The data is in. Nearly three years into expanded telehealth flexibilities, we are finally seeing an influx of substantial and peer-reviewed research on the expansion and impact of telehealth on the health care system. The Healthcare Leadership Council and the Alliance for Connected Care invite you to join a virtual panel of experts who will discuss the implications of both their own and national telehealth data on our understanding of healthcare utilization, quality, and access. These findings could not be more crucial for policymakers weighing the implications of permanent telehealth expansion.
Centers for Disease Control and Prevention (CDC): CDC Clinical Practice Guideline for Prescribing Opioids for Pain (11/3) – The CDC released updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, are intended to help clinicians work with patients to ensure safe and effective pain care is provided. Notably, the CDC included telehealth visits, including audio-only visits, as one of the accepted modalities for clinicians to monitor patients tapering their opioid use. The CDC also clarified that other health care professionals including nurses, pharmacists, and behavioral health professionals can support clinicians and patients during the ongoing taper process through telephone contact and telehealth visits.
Inside Telehealth: HHS Secretary Becerra Calls on Congress to Permanently Extend Telehealth Waivers (11/3) – During a roundtable on Latino mental health, HHS Secretary Becerra called on Congress to permanently extend some of the pandemic telehealth waivers as HHS is limited because of statute. Secretary Becerra said the reason HHS was allowed to establish telehealth was because of the COVID-19 public health emergency (PHE). As the Administration gets closer and closer to ending the PHE, those powers will cease to exist, which means the ability to access expanded telehealth flexibilities will too unless Congress acts.
Centers for Medicare & Medicaid Services (CMS): Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule (11/1) – CMS issued
the CY 2023 Medicare Physician Fee Schedule final rule, which includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. CMS finalized a number of policies related to Medicare telehealth services, including:
CMS finalized policies to make several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List.
CMS acknowledged the Alliance for Connected Care’sconcerns
around potentially paying for telehealth at a lower (facility) rate after the public health emergency. CMS will continue to allow for payment be made for Medicare telehealth services at the rate that ordinarily would have been paid under the PFS if the services were furnished in-person through the end of the of CY 2023.
CMS also clarified in the final rule that it does not believe the initial in-person visit requirement applies to beneficiaries who began receiving mental health telehealth services in their homes during the PHE (although annual requirements still apply). This is a positive development, as it will keep patients who began therapy during the PHE from being cut off from their care.
Inside TeleHealth provided additional coverage of the telehealth policies finalized in this final rule, including Alliance for Connected Care commentary on some of the major telehealth wins included in the rule.
CMS: CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (11/1) – CMS released
the CY 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. CMS finalized the proposal to have Medicare pay hospital outpatient departments to provide remote behavioral health services to people at home, which will improve access to care in rural communities and promote health equity. Notably, the rule adds flexibility for practitioners to offer remote services from outside the hospital.
Office for the Advancement of Telehealth: Best Practice Guide for Direct-to-Consumer Telehealth Care (11/1) – The Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth released a best practice guide for direct-to-consumer telehealth care. The guide provides an overview of types of direct-to-consumer telehealth, tips for developing a direct-to-consumer strategy, and how to bill for direct-to-consumer telehealth.
CMS: CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements — Final Rule (CMS-1766-F) (10/31) – CMS issued the calendar year (CY) 2023 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for home health agencies (HHAs). CMS received 44 comments on the discussion regarding the collection of telehealth data on home health claims. The majority of commenters agreed that the collection and analysis of data on the use of telecommunications technology on home health claims will greatly assist with accurate cost reporting.
CMS: Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule (CMS-1768-F) (10/31) – CMS issued a final rule updating payment rates and policies under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. CMS received a few telehealth comments requesting changes to Medicare payments for home dialysis. Comment topics included allowing clinics to bill for telemedicine related to home dialysis, lack of high-speed internet as a barrier in telehealth access, and to explore the role of telehealth in providing care to home dialysis patients.
Indian Health Service: Indian Health Service Further Expands Telehealth Services to Meet Patient Needs (10/31) – The Indian Health Service (IHS) announced the expansion of telehealth across IHS federal facilities to meet the needs of American Indian and Alaska Native patients. In July 2021, IHS awarded a clinical video telehealth contract to AA RingMD, a secure, cloud-based solution that enables patient-to-provider and provider-to-provider telehealth meetings. IHS has been working with AA RingMD staff and engineers to prepare for implementation.
