Geisinger's journey to greatly expanded telehealth Bill Siwicki April 19, 2022 The prolific health system is now able to offer telemedicine appointments to patients for primary care, urgent care and more than 70 specialties. More than 8% of total outpatient visits now are conducted virtually. Rural Pennsylvania is bigger than the states of New Jersey, Massachusetts, New Hampshire and Vermont combined. Some 75%, or 33,394 square miles, of Pennsylvania are considered rural. The geography is diverse, from rugged mountainous terrain to large stretches of farmland. High-profile health system Geisinger and its affiliated entities serve 45 predominantly rural counties throughout central and northeastern Pennsylvania, 31 of which are a part of Appalachia, a unique region of the Appalachian Mountains that cuts through the western part of the state. THE PROBLEM "Access to specialty care for many of our communities is scarce; these communities already are faced with primary care shortages, and for those who need to seek specialists and sub-specialists, long travels often are a costly and time-consuming reality," said Tejal A. Raichura, director of the center for telehealth at Geisinger. "Surveys show that rural Pennsylvanians are not taking care of themselves as well as their urban counterparts," she continued. "Fewer rural residents than their urban counterparts get the recommended exercise. Rural residents have higher rates of obesity, with almost two-thirds at risk for chronic diseases based on their sedentary lifestyle." Rural residents are in poorer physical condition, have more health risks and are more likely to lack health insurance, she added. The wage gap between urban and rural Pennsylvanians is getting wider. In fact, it has doubled in the last 30 years. Improving the quality of healthcare while lowering costs and increasing access in rural Pennsylvania counties is challenging, she said. "In 2018, Geisinger leadership committed to expanding our telehealth program and invested in a platform that could cover various elements of virtual care, including video visits to the home and our clinics, tele-stroke visits at our various inpatient units and emergency rooms, and video visits to non-Geisinger organizations, including other hospitals, skilled nursing facilities, correctional facilities, et cetera," Raichura recalled. PROPOSAL The business plan requested support for an expanded telemedicine program, one that would connect distantly located expert physicians trained in several specialties – including neurology, stroke/intensive care, pediatrics, primary care, geriatrics, psychiatry, endocrinology, rheumatology, podiatry and several others – with rural and underserved communities, allowing residents to access specialty care where they live and work. For Full Article: https://www.healthcareitnews.com/news/geisingers-journey-greatly-expanded-telehealth < Previous News Next News >

Increased Access to Care Via Telehealth in CHCs: NACHC Survey on Audio-Only Telehealth and Health Centers Center for Connected Health Policy July 2021 The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Temporary telehealth policies during the pandemic, particularly those related to audio-only, highlighted the capacity of community health centers (CHCs) to increase patient access to care in underserved communities. The National Association of Community Health Centers (NACHC) recently released a report on their survey of CHCs to assess their telehealth experiences over the course of the public health emergency and determine what the effects would be upon termination of temporary policies, and how that would impact their providers and patients. The concern from CHCs about possibly losing the ability to utilize telehealth was significant, with over 90% of respondents saying that without the extension of existing flexibilities it will be difficult to reach vulnerable populations, and over 80% stating that it will lead to worse outcomes for patients with behavioral health needs. Overall, the report suggested that losing audio-only coverage would likely exacerbate existing health disparities. Prior to the pandemic, health centers faced numerous federal restrictions that limited their ability to use telehealth. According to the report, previously only around 40% had used telehealth and audio-only modalities. Once allowed during the pandemic, however, nearly all CHCs utilized telehealth and delivered critical health care services to 30 million patients. Urban health centers and those serving low-income populations were also found to have higher rates of providing services via telehealth and audio-only, and 92% of health centers said audio-only improved patient access to care. To continue to provide this expanded access to care post-pandemic via telehealth the report discussed the need for Congressional action to permanently remove restrictions around use of audio-only and originating/distant site limitations, as well as ensuring reimbursement parity. In addition, as many states struggle to determine their post-pandemic policies related to telehealth, it has become apparent that the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) must also clarify whether states can continue to allow audio-only coverage under Medicaid and still receive federal matching funds. The value and necessity of audio-only was stressed throughout the survey. Benefits of audio-only telehealth included: *Reduced no-show rates *Improved patient/provider relationships *Better coordination of care amongst providers and families *Improved chronic care management The report concludes that without continued telehealth coverage for CHCs, all of the stated benefits will disappear, create a barrier to the provision of quality health care, and negate the ability for health centers to bring equity and access to underserved communities that would otherwise likely go without needed services. The authors urge the federal government to act and preserve access to care via telehealth in health centers across the country. Currently, there is active legislation federally and in many states that seeks to expand and extend telehealth and audio-only policies, including those for health centers. The fate of these bills remains unknown, but it is clear that the ideal resolution would need both federal direction and state engagement. A small but limited step was taken with CMS’s newly proposed physician fee schedule (PFS) for 2022. CMS is proposing to expand the definition of a “mental health visit” for CHCs by including mental health services provided through “interactive, real-time telecommunications technology”, including audio-only if the patient is not capable or does not consent to the use of live video. Additionally, the rate paid for eligible services would be at parity. This proposal is still rather narrow, but many of the existing restrictions, as mentioned previously, live in federal statute and must first be addressed by Congress. < Previous News Next News >

Improving digital engagement — patients say, 'Show me you know me' Beckers Hospital Review February 1, 2022 Patients are consumers. The best brand experiences, whether online or in person, influence consumers’ expectations about healthcare encounters. Today's patients want the healthcare journey to be user-friendly and tailored to their needs. Becker's Hospital Review recently spoke with Zak Pines, vice president of partnerships at Formstack, about digital engagement in healthcare and how health systems can use technology to create patient experiences that are safe, accessible and personalized. 'Show me you know me' Patients expect providers to know them. Mr. Pines recounted a personal experience that illustrates what the patient journey shouldn't look like. "Not too long ago, I scheduled a minor medical procedure. I received a package of paper forms that I had to fill out by hand and mail back to the hospital," he said. "I didn't put enough postage on the envelope, so it was returned to me. It was a nightmare scenario." Instead of an impersonal, paper-based process, the ideal would have been web-based forms with much of the information prefilled based on the provider's knowledge of the patient. "The key is that the healthcare organization shows that it knows who I am," Mr. Pines said. "They're cognizant of the information that patients have supplied to them in the past. With that data, it's possible to offer a 'review, verify and update' experience, rather than constantly asking people for the same information in a disconnected way." Read full article here: https://www.beckershospitalreview.com/improving-digital-engagement-patients-say-show-me-you-know-me.html < Previous News Next News >

