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 submits comments in response to Healthy Future Task Force Modernization Subcommittee RFI (3/4) - The Alliance for Connected Care submitted comments
in response to the Healthy Future Task Force Modernization Subcommittee request for information regarding the utilization of wearable technologies, the expansion of telemedicine, and digital modernization efforts in the United States health care system. Comments focused on recommendations around telehealth expansion, including which pandemic-era telehealth flexibilities should be made permanent and how Congress can address licensure barriers that impede patient access to care. The goal of the Healthy Future Task Force is to build on Republican health policy goals and craft patient-focused agendas for the future. The Modernization Subcommittee aims to harness technological innovations to deliver affordable, quality care to all Americans.
Politico Pro: Telehealth negotiations hit roadblocks (3/4) –Congress continues to negotiate whether to extend Medicare telehealth rules that were adopted early in the pandemic after the public health emergency (PHE) ends as part of the upcoming omnibus spending bill. However, different narratives are being communicated from both sides of the aisle, with Republicans saying Democrats are holding up a deal by turning down Republican-proposed pay-fors, and Democrats saying Republicans are “dragging their feet” in hopes of letting telehealth lapse or agreeing to a short-term extension of 25 days post-PHE. Alliance for Connected Care executive director Krista Drobac said, “Finger pointing is not helpful. We need to get this done for American seniors.”
Modern Healthcare: Telehealth Visits Offer a Convenient Way to Address Primary Care Needs Within Patient-Physician Relationships (3/2) – A recent survey from the commercial real estate firm JLL found that more than 30 percent of telehealth visits resulted in a physician office visit, a much higher number than Alliance Member MedStar Health’s referral rate of less than 15 percent. According to Krista Drobac, Executive Director of the Alliance for Connected Care, “JLL’s survey is misleading. It failed to specify the types of services leading to in-person referrals and whether telehealth helped patients avoid emergency or urgent care. This kind of patient self-reported data makes the leap to over-utilization way too simplistic. It's also important to compare these visits to regular, in-person evaluation and management visits. Those often lead to follow-up care, so we may not be seeing any difference between in-person and telehealth for follow up to specialists, etc.”
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Administration
CMS: Preliminary Medicaid and CHIP Data Snapshot of Services through August 31, 2021 (3/4) – The Centers for Medicare & Medicaid Services (CMS) released an update to the Medicaid and Children’s Health Insurance Program (CHIP) COVID-19 data snapshot, which includes data through August 31, 2021. The snapshot provides information on service utilization by beneficiaries during the COVID-19 Public Health Emergency (PHE), including data on services delivered via telehealth and for mental health and substance use disorders, among other areas. The snapshot notes that service delivery via telehealth for all age groups increased dramatically starting in April 2020 compared to prior years, and declined from May 2020 through August 2021, aside from a slight increase in use from December 2020 through March 2021. The data also showed that services delivered through telehealth were highest among adults age 19-64 for this population.
Federal Communications Commission: Digital Health Symposium: Advancing Broadband Connectivity as a Social Determinant of Health (3/3) – The Federal Communications Commission’s (FCC) Connect2Health Task Force hosted a virtual event which gathered public and private sector thought leaders from a variety of disciplines, including telecommunications and health care, to discuss issues around recognizing broadband connectivity as a social determinant of health. Achieving digital health equity through improving broadband access and adoption is an FCC priority and was an overarching theme of the event. Participants in the event explored the future of broadband-enabled health technologies and how FCC policies and programs could support ongoing innovations within the social determinants of health framework, among other things.
White House: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union (3/1) – President Biden announced a strategy to address the nation’s mental health crisis ahead of his first State of the Union. This strategy included expanding access to tele- and virtual mental health care options. To do so, the Administration will work with Congress to ensure coverage of tele-behavioral health across health plans, and support appropriate delivery of telemedicine across state lines. HHS will create a learning collaborative with state insurance departments to identify and address state-based barriers, like telehealth limitations, to behavioral health access. Lastly, the United States Office of Personnel Management will facilitate widespread, confidential, and easy access to telehealth services, in part by strongly encouraging Federal Employees Health Benefits Program carriers to sufficiently reimburse providers for telehealth services, and to eliminate or reduce co-payments for consumers seeking tele-mental service.
