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.
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Administration
HHS: Fall 2021 Regulatory Agenda (12/10) – HHS released its Fall 2021 Regulatory Agenda. Notably, the Substance Abuse and Mental Health Services Administration (SAMHSA) plans to issue a proposed rule in September of next year titled, “Treatment of Opioid Use Disorder With Buprenorphine Utilizing Telehealth.” The description is below:
- In the face of an escalating overdose crisis and an increasing need to reach remote and underserved communities, extending the buprenorphine telehealth flexibility is of paramount importance. To permanently continue this flexibility among OTPs after the COVID-19 public health emergency ends, SAMHSA proposes to revise OTP regulations under 42 CFR part 8.
- This change will help facilitate access to and ensure continuity of medication treatment for opioid use disorder in SAMHSA-regulated opioid treatment programs. The change will likely reduce long-term costs at the practice level, while also facilitating access to treatment. However, a minority of providers may face upfront technology costs as they scale-up the provision of treatment via telehealth. We expect that since many providers have now shifted in part to telehealth services during the COVID-19 Public Health Emergency, their costs should now be related to equipment upgrades and software updates. The cost to patients would involve either use of Wi-Fi, data usage with their respective cellular devices or landline telephone service. We expect that many patients already have acquired some of these services, so the cost would be monthly maintenance of such services.
CMS: Update to State Medicaid and CHIP Telehealth Toolkit (12/6) – CMS released an updated Medicaid telehealth toolkit, to clarify that states may deliver covered services via audio-only telehealth both during the COVID-19 Public Health Emergency (PHE) and beyond the PHE. This release also provides additional support state Medicaid and CHIP agencies in their adoption and implementation of telehealth. “Nothing in federal Medicaid law or policy prevents states from covering and paying for Medicaid services that are delivered via audio-only technologies,” CMS says. “This broad flexibility to cover and pay for Medicaid services delivered via telehealth, including via audio-only technologies, was in place prior to the COVID-19 PHE, has not changed during the COVID-19 PHE, and will continue to be available to states after the end of the COVID-19 PHE.”
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Congress
Telehealth Extension Act (12/9) – Rep. Doggett (D-TX) and 30 bipartisan cosponsors introduced the Telehealth Extension Act (H.R.6202), which would establish requirements for the provision of certain high-cost durable medical equipment and laboratory testing; to extend and expand access to telehealth services. View the press release and bill text on our tracker when posted.
The Telehealth Extension Act would:
- Permanently lift geographic and site-based restrictions so Medicare beneficiaries can use telehealth regardless of their zip code, and in the comfort and convenience of their own home or at designated health facilities offering telehealth.
- Support the adoption of telehealth in underserved communities by ensuring Federally Qualified Health Centers, Rural Health Clinics, Indian Health Service facilities, and Native Hawaiian Health Care Systems can furnish telehealth services.
- Provide a two-year temporary extension of COVID-19 emergency telehealth waivers. These waivers include permitting providers like Speech Language Pathologists, Occupational Therapists, and Physical Therapists to furnish telehealth services; enabling Critical Access Hospitals to continue providing outpatient behavioral therapy services through telehealth; and permitting payment for appropriate audio-only services.
- Promote program integrity with reasonable guardrails for a small subset of telehealth services that have been targets of fraud without limiting patients’ access to care. The bill would require an in-person appointment within 6 months prior to ordering high-cost durable medical equipment (DME) or major clinical laboratory tests. The legislation also authorizes CMS to audit outlier physicians ordering DME and lab tests at high rates and recover fraudulent payments. Finally, CMS will track who is billing for DME and lab tests by requiring providers to use their own national provider identifier (NPI) when billing Medicare for a telehealth service.
- Improve disaster preparedness by providing broad authority for CMS to authorize telehealth flexibilities during future emergencies.
Inside Health Policy: Congress Poised to Let CARES Pre-Deductible Telehealth Provision Expire (12/8) – The House failed to include an extension of a provision enacted through the CARES Act that has allowed employers to provide coverage for telehealth services pre-deductible for individuals with HDHP-HSAs in its newly passed provider relief measure. This provision is set to expire on December 31, 2021, as it is not tied to the public health emergency unlike other telehealth flexibilities. This policy was on the short list of provisions that the House and Senate was considering for this bill, but fell out during negotiations with the Ways & Means Committee due to lack of Democratic support. This policy has been widely adopted and is currently used by about 40 percent of employers, and groups including the Alliance for Connected Care continue to advocate for the policy’s extension.