Mental Health vs. Primary Care: How Americans Are Using Telehealth Robin Gelburd, J.D. April 19. 2022 Social workers and psychiatrists are among the providers Americans are frequently visiting via telehealth, highlighting the pandemic’s continued mental health impact. Ever since the COVID-19 pandemic began, many Americans have been receiving health care via telehealth. The question arises: Who are the health care professionals on the other end of all these video links and phone calls? According to new evidence from private insurance claims data, the top specialty providing telehealth services nationally this past January was social worker. Because the most common telehealth service social workers provide is psychotherapy, this is just one sign of how prevalent the provision of mental health services through telehealth has been, as our country continues to grapple with the pandemic and its impact on many fronts. Tracking Telehealth Month by Month FAIR Health has been tracking telehealth trends on a monthly basis since January 2020 with the Monthly Telehealth Regional Tracker. Drawing on our repository of billions of private health care claims, the Telehealth Tracker documented the rapid rise in telehealth usage in the early months of the pandemic and has followed the evolution of telehealth since then. The Telehealth Tracker is a free, interactive, online map of the four U.S. census regions (Midwest, Northeast, South and West) that allows the user to view an infographic on telehealth for a specific month in the nation as a whole or in individual regions. The Telehealth Tracker itself evolved as the pandemic continued. In the first year, to study the impact of the COVID-19 pandemic on telehealth, each month in the pandemic year of 2020 was compared to the corresponding month in the pre-pandemic year of 2019. In 2021, the focus turned to month-over-month rather than year-over-year changes. In 2022, we’ve added new features: the top five telehealth provider specialties rendering telehealth services and the Telehealth Cost Corner, which presents a specific telehealth procedure code and its median costs. Continuing from previous years are the percent change in telehealth’s share of medical claim lines, the top five telehealth procedure codes and the top five telehealth diagnoses. (A claim line is an individual service or procedure listed on an insurance claim.) Provider Specialties In January 2022, social worker was the provider specialty rendering the most telehealth services nationally and in every region but the West. In the West, primary care physician was the leading provider specialty, ahead of social worker by just a tenth of a percentage point in terms of each specialty’s share of telehealth claim lines. In every other region and nationally, primary care physician was in second place behind social worker. Nationally, psychiatrist, psychologist and primary care nonphysician were in third, fourth and fifth place, respectively. Though the regions varied in the order of provider specialty, in all of them – as in the nation as a whole – three of the five top specialties were related to mental health: social worker, psychiatrist and psychologist. The share of telehealth services provided by social workers varied by region. Nationally, social workers accounted for 28.7% of telehealth claim lines. In the Midwest, where their share was greatest, they accounted for 32.2%; in the West, where it was least, they made up 22.4%. Diagnoses Throughout 2021 and into January 2022, mental health conditions constituted the top telehealth diagnostic category nationally and in every region. In January, mental health conditions accounted for 58.9% of telehealth claim lines nationally – up from 55% in December 2021. By comparison, mental health conditions also were No. 1 among telehealth diagnoses in 2020, but accounted for only 44% of telehealth claim lines nationally. Throughout 2021, generalized anxiety disorder was the top telehealth mental health diagnosis nationally and in most regions, though major depressive disorder was No. 1 in the West. From May to July 2021, and again from September to October, substance use disorders emerged as one of the top five telehealth diagnoses nationally. Procedure Codes Throughout 2021, the telehealth procedure code used most often nationally was the code designating one hour of psychotherapy. This remained the nation’s top telehealth procedure code in January 2022, when it accounted for 23.1% of telehealth claim lines. The nation’s top five codes contained two other psychotherapy codes that month: one in fourth place designating 45 minutes of psychotherapy and another in fifth place marking a 30-minute psychotherapy visit with evaluation and management. In three of the four census regions, all three of these codes were in the top five, with one hour of psychotherapy in first place. In the South, however, the top five telehealth codes contained one hour of psychotherapy in first place and 45 minutes of psychotherapy in fifth place, but did not include the code for a 30-minute visit. Services Besides Mental Health Despite the dominant position of mental health services, telehealth also offers a gateway to services and treatments for many other conditions. In January, along with mental health conditions, the top five telehealth diagnostic categories nationally also included acute respiratory diseases and infections, COVID-19, developmental disorders and joint/soft tissue diseases and issues. The Telehealth Cost Corner was created to spotlight the costs of a different telehealth procedure code each month. For January, the spotlight was on the code designating treatment for a speech, language, voice, communication and/or hearing processing disorder. This code is most commonly used by speech-language pathologists to help correct specific speech or language disorders – typically in young children with developmental language delays and/or autism, though sometimes also in older adults after stroke or other debilitating incidents. Provider Specialties In January 2022, social worker was the provider specialty rendering the most telehealth services nationally and in every region but the West. In the West, primary care physician was the leading provider specialty, ahead of social worker by just a tenth of a percentage point in terms of each specialty’s share of telehealth claim lines. In every other region and nationally, primary care physician was in second place behind social worker. Nationally, psychiatrist, psychologist and primary care nonphysician were in third, fourth and fifth place, respectively. Though the regions varied in the order of provider specialty, in all of them – as in the nation as a whole – three of the five top specialties were related to mental health: social worker, psychiatrist and psychologist. The share of telehealth services provided by social workers varied by region. Nationally, social workers accounted for 28.7% of telehealth claim lines. In the Midwest, where their share was greatest, they accounted for 32.2%; in the West, where it was least, they made up 22.4%. Diagnoses Throughout 2021 and into January 2022, mental health conditions constituted the top telehealth diagnostic category nationally and in every region. In January, mental health conditions accounted for 58.9% of telehealth claim lines nationally – up from 55% in December 2021. By comparison, mental health conditions also were No. 1 among telehealth diagnoses in 2020, but accounted for only 44% of telehealth claim lines nationally. Throughout 2021, generalized anxiety disorder was the top telehealth mental health diagnosis nationally and in most regions, though major depressive disorder was No. 1 in the West. From May to July 2021, and again from September to October, substance use disorders emerged as one of the top five telehealth diagnoses nationally. Procedure Codes Throughout 2021, the telehealth procedure code used most often nationally was the code designating one hour of psychotherapy. This remained the nation’s top telehealth procedure code in January 2022, when it accounted for 23.1% of telehealth claim lines. The nation’s top five codes contained two other psychotherapy codes that month: one in fourth place designating 45 minutes of psychotherapy and another in fifth place marking a 30-minute psychotherapy visit with evaluation and management. In three of the four census regions, all three of these codes were in the top five, with one hour of psychotherapy in first place. In the South, however, the top five telehealth codes contained one hour of psychotherapy in first place and 45 minutes of psychotherapy in fifth place, but did not include the code for a 30-minute visit. Services Besides Mental Health Despite the dominant position of mental health services, telehealth also offers a gateway to services and treatments for many other conditions. In January, along with mental health conditions, the top five telehealth diagnostic categories nationally also included acute respiratory diseases and infections, COVID-19, developmental disorders and joint/soft tissue diseases and issues. The Telehealth Cost Corner was created to spotlight the costs of a different telehealth procedure code each month. For January, the spotlight was on the code designating treatment for a speech, language, voice, communication and/or hearing processing disorder. This code is most commonly used by speech-language pathologists to help correct specific speech or language disorders – typically in young children with developmental language delays and/or autism, though sometimes also in older adults after stroke or other debilitating incidents. < Previous News Next News >

New Study Pitches Telehealth as Safer Than the Doctor’s Office Eric Wicklund, mhealthintelligence August 2021 In a nod to the value of telehealth in primary care, researchers have found that a person visiting the doctor's office shortly after a visit from someone with the flu has a much higher chance of getting the flu as well. A new study makes a strong case for telehealth as an alternative to the doctor’s office, particularly during flu season. Researchers from the University of Minnesota School of Public Health, Harvard Medical School and the university’s T.H. Chan School of Public Health and athenahealth have found that people who visit their doctor’s office after someone infected with the flu has visited that office are much more likely to come down with the flu themselves. That same increase wasn’t seen in people seeking treatment for issues like urinary tract infections. The study, published this month in Health Affairs, suggests that primary care providers embrace virtual visits as a means of reducing that chance of infection. “It’s a widely accepted fact that patients can acquire infections in hospital settings, but we show that infection transmission can happen when you visit your doctor’s office, too,” Hannah Neprash, an assistant professor at UM’s School of Public Health and one of the study’s authors, said in a news release issued by the university. “Our findings highlight the importance of infection control practices and continued access to telemedicine services, as health care begins to return to pre-pandemic patterns,” she added. "In-person outpatient care for influenza may promote nontrivial transmission of these viruses. This may be true for other endemic respiratory illnesses too, including COVID-19, but more research is needed." The study, which tracked office visits from a national sample of insurance claims and EHR data compiled by athenahealth, is reportedly