Please find below updates on how the health care system is leveraging telehealth and remote patient monitoring - including research, data, and polling on its current use in response to COVID-19.
Sign Letter to Congress on Medicare Telehealth
Please join the Alliance for Connected Care and other digital health organizations in signing a multistakeholder letter to Congressional leaders calling for a permanent end to location restrictions for telehealth in Medicare, continued FQHC/RHC telehealth payment, removal of the in-person visit requirement prior to access to mental health services through telehealth, and continued telehealth waiver abilities for CMS. The letter - building on the momentum of the 340-group letter last July - is intended to revitalize our efforts around priority Medicare asks to Congress.
Organizations may SIGN THE LETTER HEREby COB Friday, July 23. Please feel free to share with a wide range of organizations who may be interested in advocating for continued telehealth access in Medicare.
HHS Office of Inspector General (OIG): Principal Deputy Inspector General Grimm Provides Update on Oversight of COVID-19-Related Programs (7/6) – PDIG Grimm shared an update on OIG’s work with a focus on oversight of COVID-19-related programs during a June American Health Law Association Annual Meeting. “The question – and challenge for us now – is whether this inflection point is the spot on the timeline where we also collectively address consequential problems that have continued, resulting in significant effects on patients, providers, and health care programs,” she said. “Telehealth may be the prime example.” However, she also highlights those new policies and technologies must not be compromised by fraud, abuse or misuse. “Effectively expanding telehealth and ensuring program integrity will take effort on a number of fronts that may not be considered traditional compliance issues: cybersecurity, interoperability, and patient access to technology.”
Rosen Leads Colleagues in Calls to Increase Funding for Mental Health, Telehealth, and Distance Learning Programs(7/7) – Sen. Rosen (D-NV) led 12 Senators in a letter to Senate Appropriations Committee, Labor, Health, and Human Services and Education Subcommittee Chair Murray (D-WA) and Ranking Member Blunt (R-MO) requesting robust and sustained funding for the Pediatric Mental Health Care Access Program and the Emergency Medical Services for Children program. Sen. Rosen (D-NV) also led 14 Senators in a letter to Senate Appropriations Committee, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Subcommittee Chair Baldwin (D-WI) and Ranking Member Hoeven (R-ND) requesting support for the U.S. Department of Agriculture’s (USDA) Distance Learning and Telemedicine (DLT) grant program.
“We know there is a significant shortage of children's mental health providers, particularly in rural and underserved areas. This is where technology can play a role in bringing care to areas that need it most. The Pediatric Mental Health Care Access Program provides grants to integrate mental health services into pediatric primary care settings through telehealth,” wrote the Senators in their letter advocating for pediatric mental health and medical services. “We also must continue to invest in emergency care for our children. The Emergency Medical Services for Children program is the only federal grant program dedicated to improving the health outcomes of children in emergency departments. This critical program improves pediatric capacity within our emergency systems, ensuring that children receive the specialized care they need at the most critical moments.”
“The DLT grant program assists rural and tribal communities in acquiring distance learning and telemedical technologies so that local teachers and medical service providers can connect to educators and medical professionals in other parts of the country. Since 1994, the DLT grant program has helped to establish hundreds of distance learning and telemedicine systems, improving the quality of life for thousands of residents in rural communities all across the United States,” wrote the Senators in their letter advocating for the Distance Learning and Telemedicine (DLT) grant program. “DLT grants enable rural communities to overcome any barriers they face in accessing healthcare or education, including long travel distances or a shortage of providers. Given the critical importance of these programs, we urge you to fund the USDA’s Distance Learning and Telemedicine grant program at or above the President’s request for FY22.”
The full text of the letter to Chair Murray and Ranking Member Blunt can be found here. The full text of the letter to Chair Baldwin and Ranking Member Hoeven can be found here.
State Telehealth Activity
Springfield, Massachusetts WWLP: Telehealth becoming more popular even as pandemic restrictions ease (7/9) – Even though COVID restrictions have been limited, organizations like MHA continue to offer virtual visits. Many people reported it being much more convenient than meeting in person. The state even passed a law allowing a wider use of telehealth and prohibiting insurance companies from not covering it or charging more. Which MHA says is so important for a variety of reasons.
ABC Action News WFTS Tampa Bay: Patients frustrated over changes to telehealth services after state executive order expires (7/9) – Florida Governor Ron DeSantis recently let an executive order that relaxed several telehealth rules during the pandemic to expire, after being renewed several times. This has been significantly impacting patient care, especially for the disabled and chronically ill patients who relied on telehealth throughout the pandemic. Some physician groups are hoping to permanently expand telehealth regulations in the state, but any potential changes will have to wait until next legislative session. “I have patients who are now telling me I don’t know how I’m going to be able to get down there to do an exam,” said Dr. David Berger, Board Certified Pediatrician at Wholistic Pediatrics and Family Care. Leonardo Palacios, whose mother has been using telehealth services says it’s a big disappointment for his mother, and now an added challenge to have to go back to the doctor in person. “She needs to be able to rest from her pain and have some relief. I don’t understand, what good does it do to go back to going in office,” said Palacios. Some physician groups are hoping to permanently expand telehealth regulations in Florida, but any potential changes will have to wait until the next legislative session. “We’ve had this work successfully so whatever concerns there were when the legislators carved out to not allow it in 2016, clearly the sky has not fallen. Medical care has not been compromised. Patients have been doing well. There is no problem here,” said Berger.
