July 19, 2021

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.

Sign Letter to Congress on Medicare Telehealth

Please join the Alliance for Connected Care and other digital health organizations in signing a multistakeholder letter to Congressional leaders calling for a permanent end to location restrictions for telehealth in Medicare, continued FQHC/RHC telehealth payment, removal of the in-person visit requirement to access to mental health services through telehealth, and continued telehealth waiver abilities for CMS. The letter - building on the momentum of the 340-group letter last July - is intended to revitalize our efforts around priority Medicare asks to Congress. Without Congressional action restrictions on Medicare reimbursement of telehealth services will go back into effect.

Organizations may SIGN THE LETTER HERE by COB Friday, July 23. Please note this letter is open for organizational signers only.

Please reach out to Crystal Wallace at crystal.wallace@connectwithcare.org with any questions

Administration Activity

Center for Medicare and Medicaid Services (CMS) Proposed Medicare Physician Fee Schedule (PFS): (7/13) – CMS issued the proposed Medicare PFS for Calendar Year (CY) 2022. Comments are due by September 13, 2021. Notably, CMS is proposing to retain all services (130+) added to the Medicare telehealth services list on a Category 3 basis until the end of CY 2023 – December 31, 2023 – to allow for time to collect more information regarding utilization of these services during the pandemic, and provide stakeholders the opportunity to continue to develop support for the permanent addition of appropriate services to the telehealth list through the regular consideration process, which includes notice-and-comment rulemaking. In addition, CMS is proposing to permit audio-only communication technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes. CMS proposes to allow Rural Health Clinics and Federally Qualified Health Clinics to use telehealth for mental health visits, as well. Disappointedly, CMS is proposing to require an in-person visit be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter.

• CMS is seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology.
• CMS is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiary’s regular practitioner.

CMS is also soliciting comment on: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not CMS should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails CMS should consider putting in place in order to minimize program integrity and patient safety concerns.

Finally, CMS has proposed changes to the Medicare Diabetes Prevention Program expanded model. The Alliance for Connected Care has endorsed the PREVENT DIABETES Act, which would allow CDC-recognized virtual suppliers to participate in the program. CMS declined to adopt such policies in their proposed rule.

View the Press release, Fact sheet, MDPP Fact sheet, Proposed Rule

Congressional Activity

HEALTH Act (H.R. 4437): (7/16) – Reps. Thompson (R-PA) and Butterfield (D-NC) introduced the Helping Ensure Access to Local TeleHealth, or the HEALTH Act, which codifies Medicare reimbursement for telehealth services rendered by community health centers and rural health clinics. The bill also allows these health facilities to continue to utilize audio-only telehealth visits for patients who do not have access to quality broadband. View the press release and bill text.

House Ways & Means Committee Racial Equity Initiative Co-Chairs Outline Recommendations for Infrastructure Legislation (7/13) – House Ways & Means Committee Racial Equity Initiative (REI) co-chairs Reps. Horsford (D-NV), Gomez (D-CA) and Sewell (D-IL) sent a memorandum to House Ways & Means Committee Chair Neal (D-MA) highlighting the ways measures related to transportation, jobs, health care, climate change mitigation, and community investment can purposely counteract generations of discriminatory policy across racial and ethnic lines and expand opportunities for historically marginalized communities.

Notably, the chairs include a recommendation to ensure telehealth and virtual care expansions center racial, health, and economic equity in design and implementation, and prioritize high quality health technologies developed using anti-bias principles and method.