the first to connect the dots between office visits and the progression of a flu outbreak. According to that data, patients visits their primary care provider were almost 32 percent more likely to contract the flu within two weeks if that PCP had seen someone with the flu within the previous two weeks. In addition, that office would then serve as an incubator for the flu, infecting more patients over time. Neprash and her fellow researchers say their study supports the need for “triage to telemedicine” policies in clinics and medical offices when a patient shows signs of a contagious viral infection like the flu. “Given that upper respiratory symptoms are among the most common reasons for any patient to see a physician, these results highlight the importance of protocols to mitigate the risk for transmission,” the study notes. “Clinically, many of these patients will be at low risk for complications with telemedicine evaluation.” It also suggests that care providers develop “strict infection control practices” whenever a patient showing signs of the flu or a similar virus need to be seen in person. This would include mask-wearing, hand hygiene and putting patients in separate exam rooms that can be decontaminated after a visit. Finally, the study makes a case for continued support for telehealth coverage at a rate equal to in-person care. “Lawmakers in Congress are actively debating the future of telemedicine policy and how it should be reimbursed after the worst of the COVID-19 pandemic recedes,” the study notes. “It is possible that telemedicine reimbursement after the pandemic will be restricted to certain specialties or diagnoses or reimbursed at a rate low enough that many clinicians decide to forgo telemedicine as a mechanism for care delivery. Our results argue that clinically, for infection control, telemedicine should remain a financially viable option for clinicians to provide care for viral respiratory symptoms. < Previous News Next News >

New FAIR Health White Papers Shows Large Telehealth Utilization Increases Before COVID-19 Center for Connected Health Policy April 2021 Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. In its fourth edition of the Healthcare Indicators and Medical Price Index White Paper, FAIR Health found that the fastest area of healthcare utilization growth from 2018 to 2019 occurred for telehealth services. FAIR Health conducted the annual analysis using its data repository of 32 billion claims for patients in commercial insurance plans. Results showed that telehealth utilization increased by 73% from 2018 to 2019 with telehealth claims comprising over one-third of all health care claims in 2019. FAIR Health also noted that the most common claim type for telehealth was for mental health services, bolstering other recent evidence that telehealth utilization continues to grow for behavioral and mental health services. The findings are an important contribution to ongoing policy discussions about where telehealth is going after the pandemic. While most telehealth experts have been paying close attention to telehealth utilization during the pandemic, these findings suggest that the story of telehealth’s rapid growth likely begins in 2019, one year prior to the public health emergency. FAIR Health is a national nonprofit organization that maintains a large database of privately insured healthcare claims data. The organization performs healthcare utilization and cost analyses on market trends for use by researchers, consumers, and industry stakeholders. For more information about FAIR Health's data, view their website. FAIR Health Consumer: https://www.fairhealthconsumer.org/#about FH Healthcare Indicators and FH Medical Price Index 2021: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/FH%20Healthcare%20Indicators%20and%20FH%20Medical%20Price%20Index%202021--A%20FAIR%20Health%20White%20Paper--FINAL.pdf < Previous News Next News >

TELEHEALTH: THE JOURNEY FROM VIDEO VISITS TO STRATEGIC BUSINESS TOOL By Mandy Roth at HealthLeaders April 6, 2021 New approaches to telehealth can help organizations meet their key objectives. KEY TAKEAWAYS: *Asynchronous communication increases provider efficiency and provides a way to address physician shortages. *Virtual hospitals reduce healthcare costs and support the transition to value-based care. *A cloud-based platform enables 24/7 personalized care, moving care upstream to improve outcomes and reduce the cost of care. 2020 was a remarkable year for healthcare innovation, and telehealth finally achieved scale across the industry. Driven by a need to deliver healthcare at a distance, hospitals and health systems stood up new services seemingly overnight, fanned the flames under languishing programs, or found new uses for thriving virtual care initiatives. Now that telehealth has become a fixture in the healthcare delivery firmament, it's time to examine what comes next. While current use predominantly focuses on televisits between providers and patients, and mysteries remain about reimbursement and licensure issues after COVID-19, forward-thinking healthcare executives are using the technology to enable new models of care. Health systems are employing telehealth to transform healthcare delivery in ways that address strategic business objectives: improve outcomes, reduce provider burden, enhance patient experience, improve access, and ameliorate workforce labor issues. HealthLeaders spoke to visionary leaders and digital healthcare experts who shared their insights and perspectives about what organizations should focus on now, next, and in the future to unlock the potential of telehealth. Coverage includes case studies about asynchronous care, remote monitoring, and a futuristic cloud-based platform fueled by artificial intelligence. Health systems shared details about how these initiatives work and how they evaluated the return on investment. These new approaches to telehealth can help organizations meet their strategic objectives and provide information to inspire other organizations on their own telehealth journeys. WHAT'S NOW: PRESBYTERIAN HEALTHCARE SERVICES ENHANCES EFFICIENCY WITH ASYNCHRONOUS COMMUNICATION Strategic Objectives: *Increase provider efficiency and address physician shortages *Reduce costs per patient encounter *Reduce ER and urgent care utilization At the beginning of 2020, physicians and consumers had not yet fully embraced the concept of virtual video visits; many were skeptical about the ability to deliver care effectively in this manner. Yet after the pandemic forced the adoption of virtual visits, their reputation and usage forever changed. Today, asynchronous communication faces the same hurdles. Providers and patients don't understand how it works and question its value. "It's a technology whose time has not yet come," says Oliver Lignell, vice president of virtual health at health system consultancy AVIA, which helps members accelerate their digital transformation initiatives. "It's not yet mainstream, but it should be." Presbyterian Healthcare Services, an Albuquerque, New Mexico–based nonprofit integrated healthcare delivery system, began investigating this approach to healthcare four years ago. "It's been incredibly effective," says Ries Robinson, MD, senior vice president and chief innovation officer. Between the system's nine hospitals and a health plan it offers, the organization serves a third of the state's residents. With a shortage of practitioners in New Mexico, and 70% of the care it provides covered by capitated contracts, Presbyterian needed to find a way to operate more efficiently. Asynchronous communication worked. Last year, a designated group of employed urgent care physicians handled 50,000 asynchronous visits for low-acuity care, and spent an average of two minutes on each encounter—far less than the 15–18 minutes it takes to conduct a typical video call. This form of care does not occur in real time. Depending on the platform used, a patient completes and submits an online form via secure email, text, or an app, detailing his or her complaint and relevant history. A physician receives the information, processes it, and sends a response back to the patient with instructions and prescriptions, if necessary. Presbyterian physicians usually respond within 15 minutes; some health systems using asynchronous communication allow up to 24 hours. There is no direct audio or video exchange with the patient unless the physician thinks it is warranted and escalates the encounter. Asynchronous communication offers some distinct advantages to health systems, say the experts. Synchronous care, which includes video, audio, and in-person visits, comes with an Achilles' heel: Regardless of venue, the physician spends about the same amount of one-to-one time with the patient, says digital medicine expert Ashish Atreja, MD, MPH, chief information and digital health officer at UC Davis Health in Sacramento, California. "The real growth you're going to see in value," he says, "is the ability to deliver one-to-many care." Asynchronous communication is a step in that direction. "One of the most important things asynchronous communication does is help scale response," says Ann Mond Johnson, MBA, MHA, CEO of the American Telemedicine Association. In addition, because patients can use it with a phone or the internet, it can address issues of access, she says. Robinson says the SmartExam™ platform Presbyterian is using, made by Bright.md, includes features that appeal to its physicians. It automatically enters chart-ready SOAP (Subjective, Objective, Assessment, and Plan) notes into the electronic medical record (EMR), creates billing files, and manages patient follow-up communications. "It's extremely elegant," says Robinson. SmartExam's design, which asks patients questions in an interview-style exchange, and advanced logic has earned the trust of the physicians who use it, he says. "I remember the first time [physicians] said, 'I trust it'; I thought that was kind of a funny term to use," Robinson recalls. When he asked the doctors what they meant, they explained that the tool is thorough and consistent