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: Drug Enforcement Administration (DEA) Summary of the Notice of Proposed Rulemaking on Telemedicine Prescribing of Controlled Substances (2/27) - On February 24, 2023, the DEA released two major proposed rules around telehealth prescribing of controlled substances. The Alliance for Connected Care will continue to advocate on this issue, as we believe the current restrictions as written would effectively end most patient-provider relationships established over the last three years which rely on a telehealth practitioner prescribing a controlled substance.
Read the summaries for these proposed rules below:
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Selected Alliance Coverage
Politico Pro - DEA plans to revoke pandemic telemedicine rules “If the Biden Administration was proud of this, they wouldn’t have put it out after 7 p.m. on Friday,” said Krista Drobac, Executive Director of the Alliance for Connected Care, a telehealth lobbying group that had pushed for the DEA to maintain telemedicine access. “It’s absolutely antithetical to their goals on mental health.” (Similar statement in "Inside Telehealth: Key Telehealth Group, Upset With DEA Rule, To Lobby Congress, Agency For Changes)
Modern Healthcare- DEA's proposed remote prescribing rule draws criticism “I think it’s going to be extremely problematic for companies offering services primarily virtually or outside of the immediate geographic footprint of their facility,” said Chris Adamec, Vice President of the Alliance for Connected Care. “Many of the patients who are receiving these services will be cut off from access.”
Axios - DEA rules on prescribing controlled substances roil behavioral health The rules also did not acknowledge a long-awaited special registration process for remote prescribing of controlled substances Congress wrote into the Ryan Haight Act of 2008, said Krista Drobac, executive director of telehealth lobbying group Alliance for Connected Care.
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Congress
Politico Pro: Lawmakers on Both Sides Don't Like the DEA's New Telehealth Rules (3/3) - Republicans and Democrats in Congress are criticizing a Biden Administration proposal to make it more difficult for patients to access some controlled substances and other drugs by scaling back rules that facilitated prescribing by telehealth during the pandemic. Sens. Whitehouse (D-RI) and Warner (D-VA) and Reps. Schweikert (R-AZ) and Bucshon (R-IN) all shared similar sentiments.
“We should be building on the gains in access made during the pandemic and continue the telemedicine services many people on the road of recovery have come to rely on,” said Sen. Sheldon Whitehouse (D-RI). “We learned in the pandemic that telehealth treatment for opioid addiction can be done safely and effectively.”
Sen. Warner (D-VA): Statement of U.S. Sen. Mark R. Warner on Proposed DEA Rule on Future of Telehealth Prescriptions (3/1) - Sen. Warner (D-VA) released a statement on the DEA's proposed rule on the use of telemedicine to prescribe controlled substances:
“Given the dramatic shortage of mental health providers nationwide, expanded access to prescribers through telehealth is key to making sure that patients can continue getting their medications, including those that treat opioid use disorder, as they have for the past three years....Unfortunately, despite what Congress has been directing it to do since 2008, the rule proposed by the DEA once again neglects to set up a special registration allowing specially certified and trained prescribers to continue to safely prescribe controlled substances virtually without requiring an in-person visit."
Sen. Cassidy (R-LA): Cassidy, Shaheen, Scott, Kelly Reintroduce Bill to Allow HSAs to Be Used for Direct Primary Care (3/2) - Sens. Cassidy (R-LA), Shaheen (D-NH), Scott (R-SC), and Kelly (D-AZ) introduced the Primary Care Enhancement Act (S. 628), which would increase access to affordable preventative and primary care by allowing health savings accounts (HSAs) to be used to pay for direct primary care (DPC). With DPC, care is delivered in any setting, including using virtual care, telemedicine, and office visits beyond normal business hours.
Rep. Walberg (R-MI): Co-Chairs Launch Bipartisan Rural Broadband Caucus for the 118th Congress (3/1) - Reps. Walberg (R-MI), Clyburn (D-SC), Wittman (R-VA), Latta (R-OH), Kuster (D-NH), Craig (D-MN), Hudson (R-NC), and Fernandez (D-NM) announced the continuation of the bipartisan Rural Broadband Caucus in the 118th Congress. Expanded broadband access is key to the continued growth of telehealth.
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Sign-On Opportunity: Support the Telehealth Benefit Expansion for Workers Act
During the COVID-19 public health emergency (PHE), the Departments of Labor, Health and Human Services, and Treasury stated that they would not enforce any penalties if employers wanted to offer telehealth services to their employees who were not eligible for employer-sponsored health insurance. This flexibility is set to expire when the PHE ends on May 11, 2023.
