Inside TeleHealth: Medical Boards to Vote Saturday on New Telemedicine Policy (4/29) – The Federation of State Medical Boards is set to vote on its first update in nearly a decade to guidance on the appropriate use of telemedicine in the practice of medicine. The updated document contained sections related to licensure exceptions, standards of care, patient privacy, and health equity, among others. The Alliance for Connected Care submitted comments
in response to the draft document in February, focusing on the proposed definition of telemedicine included in the draft, the proposed licensure section, and ways to incorporate health equity into telemedicine services to address the digital divide. The Alliance recommended that the FSMB consider broadening the circumstances in which it recommends interstate licensure for telehealth treatment, and that the modality of care should be the decision of the patient and provider, as telephone remains an important and clinically appropriate access point for many patients.
Advisory Board: Telehealth did not lead to more follow-up care, study finds. Here’s why that matters (4/28) – Telehealth patients did not require more follow-up care than in-person patients according to a new study
published in JAMA Network Open, suggesting these findings may help shape telehealth policies moving forward. Telehealth patients with chronic conditions, such as hypertension or heart failure, were less likely to require follow-up care than in-person patients. While this study was of commercially insured patients, this is pertinent for Medicare beneficiaries given around 30 percent of traditional Medicare beneficiaries have six or more chronic conditions. Krista Drobac, executive director of the Alliance for Connected Care, highlighted that this finding could be important for telehealth’s impact on Medicare beneficiaries as a result.
Modern Healthcare: Telehealth didn't lead to unnecessary care in 2020, study says (4/26) – According to a study
of 40.7 million commercially insured adults with acute clinical conditions published in JAMA Network Open, patients treated for most acute conditions via telehealth were as likely or slightly more likely to need a follow-up visit as those who sought in-person care to start. Telehealth patients with chronic conditions were less likely to need follow-up care. The finding that telehealth resulted in a lower chance of follow-up care for patients with chronic conditions is promising for Medicare beneficiaries, said Krista Drobac, executive director of Alliance for Connected Care. “If the researchers found lower rates of follow up for chronic conditions, that might mean that telehealth in Medicare will yield lower overall follow up because more seniors have chronic conditions.”
During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure requirements to facilitate patients getting care. The Alliance for Connected Care maintains a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state.
CMS: Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQ (4/29) – CMS released an updated version of the Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQ, which provide clarity around which telehealth services are valid for data submissions for the HHS-operated risk adjustment program. One updated question asks, in light of the continuing COVID-19 pandemic, if HHS could clarify what telehealth service codes would be valid for inclusion for the 2022 benefit year HHS-operated risk adjustment program, among other updates.
Inside Health Policy: Telehealth Stakeholders Say Quality Concerns Unique to Nursing Homes (4/29) – Telehealth stakeholders view CMS’ concerns about telehealth quality-of-care in nursing homes as an issue limited to long-term care facilities and not indicative of broader telehealth care quality problems. CMS is currently reviewing data on telehealth utilization and looks forward to working with Congress and other stakeholders on the future use of this innovative health care option. In addition, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) is working with other OIG members and the office’s Pandemic Response Accountability Committee (PRAC) to examine what telehealth technologies are in use and how they will impact six federal programs, including Medicare.
Inside Telehealth:DEA Working Toward Making Telehealth Prescribing Waiver Permanent (4/28) – The Drug Enforcement Administration (DEA) confirmed it is working to turn a temporary waiver that has allowed telehealth prescribing of controlled substances during the pandemic into a permanent one. The DEA pointed to language it included in a recent press release when asked if the agency was taking regulatory steps in response to congressional and stakeholder pressure to make virtual prescribing permanent. As background, the Ryan Haight Online Pharmacy Consumer Protection Act, enacted in 2008, amended the Controlled Substances Act with provisions intended to prevent the distribution of illegal drugs via the internet. Among other measures, the Ryan Haight Act makes it illegal for physicians to prescribe controlled substances for patients over the internet without first evaluating them in person. During the COVID-19 public health emergency, the rule has been suspended to allow for greater flexibility in telehealth. The Alliance for Connected Care has long advocated in this space and looks forward to reviewing regulations from the DEA.
HHS: Telehealth for HIV Care Guide (4/27) - HHS published a new guide
for health care providers outlining how telemedicine can be used to improve the diagnosis, treatment and prevention of HIV/AIDS. The guide states that telehealth can proactively help prevent the spread of HIV to protect patients and the community, and that the incorporation of telehealth into a primary care practice can overcome barriers to HIV diagnosis, treatment, and prevention by giving patients a safe, convenient way to access HIV prevention and care services. Testing for HIV can be conducted remotely, since options for at-home, self-administered tests are available. Telehealth follow-up, such as support groups and counseling, to address the impact of receiving a diagnosis is also an important part of care, the guide adds.