in a way humans cannot replicate. "That's what the providers really like." Even the best medical assistant, he says, may vary in how they ask questions of patients, forget to include certain details, or package assessments differently. While Robinson says the health system has detailed financial models that justify the cost of the platform, he declines to disclose the figures, but notes, "It hasn't been an astronomical investment by any stretch of the imagination." Expenses include a one-time cost for EMR integration, ongoing charges for using the platform on a per-patient per-use basis, and marketing and promotion. He also provides formulas to calculate estimated cost savings. They include: *Better utilization of providers' time and related staffing expenses, by reducing each of 50,000 encounters from 15–18 minutes for a video encounter to two minutes for an asynchronous visit. *More appropriate ER usage. Out of 50,000 patients, 8% were redirected away from the ER. This figure is based on patient survey responses indicating they would have visited the ER had the platform not been available. With an average ER visit costing more than $500, says Robinson, "there's a significant savings." *Reduced workload at urgent care facilities. "Just assume 20,000 [of these patients] would have gone to an urgent care that we own," he says. The time and expense of urgent care staffing is used to calculate the savings. Patients also save money, says AVIA's Lignell. Nationally, he says the typical cost for an asynchronous visit is about $20, and many health systems offer these visits for free. This compares to a national average cost of $50 for a video visit and $125 for an in-person visit. There is one additional element that has contributed to the success of asynchronous visits for Presbyterian: a digital front door. Patients visit the pres.today webpage, enter their condition and insurance information, and are automatically directed to the appropriate level of care, one of which includes the option for online visits (using asynchronous care). Because of the asynchronous initiative's success, the health system is expanding its use beyond low-acuity care. Future plans involve developing new uses for the platform, capturing symptoms and history to create greater efficiencies for video visits and even in-person care. "We have gotten religion around the idea of capturing as much information as you can in a sophisticated manner before the visit," says Robinson. "You maximize the quality of care and the efficiency of the visit. We're taking that idea and pushing it forward in multiple avenues of care here at Presbyterian." Value-based care will drive further adoption of these models, says Lignell. "The advantages from a total cost of care standpoint are huge," he says. "It's much less expensive to deliver care this way." While the bulk of growth has been in low-acuity primary care, he says asynchronous care is now being explored in specialty and higher-acuity care, as well as in e-consults between providers. "The asynchronous model is proving to be incredibly efficient for health systems," says Lignell. "That's one of the reasons why it has so much promise." WHAT'S NEXT: ATRIUM HEALTH LAUNCHES A VIRTUAL HOSPITAL Strategic Objectives: *Increase bed capacity, limit staff and patient exposure to COVID-19, and conserve PPE *Reduce costs and support the transition to value-based care *Improve patient satisfaction and experience "Remote patient management is widening the aperture from the episodic-based healthcare reality that we've known for decades towards a 24/7, always-on ubiquitous reality," says Rasu Shrestha, MD, MBA, executive vice president and chief strategy and transformation officer at Atrium Health. Long before COVID-19 hit American shores, health systems began launching remote monitoring programs, particularly to manage chronic diseases. Hospital at home initiatives, or virtual hospitals, are a robust manifestation of this endeavor. While these models have demonstrated cost savings, adoption has been slow due to reimbursement issues. The pandemic offered a trifecta of motivating factors to accelerate adoption of the virtual hospital model: bed capacity issues, a need to limit staff and patient exposure, and dwindling supplies of personal protective equipment (PPE). With these issues in mind, during March 2020 a handful of clinicians approached Atrium Health administrators, suggesting that the 42-hospital Charlotte, North Carolina–based nonprofit health system consider launching a hospital at home initiative. Two weeks later it was operational, says Scott Rissmiller, MD, executive vice president and chief physician executive. In the first 10 months, the virtual hospital admitted 51,000 patients. "We are able to keep patients in their homes, protect our teammates from infection, and also protect patients," Rissmiller says. "It freed up a good bit of capacity in our acute facility," enabling the health system to reserve that space for its more acute COVID-19 patients. The virtual hospital maintains two "floors." The first floor functions as an observation unit; the second floor is reserved for patients requiring more intensive care, says Rissmiller. Any COVID-19-positive patient is admitted to the first floor of the virtual hospital and receives digital tools to monitor temperature, blood pressure, pulse, and oxygen levels. These devices deliver data via Bluetooth® to a smartphone app developed by the health system's IT department. That data feeds into the patient's EMR, fully integrating into the patient's continuum of care, Rissmiller explains. In a bunker back at Atrium Health's call center, a team of clinicians monitors data and checks in with first-floor patients daily. Second-floor virtual patients have the same home monitoring tools, but receive "much more intensive management" and frequent check-ins, he says. In addition, community-based paramedics visit homes to administer IV fluids, IV antibiotics, breathing treatments, EKGs, and other interventions. This arrangement created additional opportunities to reduce hospital bed capacity. "We were one of the first in the nation to get in-home remdesivir, one of the COVID treatments," says Rissmiller. "To receive remdesivir, you have to be on oxygen therapy, so these patients are sick." In a 10-month period, Atrium Health administered about 150 therapeutic rounds of the drug, he says, which saved about 500 hospital days that would have been required if those patients had been hospitalized. "From a quality standpoint, we do not view this any differently than if these patients were within the walls of our hospital," says Rissmiller. All measures, including length of stay as well as readmission, transfer, and mortality rates, have been almost identical to inpatient stats, and patient satisfaction has been "extremely high," he says. "Patients really would rather be in their home surrounded by their loved ones and support system." The hospital at home initiative has been a "costly endeavor," says Rissmiller. "When we realized this pandemic was going to be significant, our CEO [and President Eugene Woods, MBA, MHA, FACHE] called me and said, 'Scott, whatever you need to care for our patients and communities—do it. We'll figure out the costs later.' It freed us up to be able to do things like this." As it turned out, costs have been offset by funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which enable Atrium Health to bill for many of the services provided. The organization also is one of a handful of healthcare systems that are doing a pilot with the Centers for Medicare & Medicaid Services, which views virtual beds as real hospital beds. "The reimbursement is similar because of the level of service we're providing," says Rissmiller. Initially, though, "it was all upfront costs for us, but the return was in bed days." A focus on reimbursement continues "as we are now maturing the program," he says. "Our concern is that the reimbursement will go away once those [pandemic] emergency orders expire. We're working with the state, our payers, Medicare, and others to make sure that this continues to be reimbursed at a level that allows us to continue to grow it and cover our costs." "Out of necessity, COVID ultimately accelerated health systems' desire to think through their digital strategies and determine how digital fits into their overall care and business models," says Brian Kalis, MBA, managing director of digital health and innovation in consulting firm Accenture's health practice. "New models are starting to pop up, and care is shifting to the home." Strategic goals include producing outcomes that equal or exceed inpatient care, while also improving labor productivity, Kalis says. "A majority of health systems coming out of COVID are putting care at home as a key strategic focus. That requires a collection of new models to deliver care, putting different care team compositions in place, and [utilizing] technology to help a broad range of conditions for pre-acute, acute, and post-acute care." Atrium's virtual hospital has already expanded beyond COVID-19 patients. Once the surge diminished in July, Rissmiller "challenged the team to look at [the initiative] through the lens of a non-COVID world. Can this become a new way of caring for patients that makes sense to the patient and to us as a healthcare system?" There is now a list of 10 diagnoses to be considered for hospital at home care, and congestive heart failure patients have already been admitted into the virtual facility. "We're starting to branch out," he says. "We're also starting to focus on different communities to make sure that we're doing this in a way that helps with our underserved populations and gives them the resources they need to manage care at home rather than coming through the emergency department." While Atrium Health rolled out its program in two weeks, Rissmiller says, "this is something that would be incredibly hard to start up on your own if you hadn't had the 10 years of virtual experience that we've had building these capabilities, but also the confidence to be able to deliver