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Congress
E&C Republicans: Oversight Subcommittee Leader Griffith Opening Remarks on Lessons Learned from the COVID-19 Pandemic (3/2) – The House Energy and Commerce Committee, Oversight and Investigations Subcommittee held a hearing on the lessons learned from the COVID-19 pandemic. In his opening remarks, Subcommittee Ranking Member Griffith (R-VA) commented: “One of the best things to come out of the pandemic for rural areas like my district is increase use of telehealth. Thanks to flexibilities from the Centers for Medicare & Medicaid Services and others, residents who were shuttered into isolation could connect to their doctors and nurses virtually. From mental health appointments to cardiology checkups, doctors and patients alike were appreciative for the ability to use at-home equipment to monitor and test.”
Data Mapping to Save Moms’ Lives Act (3/2) – On March 2, the Senate passed by unanimous consent the Data Mapping to Save Moms’ Lives Act (S. 198), which directs the Federal Communications Commission to include data on certain maternal health outcomes in its broadband health mapping tool. The purpose of this tool is to identify areas where high rates of poor maternal health outcomes overlap with lack of access to broadband services in order to pinpoint where telehealth services can be most effective.
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Telehealth Research, Reports and Surveys
mHealth Intelligence: Multiple Sclerosis (MS) Patients Report Satisfaction With Telehealth During Pandemic (3/2) – According to a study
published in the Archives of Physical Medicine and Rehabilitation, about 42 percent of multiple sclerosis (MS) patients received care related to their condition via telehealth, and a majority (77 percent) reported they were satisfied with the virtual care. Results showed that far fewer MS patients said they had been exposed to COVID-19 as compared with controls, implying that they are generally more cautious than the healthy controls group. Researchers concluded that telehealth was extremely beneficial for MS patients during the COVID-19 pandemic and that it is worth continuing in the future.
Healthcare IT News: Audio-only telehealth benefits patients in need, study finds
(3/2) – A recent study
from the University of California on telehealth implementation at community health centers serving primarily Chinese and Latino immigrants found that although phone visits were beneficial to historically marginalized patients, continued virtual care use depends on increased technological resources. The results of the study highlighted the importance of reimbursing audio-only visits post-pandemic and investing in efforts to improve the quality of language services in telemedicine encounters.
mHealth Intelligence: Telehealth-Enabled Social Services Helped Boost Patient Satisfaction (3/2) – A study
by Mayo Clinic found that using a tablet to connect patients virtually with social workers during primary care visits resulted in high satisfaction levels. Providers and social workers who engaged in the service were also asked for feedback and provided similar responses, highlighting the accessibility and convenience of telehealth. The findings suggest that although in-person social work has proven successful in the past, providing it through telehealth is an option worth considering.
PYMTS: Digital, Flexible Payment Plans Key to Expanded Behavioral Healthcare Access (3/2) – A recent PYMTS survey
found that three in five patients who interacted with a behavioral health practitioner in the last year did so digitally — a share that significantly outpaces the shares of patients digitally accessing any other type of health care. Financing remains a vital issue for some patients, especially those who are uninsured. Flexible payment options can make telehealth treatments and behavioral health more affordable and accessible for patients. Increased transparency on the cost of care and the use of digital innovations can help patients connect with specialists and get the treatments they need.
McKnights Long-Term Care News: Telemedicine helped nursing home residents avoid ER visits, research finds (3/1) – Findings published
in the Journal of Post-Acute and Long-Term Care Medicine found that skilled nursing facilities (SNF) were able to limit emergency room visits after implementing a more robust telemedicine program. The study was part of an effort to determine if telemedicine services could provide early detection and management of treatment problems in residents and prevent emergency transfers. Findings showed that SNF were able to identify changes in resident conditions with telemedicine among 42 percent of the patients requiring further evaluation, and of those patients, nearly 70 percent were able to remain at the SNF for treatment while the other 30 percent had to be transferred to the emergency room.
American Academy of Pediatrics: Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care (2/28) – The American Academy of Pediatrics published an article examining how telehealth can improve access, quality, and cost in pediatric care. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care.