View the press release and memorandum

Matsui And Colleagues Lead Effort To Advance Permanent Expansion Of Coverage For Telehealth Services (7/12) – Reps. Matsui (D-CA), Curtis (R-UT), Welch (D-VT) and Burgess (R-TX) sent a letter to HHS Secretary Becerra encouraging the agency to consider making coverage for certain telehealth services added during the public health emergency permanent through the annual Medicare payment rulemaking process. The letter also urges HHS to identify any gaps in their regulatory authority where the Centers for Medicare and Medicaid Services (CMS) and Congress can work together in a bipartisan fashion to permanently expand and improve the accessibility of telehealth services. The lawmakers encourage CMS to take action where appropriate in the upcoming CY 2022 Medicare Physician Fee Schedule rule. View the press release and letter

State Telehealth Activity

WHSV 3 News: Gov. Northam promises statewide broadband access by 2024 (7/16) – On July 16, Virginia Governor Ralph Northam announced that $700 million in economic relief funding would go toward broadband expansion to accelerate the governor’s 10-year goal for achieving state-wide access. Northam said he hopes that all of the Commonwealth of Virginia will have internet access by 2024.

mHealth Intelligence: Texas Governor Oks telehealth, RPM services, broadband expansion (7/14) – Texas Governor Greg Abbot signed two bills into law (HB 4 and HB 5) that would expand telehealth coverage and access in the state, joining over 20 other states that have taken action to expand telehealth over the past several months. House Bill 4 will expand the use of connected health platforms for preventive health and wellness screenings, case management services, physical, occupational and speech therapy, nutritional counseling, assessments and behavioral health services, and more in the Medicaid and other public health plans. This includes services delivered by audio-only telehealth, if appropriate. This bill also establishes reimbursement through the Medicaid managed care program for remote patient monitoring services. House Bill 5 expands the make-up and duties of the state’s new Broadband Development Office and council, which would monitor the progress of broadband expansion and identify barriers to internet access in the state.

STAT: ‘The party is winding down’: States and insurers resurrect barriers to telehealth, putting strain on patients (7/13) – State-issued emergency declarations and insurer policies that were issued at the start of the pandemic to encourage telehealth use are beginning to expire or be phased out. Providers and patients are trying to stay apprised of changing rules and to keep virtual appointments, even by patients driving across state lines to take virtual visits from their car to legally receive care from their providers of choice. The “rest stop televisit” is becoming more common. Emergency orders enacted during the pandemic extended licenses to providers in neighboring states, but the expiration of these orders would require such providers to now obtain a license in that state to continue seeing patients, which is a costly burden.

Wall Street Journal: A Cancer Patient’s Brutal Commute (7/12) – This op-ed tells the story of Maki Inada, a biology professor in upstate New York and current cancer patient being treated at Dana-Farber Cancer Institute in Boston, MA. Throughout the pandemic, Inada was able to have appointments with her doctors via telehealth instead of driving over five hours for an in-person appointment. Recent regulatory changes rescinding state flexibilities and temporary waivers that allowed out-of-state providers to provide care to patients in their state have caused patients like Inada to scramble to see their doctors across state lines, driving long hours to see them in patient or driving across state lines to take a telehealth visit from their cars. This article outlines the outdated licensure requirements that present barriers to patients seeking care from providers across state lines, even via telehealth and solutions for licensure reciprocity.

National Law Review: The “State” of Telehealth: Delaware Expands Access to Telehealth (7/12) – Last month, Delaware Governor John Carney signed the Telehealth Access Preservation and Modernization Act of 2021, which continues and enhances Delaware residents’ access to telehealth services and, through the adoption of the Interstate Medical Licensure Compact, ensures that telehealth services can be provided through qualified medical practitioners in a streamlined and efficient pathway to licensure that meets the health care delivery system needs of the 21^st century. The bill makes permanent many telehealth flexibilities enacted during the pandemic, such as permitting the use of audio-only telehealth and eliminating in-person requirements.

National Governors Association: Governors Lead on Expanding Access to Affordable Broadband for Telehealth Services (6/25) – Closing the digital divide has long been a priority for the nation’s Governors, and the COVID-19 pandemic moved many into action to expand access to critical telehealth services. Governors have championed the importance of increasing affordable broadband access and play a critical role in expanding access to services via telehealth, both in providing emergency connections during COVID-19 and for taking steps to enhance such services in the future. This article provides a round-up of state-level examples of actions governors took during the pandemic to expand access to telehealth and efforts to make some of these initiatives permanent moving forward.