these kinds of services at home. It takes a while for clinicians to understand that care can be delivered safely virtually. We also have a culture at Atrium Health that really enables our clinical leaders to lead and their voices to be heard. That, more than anything, is the secret sauce that's allowed for innovations like hospital at home." WHAT'S IN THE FUTURE: HIGHMARK HEALTH DEVELOPS PLATFORM TO DRIVE 24/7 CARE Strategic Objectives: *Move care upstream to improve outcomes *Reduce cost of care, patient traffic, and volume *Enable 24/7 personalized care Unleashing the potential of virtual care requires strategic innovation fueled by imagination. Highmark Health is one organization traveling along this path. To understand the power of an initiative now underway at the Pittsburgh-based payer-provider system, one must imagine the potential to do something that is currently not possible. For example, take the hypothetical case of an individual living independently at home with six medical conditions. What if real-time data alerts her care team that her health status has subtly changed? What if this alert takes the complexity of her medical history into account and offers decision-support tools to accelerate clinical action before her health deteriorates? The Living Health Model, fueled by the Living Health Dynamic Platform—a Google Cloud–based technology infused with artificial intelligence and advanced analytics—could be the missing link that will enable care to move upstream. The concept revolutionizes the current perception of telehealth and enables 24/7 care. It aims to connect the provider, patient, and payer in novel ways to improve health outcomes, reduce clinician administrative burdens, enhance patient engagement, and reduce costs, says Karen Hanlon, executive vice president and chief operating officer at Highmark Health. "We believe that we have the capabilities and resources to pull it together," says Tony Farah, MD, FACC, FSCAI, Highmark Health's executive vice president and chief medical and clinical transformation officer, who is also a practicing cardiologist. The platform will amplify the impact of remote monitoring tools, which many health systems already use for chronic disease management. By adding sophisticated data analytics, machine learning, decision support, and patient education tools, the system will support comprehensive care rather than managing diseases in silos, Farah says. "Our partnership with Google Cloud is going to not only accelerate our strategy, but also help us scale it." Data will be constantly mined to determine the "next best action" required to proactively care for a patient and formulate a personalized care plan that delivers a "curated" experience based on the patient's personal needs, says Hanlon. For patients with no apparent health conditions, the system may focus on wellness. While full realization of this concept may be years down the road, Hanlon says the first iteration of the platform will be functional at the end of 2021. Accenture cloud expert Geoff Schmidt, managing director, global lead—life sciences technology, says Highmark Health's plans align with what he's seeing in the life sciences sector. Health leaders should not think of the cloud as a capability or an IT initiative, he says; "think of it as a business transformation enabler." Cloud technology is accelerating companies' three- to five-year strategic plans, compressing those timelines down to 12 to 18 months. "We're seeing dramatic transformations and acceleration of CEO agendas because of the capability that the cloud can provide." Partnering with an outside player is a smart move for health systems that want to expedite their transformation initiatives, says Schmidt. "Major technology partners are innovating at a scale that is, just frankly, hard for payers or providers to keep up with." Prior to its partnership with Google Cloud, Highmark Health piloted "analog" proofs of concept, according to Farah. These pilots involved addressing healthcare for several patient populations, including high-risk patients with multiple comorbidities as well as individual chronic conditions like COPD, heart failure, diabetes, and hypertension. Physicians were asked to improve health outcomes in 12 months. "The patient experience went through the roof, and in almost every case—with the exception of diabetes—the total cost of care came down," says Farah. "I would say physician engagement was our secret sauce." "Consumer engagement is also a key component," says Hanlon. "There are a lot of solutions out there. They're very siloed and they're not integrated. We can have the best solutions in the world, but if the consumer and the clinician are not using them, they will have no impact." While Highmark Health does not disclose the company's investment in this platform, "you can guess that it is a fair amount," says Hanlon. In addition to activating the initiative at Allegheny Health Network, a nonprofit health system that Highmark owns and operates, "at the same time we're a health plan serving 5.6 million members," she says. "The ability to interact with all of those members is incredibly important to us. When you look across our book of business, we're probably managing somewhere in the neighborhood of $26 billion in healthcare costs a year. When we look at the investments that are needed to support that base of membership and that level of healthcare spend, we feel it's appropriate and we can justify the investment." Being both a payer and a provider imbues Highmark Health with the motivation and influence to transform healthcare delivery in this way, Hanlon says. The company is a Blue Cross Blue Shield–affiliated payer operating in three states, and also functions as a provider through the Allegheny Health Network. "By having both of those assets in the portfolio," says Hanlon, "it's easier for us to align on the path forward and the economic model." But to characterize this venture merely as a mechanism to save money misses the point, she says. The model is designed to improve patient outcomes by moving care upstream, explains Farah. "Conditions that exist today will be prevented from deteriorating, and conditions that haven't developed will be prevented—or, at a minimum, be delayed in development. That's the primary goal, and it results in a reduction in total cost of care. It flips the equation from focusing on finances to focusing on health." In addition, for the Living Health Model to be effective, it must work with entities outside of the facilities owned by the Highmark Health system, which provides health plans in Pennsylvania, Delaware, and West Virginia. Allegheny Health Network operates facilities in 29 Pennsylvania counties and portions of New York, Ohio, and West Virginia. "We're looking to have impact across all of the markets that we serve as our insurance company, not just where we own a provider asset," says Hanlon. "The progression of value-based care has been a slow march. I think this platform will be a tool to enable providers to continue down that path. Part of our focus is developing other tools we believe will be necessary for the providers to succeed in a value-based environment. We recognize that we're going to have to be a leader in helping others to move down that path." A FRAMEWORK FOR MOVING FORWARD Planning for the future of telehealth requires rethinking the present. "If the only way that you look at telehealth is as a way to replace one-to-one physical visits with a telehealth visit, you're not changing the world; you're just creating a little bit more convenience," says Roy Schoenberg, MD, MPH, president and CEO of Amwell, a Boston-based technology company that provides telehealth technology to health systems. "If you look at telehealth as a product, you're going to end up behind the competitive landscape curve. If you look at telehealth as an operating system, [it becomes a] mechanism for the digital distribution of care." Transforming the way healthcare is delivered requires changing, from the ground up, the way health systems think about their relationships with patients, Schoenberg says. Telehealth can alter dynamics related to patient traffic and volume, patient flow, transitions of care, and assumption of risk. "When you equip yourself with telehealth capabilities," Schoenberg says, "you should ask yourself, 'Does the system that I buy allow me to create new applications for telehealth that the vendor didn't think about?' [You] should imagine plans for patients that incorporate and take advantage of telehealth. The result of that is a completely different beast." This article appears in the March/April 2021 edition of HealthLeaders magazine. - https://www.healthleadersmedia.com/telehealth/telehealth-journey-video-visits-strategic-business-tool < Previous News Next News >

