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.
Roll Call: (5/12) – An article in Roll Call highlights efforts from the Alliance for Connected Care and others in convincing those on Capitol Hill and elsewhere that preconceived – and pre-COVID-19 – perceptions of telehealth are unfounded. “We have great frustration with our inability to convince lawmakers with evidence and data and experience that telehealth is not uniquely subject to fraud, nor is it going to cause over-utilization,” said Krista Drobac, executive director of the Alliance for Connected Care. One survey from hospital giant Ascension found that just 14 percent of telehealth patients would have done nothing if a virtual visit were not an option. Survey data that the Alliance for Connected Care collected from other health systems show that the number of overall services remained largely flat throughout the pandemic, even as doctor’s offices reopened.
Centers for Medicare & Medicaid Services (CMS): (5/14) – CMS released data highlighting the continued impact COVID-19 is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services. CMS found that from March through October, 2020, beneficiaries have forgone millions of primary, preventive and mental health care visits. Further, while utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound. In addition, the updated data snapshot demonstrates a marked increase in the number of services delivered via telehealth compared to prior years. The number of services delivered via telehealth surged 2,700% during the PHE to nearly 68 million between March and October 2020. However, this increase has not been enough to offset the decline in service utilization in other areas.
Department of Veterans Affairs (VA): (5/11) – VA published its second report detailing the department’s efforts to address the COVID-19 pandemic from July 1, 2020 to Jan. 1, 2021. For instance, to continue responding to the changing needs of the pandemic, VA moved many appointments to telehealth meetings to keep Veterans and employees safe. There has been a monthly average of 745,545 video encounters resulting in a 604% increase in home or offsite telehealth visits from the same period in 2019. View the press release.
Senate Finance Committee Hearing: (5/19) – The Senate Finance Committee will hold a hearing this week on “COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned.” CMS added over 200 telehealth codes during the pandemic and dozens of bills have been introduced over the past year and a half to make some or all of these codes and other waivers permanent. Witnesses include:
Jessica Farb, Director, Health Care, United States Government Accountability Office
Kisha Davis, M.D., MPH, Member, Commission on Federal and State Policy, American Academy of Family Physicians and
Linda V. DeCherrie, M.D., Clinical Director, Mount Sinai At Home and Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System
Narayana Murali, M.D., Executive Director and Board Member of America’s Physician Groups, Marshfield Clinic
Robert A. Berenson, M.D., Institute Fellow, Urban Institute
House Energy & Commerce Committee, Health Subcommittee Hearing: (5/12) – The House Energy & Commerce Committee, Health Subcommittee held a hearing on the Fiscal Year 2022 HHS budget. On April 9, 2021, the Biden Administration released its fiscal year (FY) 2022 discretionary funding request. Of particular note, Rep. Matsui (D-CA) asked HHS Secretary Becerra what, if any, regulatory restrictions Congress and HHS can work together on that do not require additional data – citing for example statutory limitations on using telehealth in certain zip codes or requiring beneficiaries to travel to a clinical setting to receive virtual care. HHS Secretary Becerra said that “there are some things that we can do without Congress having to pass a law… we all have now learned that telehealth can be a godsend for those who don’t have easy access to health care.” A recording of the hearing as well as opening statements can be viewed here.
State Telehealth Legislation
JD Supra: (5/13) – The expansion of telehealth to include audio-only telephonic communications has garnered increased attention as state lawmakers look to permanently enact telehealth flexibilities implemented during the pandemic. Some states, such as Nebraska and Oklahoma, have passed bills that would remove restrictions on or expressly allow audio-only telehealth into law. New York also made audio-only telehealth permanent in its definition of telehealth during the summer of 2020 (Senate Bill SB416), which set off a wave of telehealth action in the state. This article reviews other telehealth action in the state of New York and examines what might be next for telehealth policy changes.
State of Reform: (5/13) – Arizona Governor Doug Ducey recently signed another significant telehealth bill into law (House Bill 2596), which would increase broadband access for Arizona’s rural and tribal communities to expand access to critical remote services, and allow private broadband providers to install telecommunications infrastructure on highways. This is part of a central goal of Governor Ducey’s to permanently extend Arizona’s temporary telehealth expansions, and follows the signing of another major telehealth expansion bill into law that makes an executive order signed at the start of the pandemic permanent.