Inside Telehealth: CMS Clarifies Confusion Among Nursing Facilities Over Role Of Telehealth (4/25) – On April 7, CMS announced
the end of some 1135 pandemic waivers that allowed certain required physician visits to be conducted via telehealth. CMS had waived the requirements for physicians and practitioners to conduct in-person visits to nursing home residents every 30 days for the first three months of a nursing home stay, and every 60 days thereafter, and allowed visits to be conducted via telehealth during the COVID-19 pandemic. The memo did not mention a separate wavier that, throughout the pandemic, lifted in-person requirements for certain physician visits that occur between those on the federally mandated schedule. After the memo’s release, long-term care facilities wanted clarity on how the different waivers’ various requirements would interact and what that meant for the use of telehealth at those facilities. A CMS spokesperson confirmed that, until the public health emergency ends, the agency will waive the requirement that prohibits physicians from billing subsequent nursing facility visits more frequently every 14 days.
House Ways and Means Committee: Hearing on the Fiscal Year 2023 Budget with Health and Human Services Secretary Becerra (4/28) – The House Ways and Means Committee held a hearing on the proposed FY 2023 HHS Budget. Secretary Becerra noted that the five-month extension for Medicare telehealth flexibilities from the March omnibus was essential. He also noted that the President’s budget addresses how to move forward with telehealth extensions once the PHE ends. Secretary Becerra also committed to working with Congress to reduce the Congressional Budget Office’s (CBO) prediction of what it expects telehealth to cost.
House Energy and Commerce Committee: Hearing on the Fiscal Year 2023 HHS Budget (4/27) – The House Energy and Commerce Committee, Subcommittee on Health held a hearing on the FY 2023 HHS Budget. HHS Secretary Becerra noted that the benefits of telehealth had been highlighted throughout the pandemic. In response to a question posed by Rep. Welch (D-VT) on telehealth and medically assisted treatment, Secretary Becerra called on Congress to provide statutory authority to give HHS more discretion around telehealth and prescribing.
Telehealth Extension and Evaluation Act (4/26) – Representatives Axne (D-IA) and Hudson (R-NC) introduced the Telehealth Extension and Evaluation Act (H.R. 7573), which would ensure key telehealth services offered during the COVID-19 pandemic will continue for two years after the end of the COVID-19 public health emergency. More specifically, the bill would extend these critical flexibilities, ensure that rural health clinics and community health centers may continue to provide telehealth, include provisions to deter fraud and abuse, and commission a study on the impact of these extended flexibilities to help chart a course toward permanent telehealth services. "This clear, 2-year extension of telehealth provisions though statute will provide certainty to beneficiaries and health care providers alike, while ensuring sufficient time is taken to analyze the impact of telehealth on patient care throughout the pandemic to inform permanent telehealth reform," said Alliance for Connected Care executive director, Krista Drobac. This bill is the House companion to the Alliance-supported bill (S. 3593) that was introduced by Sens. Cortez Masto (D-NV) and Young (R-IN) earlier this year.
Telehealth Research, Reports and Surveys
mHealth Intelligence: Disparities Common in Telehealth Use Among Pediatric CHIP Patients (4/26) – According to data from Alabama’s Children’s Health Insurance Program (CHIP), ALL Kids, researchers found that telehealth use was less common among those living in rural areas and members of lower-income families. Researchers also noted that children living in large or small rural areas were less likely to use telehealth, with 11.8 and 11.1 percent of each population having used virtual care services, respectively. The digital divide and the limited availability of resources likely played a role in creating care gaps. Researchers acknowledged that as the presence of telehealth continues to grow, it is essential to continue to increase accessibility and eliminate disparities.
Inside Telehealth: Telehealth Comprised Largest Percentage of Private Health Claims In 2020, Report Finds (4/26) – A report
by FAIR Health found that telehealth made up the largest percent of private medical insurance claims in 2020, totaling 15.41 percent of all medical claims nationally. Utilization of health care services fell in every other category, including a 38 percent decrease in utilization of ambulatory surgical centers, 30 percent decrease of emergency rooms, and 16 percent decrease of urgent care centers. Telehealth usage also expanded by more than 7,000 percent across the U.S. in 2020. This is the first of FAIR Health annual reports to reflect changes in private health insurance claims caused by the COVID-19 pandemic, including the exponential growth in telehealth.