Telehealth May Be Rural Healthcare’s Lifeline Corey Scurlock December 28, 2022 As a new year dawns, it seems like a stock-taking time in U.S. healthcare. Skyrocketing costs, underwater margins, a depleted workforce and sicker patients have most hospitals and systems thinking existential thoughts about 2023, none more so than rural facilities. According to a report by the Bipartisan Policy Center (BPC), a Washington, D.C.-based think tank, 116 rural hospitals across 31 states closed between 2010 and 2019. Many of them were small critical access hospitals. Federal Covid-19 relief funding is believed to have prevented additional closures—only two rural hospitals closed in 2021. Now, though, 631 rural hospitals are threatened with possible closure within the next few years, according to the Center for Healthcare Quality and Payment Reform. As the CEO and founder of an acute care telehealth company, I’ve observed firsthand that workforce needs are one of the primary drivers of telehealth adoption. What was once a staff shortage is now a crisis, particularly in nursing, but also among physicians. From 2020 to 2021, the total supply of registered nurses decreased by over 100,000, the largest drop in four decades. By 2025, there could be a shortage of 200,000 to 450,000 nurses in the U.S. Rural hospitals are at a particular disadvantage since they tend to have worse workforce shortages than urban hospitals. According to the BPC, “urban areas have 30.8 physicians per 10,000 residents; rural ones have 10.9 physicians per 10,000.” There are also often fewer specialists—such as cardiologists, psychiatrists, radiologists and obstetricians—in rural areas. Opportunities To Improve Care Rural hospitals have for years contracted with academic medical centers for remote episodic help with patients with clinically complex conditions, such as stroke and sepsis. To make care more affordable, we’re seeing more rural healthcare leaders embracing telehealth for supplemental care, filling in coverage gaps or for specialized consultations on complex cases so that people get the right care at the right time in the right setting. In previous articles, I wrote about how telehealth can provide clinical expertise, how telehealth specialists target “hot spots” along the patient care journey and about virtual nursing, in which veteran RNs with specialty expertise guide bedside staff and patients through the care process. Rural hospitals are in dire need of expert care at patient transition points. Virtual care often starts in what is now the front door of a hospital: the emergency room. Rural and critical access hospitals often have to park patients in the hallway as they triage. A remote intensivist steeped in critical care medicine can track the vital signs of patients and do the intake, often guiding inexperienced staff to the right site of care and helping them through tests, diagnoses and procedures. Inappropriate patient transfers are a source of inefficiencies and poor-quality care. Patients may be sent to intensive care who don’t need to be. Some can be easily treated in the ER and sent home. Others may need a complex operation, for which a transfer to a level 1 trauma center is needed. Outcomes for ER patients with delayed care are, not surprisingly, poorer. Maximizing A Stretched Workforce The BPC examined three evidence-based programs that involve using digital technology—one of which was tele-ICU—to see how they could optimize a stretched healthcare workforce and ensure that patients receive quality care in their local hospitals. Tele-ICU programs can be episodic, such as enabling two-way audiovisual communication between telehealth providers and local ICUs to get answers to questions, or they can be continuous, where a remote physician has complete access to electronic medical records, imaging systems and other databases to get timely information that informs decisions about a patient’s care. According to the BPC, “studies have demonstrated that tele-ICU programs enhanced care plans, improved clinical outcomes, reduced hospital transfers, and were associated with increased best-practice adherence.” Telehealth also facilitates the mentoring of young nurses and assesses where there are gaps in current knowledge. The BPC report mentions a study that found that 27% of hospitals with ICUs have tele-ICU capabilities. Such capabilities can potentially lead to substantial savings: The report cites a 2019 cost-benefit analysis that found that a telehealth ICU program saved $3.14 million over six months by “reducing ICU variable costs per case, decreasing length of stays and decreasing ICU mortality.” It’s a fairly straightforward story: Remote intensivists can monitor dozens of patients remotely at a time, while tele-ICU nurses can keep track of 30 to 50 patients simultaneously, compared with just three for a bedside RN. Bedside clinicians typically can deal with only one emergency at a time, while remote intensivists can handle up to four codes at once. A Path Forward Pretty soon, the pressures of the workforce shortage will likely compel many, if not most, acute care providers to adopt some virtual care across the enterprise. So it’s crucial for rural hospitals to take steps now to ingrain telehealth into their operations and make it part of the fabric of care—that way, it’s there when they need it. Here are some things for rural hospitals to think about when choosing a telehealth partner. • There are many entities offering telehealth services, ranging from large academic medical centers to consortiums of providers to vendors large and small. Make sure you have complete trust in your chosen partner. • Ensure that all of the entity’s physicians are licensed to practice medicine in your state(s). If not, they cannot order tests, prescribe medications or do anything but recommend a course of action. • Does the telehealth provider have a network of specialists in every area? For example, many vendors lack psychiatrists, who are in short supply nationally amid the explosion in demand for mental health services. • Make sure your telehealth partner understands patient flow optimization techniques that support level-loading and optimized bed utilization. Final Thoughts Through my travels and in conversations with executives across the nation, I’ve found that the word “telehealth” doesn’t sound techy anymore and that the understanding of the benefits delivered by digitally enabled care is more mature. Telehealth is now recognized as a tool that, as part of a strategic process to remedy gaps in care delivery, can be combined with change management to drive real value. Soon, in fact, “telehealth” may be replaced by “health” when we look at the evolution of care through technology. Dr. Corey Scurlock MD, MBA is the CEO & founder of Equum Medical. See original article: https://www.forbes.com/sites/forbesbusinesscouncil/2022/12/28/telehealth-may-be-rural-healthcares-lifeline/?sh=1f7657be3e9d < Previous News Next News >

Opportunity Knocking — Empanelment, COVID-19 and Telehealth By Trudy Bearden, PA-C, MPAS February 17, 2021 Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment. Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment is a foundational component of primary care and is essential in population health management. In 2019, the People-Centered Integrated Care collaborative, participants from 10 countries developed an overview of empanelment and a comprehensive definition: Empanelment is a continuous, iterative set of processes that identify and assign populations to facilities, care teams, or providers who have a responsibility to know their assigned population and to proactively deliver coordinated primary health care. That definition is accurate and comprehensive, but we must appreciate the recent, succinct statement by my Empanelment Learning Exchange colleague Elizabeth Wala, Global Advisor, Health and Nutrition at Aga Khan Foundation: “Empanelment is grouping patients under providers.” Opportunity. As a primary care clinician and health care consultant, I have been thinking hard since April 2020 about the importance of empanelment, telehealth and the COVID-19 pandemic. Just to be clear, I’m using the term telehealth as defined by the discrete set of services described by the Centers for Medicare & Medicaid Services (CMS) List of Telehealth Services. Similarly, there are amazing opportunities for other remote services, including chronic and principal care management, remote patient monitoring, virtual check-ins and more that lend themselves to applying empanelment to improve health and well-being. Maybe for another blog … Most clinicians use electronic health records (EHRs) these days and can run or request reports on their patient panels to identify which patients may need health care services. Empanelment provides each clinician with a list of names of their patients along with additional information such as age, date last seen, diagnoses, preventive and chronic care that is due and more. Here are some of the ways we can leverage empanelment and telehealth to keep people safe, expand access and capture revenue. Check in on the unseen and unknown. Empanelment is not just about those who seek health care services from us, although that’s often how it starts. The beauty of empanelment is that there should be no people on a clinician’s panel who are “unseen and unknown.” However, the Centers for Disease Control and Prevention (CDC) estimates that 41% of U.S. adults have delayed or avoided medical care during the pandemic because of concerns about COVID-19, which presents us with an opportunity. Identify who hasn’t been seen in the past 6-12 months for each clinician’s panel. Have clinicians go through the list and identify who should receive a check-in call and who should be scheduled for a telehealth visit. There may not be reimbursement for those check-in calls; although there are service codes and reimbursement for virtual check-ins, those check-ins are technically supposed to be initiated by the patient. Conduct advance care planning. If ever there was a time! And it can be accomplished by telehealth — using codes 99497 (~$85) and 99498 (~$74) — with decent reimbursement. Start with all individuals 65 and older in your panel. Ensure high-risk patients know about telehealth. Now more than ever, know who your top 5-10% highest risk patients are, including those at highest risk for adverse COVID-19 outcomes. These patients will benefit from having telehealth as an option perhaps more than any other population in your practice. Conduct targeted outreach to the top 5-10% high-risk patients to schedule a telehealth visit, if needed or to let them know about telehealth as an option. Address chronic and preventive gaps in care. As people delay care and as team-based care and pre-visit planning workflows seem to fall by the wayside, I am concerned that missed and delayed diagnoses will soar, which is both terrible for individuals and families, but is also one of the most common reasons for malpractice claims. Use panel data to identify who’s due for what: Chronic conditions, e.g., office visits, tests, vaccines, prescription renewals Preventive services, e.g., well-child visits, colorectal cancer screening (CRC), vaccinations Advise patients about the services that are due by phone, text or letter and schedule those for telehealth visits, if needed. Consider this a call to action for primary care practices! If you’re not already leveraging empanelment to optimize telehealth, expand access, make sure people are doing okay and keep people safe, what can you do by next Tuesday to up your game? < Previous News Next News >