JD Supra: Connecticut Telehealth Version 2021 and Beyond: Some Things to Know (7/8) – Connecticut Governor Ned Lamont recently signed a new telehealth law that would implement temporary statute until June 30, 2023 that codifies aspects of the telehealth related Executive Orders issued by the Governor during COVID-19. This article outlines what providers should know about this new law, including which providers are able to provide telehealth services under the law, what it means to be “in network,” if the new law still allows for audio-only telehealth, and where providers need to be located to provide such services.
WBRC: End of Alabama state of emergency changes telehealth rules out-of-state (7/8) – Due to Alabama’s COVID state of emergency recently ending, immediate changes were made to telehealth that could impact patient care. COVID allows flexibility for providers to practice across state lines, rules that were made on the state level. Now, patients in Alabama, along with other states, can no longer see a provider via telehealth that resides outside the state. Dr. Eric Wallace, a nephrologist at UAB and telehealth expert, said there’s a national conversation going on about this, including talk about having a national medical license to solve this issue, but that ultimately patients should come first.
Telehealth Research, Reports and Surveys
The Journal of Climate Change and Health: Patient transport greenhouse gas emissions from outpatient care at an integrated health care system in the Northwestern United States, 2015–2020 (August 2021) – A retrospective review of outpatient care at a health system serving over 600,000 members found that from 2015 to 2020, total outpatient and telehealth visits increased, while ambulatory visit carbon intensity decreased – suggesting that telehealth visits may lead to reduced greenhouse gas emissions. The study from Kaiser Permanente, Brigham and Women’s Hospital and Harvard Medical School attributes most of the results to the adoption of telehealth during the coronavirus pandemic, when in-person visits dropped sharply and both providers and payers limited their travel time. But the researchers noted that any telehealth service offers an opportunity to reduce stress on the environment.
Fair Health: Monthly Telehealth Regional Tracker (July 2021) – The Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving on a monthly basis. According to Fait Health data, telehealth claim lines as a percentage of all medical claims dropped 13% in April, marking the third straight month of declines. The decline appears to be driven by a rebound in in-person services, researchers said. Mental health conditions continue to rise nationally and in every U.S. region. As Krista Drobac, executive Director of the Alliance for Connected Care has noted, "In-person [care] is always going to be alive and well," said Krista Drobac, executive director of the Alliance for Connected Care. "It's up to us as advocates to create a regulatory environment where telehealth can be an option in the long term." A subset of patients has chosen telehealth as a substitute for in-person visits, rather than a supplement to it, she said. Regional and national statistics dating back to January 2020 can be found here.
National Library of Medicine: Telehealth was Beneficial during COVID-19 for Older Americans: A Qualitative Study with Physicians (7/10) – Interviews with physician from September to November 2020 identified five major telehealth themes: (1) telehealth uptake was rapid and iterative, (2) telehealth improved the safety of medical care, (3) use cases were specialty-specific (for geriatricians and primary care physicians telehealth substituted for in-person visits; for emergency physicians it primarily supplemented in-person visits), (4) physicians altered clinical care to overcome older patient barriers to telehealth use, and (5) telehealth use among physicians declined in mid-April 2020, due primarily to patient needs and administrator preferences, not physician factors.
McKinsey & Company: Telehealth: A quarter-trillion-dollar post-COVID-19 reality? (7/9) – A year ago, McKinsey estimated that up to $250 billion of US healthcare spend could potentially be shifted to virtual or virtually enabled care. McKinsey has updated their research to assess implications for telehealth and virtual health more broadly going forward. Findings include the following insights:
Telehealth utilization has stabilized at levels 38X higher than before the pandemic. After an initial spike to more than 32 percent of office and outpatient visits occurring via telehealth in April 2020, utilization levels have largely stabilized, ranging from 13 to 17 percent across all specialties. This utilization reflects more than two-thirds of what we anticipated as visits that could be virtualized.
Similarly, consumer and provider attitudes toward telehealth have improved since the pre-COVID-19 era. Perceptions and usage have dropped slightly since the peak in spring 2020. Some barriers—such as perceptions of technology security—remain to be addressed to sustain consumer and provider virtual health adoption, and models are likely to evolve to optimize hybrid virtual and in-person care delivery.
Some regulatory changes that facilitated expanded use of telehealth have been made permanent, for example, the Centers for Medicare & Medicaid Services’ expansion of reimbursable telehealth codes for the 2021 physician fee schedule. But uncertainty still exists as to the fate of other services that may lose their waiver status when the public health emergency ends.