The Center Square: (5/10) – The Illinois House passed House Bill 3498, which would remove barriers to telehealth services related to reimbursement structures in place for providers. Charles James, president-elect of the Illinois Rural Health Association, said this bill addresses a problem at the state level that resulted in providers at rural health clinics and community health centers not getting paid for remote patient visits, however the issue still remains a problem at the federal level.
(5/10) – States and federal agencies are developing and implementing permanent telehealth policy changes as a result of the progress made during COVID-19, aimed at continuing to expand coverage and reimbursement of telehealth services beyond the pandemic. This analysis provides information on new state-level telehealth policy developments in Alaska, California, Colorado, Delaware, Kentucky, Maryland, Minnesota, Nebraska, New Jersey, South Dakota, Texas and Washington D.C.
Legislative Analyst’s Office: (May 2021) – This budget series post provides an analysis of the Governor of California’s Medi-Cal telehealth proposal, providing an overview of the Governor’s January budget proposal for an ongoing, post-pandemic telehealth policy, an assessment of the Governor’s proposals, and issues for legislative consideration.
Public Policy Institute of California: (5/12) – This article makes the case for why telehealth expansion in the state of California can help bring equity to health care. By expanding telehealth in the state, telehealth services can help expand access to care for rural residents, persons with disabilities, and low-income individuals who may lack transportation or flexibility to leave work to go to a health care appointment. The article provides an overview of how access to telehealth has made a difference for these populations and how such policies will be key for prioritizing health equity moving forward.
National Academies of Sciences, Engineering and Medicine (NASEM): (5/11) – A new report from the National Academy of Medicine argues that all federal and state policy changes expanding the scope of nursing practice during the pandemic should be made permanent by 2022, along with telehealth eligibility, insurance coverage and equal payment for services provided by nurses. The report also calls for increased funding to expand the workforce of nurses in specialties facing shortages such as public and community health, behavioral health, primary care, long-term care, geriatrics, school health and maternal health.
Revcycle Intelligence: (5/10) - In a recent special report, MGMA outlines insights from health care leaders on how practices can rebuild to pre-pandemic patient volumes and revenues through staffing stability, patient engagement, and telehealth. Among findings
in the report included that while specialist physicians saw the steepest decrease in compensation at the onset of the pandemic, primary care providers also saw steep compensation drops in March and April 2020, but telehealth expansion helped to restore volumes and compensation in the spring.
Telehealth News and Market Developments
CNBC: (5/14) – An op-ed argues that stronger remote patient monitoring and telemedicine policies will be critical post-COVID for rural, low-income and elderly populations. A significant level of legislative activity indicates that policymakers are aware of the problem and interested in expanding access to virtual health-care. In fact, more than 200 bills are pending at the state level, and dozens of bills have been introduced in Congress – from both sides of the aisle – to allow Medicare and Medicaid coverage and reimbursement of digital health tools to continue beyond the coronavirus pandemic. However, a patchwork of laws is insufficient to improving patient access to care.
Association for Clinical Oncology (ASCO): (5/14) – In response to the House and Ways Means Health Subcommittee hearing entitled “Charting the Path Forward for Telehealth,” the Association for Clinical Oncology submitted comments conveying the organization’s view on how patients with cancer and oncology professionals are better served when telehealth can be utilized. The Association cited expanded patient access and health equity as reasons for implementing broader telehealth coverage across the United States.
American Academy of Neurology (AAN): (5/13) – The American Academy of Neurology published a ‘Telehealth Position Statement’ which updates the 2014 statement to include experiences learned during the COVID-19 pandemic and asks members of Congress for a “permanent expansion of telehealth services to improve safety and access to care and to reduce health care costs for people with neurologic disease.”
Axios: (5/13) – Mayo Clinic and Kaiser Permanente announced they have teamed up to scale the use of hospital care in patients' homes, starting with a shared investment in Boston-based company called Medically Home Group. Medically Home sets up all the necessary tools, such as remote monitoring technology as well as an integrated care team, to monitor and offer care to patients in their homes. They estimate 30% of hospitalized patients can benefit from the model.