Consumer Survey Data Supports Use of Virtual Visits Center for Connected Health Policy July 2021 The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. The Deloitte Center for Technology, Media & Telecommunications released the second edition of their Connectivity and & Mobile Trends 2021 survey, which gathered information from consumers about their relevant experiences during the pandemic. Using an online methodology of over two thousand consumers surveyed in March 2021, the report looks broadly at how the pandemic has influenced innovation and the “digital home,” including the increase in virtual doctor visits and patient telehealth preferences. In regard to telehealth, they found that over half of Americans had a virtual visit, 80% of those patients were satisfied with their experiences, and 62% were likely to schedule future telehealth visits post-pandemic. Almost 30% of consumers reported assisting someone else in their household with a telehealth visit. The top reasons patients said they liked having their appointments virtually was because of the ease in attending, reduced chance of getting COVID-19, and that it made scheduling and sharing medical information easier. While 30% of consumers reported no challenges, others did report they found the lack of human connection challenging, as well as the inability to have their vitals collected which was indicated more frequently among older patients. The report also looked at individual use of “wearables” to advance health and wellness, presuming their ability to support health care providers will continue to grow along with telehealth – although the authors also stated both will likely require the evolution of the regulatory landscape. Interestingly enough, use of wearables was actually found to be mixed during the pandemic and 39% said cost is the primary reason they haven’t bought one. Also, of note for those that had used wearables was that 60% claimed not to be concerned about privacy of their wearable-generated data, which is often raised as one of the main regulatory concerns related to increased innovation in health care. To review additional details about the information gathered, please view the findings in their entirety - https://www2.deloitte.com/content/dam/insights/articles/6978_TMT-Connectivity-and-mobile-trends/DI_TMT-Connectivity-and-mobile-trends.pdf#page=8. < Previous News Next News >

Accessibility to Telehealth Andrew Donnellan, Nov 03, 2021 Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Telehealth has many benefits including reduced, or eliminated travel and wait times; decreased exposure to communicative diseases; easier access to healthcare professionals and therapeutic interventions; and greater flexibility. However, for many individuals with disabilities, Telehealth and its associated benefits may be out of reach due to web inaccessibility. Benefits can become barriers because of websites’ inconsistent compatibility with screen readers, closed captions, magnifiers, speech to text software (used by individuals with limited dexterity), easy to understand instructions and hyperlinks (for individuals with cognitive disabilities), and alternative text formats. Although Telehealth companies provide guidance on ensuring accessibility by conforming to guidelines laid out in Section 508 of the 1973 Rehabilitation Act, it is only voluntary because the Act only applies to federal agencies and not private companies. So, while an individual with a disability will be met with a relatively accessible federally funded Telehealth website, that same individual may be greeted by an inaccessible private Telehealth website. But wait! What about the Americans with Disabilities Act (ADA)?! Surely it requires public accommodations like Telehealth websites to be accessible?! While the ADA does require brick-and-mortar private businesses that are labeled as public accommodations to be accessible, there is no such mandate for websites. Because of this, federal courts are split by jurisdiction on how to apply the ADA to websites: some jurisdictions say the ADA applies to all websites; some say it is inapplicable to all websites; and others conclude it applies only if the website has a connection, or "nexus," to the physical, brick-and-mortar place it represents. This lack of consistency can leave a disabled Telehealth user without an accessible Telehealth website simply because they live in a jurisdiction that does not ensure accessibility to websites. What can be done to help solve this problem? Perhaps the most comprehensive solution would be for the Department of Justice (DOJ), the federal Department tasked with enforcing the ADA, to finally answer the repeated calls by private business owners, courts, and other federal agencies for guidance by issuing a concrete rule requiring website accessibility under the ADA. However, because the Department proposed such a rule in 2010 and then withdrew from its proposal in 2017, it appears that those calls for guidance will go unanswered, save for a few amicus briefs and unofficial statements. Another, and perhaps more viable, solution is to lobby state senators to implement legislation requiring accessible Telehealth. It appears the ball has already started rolling because just this year, the New Jersey legislature has proposed a new bill that requires Telehealth to “ include accessible communication to facilitate the use of… Telehealth by individuals with a disability….” Access to accessible Telehealth should not be based on the coincidence of location, but on the coincidence of being human. Since we are all human, we all deserve accessible Telehealth — it is a right. This right will not be realized unless, and until, we stand up and demand mandated accessible websites. https://southwesttrc.org/blog/2021/accessibility-telehealth < Previous News Next News >

New MACPAC Report to Congress: Recommendations to improve mental health access include telehealth Center for Connected Health Policy June 2021 Recommended ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2021 Report to Congress last week that recommends ways to improve access to mental health services for adults, children, and adolescents enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP). While the report and recommendations did not evaluate telehealth directly, they did occasionally reference telehealth’s ability to increase access to mental health services and recommend that the promotion of telehealth be included in various programmatic guidance. For instance, the report highlights telehealth programs that connect youth to telehealth counseling services and recommends the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issue joint guidance addressing how Medicaid and CHIP can be used to fund a behavioral health crisis continuum that includes how telehealth can be used to ensure access to crisis care. They also recommend that opportunities to cover telehealth and other technology-enabled services be described in CMS and SAMHSA guidance specific to children and adolescents with significant mental health conditions. The report additionally looks at how to promote care integration through electronic health records (EHRs) and value-based payment (VBP) programs, which include measures related to expanded use of telehealth. It also discusses the non-emergency transportation (NEMT) benefit in Medicaid, mentioning that many changes in how the program is administered are occurring which require additional data to assess its value, such as how expanded availability of telehealth services may lessen its need in certain circumstances. For more information, please access the full MACPAC report - https://www.macpac.gov/wp-content/uploads/2021/06/June-2021-Report-to-Congress-on-Medicaid-and-CHIP.pdf < Previous News Next News >

Biden-Harris Administration Announces Availability of Up To $500 Million in Emergency Rural Health Care Funds Under the American Rescue Plan U.S. Department of Agriculture August 2021 Funding Will Expand Access to COVID-19 Vaccines, Health Care Services and Food Assistance in Rural America The Biden-Harris Administration today announced that the United States Department of Agriculture (USDA) is making up to $500 million available in grants to help rural health care facilities, tribes and communities expand access to COVID-19 vaccines, health care services and nutrition assistance. President Biden’s comprehensive plan to recover the economy and deliver relief to the American people is changing the course of the pandemic and providing immediate relief to millions of households, growing the economy and addressing the stark, intergenerational inequities that have worsened in the wake of COVID-19. “Under the leadership of President Biden and Vice President Harris, USDA is playing a critical role to help rural America build back better and equitably as the nation continues to respond to the pandemic,” Agriculture Secretary Tom Vilsack said. “Through the Emergency Rural Health Care Grants, USDA will help rural hospitals and local communities increase access to COVID-19 vaccines and testing, medical supplies, telehealth, and food assistance, and support the construction or renovation of rural health care facilities. These investments will also help improve the long-term viability of rural health care providers across the nation.” Background: Beginning today, applicants may apply for two types of assistance: Recovery Grants and Impact Grants. The Biden-Harris Administration is making Recovery Grants available to help public bodies, nonprofit organizations and tribes provide immediate COVID-19 relief to support rural hospitals, health care clinics and local communities. These funds may be used to increase COVID-19 vaccine distribution and telehealth capabilities; purchase medical supplies; replace revenue lost during the pandemic; build and rehabilitate temporary or permanent structures for health care services; support staffing