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Telehealth Expansion Act of 2021: (11/16) – Representatives Steel (R-CA) and Lee (D-NV) introduced the Telehealth Expansion Act (H.R. 5981), which would make permanent a waiver created by the CARES Act to allow individuals with a high-deductible health plan coupled with a health savings account (HDHP-HSA) to access telehealth services without first having to meet their deductible. This provision is currently set to expire December 31, 2021. The Alliance for Connected Care has endorsed this bill, along with the Senate companion of the bill (S. 1704). A statement made by the Alliance on this legislation can be found here.
Cures 2.0 Act: (11/17) – Representatives DeGette (D-CO) and Upton (R-MI) along with 54 bipartisan representatives introduced Cures 2.0 Act (H.R. 6000), which would take steps to address the ongoing COVID-19 pandemic, establish a new advanced research agency for health, ARPA-H, and make some pandemic-related telehealth flexibilities permanent. Specifically, the legislation includes:
Sec. 402. Strategies to Increase Access to Telehealth under Medicaid and Children’s Health Insurance Program: collaborating with Reps. Blunt Rochester (D-DE) and Burgess (R-TX) to include the Telehealth Improvement for Kids’ Essential Services (TIKES) Act. This policy would provide guidance and strategies to states on effectively integrating telehealth into their Medicaid program and 4 Children’s Health Insurance Program (CHIP), review the impact of telehealth on patient health and encourage better collaboration.
Sec. 403. Extending Medicare Telehealth Flexibilities: working with Reps Carter (R-GA) and Blunt Rochester (D-DE) to include the Telehealth Modernization Act. The Alliance has endorsed this legislation which would permanently remove Medicare's geographic and originating site restrictions which require a patient to live in a rural area and be physically in a doctor's office or clinic to use telehealth services. It would also allow the Secretary of HHS to permanently expand the types of health care providers that can offer telehealth services and the types of services that can be reimbursed under Medicare.
State of Reform: Florida health care bills to keep an eye on in the 2022 legislative session (11/18) – Florida legislators are continuing to file bills in advance of the start of the 2022 legislative session that begins on January 11, 2022. Among the bills filed this month include a telehealth bill (SB 726), which would prevent Medicaid managed care plans from working with providers who administer services solely through telehealth to help meet the needs of their beneficiaries. The bill would ensure that health care policies continue to cover services administered through telehealth moving forward.
Globe Newswire: New Jersey Implements Nurse Licensure Compact
(11/16) – New Jersey completed the process of implementing the Nurse Licensure Compact (NLC). In March 2020, the New Jersey Board if Nursing had partially implemented the compact, meaning that nurses who resided in other compact states and held an active multistate license in their state of residence were able to practice in New Jersey. Now that the compact is fully implemented, nurses whose primary state of residence is New Jersey will be able to apply for a multistate compact license to practice in other states in the NLC.
Office of Governor Cooper: Governor Cooper Announces Intent to Sign Legislative Budget (11/16) – North Carolina Governor Roy Cooper announced his intent to sign the legislative budget for the state. The budget will expand high-speed internet across the state so people can access education, telehealth and work. The budget also includes a $10 million grant program hospitals can apply for to expand telepsychiatry services to outpatient settings like primary care offices.
Telehealth Research, Reports and Surveys
The Commonwealth Fund: Telemedicine, modernized licensing can help bridge health disparity gap (11/19) – A report by the Commonwealth Fund found pervasive racial and ethnic inequities across health systems in all 50 states. The state-by-state analysis pointed to policy changes that could help bridge the gap, such as policies to help ensure health coverage, reduce administrative burden and improve service delivery – including via telemedicine and licensure modernization. When it comes to improving the delivery of services, one recommendation was to ensure that telemedicine remains an option, as it is an effective strategy for providing patients with convenient access to care. Another recommendation was to modernize medical licensing by allowing health care professionals to more easily practice across state lines.
JAMA Oncology: Evaluation of Telemedicine Use Among US Patients With Newly Diagnosed Cancer by Socioeconomic Status (11/18) – Newly diagnosed cancer patients with high socioeconomic status were more likely to have a telehealth visit in the 30 days following their diagnosis compared to patients with low socioeconomic status, according to a new study. Researchers from the University of Kansas analyzed 16,006 patients who were newly diagnosed with breast, lung, prostate, or colorectal cancer between January 1 and August 31, 2020. Around half of the patients were between 18 and 64 years old while the other half were over 65. Despite telehealth visit volumes rising from 0.4 percent in January to its height of 54 percent in April 2020, telehealth use among the study population was divided based on socioeconomic status.
STAT: A telehealth effort to treat PTSD and bipolar disorder in rural areas showed ‘huge gains.’ Now comes the hard part (11/17) – Over a four-year span, a study led by researchers at the University of Washington sought to deliver treatment to rural patients with post-traumatic stress disorder and bipolar disorder, complex diagnoses for which treatment is often located hours away, if it’s accessible at all. The Study to Promote Innovation in Rural Integrated Telepsychiatry, or SPIRIT found a 32% improvement on a scale of mental health functioning, and underscores the potential of technology to address gaps in rural health care.