Representatives Walberg (R-MI), DelBene (D-WA), Craig (D-MN), Estes (R-KS), Sherrill (D-NJ), and Allen (R-GA) recently introduced the Telehealth Benefit Expansion for Workers Act of 2022 (H.R. 824), which would permanently treat telehealth services as excepted benefits. With the PHE ending on May 11, passage of this legislation is essential to providing certainty and ensuring expanded, long-term access to these services.
We invite your organization to sign-on to this stakeholder letter expressing support for and endorsing the legislation, that will ensure hardworking employees, retirees, and their families can access high-quality, cost-effective care when and where they need it most, regardless of employment status.
The deadline to sign on to this letter is Friday, March 17.
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Administration
CDC: Percentage of Adults Who Used Telemedicine in Past 12 Months (3/3) - The CDC released data on the percentage of adults who used telemedicine by sex and health insurance coverage. Overall, in 2021, 35.3 percent of adults aged 18–64 years had a telemedicine visit with a health care professional in the past 12 months. The percentage was higher among women than men overall (41.7 percent versus 28.8 percent). Women were also more likely than men to have had a telemedicine visit among those with private health insurance (44.4 percent versus 30.5 percent), Medicaid or other public coverage (42.4 percent versus 34.3 percent), and those who were uninsured (19.5 percent versus 9.8 percent). Adults with private health insurance (37.5 percent) or Medicaid or other public coverage (39.3 percent) were more likely to use telemedicine compared with uninsured adults (14 percent), and this pattern was seen for women and men.
AHRQ: AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use (3/2) - The Agency for Healthcare Research and Quality (AHRQ) announced an information collection project, “The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use.” This program aims to improve two at-risk areas among telemedicine practices by implementing the AHRQ- and Johns Hopkins Armstrong Institute for Patient Safety and Quality (JHAI)-developed Comprehensive Unit-based Safety Program (CUSP) approach: (1) the diagnostic process for breast, colorectal, and lung cancer; and (2) antibiotic stewardship (AS). This program constitutes the first large-scale implementation of a quality improvement effort for the cancer diagnostic process and AS in telemedicine. Comments are due April 3, 2023
Multi-Jurisdictional Contractor Advisory Committee (CAC): Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) for Non-Implantable Devices (2/28) - Medicare Administrative Contractors held their Medicare Multi-Jurisdictional Contractor Advisory Committee (MJCAC) meeting. Multiple subject matter experts (SME) shared supporting data and studies around RPM and RTM. Notably, multiple SMEs noted the need to separately consider RPM and RTM issues. Learn more about the Alliance's advocacy around this issue.
CMS: CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency (2/27) - As part of ongoing efforts to provide up-to-date information to prepare for the end of the Public Health Emergency (PHE) for COVID-19, CMS released a new overview fact sheet on CMS waivers, flexibilities, and the transition forward. The fact sheet provides clarity on several topics, including telehealth services.
Inside Telehealth: Telehealth Stakeholders Upset Over DEA’s In-Person Prescribing Regs (2/24) - Telehealth stakeholders are upset with the DEA's plan to reimpose some restrictions on telehealth prescribing of controlled substances after the COVID-19 PHE ends, and they hope to work with Administration officials to come up with what they view as a more balanced approach. The Administration proposes to allow telehealth prescribing of schedule III and IV controlled substances following a telehealth encounter but requires the patient be seen in-person within 30 days prior to additional prescriptions. For additional coverage, see mHealth Intelligence and The New York Times.
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Telehealth Research, Reports and Surveys
Annuals of Medicine: Adaptation of the Tele-Harm Reduction Intervention to Promote Initiation and Retention in Buprenorphine Treatment Among People Who Inject Drugs (3/1) - The Tele-Harm Reduction (THR) intervention is a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP. The study found that harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatizing approach. This intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program setting.
Spine Journal: Utilization and Satisfaction Remain High Even After Easing of COVID-19 Lockdown Restrictions (3/1) - This study aimed to define telemedicine utilization rates during and after the initial height of the COVID-19 lockdown period and to determine patient satisfaction with telemedicine during and after the initial height of the COVID-19 lockdown period for spine patients at an orthopedic specialty hospital. The rate of telemedicine utilization in spine patients remains high, at approximately 1/3 of all visits, even after the initial peak coronavirus lockdown period. In addition, patient satisfaction with telemedicine remained consistent throughout the study period, regardless of pandemic restrictions on in-person visits.