Health Affairs: (5/10) – Health Affairs this past week published several articles on telehealth including:
Congress: Act Now to Ensure Telehealth Access for Medicare Beneficiaries. Without intervention from Congress, many Americans that have come to rely on telehealth services during the PHE will abruptly lose access to these services once the PHE ends. The author states that Congress can act now to remove the origination and geographic restrictions on telehealth coverage and ensure access to telehealth for all Medicare beneficiaries.
Mutual Recognition of Physician Licensure by States Would Provide for Better Patient Care. The COVID-19 pandemic has encouraged the rapid adoption of telehealth and demonstrated the practicability and utility of flexibility in physician licensure. The state-based system of medical licensure in the US continues to restrict access to telehealth adoption and increased flexibility of medical practice. Attempts to ease licensure restrictions such as with the Interstate Medical Licensure Compact (IMLC) are not sufficient, as several barriers to obtaining licensure in other states remain. This blog looks at this issue and asserts that recognizing medical licenses from sister states would expand access to telehealth services and better prepare the US for future public health emergencies. Mutual recognition, which will reduce barriers to interstate practice, is necessary to promote convenient patient access to safe medical care at lower cost.
How Telehealth Can Enable New Care Management Strategies in Alternative Payment Models. The authors note that telehealth can help shift care management strategies under APMs from a one-directional “pull” intervention to a bidirectional intervention that includes a “push” component. Further, these benefits could be applied to programs targeting outlier patients to improve their effectiveness, for instance by reducing staffing and other program costs or improving patient triage. However, it remains unclear what elements of telehealth are best implemented within APMs, as compared to the broader fee-for-service environment, the author notes.
Understanding the Case for Telehealth Payment Parity. As policymakers determine the future of telehealth payment policy, CMS, state Medicaid programs, and commercial insurers should wait for sufficient data to accurately estimate the impact of telehealth on access, costs, and quality. In addition, while there are several arguments against payment parity for telehealth, data has already shown that prior beliefs about clinical effort, value, overuse, and practice expenses can be counterargued. The authors find that these organizations should temporarily continue payment parity for video and audio-only telehealth after the public health emergency to allow telehealth to flourish outside of the pandemic. Thereafter, robust research can be used to determine whether their investment in telehealth improves care for beneficiaries and whether or not payment rates are aligned with the costs of delivering telehealth.
The Coming Conflict Over Tele-Visits: The Need for Innovation in Payment and Information Sharing. Physicians, payers, legislators, and regulators are working to define the best uses of tele-visits to increase the value of these services to patients and to the long-term sustainability of health care costs. As the COVID-19 PHE comes to an end, tension about what is the most appropriate use for tele-visits and how best to pay for them will intensify in both public and private reimbursement programs, the article notes.
Center for Connected Health Policy, “Telehealth & Medicaid: Medicaid Telehealth Policies for Seniors.” This webinar brought together Medicaid officials from Connecticut and California for a panel discussion about how state programs and Medicaid agencies incorporate telehealth into their services for seniors and other benefits for dually-enrolled Medicare and Medicaid beneficiaries. Panelists discussed telehealth flexibilities implemented during the pandemic and which changes they believe the state will permanently adopt moving forward after the end of the public health emergency.
Health Affairs, “Podcast: Three Unanswered Questions for Telehealth’s Future.” In this episode of the Health Affairs This Week podcast, Chris Fleming and Rob Lott of Health Affairs discuss a recently published series of blog articles on how COVID-19 has reshaped the telehealth landscape, and unpack the biggest questions regarding the future of telehealth.
Chief Healthcare Executive, “Podcast: Telehealth, Remote Monitoring, and the American Rescue Plan with Waqaas Al-Siddiq.” On this episode of the Data Book podcast, Waqaas Al-Siddiq, PhD, founder and CEO of Biotricity, discussed how telehealth and remote patient monitoring will help shape health care going forward and what challenges lay ahead. Podcast guests also discussed how the Biden Administration’s American Rescue Plan has impacted these health care technologies and what efforts are being taken to ensure they continue to be accessible to patients.