Physician’s Weekly: Telemedicine bridge clinics may be helpful for opioid use disorder treatment (4/25) – According to a study
published in the Journal of Addiction Medicine, telemedicine bridge clinics had high show rates and allowed patients to fill prescriptions for opioid use disorder (OUD). The results show that 77 percent of the bridge clinic patients filled two or more buprenorphine prescriptions after their initial visit, indicating high engagement. Most of the patients (62 percent) had insurance through Medicaid, though 19 percent were uninsured. Outcomes were similar between those who used phone-only versus audiovisual visits. The results suggest that telemedicine bridge clinics may be useful long-term for patients suffering from OUD.
American Medical Association: Majority of physicians say telehealth enables more comprehensive quality care (4/25) – A survey
conducted by the American Medical Association found that the vast majority of physician respondents say they're currently using telehealth. The results suggest enduring interest in virtual care among physicians. Among physician respondents, 85 percent indicated they currently use telehealth, with the majority of decreased use attributed to a mix of virtual and in-person visits. There findings are similar to a survey
conducted by the Alliance for Connected Care in March. An accompanying blog post on this survey from the American Medical Association can be found here.
Parkinson’s News Today: Patients Prefer Telehealth Over Visits in Person for Certain Services (4/25) – A recent survey published in Movement Disorders found that telehealth services during the COVID-19 pandemic were perceived to be a good alternative to in-person health care appointments among people with Parkinson’s disease. Respondents said telehealth reduced travel, was more convenient, was suitable for follow-up appointments, and was preferred for speech-language pathology and mental health sessions. More than 40 percent of respondents reported that video or phone telehealth services were equally or more satisfying than in-person visits across all service types.
State Telehealth News and Activity
South Carolina Department of Health and Human Services: SCDHHS Announces Updates to Critical Telehealth Flexibilities to Continue Access to Care for Healthy Connections Medicaid Members (4/29) – The South Carolina Department of Health and Human Services (SCDHHS) announced the extension of most of the temporary telehealth flexibilities it created during the COVID-19 public health emergency. The updates to these telehealth flexibilities could be categorized as: 1) flexibilities that will be made permanent – such as reimbursing physicians, nurse practitioners, and physician assistants for telehealth services delivered to Medicaid beneficiaries; 2) those that will be extended for further evaluation for one year after the federal PHE ends – including reimbursing behavioral health providers for psychiatric diagnostic evaluations and individual and family psychotherapy delivered via telehealth; 3) and those that will expire with the federal PHE – including family support services, occupational therapy, and others.
The Oklahoman: Health professionals answer the call of telemedicine in Oklahoma
(4/28) - Telemedicine use in Oklahoma grew significantly as a result of the COVID-19 pandemic, according to an online survey conducted by the Oklahoma State Medical Association in 2020. The survey indicated that 84 percent of physicians did not use telemedicine prior to the pandemic, but 72 percent had adopted telemedicine into their practice since the beginning of the pandemic. This article highlights three physicians and their experience with telemedicine over the past two years, including how virtual visits have impacted them and their communities and how they see telemedicine being leveraged moving forward in Oklahoma.
Health Affairs: Ensuring Telehealth Access for North Carolina Farmworkers
(4/26) - There are more than two million farmworkers in the United States and approximately 100,000 in North Carolina alone, many of which face significant barriers to health care. Research has shown that farmworker patients are receptive to virtual care, but despite demonstrated interest among farmworkers and the fact that this population is gaining access to cell phones and smartphones, telehealth has yet to be widely adopted by this population. This article explores where farmworkers seek care, how telehealth can be used to reach farmworkers using North Carolina as a case study, and considerations for digital health equity.
JD Supra: Tracking Telehealth Changes State-by-State in Response to COVID-19 (4/25) – The latest update of Manatt Health’s 50-state tracker for policy, regulatory and legal changes related to telehealth outlines recent state changes in Colorado, Kentucky, Hawaii, Mississippi, Tennessee and Virginia. Colorado passed House Bill 1076, which allows for prescribing, selecting, and fitting of hearing aids via telehealth. Hawaii passed House Resolution No. 60, which establishes a telehealth and telephonic services working group to address the complexities surrounding the appropriate use of telehealth and telephonic services. Virginia passed House Bill 537, which allows behavioral health providers, psychologists, and licensed social workers licensed and in good standing in another state or territory to provide behavioral health services via telehealth to patients located in Virginia for no more than one year.
