Please find below the latest developments in federal and state virtual care policy as well as research, data, and polling on virtual care.
This is the public update of the Alliance, issued quarterly. The biweekly Alliance newsletter is now members-only. Was this email forwarded to you? Subscribe here or feel free to contact us about membership.
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SIGN-ON LETTER OPPORTUNITY
Urge Congress to Act Well in Advance of December
Please sign a joint letter calling for action on telehealth that allows for implementation time prior to the expiration of statutory restrictions on December 31, 2024.
We invite organizations to sign this letter through this form by February 21 by EOD (deadline extended).
Contact rikki.cheung@connectwithcare.org with any questions.
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February 13, 2024
Chris Adamec will become executive director of the Alliance, continuing to drive forward coalition advocacy to ensure patients have access to, and clinicians are reimbursed for virtual care. With more than 15 years of experience in Washington, and four years with the Alliance, Mr. Adamec has relationships across the stakeholder spectrum, in Congress, the Executive Branch and deeply understands the policy. Founder, Krista Drobac, will continue to serve the Alliance through strategic guidance and thought leadership.
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Alliance for Connected Care: Alliance for Connected Care Announces New Members and Leadership (2/13) - The Alliance for Connected Care (“the Alliance”) welcomes several clinician and patient advocacy organizations to its membership, and a new Executive Director. During this critical policy year for telehealth and remote patient monitoring, it is essential to have a wide range of leading voices together in a coalition. With patients, hospital systems, physicians, nurses, technology innovators, retailers and health plans as members, the Alliance truly speaks with a cross-sector voice.
Following are new Alliance for Connected Care members in 2024:
“The PAN Foundation was part of the Alliance advisory board where we supported the Alliance’s efforts to push for policies that ensure continued access to telehealth services. Today, we are thrilled to join the Alliance as a member as we continue our efforts advocating for permanent telehealth polices, including audio-only services, to increase equitable access for all.” Amy Niles, Chief Advocacy and Engagement Officer, PAN Foundation
“The American Association for Marriage and Family Therapy was part of the Alliance advisory board. As an organization representing the professional interests of over 70,000 licensed marriage and family therapists, we are excited to join the Alliance as a member and support the mission for permanent access to virtual care for behavioral health providers and other clinicians.” Roger D. Smith, J.D., Chief Advocacy Officer & General Counsel, American Association for Marriage and Family Therapy
“Compassion & Choices proudly served on the Alliance advisory board to help address the need for permanent telehealth access for terminally ill patients. As the nation’s oldest and largest nonprofit organization working to improve end-of-life care, we are eager to join the Alliance as a member to advocate for easier patient healthcare access through telehealth.” Bernadette Nunley, National Director of Policy, Compassion & Choices
“The Association for Behavioral Health and Wellness (ABHW), which represents health payers who provide mental health and substance use disorder benefits to over 200 million people, is delighted to join the Alliance. We are especially looking forward to working with our Alliance partners on ensuring that buprenorphine can be prescribed through telehealth and eliminating the six-month in-person requirement for tele-mental health care.” Pamela Greenberg, President & CEO, Association for Behavioral Health and Wellness
“The American Academy of Physician Associates, representing more than 168,000 PAs, is honored to be a part of the Alliance for Connected Care. PAs are driven by a commitment to expanding patient access to high-quality medical care, and telehealth is a powerful tool for ensuring more patients get the care they need, when they need it.” Tate Heuer, Vice President, Federal Advocacy, American Academy of Physician Associates
OTHER TOP ALLIANCE NEWS
Alliance Opposes Duplicate Coding for Telehealth Services - The Alliance for Connected Care discouraged CMS from adopting new codes for telehealth that would duplicate codes for services already covered in Medicare.
Alliance Urges AMA to Ensure Coding for RPM and RTM Accurately Represents Clinical Utilization - The Alliance for Connected Care provided feedback to the CPT Editorial Panel on significant changes to remote monitoring codes.
