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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The Alliance for Connected Care commissioned an independent Medicare claims data analysis to better understand telehealth utilization and the potential financial impact of long-term telehealth expansion on the Medicare program. As expected, the findings of this analysis align with the individual experiences and data collected by Alliance for Connected Care members -- showing that telehealth does not lead to more utilization of services or more follow up visits.
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Politico Pulse: New Telehealth-Use Data (10/20) - Telehealth isn’t adding extra volume to Medicare usage that could drive up health care costs, says a new independent analysis by health policy analysis group Teus Health. The analysis was commissioned by Alliance for Connected Care. Evaluation and management visits in Medicare remained below 2019 levels in 2021 despite expanded telehealth access, according to the report. It also didn’t find evidence that patients using virtual care needed more revisits for the same issue than patients accessing care in person. The analysis also added to the growing body of evidence showing that treatment for mental health conditions, primary care and substance use disorder is particularly in demand via telehealth.
Inside Telehealth: Alliance For Connected Care: New Data Prove Telehealth Is Substitutive (10/17) - The Alliance for Connected Care has collected data it says prove that telehealth substitutes for instead of adding to in-person services, coming after the Congressional Budget Office said the verdict is still out on the hot-button issue that is center stage as telehealth stakeholders lobby to extend regulatory flexibilities that allowed telemedicine to explode during the COVID-19 pandemic. “We haven’t seen any increase in total utilization so those people getting telehealth are people who would have had in-person visits, so it is a full substitution effect. There is no data to show that more services are used when telehealth is available,” said Alliance for Connected Care.
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Advocacy
Sign New Letter to Congress on High-deductible Health Plan Telehealth - In addition to our previous advocacy, the Alliance for Connected Care is joining another group letter urging Congress to extend the flexibility allowing pre-deductible coverage of telehealth services in a high-deductible health plan coupled with a health savings account (HDHP-HSA) as part of a year-end legislative package. The letter explains that health coverage is offered prospectively and, therefore, this matter must be addressed before 2023. Responses are requested by November 10th.
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Congress
Rep. Kuster: Kuster, Trahan Call on Biden Administration to Support Audio-Only Telehealth Flexibility for Opioid Addiction Treatment (10/19) - Reps. Kuster (D-NH) and Trahan (D-MA) wrote a letter to the Drug Enforcement Agency (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) requesting the extension of temporary telehealth flexibilities for the treatment of opioid use disorder (OUD). Currently, buprenorphine treatment for OUD can be initiated via audio-only telehealth services under the COVID-19 public health emergency (PHE) declaration. For additional coverage, see Fierce Healthcare and Inside Telehealth.
Sen. Moran: Sens. Moran, Tester Push to Expand VA Telehealth Services for Rural Veterans (10/17) - Sens. Moran (R-KS) and Tester (D-MT) urged the Department of Veterans Affairs (VA) to expedite its efforts to establish a telehealth grant and access point program to better care for rural veterans as directed under the law. Sens. Moran and Tester further highlighted how the new grant program would allow non-VA facilities, including Veterans Service Organizations (VSOs), nonprofits or businesses, to become a telehealth access point for local veterans living in rural or remote areas to receive care closer to home. VSOs in particular have been consistent supporters of increasing telehealth access for veterans in rural and remote areas and would be able to utilize the program to help bolster veterans’ access to care.
Rep. Murphy: A Republican Path Forward (10/17) - Rep. Murphy (R-NC) published an opinion piece in the North State Journal detailing the House Republican “Commitment to America” policy agenda. He highlights the Healthy Futures Task Force priority to safeguard telehealth access. For more information on their telehealth priorities, see the full recommendations here.
Politico: Budget Wonks' Say Telehealth's Future (10/19) - Sen. Schatz (D-HI) was championing telehealth before the COVID-19 pandemic made it commonplace. As this Congress winds down, the Hawaii Democrat is pressing colleagues to take up legislation to extend the Health and Human Services Department’s pandemic rules that allow Medicare beneficiaries to more easily have virtual appointments with their doctors. He notes that the Congressional Budget Office (CBO) is the biggest challenge for telehealth legislation to move forward. "There’s no evidence at all in the real world that telehealth costs more money, but the idiosyncrasies of CBO scores sometimes make it seem like it’s an expensive proposition." Sen. Schatz (D-HI)
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Administration
HHS Office of Inspector General (OIG): Home Health Agencies Used Multiple Strategies To Respond to the COVID-19 Pandemic, Including Telehealth (10/18) - Home health agencies (HHAs) developed strategies to respond to challenges during the COVID-19 pandemic, including telehealth. Telehealth flexibilities under the public health emergency have helped HHAs provide care while reducing COVID-19 exposure and dealing with staffing shortages. OIG recommends that the Centers for Medicare and Medicaid Services (CMS) evaluate how HHAs are using telehealth-specifically, the types of services provided via telehealth and the characteristics of patients who benefit from these services.