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Telehealth Research, Reports and Surveys
AJMC: Telehealth User Experiences During COVID-19: A Case Study of Outpatient Cardiovascular Clinics Affiliated With a Large Academic Practice (12/10) – The COVID-19 pandemic led to a rapid and universal uptake of telehealth. This cross-sectional observational study between May and September 2020 examined providers’ and patients’ perceptions about barriers to telehealth use.
- The top barriers reported by the 43 providers who completed the survey were lack of vitals/electrocardiogram (80%), internet quality (64%), and patients experiencing technological challenges (61%).
- More than two-thirds transitioned their practice to greater than 75% telehealth during the pandemic, and 58% expected to offer up to 25% of their care through telehealth after COVID-19.
- Of the 64 patients, top barriers to telehealth use included poor audio (18%) and video (12%) quality and familiarity with technology (18%). Although 49% rated the telehealth visit better than or just as good as an in-person visit, 31% rated it worse. The majority (66%) would definitely or probably use telehealth again.
Kaiser Family Foundation: State Policies Expanding Access to Behavioral Health Care in Medicaid (12/9) – States are taking advantage of new federal policy options to address behavioral health issues in Medicaid and are also developing other initiatives to improve mental health and substance use outcomes. KFF issued a brief that summarizes state initiatives to expand behavioral health care in Medicaid in state fiscal year 2021 and/or 2022. Among them include telehealth:
- As of July 1, 2021, all responding states cover audio-visual telehealth delivery of behavioral health services, and almost all also cover audio-only delivery of these services. All responding states (47) reported that they sometimes or always covered audio-visual delivery of FFS mental health and SUD services. Almost all reported covering audio-only delivery of FFS mental health (45 states) and SUD services (44 states). Nearly all MCO states reported requiring MCOs to cover the same services via telehealth as covered in FFS. Across service categories, most states are considering post-pandemic telehealth policies, with many weighing expanded access against quality concerns especially for audio-only telehealth. States were more likely to report plans to maintain audio-only coverage for mental health and SUD services compared to other, non-behavioral health services.
- States report that telehealth helped maintain and expand access to behavioral health care during the pandemic. Thirty-one states (out of 45 responding) reported that telehealth, especially expanded audio-only coverage, had particular value in maintaining or improving access to behavioral health services. The survey also asked states to identify the top two or three categories of behavioral health services that had the highest telehealth utilization during FY 2021; states most frequently identified psychotherapy, counseling (for mental health conditions and/or SUD), and patient evaluations.
FAIR Health: Monthly Regional Tracker (12/6) – From August to September 2021, mental health conditions increased in percentage share of all telehealth claims nationally, according to FAIR Health’s Monthly Telehealth Regional Tracker. The Monthly Telehealth Regional Tracker uses FAIR Health data from privately insured populations, including Medicare Advantage to track how telehealth is evolving on a monthly basis. In the case of mental health services, telehealth has helped populations overcome stigma, gain easier access and receive more consistent care, said Krista Drobac, executive director of the Alliance for Connected Care, and reported by Modern Healthcare and Advisory Board. Overall telehealth usage rose to 4.4% of all medical claims in September, as COVID-19 variants and surges slowly began driving patients away from in-person visits. Though virtual care appointments increased in the Midwest and West, they decreased in the Northeast and there was no change in their use in the South. Reductions in telehealth usage are not inherently bad, Drobac said, as industry experts always expected telehealth levels to fall as patients returned to in-person visits. What matters is the ability to pursue virtual options.
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State Telehealth News and Activity
Cleveland.com: Ohio General Assembly sends Gov. Mike DeWine bill permanently expanding telehealth (12/8) – The Ohio General Assembly passed House Bill 122, which would make permanent the temporary flexibilities implemented at the start of the pandemic for telehealth visits to psychologists or therapists, audiologists, physical therapists, dietitians, optometrists and other health care providers. The bill would require public and private insurance to reimburse medical providers for covered telehealth services. It now awaits signature from Governor DeWine.