Alliance Celebrates Its 10 Years - For 10 years, the Alliance for Connected Care has improved access to care through the reduction of policy, legal, and regulatory barriers to the adoption of telehealth and remote patient monitoring.
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Administration
Substance Abuse and Mental Health Services Administration (SAMHSA): Medications for the Treatment of Opioid Use Disorder (2/2) – SAMHSA released a final rule, which updates standards of care to reflect evidence-based practice in 2023, removes the requirement for a one-year period of opioid addiction prior to admission to an OTP, promotes the integration of harm reduction and recovery support services into OTPs, and further aligns the definition of treatment practitioner with the existing workforce of appropriately licensed practitioners. The final rule will be effective April 2, 2024, and the compliance date is October 2, 2024.
Department of Health and Human Services (HHS): Biden Administration Marks Two Years of Advancements in HHS’ Overdose Prevention Strategy with New Actions to Treat Addiction and Save Lives (2/1) – HHS announced actions the Biden Administration has taken to address the overdose epidemic. Among actions include the extension of telemedicine flexibilities through December 31, 2024 to allow practitioners to prescribe schedule II-V controlled substances (“controlled medications”) pursuant to a telemedicine visit without conducting an initial in-person medical evaluation.
Centers for Disease Control and Prevention (CDC): Telemedicine Use Among Physicians by Physician Specialty: United States, 2021 (2/1) – A CDC study found that primary care and medical specialists were more likely to be satisfied with telemedicine technology compared with surgical specialists. More medical specialists (27.4 percent) used telemedicine for 50 percent of their patient visits or more than primary care physicians and surgical specialists. Most primary care physicians (76.7 percent) and medical specialists (73.1 percent) were able to provide a similar quality of care during telemedicine visits as in-person visits “to some extent or a great extent” compared with about one-half of surgical specialists (50.6 percent). Read more about the report in CDC’s blog.
Department of Veterans Affairs (VA): Improving Access to Surgical Care: Safety, Efficacy, and Satisfaction With Postoperative Telehealth (1/18) – A quarter of US Veterans reside in rural communities and are significantly older than their urban counterparts. Providing timely access to care is especially important in this older, independent and medically complex cohort. Routine telehealth for low and high-complexity surgery could be of particular benefit to rural patients by reducing travel challenges, costs, improving scheduling flexibility and reinforcing independence. Findings from this study, once completed, could lead to standardization for telehealth follow-up after surgery.
VA: Telenephrology Provides Critical Kidney Care to Veterans Across the Country (1/17) – VA is using telehealth to increase Veterans’ access to kidney care. VA’s TeleNephrology program connects Veterans with kidney specialists across the country to provide them with care through telehealth. Instead of traveling long distances for an in-person nephrology appointment, Veterans can connect with a VA nephrologist at their local VA community-based outpatient clinic. VA’s TeleNephrology program launched in 2020 and now provides care to more than 1,500 Veterans with kidney disease. More than 90 percent of Veterans return to TeleNephrology for their follow-up visits.
Advanced Research Projects Agency for Health (ARPA-H): ARPA-H Program Aims to Improve Rural Health Care Access (1/16) – ARPA-H launched the Platform Accelerating Rural Access to Distributed & InteGrated Medical care (PARADIGM) program, which would drive breakthroughs to improve health outcomes for all Americans, including for diseases like cancer, PARADIGM will enhance early detection and management in rural communities across the nation. PARADIGM aims to create a multi-functional, rugged electric vehicle platform that integrates many different medical devices to treat a large variety of health conditions. The program will do this by building software that will connect on-board and remote medical devices with any electronic health record (EHR) system.
Health Resources and Services Administration (HRSA): Behavioral Health Integration (BHI) Evidence Based Telehealth Network Program Grant (1/9) – HRSA released a Notice of Funding Opportunity (NOFO) to integrate behavioral health services into primary care settings using telehealth technology. HRSA will award approximately $8.75 million to up to 25 grantees over a period of five years. Applications are due March 22, 2024.
