The Alliance, National Organization for Rare Disorders (NORD), and ALS Association collaborated on a letter urging state governors and legislatures to consider maintaining and expanding medical licensure flexibilities for the duration of the federal public health emergency. This is critical to ensure patients, particularly patients with compromised immune systems that are still vulnerable to contracting the virus, can access health care regardless of where they reside through the facilitation of care across state lines as the pandemic continues. We will plan to send this letter to all 50 governors across the US, and we are also requesting input in the form on contacts that organizations might have within state governors’ offices. The deadline to sign on to this letter is Tuesday, October 19. You can access the sign-on form here.
The Alliance is seeking endorsement of a joint letter urging Congress to continue the virtual care provision enacted in the CARES Act that enabled employers/insurers to provide covered telehealth services to individuals with HDHP-HSAs before their deductible is met. Without this change, access to these telehealth services will end in December 2021. The letter also asks Congress to expand these provisions to primary care, as will be included in the soon to be introduced Primary and Virtual Care Affordability Act. The deadline to sign on to this letter is Friday, October 15. You can access the sign-on form here.
Protecting Telehealth Access Act (H.R.5425): (9/29) – Representatives O’Halleran (D-AZ), McKinley (R-WV), Kind (D-WI) and Smith (R-NE) introduced the Protecting Telehealth Access Act (H.R.5425), which would protect access to telehealth services under the Medicare program. Specifically, the Protecting Telehealth Access Act would:
allow payment-parity for audio-only health services for qualifying appointments;
permanently waive the geographic restriction allowing patients to be treated from their homes;
permanently allow rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to serve as distance sites for providing telehealth services; and
allows Critical Access Hospitals (CAHs) to directly bill for telehealth services.
The Alliance for Connected Care has endorsed the legislation.
Krista Drobac, Executive Director, Alliance for Connected Care: “The Protecting Rural Telehealth Access Act calls needed attention to the importance of rural telehealth, including options for audio-only services and flexibility needed by rural providers like Critical Access Hospitals. The Alliance for Connected Care is pleased to see bipartisan, bicameral consensus around this legislation, which will expand patient access even in counties with health workforce shortages.”
Federal Communications Commission (FCC): FCC Announces Second Set of Awards for COVID-19 Telehealth Round 2 (9/29) – FCC announced an additional 72 applications for funding commitments totaling $41,113,186 for Round 2 of its COVID-19 Telehealth Program. This is the FCC’s second funding announcement of approved Round 2 applications following the nearly $42 million awarded on August 26 to health care providers in each state, territory, and the District of Columbia.
HHS: Biden-Harris Administration Provides Nearly $1 Billion in American Rescue Plan Funds to Modernize Health Centers and Support Underserved Communities (9/28) – HHS awarded nearly $1 billion in American Rescue Plan funding to nearly 1,300 Health Resources and Services Administration (HRSA) Health Center Program-funded health centers in all 50 states, the District of Columbia, and the U.S. territories to support major health care construction and renovation projects. Health centers will use this funding for COVID-19-related capital needs, constructing new facilities, renovating and expanding existing facilities to enhance response to pandemics, and purchasing new state-of-the-art equipment, including telehealth technology, mobile medical vans, and freezers to store vaccines.
mHealth Intelligence: CMS Faces a Call to Improve Telehealth Coverage for Rural Health Providers (9/27) – A letter
signed by the Alliance for Connected Care and roughly 20 other organizations made news coverage this week. The letter, sent to CMS Administrator Brooks-LaSure urges CMS to address Critical Access Hospital (CAH) telehealth. “We agree that telehealth payment should be addressed for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and also believe outpatient behavioral therapy services offered by Critical Access Hospitals (CAHs) are a key component of a comprehensive rural behavioral health strategy,” the letter says.
State Telehealth News and Activity
The Morning Call: Readers React: State needs to extend telemedicine waivers (9/30) – With Pennsylvania’s Department of State COVID-19 waivers allowing telemedicine set to expire on Friday, October 1, constituents weighed in with how this would impact patient care. This reader notes how if state legislators and the governor don’t extend telehealth, many patients who depend on it will suffer as the pandemic continues on. He cites seniors who are home-bound and greatly benefited from telehealth during COVID not being able to access medical care, as well as a choice his son, who is receiving treatment from an out-of-state brain injury specialist, would have to make about ending treatment if telehealth with out-of-state providers was no longer an option.
mHealth Intelligence: Thomas Jefferson University Takes on Telehealth, mHealth Barriers (9/29) – Philadelphia-based Thomas Jefferson University launched the Jefferson Center for Connected Care, a new effort by the health system to take on barriers to telehealth and mHealth access. The Center’s goal is to address the digital divide, and will house the Jefferson Telehealth Leadership Fellowship which has been responsible for launching the JeffConnect virtual care program. The Center will also use a $250,000 grant from PCORI to host a conference next spring focused on reducing telehealth disparities.