Telehealth Research, Reports and Surveys
Institute for Medicaid Innovation: Survey: Medicaid Health Plans Share Successes During COVID-19 Response, Identify Challenges in Data Collection and Sharing (11/4) – The Institute for Medicaid Innovation (IMI) release the results from its 2022 Medicaid managed care organization survey, which offered insights and could help support efforts led by Medicaid health plans and state agencies to meet enrollees’ needs post-COVID. The survey results were included in a series of fact sheets, including one fact sheet focused specifically on telehealth. The fact sheet outlines both patient and provider barriers encountered by Medicaid health plans, Medicaid health plans’ use of specific telehealth modalities, and outcomes Medicaid health plans attributed to telehealth (to include increased patient access at 71 percent).
Healthcare Dive: COVID-19 Telehealth Diagnoses Fell in August (11/3) – According to Fair Health’s monthly tracker, COVID-19 diagnoses fell by about one percent to two percent as a share of telehealth claims nationally in August. In the South and West, COVID-19 fell from the second top diagnosis to the third from July to August. It remained in second place in the Midwest and Northeast. Mental health conditions remained the top telehealth diagnoses nationally and in every region, and one hour of psychotherapy remained the top telehealth procedure code.
PR Newswire: Survey: Consumers Prefer Telehealth Over In-office Visits for Routine Care (11/1) – A survey, sponsored by Epic-based virtual care platform KeyCare, found that 79 percent of consumers stated it was important that both their regular doctor and their telehealth provider had access to their health records for sharing critical data such as current medications or chronic health conditions. When given a choice between an in-office or a telehealth visit for several types of issues, respondents chose telehealth as their top choice almost half the time. For minor but urgent issues, 41 percent of respondents chose telehealth, compared to 19 percent for first-available, and six percent for whatever time worked best in their schedules. These findings suggest that patients want more telehealth options and prefer the idea of receiving virtual care from doctors and care teams who have the ability to view and share their comprehensive health records.
Hypertension: Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series Analysis in Three US Health Care Organizations (11/1) – A study published in the Alliance for Connected Care’s advisory board member American Heart Association’s journal Hypertension found that the availability of telemedicine may have helped mitigate the rise in blood pressure (BP) levels that was observed during the early months of the COVID-19 pandemic. In the study, supported by the National Institutes of Health (NIH), researchers found that blood pressure levels noticeably increased in the eight months after stay-at-home orders were issued in comparison to the roughly 18 month period before the pandemic. Researchers recommended that opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters or emergencies. For additional coverage, see The Hill.
Elevance Health: What Consumers Want from Virtual Primary Care – Findings (10/31) – A survey commissioned by Elevance Health found that 94 percent of adults who have used telehealth to access primary care are satisfied with the virtual experience, with 79 percent feeling in charge of their health. The poll also found that convenience and accessibility were top draws for telehealth among consumers. Other notable findings include:
People with a chronic health condition are more likely to be familiar with virtual primary care (52 percent vs. 42 percent).
41 percent of people with a primary health care doctor want to see more use of digital communication, such as text messages or emails.
52 percent with a primary care physician say they would use virtual primary care in addition to the care they receive from their current primary health care provider within the next year, while 59 percent are likely to do so within the next two to five years, and 62 percent beyond the next five years.
84 percent of people who have accessed virtual primary care say it has been very useful during the pandemic and that they plan to continue using it as pandemic conditions improve.
Large majorities of respondents say they want to use virtual primary care for prescription refills (76 percent), referrals to specialists (72 percent), non-urgent (67 percent) and/or urgent issues (58 percent).
71 percent say that the nation's care delivery system is improving with the use of telehealth.
83 percent say it's a great way to increase access to health care for people who may otherwise be unable to visit a provider in person.
Prescribe FIT: Prescribe FIT Releases Comprehensive Report on the State of Remote Patient Monitoring Technology for Orthopedics Today (10/30) – A white paper from Prescribe FIT outlines the current landscape for remote monitoring, analyzing data on its ubiquity and efficacy. The white paper references a review of several studies that demonstrate remote monitoring to produce clinically meaningful weight loss for patients, even helping them lose more weight relative to other interventions. Importantly, the report notes that barrier to entry is low for orthopedic practices, as remote patient monitoring companies can assist with implementation, monitoring, and coaching patients through their treatment program.