HHS Office of the Assistant Secretary for Preparedness & Response: Renewal of Determination that a Public Health Emergency Exists (10/13) – On October 13, Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the current public health emergency (PHE). The PHE will now continue for another 90 days (January 13, 2023), meaning expanded telehealth access will continue during this time frame.
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Telehealth Research, Reports and Surveys
Cureus: Management of Obese Type 1 Diabetes Through Telemedicine During COVID-19 Pandemic Lockdown: A Case Report (10/21) - This report shows that lifestyle modification through telemedicine can immensely help in managing uncontrolled Type 1 diabetes mellitus (T1DM) with associated morbid obesity in lockdown situations, with the help of the diabetes educator. In this case, the complicated history of double diabetes was taken through telephonic and online consultations with the help of a nutritionist and diabetes educator, and the treating clinician supervised the insulin doses and frequency. Implementing diabetes education via telemedicine in circumstances such as the COVID-19 pandemic can help achieve the best possible compliance for strict diet adherence, regular exercise and monitoring, reducing obesity, glycosylated HbA1c, insulin doses, and risk of depression in a person with double diabetes.
AHIP: New AHIP Resource: The Role of Telehealth in Expanding Mental Health Support (10/20) - AHIP released an infographic that highlights how health insurance providers are breaking down the barriers to telehealth, leading to lower patient costs, improved convenience and access to care, more choices of doctors and clinicians, and improved quality of care.
Takeaways from the infographic include:
- Almost 40 percent of mental health visits were conducted through telehealth in 2020, for example, compared to less than 1 percent in 2019, a 100-fold increase.
- Telehealth accounted for 66 percent of all mental health visits for kids during the COVID-19 pandemic.
- 57 percent of patients preferred telehealth for their mental health visits.
Trilliant Health: 2022 Trends Shaping the Health Economy (10/20) - The 2022 Trends Shaping the Health Economy analysis found telehealth volumes peaked at 73.7 million visits in the second quarter of 2020, while visits during the first quarter this year reached 46.4 million. About 80 percent of patients had between one and four visits last year. Behavioral health continues to be a significant use case for telehealth, making up nearly 60 percent of visits during Q1 2022. In comparison, more than 32 percent of telehealth visits were for behavioral health reasons during the first quarter in 2019.
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The Center for Connected Health Policy released their Fall 2022 Summary Report, which highlights certain aspects of telehealth policies. The report found that audio-only telehealth more than doubled since Spring 2021. For licensure, more states than ever before have added a cross-state licensure exception, out-of-state telehealth registration process or telemedicine license. For additional coverage, see Beckers Hospital Review.
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JD Supra: Telehealth's Post-Pandemic Growth Trajectory (10/18) - DEA waivers regarding the Ryan Haight Act could play a major role in telehealth’s future. In the first decade of the 21st century, Congress enacted the Ryan Haight Online Pharmacy Consumer Protection Act in 2008 as part of an attempt to rein in the burgeoning online marketplace for prescription drugs—particularly those involving controlled substances—which had largely evaded prior enforcement actions. However, public policy has failed to enact the waiver of the Ryan Haight Act.
Journal of AHIMA: Solutions for Challenges in Telehealth Privacy and Security (10/17) - Telehealth, using electronic information and telecommunication technologies to provide care for patient visits, has rapidly grown and plays an important role as a valuable resource during and after the post-COVID-19 pandemic. However, privacy and security in telehealth practices have been identified as major concerns and challenges for the development of successful telehealth services. Patients’ information, both clinical and administrative, should be protected from breaches and cyberattacks. Ultimately, patients should have the ability to control, access, and manage their personal and health information. For additional coverage, see Inside Telehealth.
JAMA Network Open: Association of Adequacy of Broadband Internet Service With Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic (10/17) - This study published in JAMA Network Open found veterans living in areas with poor broadband speed were less likely to use video telehealth after the onset of the COVID-19 pandemic, pointing to potential disparities in access. The findings suggest that broadband availability is associated with video-based telemedicine use. Addressing broadband can increase access to equitable telehealth services. For additional coverage, see Mobi Health News.
Ochsner Health: Digital Health Pilot Dramatically Improves Outcomes for Medicaid Patients Battling Chronic Diseases, Among First to Do So (10/17) - Ochsner Health, a health system in the Southeastern United States, released the findings of a new pilot program that highlights how access to digital medicine with remote patient management can improve outcomes for Medicaid patients battling chronic diseases like hypertension and Type 2 Diabetes. Nearly half of all out-of-control hypertension patients under control at only 90 days, which was 23 percent more likely than usual care. Control rates continued to improve as patients remained in the program during its first 18 months. More impressively, 59 percent of people with poorly-controlled diabetes achieved control over their condition as part of the digital program – a rate twice as high as usual care. For additional coverage, see mHealth Intelligence.