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ALLIANCE TELEHEALTH RESOURCE
The Alliance for Connected Care maintains a tracker on legislation with significant telehealth or remote patient monitoring provisions.
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Congress
Rep. Balderson (R-OH): What They Are Saying: Support for the Congressional Digital Health Caucus (2/9) - Reps. Balderson (R-OH) and Kelly (D-IL) launched the Congressional Digital Health Caucus, which would inform policymakers of the advancements in digital health innovation.
“The Alliance for Connected Care applauds the creation of the Congressional Digital Health Caucus, which will support new capacity for crucial and ongoing conversations about the potential for digital health tools, such as remote patient monitoring, and their potential to improve care and health outcomes for all Americans,” said Chris Adamec, Alliance for Connected Care.
Rep. Steel (R-CA): Introduction of Equal Access to Specialty Care Everywhere (EASE) Act (1/30) – On January 30, Reps. Steel (R-CA) and nine bipartisan cosponsors introduced the Equal Access to Specialty Care Everywhere Act (EASE) (H.R. 7149). The bill would require the Center for Medicare and Medicaid Innovation (CMMI) to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries.
Sen. Cassidy (R-LA): Introduction of the Telemental Health Care Access Act (1/24) – On January 24, Sens. Cassidy (R-LA), Smith (D-MN), Thune (R-SD), and Cardin (D-MD) introduced the Telemental Health Care Access Act (S. 3651), which would ensure coverage of mental health services furnished through telehealth. Specifically, the bill removes the statutory requirement that Medicare beneficiaries be seen in person within six months of being treated for mental health services through telehealth. The Alliance endorsed this bill again this Congress.
Sen. Schatz (D-HI): Schatz Leads Group of Bipartisan Lawmakers Calling for Permanent Access to Telehealth for Medicare Beneficiaries (1/23) – Sens. Schatz (D-HI), Co-Chair of the Senate Telehealth Working Group, led a group of bipartisan lawmakers to urge the U.S. Department of Health and Human Services (HHS) to work with Congress to ensure Medicare beneficiaries maintain access to telehealth. In a letter to HHS Secretary Xavier Becerra, the lawmakers underscored the urgent need to act on making pandemic-era telehealth flexibilities permanent.
Rep. Curtis (R-UT): Introduction of Rural Broadband Protection Act (H.R. 7005) (1/17) – Reps. Curtis (R-UT) and Kuster (D-NH) introduced the Rural Broadband Protection Act (H.R. 7005), which would require the Federal Communications Commission to establish a vetting process for prospective applicants for high-cost universal service program funding. “From helping…[ensure] seniors have access to telehealth services regardless of where they live, access to quality, reliable broadband is essential to participating fully in the 21st-century,” said Rep. Kuster (D-NH).
Sen. Markey (D-MA): Sen. Markey (D-MA) Urges FDA to Include Civil Rights and Medical Ethics Advocates in Digital Health Technologies Committee (12/19) – Sen. Markey (D-MA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Retirement Security, led his colleagues in a letter
to Federal Drug and Administration (FDA) Commissioner Califf urging the agency to ensure that its new Digital Health Technologies Advisory Committee prioritizes the health and safety of all Americans, by asking the FDA to include members with civil rights, medical ethics, and disability rights backgrounds on the Committee. The Committee will advise on the development, regulation, and implementation of digital health technologies (DHTs), such as artificial intelligence (AI), telehealth, and wearable devices.