Fierce Healthcare: Patient Preference Survey Finds Drop in Telehealth Use, ER Visits Compared to 2021 (10/28) – Stericycle Communication Solutions, a patient engagement solutions vendor, released its third annual survey, which found that 45 percent of respondents had used telehealth in the last year, compared to 78 percent in 2021 and 71 percent in 2020. These findings are likely due to consumer preference, not a lack of telehealth availability. Among those that had used telehealth, younger adults were much more likely to have done so. These consumers (ages 18 to 34) were also more likely to seek care at nontraditional venues like retail health clinics and to display less provider loyalty than older generations (age 55 and up). Respondents of all ages prioritize location and convenience when seeking care, followed by insurance coverage and the quality of the provider.
Kaiser Family Foundation: Employer Health Benefits 2022 Survey (10/27) – Employers remain optimistic about the future role of telemedicine, even as COVID-19 pandemic restrictions ease. Kaiser Family Foundation’s annual Employer Health Benefit survey found that employers surveyed think telemedicine will be important for several kinds of care, with 36 percent saying that telemedicine will be very important in providing access to behavioral health services in the future, and another 31 percent saying it will be generally important. Employers think telemedicine is important for employees in remote or rural areas. Of the employers surveyed, 40 percent said that telemedicine will be very important in providing future access to care for enrollees in remote areas, and another 27 percent said it will be important for providing care. For additional coverage, see Becker’s Payer Issues.
Telehealth News and Market Developments
Forbes: Building a Telehealth Primary Care Workforce During a Physician Shortage (11/2) – Telehealth, is an oft-cited solution to the myriad of health care problems created by the U.S. physician shortage. Virtual care allows access to physicians for those who might not otherwise have it because of such things as a lack of nearby physicians in their rural community, mobility issues or lack of transportation. Specifically, primary care physicians are an important part of the growing telehealth landscape. But, if the telehealth trend continues as expected, then primary care physicians will need training, pay and support to ensure virtual exam rooms are staffed with experienced, trained and knowledgeable primary care physicians.
PR Newswire: Veta Health Partners with Parkview Health to Support Telehealth Monitoring (11/2) – Veta Health announced the launch of its virtual care offering at Parkview Health (Parkview), a not-for-profit, Indiana-based network. In partnership with Veta Health, Parkview will offer its patients virtual care programs designed to support patient recovery and self-management at home. The initial focus is utilizing Veta Health's patient engagement, device-based monitoring, and telehealth tools to manage patients who are at risk of readmission through Parkview's telehealth monitoring program. Parkview, which serves a large rural patient population, is utilizing the Veta Health virtual care platform to reduce disease exacerbation following discharge.
Healthcare IT News: Telemedicine Boosts Value-Based Care Performance for a Pediatric Practice (11/1) – Happy Kids, a pediatric practice in Arizona, experienced a 40 percent drop in patient volume during the COVID-19 pandemic. Happy Kids partnered with Equality Health and began to offer the Care Empower technology platform, which includes a telehealth solution. Care Empower allowed Happy Kids to offer health care with a virtual care approach for its patients. Telehealth now accounts for about 25 percent of Happy Kids’ visits. Before the pandemic, the practice averaged between 1,800 and 2,000 visits per week. After integrating telehealth technology, Happy Kids is seeing closer to 2,600 patients a week, which includes about 600 virtual visits. Compliance for taking medications, following up for the management of chronic care, and attending labs have also vastly improved.
Healthcare IT Today: Overcoming Barriers to Emergency Care During a Telehealth Appointment Overcoming Barriers to Emergency Care During a Telehealth Appointment (11/1) – What happens during a telehealth visit if the provider recognizes that the patient needs urgent help due to an emergent situation? When an emergency happens during a telemedicine event, the provider’s office can become chaotic. Telemedicine911 enables providers to seamlessly hand the patient off to the appropriate EMS provider no matter where the patient is located. The platform is integrated into a public safety answering point’s (PSAP) existing 911 software, allowing the dispatcher to quickly deploy EMS teams to the right location.