Telehealth Research, Reports and Surveys

JAMA Health Forum: Telemedicine Use Higher Among PCPs with Value-Based Payment (7/16) – A study of Medicare Advantage enrollees during the COVID-19 pandemic found that telemedicine use was higher among primary care practices with value-based payment models. Although fee-for-service primary care organizations appeared to have a big near-term financial incentive for telemedicine use, results revealed that telemedicine was significantly more popular among practices reimbursed by value-based payment models.

Anthem: State of the Nation’s Mental Health Inaugural Report (7/14) – The Hispanic/Latino community was the most engaged in telehealth for mental health visits in 2020 – adopting the technology more than any other ethnic or racial group, according to a new analysis of Medicaid members in 14 states as part of an Anthem, Inc. State of the Nation’s Mental Health special report during National Minority Mental Health Awareness Month. Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID.

• A higher percentage of Hispanic-Latinos were already receiving in-person or telehealth mental health visits before COVID-19. D
• During COVID-19, almost 40 percent of Hispanic/Latino members had a telehealth visit, while White members had 34 percent, Asian members had 33 percent and Black members had 28 percent.

While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups.

• Black people had the lowest percent of combined telehealth and in-person visits – 56 percent – before COVID-19 and remained the lowest with 49 percent after COVID-19.
• On average, Black people had 7 percent fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds.

Healthcare IT News: Deaconess Health RPM program reduces cost of care by $7.4 million (7/12) – Deaconess has had a $7.4 million reduction in total cost of care since the start of the program. When the team analyzed the data by readmission risk cohorts (<10% risk, 10-19% risk and >20% risk of readmission), it consistently saw total cost of care reductions in the >20% risk of readmission cohort. Remote patient monitoring technology also has helped the health system drop its 30-day readmission rate from 14% to 6%.

Journal of Medical Internet Research: Survey: Most patients satisfied with telehealth visits (June 2021) – A study in the Journal of Medical Internet Research found more than 80% of patients who had a telehealth visit sometime between June 21 and July 12, 2017, said that the visit was as good as an in-person visit, and nearly 93% said they would use telehealth again. More than 90% of respondents said the clinician understood their health care needs, and almost 95% said the clinician helped them develop and understand a care plan.

Telehealth News and Market Developments

Modern Healthcare: Digital health funding hits $15B high in the first half of 2021 (7/15) – Digital health companies globally raised nearly $15 billion in the first half of the year, more than double the amount raised during the same period in 2020, according to a new report from market research firm Mercom Capital Group. Here are five funding trends to take away from this year's funding so far: 1) Digital health finance in the first half of 2021 has already surpassed full-year 2020 funding; 2) Telehealth continues to dominate digital health funding; 3) Investors primarily poured money into consumer-facing companies; 4) It's no longer rare for digital health companies to go public; 5) But M&A, not IPOs, still remains the most common exit strategy.

Fierce Healthcare: Microsoft taps Teladoc to integrate telehealth into Teams app (7/14) – Teladoc Health is partnering with Microsoft to integrate telehealth into the Teams app for hospitals and health systems. The combination of communications, collaboration and workflows in Microsoft Teams with Teladoc Health’s virtual care delivery technology will simplify the way care providers work by streamlining the technology and administrative processes associated with providing virtual care, according to the companies.

Upcoming Events

July 21, National Consortium of Telehealth Resource Centers, “Changing Healthcare Delivery: UMMC Center for Telehealth on the Rise.”

July 28-29, Health Leaders, “Telehealth and Connected Health Now Online Summit.”

August 9-13, HIMSS, “HIMSS21 Conference.”

August 11, AHIP, “Providing Comprehensive Virtual Care with Artificial Intelligence.”

Past Events

Healthcare IT News, “Telehealth making it easier for people with disabilities to access care.” In this episode of Telehealth Connection TV, Professor Rupa S. Valdez says improvement is still needed and outlines how vendors and informaticists can boost virtual care accessibility.

Please subscribe to this newsletter and send any news or events to crystal.wallace@connectwithcare.org for inclusion.