Office of Governor Kathy Hochul: Governor Hochul takes bold action to alleviate potential health care staffing shortages (9/27) – New York Governor Kathy Hochul signed an executive order to expand the eligible health care workforce and allow additional health care workers to administer COVID-19 testing and vaccinations in light of the ongoing pandemic and recent vaccine mandates for health care workers in the state. The executive order aims to alleviate potential staffing shortages in hospitals and other health care facilities statewide. The order include several provisions to remove barriers to allow additional categories of health care workers to practice in New York, including: allowing out of state and out of country health care workers to practice in New York (including via telehealth); allowing physician visits in nursing homes to be done using telemedicine; expanding scope of practice for additional health care workers to allow for COVID testing and vaccinations; permitting emergency medical services personnel to provide community paramedicine, use alternative destinations, use telemedicine to facilitate treatment of patients in place, and such other services as may be approved by the commissioner of health; and more.
Office of Governor Gavin Newsom: Governor Newsom Signs Executive Order to Extend Telehealth Services Expansion (9/27) – California Governor Gavin Newsom signed an executive order to extend the provisions of a prior order that facilitates telehealth services by enabling medical providers to conduct routine and non-emergency medical appointments through telehealth without the risk of being penalized. This was implemented to address the ongoing pandemic and reduce the strain on the health care delivery system. This order extends the previous April 3, 2020 order which included provisions that expanded telehealth services and relaxed certain state privacy and security laws for medical providers. These provisions were set to expire on September 30, 2021, and will now continue through the end of the state of emergency or until the original order is rescinded or modified.
Telehealth Research, Reports and Surveys
HomeCare: EarlySense Launches Survey to Understand Telehealth Engagement (10/1) – EarlySense, a provider of contact-free continuous monitoring solutions, announced a new survey it is putting into the field, to gain insights from professionals across the care continuum. Titled “Finding the Gaps in Technology: Virtual Care Assessment,” the 30-question survey delves into various aspects of the virtual care model—and specifically remote patient monitoring—to determine where health care providers and remote patient monitoring stakeholders see clear benefit and where pain points still exist. The survey will run through November 19, with findings announced the first week of December 2021. Submit your responses here.
J.D. Power: Telehealth Usage Surging but Service Issues and Barriers to Access Strain Patient Experience, J.D. Power Finds (9/30) – Thirty-six percent of patients said they used telehealth in the past year, up from 9 percent in 2020’s survey. However, many users cited limited access to the services they need and inconsistencies in the care they receive.
Following are some key findings of the 2021 study:
Telehealth adoption spikes across all generations in 2021: Overall, 36% of patients have accessed telehealth services during the past year, up from just 9% in 2020 and 7% in 2019. Usage is consistent across all generational groups, with the highest usage among members of Generation Y and Pre-Boomers.1
Convenience, speed and safety drive utilization: The top reasons for telehealth utilization are convenience (57%); ability to receive care quickly (47%); and safety (36%).
Patient satisfaction declines as pain points emerge: Overall satisfaction with both direct-to-consumer and payer-sponsored telehealth services decline in 2021 from 2020. The most frequently cited barriers encountered by patients are limited services (24%); lack of awareness of costs (15%); confusing technology requirements (15%); and lack of information about providers (15%).
Uneven care for higher-risk patients: Overall satisfaction is 85 points lower (on a 1,000-point scale) among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are more likely than less healthy patients to understand the information provided during the visit; say they receive clear explanations; perceive that their visits are highly personalized; and obtain high-quality diagnoses.