Mobi Health News: Report: About a quarter of Americans used telehealth during COVID-19 (2/28) – According to Trilliant Health’s 2022 Telehealth Trends report, 25.6 percent of Americans accessed care using any type of telehealth from March 2020 through November 2021. Nearly 80 percent of users had between one and four visits, with 45.7 percent accessing only one telehealth visit. Also during this time, behavioral health telehealth utilization as a proportion of the total increased by 55 percent, from 38.23 percent to 59.3 percent.
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State Telehealth News and Activity
National Law Review: Massachusetts Updates State Telemedicine Guidance for Physicians
(3/3) – The Massachusetts Board of Registration in Medicine (BoRM), which oversees physician licensure and the practice of medicine, updated its “Policy on Telemedicine in the Commonwealth” to provide more guidance for licensed physicians on utilization of telemedicine in practice. BoRM expanded this policy to provide specific guidance on when a physician providing care via telemedicine is practicing in Massachusetts and subject to licensure and regulation by the BoRM, and specifies that the practice of medicine will not require a face-to-face encounter between a physician and patient prior to a telehealth visit.
JD Supra: What’s next for Iowa telehealth services now that the state’s COVID-19 Emergency Declaration has ended (3/1) – Iowa’s latest public health emergency proclamation, which authorized out-of-state licensed providers to practice medicine in the state of Iowa, expired on February 15, 2022 along with the state’s COVID-19 emergency declaration. The proclamation provided Iowa health care facilities the opportunity to utilize third-party telehealth service providers resulting in the expansion of health care services to those unable to participate in an in-person visit. The Iowa Board of Medicine announced that it would authorize a grace period to avoid disruptions in staffing and patient care, and that physicians have 90 days to obtain licensure in Iowa to comply with the Board’s normal licensure requirements.
Medpage Today: Location Shouldn’t Matter in Telemedicine (2/28) – At the peak of the pandemic, many providers pivoted to providing virtual care so patients could remain safely in their homes while receiving health care services. Patients enjoy telehealth, and many states are starting to look at whether they want to continue to allow providers to practice across state lines, while some are reversing the easing of rules instituted during the pandemic-driven public health emergency. This op-ed explores the “vagaries” of licensure in each state, noting how it may be time that these requirements move into the 21st
century, and must realize that patients are now more mobile and that providers are able and willing to take care of them no matter their location.
American Medical Association: How Congress, states can keep patients connected to telehealth
(2/28) – This article outlines four things the American Medical Association is encouraging state lawmakers to do when it comes to telehealth: 1) support telehealth coverage and payment; 2) provide fair payment for telehealth; 3) create care policy that supports physicians’ ability to provide telehealth; and 4) establish equity.
NCSBN: Nurse Licensure Compact Commission Annual Report Now Available (2/28) – The Nurse Licensure Compact Commission Annual Report for fiscal year 2021 was published, providing a comprehensive overview of the activities, achievements and financial performance of the Interstate Commission of Nurse Licensure Compact Administrators throughout the report period. Throughout the pandemic, the Nurse Licensure Compact allowed for greater nurse mobility, public protection and access to care, and also enabled nurses to provide telehealth nursing services to patients located in other compact states without having to obtain additional licenses.
National Law Review: Mississippi’s Telemedicine Business Registry: What You Need to Know (2/28) – Mississippi requires telemedicine companies to obtain a telemedicine business registration prior to delivering care to patients located in the state. A number of states have current or pending requirements for telemedicine companies to register. In Mississippi, each provider entity/organization delivering telehealth services to Mississippi patients is required to submit a registration application to the Department of Health’s Office of Licensure every two years, along with additional information and documentation regarding the provider entity/organization and the services it provides.
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Telehealth News and Market Developments
Healthcare IT News: Combining virtual care and personal touch to help the underserved (3/1) – Hospital technology leaders could benefit from companies that offer an umbrella of technologies and services that address health disparities for vulnerable populations to promote health outcomes and equity with an inclusive and expanded offering like non-emergency medical transportation, remote patient monitoring, food delivery and personal care. Collaboration and engagement across the health care spectrum will be important to embrace the entire patient population.
