients by making health care more convenient and more connected - such as telehealth, remote monitoring, and digital diagnostic tools. With technology, providers can rapidly and seamlessly move wisdom and expertise, not people, which can significantly improve care delivery and patient engagement to improve outcomes.
The Washington Times: Accelerated Use of Technology and Data Key to Modernizing Medicare and Medicaid (9/6) – This op-ed highlights how the government is slow to adopt the latest technology, particularly in the Medicare and Medicaid programs. The House Republican Healthy Futures Task Force, Modernization Subcommittee agenda aims to get technological health advances into the hands of patients faster. Previous telehealth rules are currently expected to be put back into place within 151 days of the PHE ending, which would reduce access to care for Medicare beneficiaries.
MedPage Today: Smoothing Out the Administrative Kinks of Telehealth (9/6) – In this op-ed, a primary care physician discussed the administrative burden of documenting disclaimers for virtual appointments. Providers should be focused on providing care, and asking providers to fill in this statement on every telehealth note is administratively burdensome. The author recommends educating patients though a video while they are in the waiting room.
Health Data Management: How One Organization Greatly Expanding Telehealth (9/6) – The Medical University of South Carolina (MUSC) now offers about 80 telehealth services, including school telehealth, hospital-at-home acute care services and tele-mental health. Without telemedicine, patient monitoring required one-on-one care. With virtual monitoring, one employee can monitor six to eight patients at once. MUSC’s teleICU program also allows a physician to remotely monitor ICUs in rural hospitals. Leveraging artificial intelligence and predictive analytics, the physician can send alerts to patients around their status.
Behavioral Health Business: Inside Behavioral Health Care’s Remote Patient Monitoring Opportunity (9/6) – Remote patient monitoring (RPM) and similar technologies may help behavioral health operators track patients outside of a provider’s office. The advancement of value-based care arrangements requires close tracking of patient care, retention, or other specific measures. RPM and similar technologies also help the behavioral health industry overcome an inherent challenge that has hampered its development: measurement-based care.
State Telehealth News and Activity
Healthcare IT News: A Rural Kansas FQHC Brings Remote Patient Monitoring to the Underserved (9/8) – The Community Health Center of Southeast Kansas (CHC/SEK), a federally qualified health center (FQHC), serves a rural, underserved area in Southeast Kansas and Northeast Oklahoma where patients lack household internet and smart devices, and face economic barriers to transportation or the ability to purchase a device such as a blood pressure cuff. With a recent grant, CHC/SEK received remote monitoring devices, such as blood pressure cuffs, scales and glucometers, to aid in telehealth appointments and care management programs. This allowed for remote patient monitoring, access to telehealth appointments with their provider, and easier access to view their medical information and schedule appointments online, which are only made possible with access to the internet.
The Tennessean: Telehealth Can Help Thousands of Recovering Tennessean by Adding More Online Medical Providers (9/6) – In 2020, there were only 1,007 providers in Tennessee capable of prescribing buprenorphine, a safe and effective medication for the treatment of opioid use disorder (OUD). By allowing providers to use telehealth to satisfy the patient-provider relationship - which allows them to begin online prescribing - this addresses the most significant barrier to treatment in Tennessee: a severe provider shortage. The removal of the in-person requirement for online prescribing is dependent upon a state of emergency. Tennessee is still currently in a state of emergency due to COVID, but it is unclear how much longer this will last. If the state of emergency is rescinded, then the in-person requirement will again be in effect for online prescribing.
Healthcare IT News: Maryland Health System Conquers the Digital Divide with Telehealth and RPM (9/6) – The University of Maryland Medical Center health system has expanded its telemedicine program to help reach all patients in need of care, regardless of location or technological savvy. The University of Maryland Medical Center was awarded $977,066 from the FCC telehealth grant program for the purchase of laptops, internet services, mobile telehealth carts, equipment for vaccine outreach, and vaccine hotline and remote patient monitoring equipment to provide telehealth.
Norfolk Daily News: Nebraska Hospitals Raise Concerns About Cuts to Telehealth Payments (9/6) – The Nebraska Hospital Association is raising concerns on behalf of its members about recent cuts by Blue Cross Blue Shield of Nebraska to the amount it pays providers for medical telehealth visits. The reduction in payments came in some of the new agreements between the insurer and hospitals that went into effect July 1. Many providers won't be able to afford to offer medical care via telehealth at the lower rate, which will disincentivize providers to provide telehealth.