Investment in virtual care and digital health more broadly has skyrocketed, fueling further innovation, with 3X the level of venture capitalist digital health investment in 2020 than it had in 2017.
Virtual healthcare models and business models are evolving and proliferating, moving from purely “virtual urgent care” to a range of services enabling longitudinal virtual care, integration of telehealth with other virtual health solutions, and hybrid virtual/in-person care models, with the potential to improve consumer experience/convenience, access, outcomes, and affordability.
JAMA: Diabetes Care and Glycemic Control During the COVID-19 Pandemic in the United States (7/6) – New research suggests that the impact of COVID-19 on diabetes care and glycemic control among patients was minimal, thanks in part to telehealth services. As the authors note, the unprecedented increase in telemedicine visits during the pandemic, although unable to overcome the overall decrease in visits, may have prevented substantive disruptions in medication prescribing.
National Library of Medicine: Older adults' access to primary care: Gender, racial, and ethnic disparities in telemedicine (7/5) – In this retrospective cross-sectional study of 17,103 patients aged ≥65 years seen at 32 clinics in the Mid-Atlantic, primary care patients were classified into two groups-telemedicine versus in person-based on the first visit between March and May 2020 and followed up for 14 days. Overall, 60.3% of patients accessed primary care via telemedicine. Black (vs. white) patients had higher odds of using telemedicine, and Hispanic (vs. not Hispanic) patients had lower odds. Compared with the in-person group, patients in the telemedicine group had lower odds of ambulatory care sensitive conditions (ACSC) hospitalization. Among patients who used telemedicine, black patients had 1.43 higher odds of ACSC hospitalization (95% CI, 1.02-2.01) compared with white patients. Finally, patients aged 85 or older seen via telemedicine had higher odds of an ACSC hospitalization compared with patients aged 65-74. The findings support the use of telemedicine for primary care access for older adults. However, the observed disparities highlight the need to improve care quality and equity regardless of visit modality.
National Library of Medicine: Physician Satisfaction with Telemedicine during the COVID-19 Pandemic: The Mayo Clinic Florida Experience (7/1) – An anonymous 38-question cross-sectional survey was distributed to 529 eligible physicians at the Mayo Clinic Florida, with 103 physicians responding (19.5%). The survey was open from August 17, 2020 through September 1, 2020. Physicians generally held positive attitudes regarding the adoption of telemedicine, and perceived that the quality of healthcare delivery as generally comparable to in-person care. Future studies are needed to explore attitudes regarding telemedicine after the pandemic, and how this virtual technology may be further utilized to improve physicians' professional and personal well-being.
Telehealth News and Market Developments
The Hill: Don't turn the convenience of telehealth into a barrier to treatment (7/9) – An op-ed published in The Hill from Sara Struwe, president and CEO of the Spina Bifida Association argues for members of Congress and regulators to not overlook the importance of patient choice, and consider a framework that reimburses for services in a manner that allows patients to access in-person and virtual care equally when necessary and desired.
mHealth Intelligence: UMass Memorial Eyes Telehealth, RPM Benefits in New Hospital at Home Program (7/9) – UMass Memorial Health is joining the Hospital at Home movement, with a new program that integrates remote patient monitoring and telehealth strategies with in-person visits to provide care management at home for patients who would otherwise be taking up a hospital bed.
Modern Healthcare: Telehealth use falls for third straight month, in-person appointments increase (6/7) – In April, telehealth utilization fell 12.5%, a trend mirrored by a gradual shift back to in-person visits at hospitals and other healthcare settings, according to FAIR Health's Monthly Telehealth Regional Tracker. Telehealth usage rose to unprecedented and inflated levels during the worst of the pandemic, so it's only natural that trend would reverse as people return to more normal activity, said Ari Gottlieb, principal at A2 Strategy. "In-person [care] is always going to be alive and well," said Krista Drobac, executive director of the Alliance for Connected Care. "It's up to us as advocates to create a regulatory environment where telehealth can be an option in the long term." A subset of patients has chosen telehealth as a substitute for in-person visits, rather than a supplement to it, she said.
Kindbridge: Kindbridge and Playtech partnership to deliver world-leading gambling research (6/7) – Kindbridge has formed the Kindbridge Research Institute to create an evidence-based teletherapy model for gambling and gaming disorders. The Kindbridge Research Institute is commissioning the Center for Gambling Studies at Rutgers University in New Jersey, a leading public research university in the US, to build the evidence-based telehealth model independently so that data produced through the treatment system can be used for peer-reviewed research and to provide data sets on a size and scale never before achieved when analyzing this population.
Center for Connected Health Policy, “Telehealth & Medicaid: Access and Equity in Medicaid Telehealth Policy.” This webinar features presentations on trends in telehealth access and equity including strategies to address these gaps. Attendees will hear from administrators from the Minnesota Department of Human Services, New York State Department of Health, and the Washington Health Care Authority.