Healthcare IT News: A Hawaii health system meets island community and COVID-19 need with telehealth (12/7) – Queen’s Health Systems in Hawaii has been building telehealth services over the last decade to meet patient needs, especially given the unique challenges many patients face given the state’s island geography and relative isolation. This began with hospital-based telemedicine and building out direct-to-patient telehealth services. During the pandemic, the health system used FCC COVID-19 telehealth funds to standardize its technology to enable video calls to be initiated out of Epic through the ExtendedCare Virtual Care Room to connect with patients at any location, which allowed staff to better care for patients with COVID who were hospitalized in the system’s infectious disease unit.
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Telehealth News and Market Developments
NY Times: Telehealth Became a Lifeline for Older Americans. But It Still Has Glitches (12/11) – Doctors and patients reminisce on their perceptions and overall positive experiences of telehealth during the pandemic. Dr. Ben Forsyth, 87, and a retired internist and university administrator had doubts about telehealth. Still, he logged on through Mount Sinai’s patient portal (“I wouldn’t say it was completely user-friendly”) on his laptop — and quickly became a convert. “It should be part of the options that people have,” said Dr. Forsyth.
Modern Healthcare: CVS Health maps out path to steer into primary care delivery (12/9) – CVS Health is launching a plan to use telemedicine, new clinics and teams of doctors, nurses and pharmacists to push deeper into managing customer health. CVS on Thursday outlined a future that it expects to be defined by delivering care with what it sees as a unique mix of resources. The company says it intends to add a few hundred primary care centers to its mix of drugstores and "HealthHUB" locations it started introducing a few years ago. The company aims to open about 1,000 of those HealthHUBs this year. Those locations can include regular drugstore services plus employees like dietitians. The clinics will include a doctor-led care team that also may include social workers and mental health specialists.
Amwell: Amwell Launches “Mind Your Mind” a Mental Health Initiative with Social Ambassador Ashley Tisdale (12/9) – Amwell announced the launch of “Mind Your Mind” a new mental health initiative designed to raise awareness for mental health issues and help people receive care via a licensed therapist or psychologist.
STAT News Op-ed: Archaic in-person exam for digital prescribing is holding back health care innovation (12/8) – Nisha Basu, a primary care physician and medical director at Firefly Health and Jonathan Bush, co-founder and chief executive officer of Zus Health argue that not all patients benefit from in-person exams, and may prevent more patients seeking and obtaining behavioral health and substance use disorder care. “There is no evidence that in-person exams reduce unnecessary or harmful controlled substance prescribing (and recall that many of the pill mills in Florida and elsewhere were in-person clinics),” the authors write.” These are vastly more powerful mechanisms to stop misuse and abuse than the pure notion of being in the same room — once — without any historical knowledge or data.” In conclusion, the authors state that, “there are other ways of accomplishing the goals of preventing patient harm that are better than the anachronistic Ryan Haight Act and are open to any of them. Mandating a superfluous in-person exam is an indiscriminate barrier to access and high-quality care. As an industry and a country, let’s focus the conversation on enabling digital health innovation to improve access to care for all.” The Alliance has advocated for the DEA to issue the long overdue Special Registration for Telemedicine Prescribing of Controlled Substances. View our activity here.
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Previous Events
Federal Communications Commission, “Commissioner Carr’s Telehealth Roundtable.” FCC Commissioner Brendan Carr held a virtual roundtable on telehealth. The roundtable featured two sets of panelists, including recipients from the FCC’s Connected Care Pilot Program and COVID-19 Telehealth initiatives, on opportunities and lessons learned from setting up, expanding, and sustaining their telehealth programs. Topics included the delivery of devices to patients, navigating patient privacy and insurance issues, motivating use of telehealth devices, connectivity challenges, and overcoming technical or other barriers to use. Panelists also discussed licensing issues faced in the provision of cross-state services, waivers provided by HHS during the pandemic, and long-term funding of these types of programs.
HIMSS TV, “Provider orgs launch pro-telehealth effort; House averts Medicare payment cuts.” This episode of HIMSS TV featured this week’s top stories, including the launch of Telehealth Access for America (TAFA), which aim to protect and expand access to telehealth. The Alliance for Connected Care is a member of this initiative.
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