Cigna/Evernorth: Impact of Behavioral Health Treatment on Total Cost of Care Study (11/16) – New research shows that when people with a diagnosed behavioral condition receive treatment, total health care costs decrease. The analysis revealed that behavioral health treatment in an outpatient setting, such as a psychologist’s office or virtual visits, leads to fewer emergency department visits and inpatient hospitalizations, decreasing costs by up to $1,377 per person in one year and up to $3,109 per person over two years.
GoodRx Health: The State of Telehealth, According to Healthcare Providers and Patients (11/15) – GoodRx Research surveyed over 1,000 patients and over 600 providers during August and September 2021 about their telehealth experiences. In the survey, both providers and consumers said that they valued telehealth and planned to use it in the future. Key takeaways:
Consumers enjoy the ease of scheduling telehealth visits and plan on using them along with in-person visits
The COVID-19 pandemic spurred telehealth use, with nearly half of respondents using telehealth for the first time during COVID-19
More than 60% of respondents plan on using telehealth alongside in-person visits
Many consumers see no difference between in-person and virtual visits with regards to quality of care, privacy, and cost
About 40% of consumers interact with providers more because of telehealth
Virtual visits for mental health care and chronic care treatment grew the most during COVID-19
Providers see good outcomes for their patients because of telehealth
Journal of the American Board of Family Medicine: Telephone vs. Video Visits During COVID-19: Safety-Net Provider Perspectives (11/12) – Telehealth increased access to care for New York State residents, with most
patients attending audio-only visits compared to video visits. Researchers looked at 36 community health centers in the state and the visits that occurred between February and November 2020. In addition, they conducted interviews with 25 primary care, behavioral health, and pediatric providers from eight community health centers.
JAMA Health Forum: Trends in Outpatient Care and Use of Telemedicine After Hospital Discharge in a Large Commercially Insured Population (11/12) – A recently published study finds
that the number of outpatient visits after hospital discharges remained stable during the COVID-19 pandemic but telehealth use for these visits increased, suggesting that telehealth was a substitute for in-person care rather than an addition
National Institutes of Health: Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults (11/3) – Findings from a recent study of patients receiving intensive psychological treatment pre-COVID-19, suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups.
Center for Connected Health Policy: State Telehealth Laws and Reimbursement Policies – At a Glance (Fall 2021) – The Center for Connected Health Policy (CCHP) released its fall 2021 State Telehealth Laws and Reimbursement Policies At a Glance document, which highlighted several trends in telehealth at the state level over the last several months. All 50 states and DC now reimburse for some type of live video telehealth services in Medicaid. Also of note is that 12 states issue special licenses or certificates, or have a telehealth specific exception for out-of-state licensed providers. This includes Arizona and Florida through their respective registration processes for out-of-state providers that would like to provide telehealth services in the state.
NPR, “Regulations are changing that will affect the future of telehealth.” NPR's consumer health correspondent Yuki Noguchi spoke about the flexibilities afforded by the PHE, and concern as rules that permitted telehealth services are in flux as state and federal governments and insurance providers weigh which policies to keep in place.
Healthcare IT News, “A look at virtual care’s future.” In the final episode of the Virtual Care Paradigm, Cedars-Sinai’s Dr. Brennan Spiegel speaks with host Jonah Comstock about health care unbound by time and location.
Tradeoffs Podcast, “Rethinking Telehealth’s Role in Treating Addiction.” This episode of the Tradeoffs
podcast explores how conversations around keeping telehealth policies for addiction treatment permanent is playing out in Ohio, one of the epicenters of the opioid epidemic. The episode features a new mom who says telehealth kept her sober through her pregnancy, a provider worried about seeing these flexibilities end, and a researcher who lays out what the field has learned so far about what works and doesn’t when it comes to telehealth and addiction treatment.
Center for Connected Health Policy (CCHP), “Medicaid & Telehealth: Summary and Findings from the Fall 2021 Webinar Series.” CCHP held a series of webinars throughout the fall on elements that were shaping or impacting permanent telehealth policies. The topics touched on issues policymakers have raised in preceding months as being significant factors in discussions and decisions for more permanent telehealth policies. Those topics included:
Alliance for Connected Care: Telehealth Data Request
Building on our important work as part of the Taskforce on Telehealth, the Alliance for Connected Care continues to collect data necessary to make the case for permanent telehealth policies. We are seeking to understand what we have learned about telehealth utilization and its effect on prevention, urgent care, transportation, and etc. Our goal is to educate a conversation about what impact expanding telehealth access in Medicare will have on federal budgeting models.
In our efforts to gather data on cost, we are asking organizations, health systems, or providers to submit data on telehealth during COVID-19. Please view our collection page here.
Utilization data: to what extent is telehealth serving as a replacement for in-person care?
Demographics/Race/Ethnicity/Age distribution: To the extent you have such data, we want to show telehealth utilization broken down by various demographics including race/ethnicity, age, gender, income, education, etc.
No-show Rates: Were no-show rates reduced, and if so, by how much?
Post-discharge: Were post-discharge transition codes (99495 and 99496) billed at a higher rate?
SNF Transfers: Did telehealth resolve skilled nursing facility -resident issues without transfer, i.e. were transfers to hospitals lower without compromising patient care?
Imaging: What happened to orders for imaging for telehealth visits, were they higher or lower for commensurate in-person care?