Key Care: Consumers Prefer Telehealth to In-Person Visits While Traveling (2/28) - A survey sponsored by KeyCare found that nearly seven in 10 (68 percent) of consumers who needed minor but urgent medical services while traveling in the prior year received care via telehealth visits with their regular physicians or affiliated members of their physicians' care teams, outpacing all other care-delivery options. The survey also reveals the importance of health systems aligning with virtual care partners to increase access for traveling patients, while decreasing the risk of their own physicians violating state telehealth licensing regulations. The results of this survey confirm that there is substantial consumer demand for telehealth services while traveling, but just as importantly, reveal a strong patient preference for virtual visits with telehealth providers who are closely connected to their main health system.
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Telehealth News and Market Developments
Healthcare IT News: New Jersey Cancer Care Launches Remote Patient Monitoring (2/28) - With the Veris Cancer Care Platform, cancer care teams at New Jersey Cancer Care can now review patients' physiologic and clinical data in real time and deliver personalized care. With the first cohort of patients onboarded for the RPM program, the center aims to achieve greater treatment compliance and drive oncology innovation with connected medical devices, a patient app and an integrated cloud-based clinician portal.
Healthcare IT News: Cleveland Clinic's Virtual Second Opinions Shown to Impact Patient Care (2/28) - With the boom of telehealth caused by the pandemic, patients by and large are more comfortable than ever looking for telemedicine advice and care. Because patients can turn to telehealth to increase access to specialists who can help them solve significant health challenges, regardless of their locations, virtual care opportunities will continue to transform traditional health care in 2023 and beyond. Healthcare IT News interviewed Gokce Sezgin, head of marketing and patient liaisons at The Clinic by Cleveland Clinic, to learn how the virtual second opinions have improved health equity as well as how the telehealth platform integrates into clinical workflows and works behind the scenes to gather patient data.
Mercer University: Mercer Medicine Partnership Allows Students to See a Doctor Without Leaving School (2/28) - Mercer Medicine has partnered with schools in the Harris County School District to provide more accessible health care while cutting down absences. The telehealth initiative allows a student or employee to schedule a virtual appointment with Mercer Medicine. Using a telehealth workstation, the nurse takes the patient’s vital signs and conducts any other exams.
Healthcare IT News: Telehealth Trends in 2023: Virtual-First, Health Equity, and More (2/27) - Michael Gorton, the founder and CEO of Recuro Health, a virtual care company that offers virtual primary and urgent care, behavioral health, at-home lab testing, genomics testing, as well as a suite of supplemental benefits, shared his thoughts on big trends in telehealth this year.
American Hospital Association: Support of the Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act (2/22) - The American Hospital Association voiced support for the Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act (H.R. 1110). The legislation mandates that HHS, MedPAC and MACPAC each conduct a report and issue recommendations on telehealth. For additional coverage, see Healthcare Finance.
American Society of Health System Pharmacists (ASHP): ASHP Calls on Biden Administration to Utilize Pharmacists to Expand Access to Opioid Treatments (2/13) - ASHP urged the Biden Administration to take immediate action to utilize pharmacists as clinical care providers in our nation’s struggle against opioid use disorder (OUD). Specifically, the letter urges the Administration to allow prescribers to initiate medications for opioid use disorder (MOUDs) via telehealth, among others. The group says if the Biden Administration takes the opioid use crisis as seriously as the COVID-19 public health emergency, it will utilize the emergency authority. For additional coverage, see Inside Telehealth.
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Upcoming Events & Hearings
March 9 - The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, "Achieving Telehealth's Potential: The Federal Policy Landscape for Interstate Telehealth Practices," featuring Alliance for Connected Care Executive Director Krista Drobac.
March 9 – TeleBehavioral Health Center of Excellence, "Behavioral Health Integration Webinar: Telehealth for Integrated Care."
March 14 - California Telehealth Resource Center, "Telemedicine Policy Update - The Past, Present, and Future of the Regulation of Telemedicine."
March 14-15 – MedTech Intelligence, "ConnectedCare Summit East."
March 15 – Mid-Atlantic Telehealth Resource Center, “2023 Summit.”
March 26-29 – HLTH, "ViVE 2023."
April 12 - Arizona Telemedicine Program, "Navigating Telehealth Legislative and Policy Changes Beyond The Public Health Emergency."
April 17-21 – Healthcare Information and Management Systems Society, “HIMSS23 Global Conference & Exhibition.”
June 13-14 – mHealth Intelligence, "3rd Annual Remote Patient Monitoring Virtual Summit: Overcoming Technology Access Hurdles to RPM."
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