American College of Surgeons: Telemedicine Reduces Odds of No-Show Clinic Visits By More Than Two-Thirds for Surgical Patients (10/16) - An American College of Surgeons (ACS) study found that telemedicine was effective at reducing no-show visits. No-show rate was highest among in-person appointments (11.7 percent) compared to telemedicine visits (2.5 percent). Research findings were presented at the Scientific Forum of the ACS Clinical Congress 2022. “Low access to transportation is the number one reason for patient no-show visits.* Telemedicine is a feasible way for us to reach out to patients who would otherwise have a lot of barriers to access the health care system,” said lead study author Connie Shao, MD, a general surgery resident at the University of Alabama Birmingham. For additional coverage, see mHealth Intelligence.
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Telehealth News and Market Developments
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Neurology Today: Telehealth in Neurology Is Here to Stay Will Regulations and Reimbursement Keep Up? (10/20) - Neurologists rapidly adopted telemedicine practices at the height of the COVID-19 pandemic. But as the PHE the federal government declared has receded, advocates for tele-neurology question whether flexible licensure and reimbursement models will remain in place to make it more universally sustainable across state lines.
MedCity News: Competing in the Age of Telemedicine (10/20) - Two-thirds of US hospitals and health systems have transitioned to include a telemedicine offering. Providing remote consultations and treatments is convenient for patients, boosts provider availability, and increases care accessibility for underserved populations. Companies like Amwell, and MDLive have shown how virtual care can meet or exceed patients’ convenience, price, and value expectations.
American Journal of Managed Care: Implications of Telehealth Use on the Future of Oncology Care (10/20) - Many oncology practices embraced telehealth during COVID-19 as a cornerstone of safety for patients with cancer, many of whom are immunocompromised, only to discover added value. Beyond merely limiting unnecessary in-person patient visits to clinics, some practices report a more comprehensive and effective application of telehealth. The American Society of Clinical Oncology published its standards and practice recommendations in September 2021, providing discrete suggestions for topics and services that can be performed in a virtual vs a face-to-face setting.
Healthcare IT News: A Closer Look at The Tech Needed for New Care-at-Home and Aging-in-Place Models (10/20) - Connecting care teams and enabling information sharing among hospitals, group practices and, most importantly, families is crucial to helping more senior citizens get health care at home. In this interview, Healthcare IT News discusses the role of health IT and telehealth's role in aging in place with Ashish V. Shah, CEO of Dina, an AI-powered platform for care-at-home models.
Economic Times: How to Make the Best Use of Telehealth (10/19) - Telehealth services have made accessing specialists a pretty simple task. There are moments when you require special attention or you might be going through some health issue that needs to be addressed by some specialist. That is where telehealth services come to the rescue, as it enables you to seek an expert anytime and anywhere.
Insider Intelligence: Samsung's Smart TV Telehealth Strategy Leaves the Hospital for Home (10/18) - Samsung partnered with virtual primary care provider HealthTap to offer telehealth visits on its smart TVs. More and more care options are shifting to the home as providers and insurers shift to value-based care models and look for the most cost-effective venue to deliver care. Telehealth is a major component in this movement.
The Verge: Opioid Addiction Doctors Want Telehealth Rules to Stay Relaxed (10/18) - Doctors treating patients with opioid-use disorder want pandemic-era telehealth rules to stay relaxed. Tens of thousands of people in the United States die each year from opioid overdoses, and telehealth makes it easier to connect people who are at risk of overdose with treatments. Some lawmakers have introduced bills that would let doctors keep distributing medication for opioid-use disorder over telehealth even after the end of the public health emergency. But some experts worry that drugs for opioid-use disorder will get caught up in backlash against telehealth prescriptions for other controlled substances, like Adderall.
Patient Engagement HIT: Retail Health Clinics Are Key on the Path to Health Equity (10/17) - Alternative care sites, such as retail health clinics, urgent care clinics, telehealth, and virtual health options, create more front doors through which patients can get medical care. Retail clinics, which are usually located in grocery stores or the local CVS, are also places folks feel comfortable visiting. Patients go there for their regular shopping, know which aisles to walk down, and are used to navigating the parking lot or taking a bus route to get there. When a patient steps into a retail health clinic or a community health clinic, or logs into a telehealth visit, they’re more likely to see a medical and administrative staff that looks more like them. That can make all the difference in patient experience and outcomes.