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Telehealth Research, Reports and Surveys
JAMA Health Forum: Characteristics of Mental Health Specialists Who Shifted Their Practice Entirely to Telemedicine (1/26) - While most mental health specialists have in-person and telemedicine visits, some have transitioned to fully virtual practice, perhaps for greater work-life flexibility (including avoiding commuting) and eliminating expenses of maintaining a physical clinic. This study found that, in 2022, 13.0 percent of mental health specialists serving commercially insured or Medicare Advantage enrollees had shifted to telemedicine only. A virtual-only practice allowing clinicians to work from home may be more attractive to female clinicians, who report spending more time on familial responsibilities, and those facing long commutes and higher office-space costs. The research suggests that introducing in-person requirements for visits and prescribing could cause care interruptions, particularly for conditions such as opioid use disorder.
The New England Journal of Medicine: Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine (1/25) – This review article presents a three-part true-life clinical vignette hat illustrates how digital health technology can aid providers caring for patients with cardiovascular disease. Although the uses of remote patient monitoring may be broad and could include management of diabetes and other cardiometabolic conditions, this review focuses on the three most common cardiovascular conditions for which remote patient monitoring is used: hypertension, heart failure, and atrial fibrillation. The foundational elements of remote patient monitoring and wearable technologies are present in cardiovascular practice today and are expected to mature. The overall goals are to shift from episodic care to asynchronous and continuous care, minimize burden on patients and caregivers, reduce structural inequities in access to care, and improve efficiency of evidence-based care delivery.
JAMA Network: Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease (1/16) – A study found receiving care from a palliative telecare team resulted in more improvements in quality of life than usual care among patients with COPD, interstitial lung disease or heart failure. In a single-blind, randomized trial of two Veterans Administration health care systems, researchers split the groups into patients that received palliative telecare from a nurse and social worker team (ADAPT intervention) and usual care (educational handout). Researchers found more improvement in COPD health status and heart failure health status at 6 months among those in the ADAPT group vs. the usual care group.
Nature Mental Health: The Digital Divide in Access to Broadband Internet and Mental Health (1/4) – A study published in Nature Mental Health found that that US counties with low densities of mental health care resources also have a higher percentage of homes without broadband access. There was an average of 7.03 mental healthcare physicians, 10.86 non-physician mental health practitioners, 1.48 psychiatric and substance abuse hospitals, 1.18 inpatient psychiatric and substance abuse treatment facilities, and 12.33 outpatient facilities available per 100,000 members of the population across US counties. However, US counties with low broadband access had reduced densities of mental health services, with an average of 3.63 mental healthcare physicians, 2.86 non-physician mental health practitioners, 1.33 psychiatric and substance abuse hospitals, 0.94 inpatient psychiatric and substance abuse treatment facilities, and 11.28 outpatient facilities available per 100,000 members of the population. The findings suggest that, while telemedicine may mitigate many key barriers to in-person mental healthcare, lack of broadband access may present an additional barrier to care for individuals already living in medically under-resourced communities.
JAMA Network: Increasing Telehealth Access Through Licensure Exceptions (12/14) – Several researchers from Harvard released a viewpoint article on interstate telehealth. The authors explain how exceptions can be used to connect patients via telehealth with a physician in another state, why this is a more practical and effective strategy, and finally what needs to happen for this to be a feasible solution. Many exceptions are limited in scope and use vague language. A set of well-crafted exceptions to physician licensure requirements designed to support interstate telehealth, adopted consistently across the states or at the federal level, would address the current problems.
Cadence: Remote Patient Monitoring Significantly Improves Health Outcomes and Reduces Total Cost of Care in Hypertension Patients (11/13) - Alliance member, Cadence presented data at the American Heart Association (AHA) Annual Scientific Sessions, which highlighted the positive impact of remote patient monitoring (RPM) on health outcomes and total cost of care for patients with hypertension. The data showed that Cadence’s remote monitoring solution helped to reduce the total monthly cost of care for enrolled hypertension patients by greater than 50% (-$311.55 patient per month).
Cadence: Study Shows Remote Patient Monitoring Significantly Improves Clinical Outcomes for Heart Failure Patients (11/13) - In a study of 215 patients, Cadence’s remote patient monitoring solution resulted in meaningful improvements in vitals and adherence to life-saving medications and guidelines amongst patients with heart failure with preserved ejection fraction (HFpEF).