Amwell and HIMSS Analytics: Building the Future of Virtual Care: Streamlined, Scalable, Sustainable. Insights from Amwell’s 2021 Survey of Health Plans, Hospitals and Health Systems, and Clinicians (9/28) – Amwell and HIMSS Analytics surveyed 100 executives at health plans, 102 senior leaders at hospitals and health systems, and 100 frontline clinicians and support staff about their post-pandemic strategy and planed investments in telehealth. Results from the survey show that priorities across hospitals, health systems, health plans and clinicians are focused on integrating telehealth as core to care delivery, improving the patient-provider experience, and achieving seamless and sustainable hybrid care models. Additional key findings include:
Shifting Focus to an Integrated, Single-Platform Strategy: 80 percent of clinicians reported that investing in fully integrated virtual or hybrid care systems would have a positive impact on clinical outcomes and patient experiences and 75 percent of payers said that access to virtual care data and insights through a single digital platform would streamline member experiences, improve patient outcomes, and support the development of innovative models of care coordination and delivery.
Continued Growth, Diversification of Uses and Investment: 94 percent of all clinicians reported using telehealth today – well above pre-pandemic levels – and over half of the payer organizations surveyed reported having several virtual care offerings. Clinicians also shared their perceived top benefits of virtual care:
82 percent cited improved patient access,
53 percent reported increased efficiency and
51 percent said improved patient experiences were telehealth’s top benefit.
Additionally, over 50 percent of clinicians said that the pandemic had positively impacted their long-term desire to use telehealth, and 56 percent of hospitals and health system leaders said they are planning to increase their investment in telehealth and virtual care solutions over the next two years.
Awareness of and Concern for Platform Sprawl: Technology and interoperability continue to be a challenge, with platform “sprawl” emerging as a new and pressing obstacle as stakeholders across the ecosystem desire a streamlined and systemized digital infrastructure, including platform consolidation. 77 percent of hospital and health system leaders shared that moving toward a single, secure, and fully integrated virtual care platform was important for their organization. 25 percent of clinicians also said that virtual care systems and current workflows are not integrated with their organizations’ existing systems, with most payers and clinicians using at least three platforms for virtual care and 20 percent of academic medical centers using eight or more digital care platforms.
American Heart Association Hypertension Scientific Sessions 2021(9/27) – Adults who needed to track their blood pressure regularly to confirm or refute a hypertension diagnosis preferred monitoring blood pressure at home versus at a clinic, kiosk or with a 24-hour wearable device, according to preliminary research presented today at the American Heart Association’s Hypertension Scientific Sessions 2021.
Comments Requested: Measuring Quality in Rural Telehealth – Respond by October 8. For more than five years, the National Quality Forum (NQF) has worked with staff and other partners of the Federal Office of Rural Health Policy to develop a rural-specific framework for measuring the performance of healthcare via telehealth. The NQF requests comment from the public on their draft framework (pdf) that covers five domains: 1) access to care and technology; 2) costs, business models, and logistics; 3) experience; 4) effectiveness; and 5) equity that calls for rural-specific measurement of quality.
Telehealth News and Market Developments
STAT: Telehealth has rapidly expanded. But companies are still struggling to reach rural populations (9/30) – Despite the wide-ranging expansion of telehealth in the past year, there is still a broad swath of the U.S. population it has largely failed to reach: the 57 million people in rural parts of the country. Company executives and analysts said that permanent policy changes are needed to make the investment in building out their offerings for rural populations not only worthwhile from a strategic standpoint, but also successful in improving access to care. Those changes include increasing access to broadband and reimbursing virtual care at the same rate as in-person treatment.
Modern Healthcare: Chicago Health System is Bringing Back the House Call (9/29) - Through a partnership with Dispatch Health, Rush will begin providing in-home medical care for acute healthcare issues that might otherwise send people to emergency departments or urgent care clinics. After initial triage to ensure a patient should not be rushed to an emergency department, the typical in-home visit will involve a DispatchHealth-employed nurse practitioner or physician's assistant along with a medical assistant driving to a patient's location, treating the condition and connecting the patient with a DispatchHealth medical doctor, usually through telehealth. The DispatchHealth car carries all the tools for most emergency care needs laboratory tests, intravenous medications and medical imaging equipment.
Thomas Jefferson University: Jefferson Launches Center for Connected Care (9/28) – Thomas Jefferson University recently launched the Jefferson Center for Connected Care, which will focus on research, innovation and education all designed to unpack and overcome the various barriers to digital access. “We want to conduct the research and provide the training needed to ensure equitable virtual access as medicine uses digital tools to increasingly care for people at home,” said the Center’s leader, physician and scientist Kristin Rising, MD MSHP, faculty member in Jefferson’s Department of Emergency Medicine in the Sidney Kimmel Medical College and in the College of Nursing.