Healthcare IT News: What An Eventual End to the PHE Would Mean to Telehealth (10/17) - Since the COVID-19 PHE was declared in 2020, HHS has renewed the legislation every 90 days. Close to the end of the most recent expiration date, October 13, HHS Secretary Becerra again signed a renewal determination and it was posted without announcement late in the day. The inevitable end of the PHE brings questions regarding what will happen to telehealth benefits and the continuum of care in the absence of the PHE loom large. This article reviews what's at stake for telehealth when the PHE ends.
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State Telehealth News and Activity
Healthcare IT News: It's Remote Patient Monitoring and Virtual Walk-In for United Health Services Hospitals (10/19) - United Health Services Hospitals, a health system serving South Central New York, launched its virtual Walk-In program in July 2019. The Virtual Walk-In was a direct to patient offering for minor acute complaints. United Health Services Hospitals was awarded $562,116 from the FCC telehealth grant program for telemedicine carts and patient monitoring devices to provide telehealth services to patients at home, many of whom are located within high-poverty, rural and underserved areas.
Inside Telehealth: Lobbyists Expect Some Resistance To Telehealth Policies At State Level (10/18) - Lobbyists said that, along with the general expansion of telehealth services at the state level, interstate licensing and the prescription of controlled substances are areas of focus as stakeholders face uncertainty of whether federal regulations will be passed. While state lawmakers recognized that expanded access to telehealth during the COVID-19 pandemic was a positive tool in responding to a public health crisis, New Mexico and Ohio are two states that attempted to walk back some of the broad telehealth policies initially adopted by the state legislature during the pandemic.
New Jersey State Sen. Schepisi: Schepisi Bill to Improve Safety of Telehealth Services Advances (10/17) - The Assembly Health Committee has advanced A-2193, the Assembly version of Senator Holly Schepisi’s bill, S-606. This legislation is designed to ensure that all patients receive the same standard of care in emergency situations regardless of whether they are in their doctor’s office or attending their appointment virtually.
Carolina Public Press: No Internet, No Telehealth: Rural North Carolina Residents Struggle to Connect with Doctors Virtually (10/18) - Fewer than one in four residents has access to broadband. There's also an average of 6.8 primary care physicians, eight nurse practitioners and 1.8 physician assistants per 10,000 Western North Carolina residents. Telehealth is often promoted as the solution to increasing access to health care. But it is not effective without a reliable internet connection. Inability to access telehealth can not only impede a person’s ability to receive basic health care, but it can also mean missing out on other benefits of virtual medicine, such as a doctor’s ability to observe a patient’s living conditions.
Commonwealth of Pennsylvania: Behavioral Health Telehealth Roadmap (10/14) - The Office of Mental Health and Substance Abuse Services (OMHSAS) released the Pennsylvania Behavioral Health Telehealth Phase II Roadmap, which was developed in collaboration with the OMHSAS Telehealth Steering Committee and Mercer Government Services Consulting. This report focuses on identifying and prioritizing recommendations for short-term and long-term implementation of telehealth services in the Commonwealth. The roadmap includes example documents developed by the Steering Committee that can be used and personalized by the provider when implementing telehealth services. For additional coverage, see Rehabilitation & Community Providers Association.
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Upcoming Events and Hearings
October 27 - Association for Behavioral Health and Wellness, "CPT Coding and Billing Changes for Mental Health: What to Expect for Calendar Year 2023."
October 28 – Center for Connected Health Policy, “CCHP Fall 2022 Webinar Series: Federal Policy & Telehealth: What to be Aware of Going Forward.”
October 28 – Mid-Atlantic Resource Center, “Questions about Telehealth Basics or Telehealth Health.”
November 9 – Mid-Atlantic Resource Center, “Questions about School-Based Telehealth.”
November 10 – National Consortium of Telehealth Resource Centers, “Telehealth Development and Expansion at Specialty Pediatric Health System.”
November 15 – Arizona Telemedicine Program, “Policy Summit.”
November 16 – Arizona Rural Health Association, “The Rural Health Landscape.”
November 16-18 – Society for Education and the Advancement of Research in Connected Health, “The National Telehealth Research Symposium.”
December 8 – American Medical Association, “Panel Discussion: 2022 Telehealth Retrospective & 2023 Predictions.”
Previous Events, Videos, and Postcasts
Politico, "Pulse Check: Telehealth's Double-Edged Sword." As lawmakers weigh whether to extend pandemic-era rules that made it easier for Medicare beneficiaries to go to virtual visits, advocates for people with disabilities fear providers’ financial incentives could turn what’s been a benefit into a danger. Ben Leonard talks with Alice Miranda Ollstein about the calculus in Congress. Plus, a dispatch from Pennsylvania, where a Pennsylvania statehouse race is testing whether the GOP’s last abortion rights supporters can survive.
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