Telehealth News and Market Developments
CNN Health: Back to the doctor’s office? Here’s what’s next for telehealth after the pandemic (4/29) – Pandemic-era telehealth flexibilities have made health care much more accessible for millions of patients, especially those managing diseases like cancer. Gary Poteat, a cancer patient based in Ohio, said that when his cancer returned during the pandemic, telehealth made a crucial difference in his care given his doctor was a four-hour drive away. Poteat noted, “It's hard to describe how the little aggravations of life, like traveling in the snow, fighting cold weather and staying in hotels, how much stress that puts on someone who's already at maximum stress from the fact I have new tumors and we don't know what we're going to do.” At such a critical point in his cancer journey, telehealth felt like a "blessing." This article explores the impact of telehealth throughout the pandemic for patients like Poteat and what the end of PHE means for these critical services.
Fierce Healthcare: Telehealth grad programs, fellowships train providers in virtual care delivery (4/28) – The sudden switch to telehealth created uncertainty in providers who felt they were unprepared by their employer for the switch. While on the surface telehealth visits may seem just like normal visits conducted over video chat, effective patient care requires a different skillset when delivered virtually. Individual courses in telehealth are becoming increasingly common in medical and health care-focused degree programs. In the future, medical schools and residencies will soon implement telehealth-related milestones for their clinicians.
Medical Device Network: Amazon continues to strengthen its position in telemedicine and virtual trials with recent collaborations (4/28) – The COVID-19 pandemic has led to increased use of decentralized clinical trials (DCTs) across the pharma industry, as well as telehealth and remote patient monitoring. Alliance Member Amazon has strengthened its position in virtual trials by announcing a collaboration with THREAD Research, a specialist DCT provider. Amazon will use its Amazon Web Services (AWS) technology platform to automate processes by utilizing artificial intelligence (AI) and machine learning tools that accelerate trial recruitment and reduce long-term costs. By using such tools, THREAD’s DCT platform will provide real-time data and insights that increase efficiencies when making innovative treatments for patients across the world.
Walmart: Walmart Health Introduces Telehealth Diabetes Program to Help Businesses Support Employees Through Education and Behavioral Care (4/28) – Alliance Member Walmart collaborated with the American Diabetes Association to close gaps that employees experience in managing Type 1 and Type 2 diabetes. The Walmart Health Virtual Diabetes Care Program, an integrative telehealth program, seeks to merge personalized diabetes education with behavioral health awareness and counseling. Available as a standalone or as part of a comprehensive medical and behavioral telehealth program, it was developed for employers and payors to help their employees and members close gaps in diabetes management among employees and their families through early intervention, which could lead to better health outcomes.
PR Newswire: A Physician and Telehealth Device Advises that Patients With Pulmonary Disorders Can Benefit From Remote Patient Monitoring Devices (4/28) – Smart Meter’s iPulseOx, a remote patient monitoring device for pulmonary disorders, helps providers manage care for patients with chronic obstructive pulmonary disease (COPD), asthma, long COVID, and other conditions. The device transmits via a cell chip to send a patient's oxygen saturation levels immediately after testing so health care providers can track trends in real time. The use of remote patient monitoring as part of care management practices helps providers improve patient adherence, leading to happier patients, better outcomes, and lowering the cost of care.
Pharmacy Times: The Challenge of Multistate Pharmacy Licensure in the Telehealth Era (4/27) - Telehealth use expanded in the pharmacy during the pandemic, however, pharmacy personnel face challenges when implementing these services, beginning with regulatory requirements affecting their ability to provide telehealth. Challenges for pharmacy personnel who wish to fully use telehealth to serve patients in multiple states include obtaining licenses to practice in each of these states. Acute shortages of pharmacists and pharmacy technicians in certain geographic regions and across areas of practice can be exacerbated by licensure requirements for such professionals. The American Society of Health-Systems Pharmacists (ASHP) has developed a series of policies that support the harmonization of laws and regulations impacting pharmacy practice across states and enhances the ability of pharmacists to practice in multiple states.
Healthcare IT News: With telehealth, Behavioral Nutrition sees many more patients (4/25) – Behavioral Nutrition, an eating disorder clinic that treats adolescents and adults using behavioral therapy and nutritional counseling, found benefits for using telehealth. The clinic, which has five locations in Massachusetts, New Hampshire, Florida, New Jersey, and Texas, found that clinicians do not have much time to learn new technology, so the seamless implementation of telehealth technology was important during COVID-19. With telehealth, the clinic was able to see approximately 50 percent more patients compared to the time before telehealth sessions were offered. Telehealth also provided a degree of confidentiality and sense of privacy that is not experienced in a walk-in clinic.