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Telehealth News and Market Developments
ALS News Today: The Importance of Telehealth Grows as My Husband’s ALS Progresses (1/25) – Kristin Neva shares her experience on how telehealth helped her husband, who was diagnosed with ALS in 2010. When she first inquired about using telehealth, the neurologist they say didn’t have a license to practice in their state. She contacted an ALS clinic in Michigan, but was told that they’d first need to have an in-person visit. Finally, during the pandemic, telehealth was feasible with the expanded flexibilities. Neva emphasizes telehealth’s ability to make accessible specialized health care easier for rural patients, especially those who can’t travel.
Wall Street Journal: The Doctor Is In, But The Patient Is Out Of State (1/19) – A physician with Mass General Brigham is suing to allow clinicians treat patients in other states remotely. A physician with Somerville, Mass.-based Mass General Brigham is suing to allow clinicians to treat patients in other states remotely, according to a Wall Street Journal article. Radiation oncologist Shannon MacDonald, MD, filed a lawsuit against the state of New Jersey's medical board to end its restrictions on out-of-state specialty telehealth. The Pacific Legal Foundation is assisting her with the complaint. Dr. MacDonald argued that the telehealth limitations violate rules against states regulating interstate commerce and First Amendment protections against states restricting certain types of speech.
Cicero Institute: 2024 State Policy Agenda for Telehealth Innovation (1/17) – Most patients still lack access to providers outside of their state via telehealth. Cicero Institute released its third annual 50-state telehealth innovation report card, which outlines policy best practices to optimize the benefits of telehealth services for providers and patients. The report includes a stoplight rating system for each state as well as specific changes that are needed in each state to improve access to telehealth across state lines.
The Atlanta Journal-Constitution: Georgia Medical Board Restores Telehealth Prescribing Flexibility (1/4) – The Georgia Composite Medical Board restored doctors’ ability to prescribe controlled substances — which include painkillers and ADHD treatments — using just a virtual doctor visit. The board will clarify its rules and revisit the issue by May 1. The move follows confusion and outcry from doctors, especially psychiatrists, after the board last month reimposed pre-pandemic restrictions on virtual prescribing, effective Jan. 1. The board had received several complaints from hospital systems and individuals about the reimposed restrictions. Doctors came to rely on telemedicine visits as a key tool during the pandemic. That new access has become important since Georgia and the nation are facing a doctor and nurse shortage in rural areas, and especially in mental health.
Kevin MD: The Path Forward for Telepsychiatry: A Call for Permanent Policy (12/23) – The U.S. is experiencing a provider shortage. Only 28 percent of people in the U.S. live in an area with enough psychiatrists and other mental health professionals available to meet the needs of the population. Other barriers to care include high costs, social or cultural stigma, lack of awareness, fear of unfamiliar care, health system complexities, and distrust of providers. Each barrier prevents access to quality, safe care that many Americans are in need of today. Dr. Georgia Gaveras, co-founder and chief medical officer of Talkiatry, shared several recommendations from its response to the Drug Enforcement Administration (DEA) notice of proposed rulemaking.
District of New Jersey: Lawsuit Alleges New Jersey’s Telehealth Licensure Rules Hamper Access to Care (12/18) – Two patients, an oncologist, and a neurologist are suing the New Jersey State Board of Medical Examiners, alleging the state’s telehealth physician licensure requirements limit access to potentially lifesaving specialty care. The lawsuit details two young patients who were able to receive telehealth consultations and follow-up care from out-of-state physicians after being diagnosed with rare brain tumors — options that are curtailed by the state’s rules that require physicians to be licensed in New Jersey when practicing remotely. The suit comes as loosened regulations on cross-state licensing adopted during the COVID-19 pandemic have begun to expire, which advocates argue can prevent patients from receiving care they need.
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