Healthcare IT News: Telehealth Summit Debrief Staffing Shortages, Wider Acceptance but Expansion Barriers (10/31) – Telemedicine technology and services vendor Avel eCare recently launched its inaugural annual Customer Forum and Innovation Summit focused on driving innovation in virtual care. Topics included the workforce shortage and burnout, increasing access to telebehavioral health, expanding critical and emergency care on demand, cybersecurity, and telehealth waivers and licensing. Healthcare IT News sat down with Doug Duskin, Avel eCare's chief executive, to get a debrief on the conference and find out the major themes and learnings.
Health Data Management: Sizing Up the Impact of Remote Patient Monitoring (10/31) – Remote patient monitoring (RPM) has transformed the way hospitals, health systems, and clinics deliver health care over the past two years. Hospitals and health care organizations can use RPM in coordination with a broader array of telehealth services to help build new outpatient revenue streams and reduce expensive in-hospital utilization. This combination of technology can reduce hospital admissions, lower health care costs and provide better care and outcomes for patients.
The Washington Post: A Psychiatry Wait List had 880 Patients and Couldn’t Keep Up (10/29) – As demand for mental health care surges, therapists are resorting to unconventional methods to meet the need. Last year, more than 129 million people lived in a federally designated mental health care professional shortage area and fewer than one-third of the U.S. population lived in an area where there were enough psychiatrists and other mental health professionals available to meet people’s needs. Expanding access to telehealth can help increase access to mental health care for adults and children in a variety of ways.
State Telehealth News and Activity
Wisconsin Department of Health Services (DHS): DHS Launches Free Telehealth Service for COVID-19 Treatment (11/2) – The Wisconsin Department of Health Services (DHS) announced a free telehealth service, which would streamline access to COVID-19 treatment. Anyone 18 and older who tests positive for COVID-19 can have a telehealth consultation with a health care clinician within 5-30 minutes. If eligible, a clinician will prescribe an oral antiviral pill that reduces the risk for severe symptoms, hospitalization, and death from COVID-19. The COVID-19 Treatment Telehealth service is available statewide, accessible through internet and telephone, and consultations are available in multiple languages.
OU Health: Oklahoma University (OU) Health Partners with Oklahoma City Public Schools on School-Based Telehealth Program (11/2) – OU Health is partnering with Oklahoma City Public Schools to provide district wide school-based telehealth and integrated health education programs. The program is receiving support from the Hearst Foundations, philanthropic entities which are independent of the Hearst Corporation. In preparation for the district-wide initiative, OU Health has launched a pilot program connecting students in six Oklahoma City Public Schools directly to health care professionals to assist with a range of childhood health conditions. This service is helping provide routine health care to kids including sick visits, behavioral care and chronic disease management, and health education.
Wisconsin DHS: Governor Evers and Wisconsin DHS Announce Grants to Expand Child Telepsychiatry Services, Access to Behavioral Health Care (11/1) – Governor Evers and the Wisconsin DHS awarded $2.5 million in American Rescue Plan Act (ARPA) funding to five organizations to increase access to child telepsychiatry services. The one-year grants of $500,000 each will support projects focused on recruiting and retaining psychiatrists and deploying technology to connect more providers with patients through virtual visits. These grants are part of Governor Evers’ broader efforts to strengthen Wisconsin’s behavioral health system at a critical moment. Over the past 12 months, Governor Evers has invested $113.2 million of ARPA funding to increase access to mental health and substance use services, enhance programs and resources for children in need, and bolster the behavioral health workforce.
KOTA Territory: Telehealth Grant Combines Technology and Sturgis First Responders (11/1) – Sturgis Emergency Medical Services, an emergency medical service (EMS) in South Dakota, was awarded funding to equip their ambulances with telecommunication equipment, which would connect doctors and nurses to EMS personnel to ensure patients receive the most appropriate care as quickly as possible. Telehealth specialists can provide status reports to the hospital about what’s happening with the patient, so that the hospital can have any supplies or staff prepped and ready to go.
Patient-Centered Outcomes Research Institute, “2022 PCORI Annual Meeting.” Possible future research initiatives were laid out at PCORI’s annual meeting. Through grants and awards funded by PCORI, researchers from around the country, including the Pacific Northwest Evidence-Based Research Center, Tennessee Consortium of Population Health, Vanderbilt University Medical Center, and Jefferson Health have been able to study the equitable use of telehealth before and during the pandemic. One grant opportunity that will be made in July 2023 seeks to study the use of telehealth in managing multiple chronic conditions among vulnerable populations in primary care.