Healthcare IT News: The future of telemedicine: purpose-built, integrated platforms (3/1) – Currently, providers must toggle between separate software programs to review and enter patient data for a single encounter, limiting provider usability. Providers need a purpose-built telemedicine system that collapses all functionality into a single, seamless platform. A single-platform approach simplifies the patient experience, helps overcome barriers to health care such as remote location or limited mobility, and promotes continuity of care among providers. As telemedicine advances, improving provider experience can help providers to adopt telemedicine.
Fierce Healthcare: Amazon provides voice-activated virtual visits on Echo devices (2/28) – Alliance member Amazon has partnered with Teledoc Health to provide on-demand medical care through Alexa-enabled devices. Through an Echo device, customers can ask to speak to a doctor for nonemergent medical care, and Alexa will connect them with the Teladoc call center. The service will be available to U.S. customers at all hours.
AHUS News: Surge in Telehealth Brings Access, Convenience to Rare Disease Patients (2/28) – Telehealth has lifted the burden of traveling long distances to obtain medical care for rare disease patients. Telehealth negates the risk of transmission of viruses like COVID-19 because patients do not have to interact with anyone in person. And for patients who are enrolled in clinical trials and face a series of follow-up visits, telehealth can reduce the number of times they have to travel, relieving the entire family from that burden. “The ability to gather biometric data and transmit electronically into a digital record transforms the ability to deliver high-quality care,” says Cynthia Horner, medical director of Alliance Member Amwell.
Forbes: Don’t Dam the Telehealth Flood (2/28) – Telehealth restrictions were loosened during the COVID-19 pandemic; however, restrictions may be reinstated once officials declare the end of the public health emergency. There have been several pieces of legislation that would permanently loosen restrictions on telehealth and ensure that health care providers are paid adequately for providing virtual care. Telehealth has many benefits including convenience for patients, particularly those with transportation issues or in rural areas, improved health outcomes, and increased savings. Congress needs to make telehealth a permanent fixture of our health care system.
Medical Economics: The Tech Savvy Physician: The Hidden Burdens of Telehealth (2/28) – Providers accustomed to treating patients in person have become burdened by being forced to offer virtual care, bringing potential technology-related issues, an informal nature and inability to physically engage with patients. Virtual care also can exacerbate, rather than alleviate, burnout. Shifting patients from in-person to virtual visits results in lower revenue for providers because they are compensated for the cost of physical infrastructure and human resources. The long-term success of telehealth will depend on the entire ecosystem making necessary adjustments to their practices and creating the infrastructure to adapt to the new reality.
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Upcoming Events
March 10 – National Association of Community Health Centers, “Telehealth Office Hours.”
March 16 – The White House, “White House Health Equity Forum: Broadband Access and Telehealth Equity.”
March 16 – HIMSS, “Digital Connectivity as a Social Determinant of Health.”
March 17 – Great Plains Telehealth Resource & Assistance Center, “Digital Health in Homes and Communities: Emerging Opportunities for Patient Engagement.”
March 22-23 – xtelligent Healthcare Media, “Telehealth22 Virtual Summit: Creating a Hybrid Healthcare Strategy with Virtual Care.”
April 7 – National Academy for State Health Policy, “State Strategies to Support Telehealth Infrastructure.”
April 21 – National Consortium of Telehealth Resource Centers, “Innovation & Integration of Telehealth into Population Health.”
Previous Events, Podcasts, and Videos
Health Affairs, “Podcast: Navigating the COVID-19 Off-Ramp for Telehealth and Medicaid Policies.” In this episode of the Health Affairs This Week podcast, Health Affairs’ Ellen Bayer and Rob Lott discuss possible implications for health policies related to Medicaid and telehealth when the COVID-19 public health emergency sunsets.
Healthcare IT News, “HIMSSCast: The supply, demand and yield of telehealth.” In this interview, Sanjula Jain, Trilliant Health chief research officer and senior vice president of market strategy, breaks down the firm's recent report on virtual care. The report takes a measured view, arguing that telehealth use tapered in 2021 from its early pandemic spike.
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