needs for vaccine administration and testing; and support facility and operations expenses associated with food banks and food distribution facilities. Recovery Grant applications will be accepted on a continual basis until funds are expended. The Administration also is making Impact Grants available to help regional partnerships, public bodies, nonprofits and tribes solve regional rural health care problems and build a stronger, more sustainable rural health care system in response to the pandemic. USDA encourages applicants to plan and implement strategies to: -develop health care systems that offer a blend of behavioral care, primary care and other medical services; -support health care as an anchor institution in small communities; and -expand telehealth, electronic health data sharing, workforce development, transportation, paramedicine, obstetrics, behavioral health, farmworker health care and cooperative home care. Impact Grant applications must be submitted to your local USDA Rural Development State Office by 4:00 p.m. local time on Oct. 12, 2021. For additional information, please see the notice (PDF, 343 KB) in today’s Federal Register. USDA encourages potential applicants to review the application guide at www.rd.usda.gov/erhc. USDA Rural Development is prioritizing projects that will support key priorities under the Biden-Harris Administration to help rural America build back better and stronger. Key priorities include combatting the COVID-19 pandemic; addressing the impacts of climate change; and advancing equity in rural America. For more information, visit www.rd.usda.gov/priority-points. Under the Biden-Harris Administration, Rural Development provides loans and grants to help expand economic opportunities, create jobs and improve the quality of life for millions of Americans in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural, tribal and high-poverty areas. For more information, visit www.rd.usda.gov . If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page. USDA touches the lives of all Americans each day in so many positive ways. Under the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov . < Previous News Next News >

CCHP Leadership Provides A Look Back at Telehealth Policy in 2022: Yes...The Year is Almost Over! Mei Kwong December 20, 2022 As another full year of living under the public health emergency (PHE) for COVID-19 comes to an end, we are taking a look back to see what has happened this year with telehealth policy on both the federal and state level. Since the PHE is still in place and likely to continue into 2023, permanent changes on the federal level have been fewer in comparison to what many states have been doing. In fact, some states began making permanent telehealth policy changes as early as late 2020. Other states have taken similar actions to their federal counterparts and put a definitive future expiration date on temporary telehealth policies. FEDERAL The most significant federal legislative telehealth policy action seen this year took place in the Budget Act of 2022 which included language extending some of the temporary waivers to telehealth in Medicare for an additional 151 days after the PHE. This statutory change led to additional clarifications that the Centers for Medicare and Medicaid Services (CMS) made in their Physician Fee Schedule for 2023 (PFS). CCHP also recently released a fact sheet on the relevant telehealth policies. The final result as the policy stands now is: For 151 Days After the PHE: Certain providers including federally qualified health centers (FQHCs), Rural Health Clinics (RHCs), occupational therapists, and physical therapists may continue to provide eligible services via telehealth under the Medicare program. The list of temporary services eligible to be delivered via telehealth and covered by the Medicare program will continue to be available during this 151-day period. The geographic limitations under permanent telehealth Medicare policy will be suspended during this 151-day period and the home will continue to be an eligible originating site for all eligible services during the extension. Audio-only can continue to be used as a modality for eligible services during the 151-day extension. Permanent policy requirements such as a previous in-person visit for mental health services taking place in a non-geographically eligible location, in the home or via audio-only is suspended during this 151-day period. Certain other federal waivers that exist under the PHE are currently not included in this 151-day grace period. This includes the Office of Civil Rights (OCR) exercising discretion in enforcing HIPAA which OCR has noted will expire when the PHE is declared over or expires, whichever comes first. As can be seen by the foregoing, very little has changed this year regarding permanent policy, just what will happen in the immediate aftermath of the end of the PHE. There have been some indications that Congress may pass legislation to extend the federal waivers, or at least some of them, beyond the 151-day period. HR 4040 authored by Representative Liz Cheney (R, WY) passed the House earlier this year, but no further action was taken. That bill would have extended some of the temporary waivers for an additional two years. However, what might be considered by Congress now is rumored to be only a one-year extension. It remains to be seen if some additional action will be taken legislatively. Feeding into the federal policymakers’ decision-making process have been several reports from various federal agencies in the past year. The Office of the Inspector General (OIG) released several reports around telehealth in 2022 including: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks The last study listed above is important to take note of given the concerns raised by policymakers for the potential of abuse and fraud. However, the OIG report noted that in the first year of COVID-19, less than 1% of telehealth claims made to Medicare raised flags for potential fraud, which should provide some reassurance to policymakers. Broadband has been an issue both on federal and state policymakers’ minds. While connectivity is a greater issue beyond how it impacts telehealth, it cannot be denied that telehealth will simply not work if the patient and provider cannot connect, although policy expansions related to audio-only have sought to mitigate this gap to a certain extent. In 2022, the Federal Communications Commission transitioned the Emergency Broadband Benefit Program into the Affordable Connectivity Program which provides assistance in paying for connectivity. The National Telecommunications and Information Administration (NTIA) compiled federal funding opportunities that support broadband planning, digital inclusion and deployment projects on one site. States have also been gearing up activity around broadband, some of it funded by the federal government such as NTIA awards to Nebraska to develop strategic plans to expand high-speed broadband and other investments made by the state itself. No doubt, broadband will continue to be a significant issue in 2023. STATES As CCHP’s recent Legislative Roundup newsletter noted, 2022 was another active year for state telehealth policy legislation, though not as robust as it was in 2021. Overall, in 2022, of the bills enacted and subjects CCHP tracked, licensure proved to be the most popular policy issue addressed with 61 bills across the states passing. This was followed by 27 enacted bills related to professional regulations and telehealth, many having to do with prescribing and 18 bills for pilot/studies/demonstrations. Enacted Medicaid and private payer reimbursement bills were 17 and 12, respectively. The licensure focus is of particular interest to note. While many of the pieces of legislation passed related to joining licensure compacts, states also made exceptions to licensure for specific situations. States are starting to address the various situations usually involving an already established relationship between patients and providers that prior to the pandemic had remained grey areas. A common concern raised during the pandemic related to licensure involved a patient temporarily re-locating to another state, perhaps as a college student, going on vacation or caring for a family member, but still wanting to receive services from their own provider in their home state. Kentucky passed HB 188 that forbids a regulatory board from promulgating regulations related to telehealth that prohibit “the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person’s state of permanent residence.” While clarity is always welcomed, the exceptions individual states are passing will create more complexity in the telehealth policy landscape particularly for practitioners who provide services in multiple jurisdictions. Reimbursement is an area that generates significant interest. For Medicaid related legislation, the type of modality used and services that would be covered under the program were popular issues addressed through legislation. For example, Virginia SB 426 requires the Medicaid state plan be amended to allow for remote patient monitoring (RPM) services for patients with certain types of medical conditions such as high-risk pregnancy and transplant patients when there is evidence that use of RPM is likely to prevent readmission to a hospital. Private payer telehealth legislation can also be quite specific. Louisiana HB 304 now requires telehealth coverage and payment parity equivalent to in-person services for physical therapy in particular. However, what we also saw were legislators moving towards ensuring there were patient protections/choice codified in state laws related to private payer plans and telehealth. Mississippi SB 2738, among other things, states that insurers cannot limit coverage of services to select third-party organizations. Commercial plans only offering telehealth delivered services to enrollees through a third party and not allowing their in-network providers to use telehealth has been a concern that was growing even prior to the pandemic. This stems from concerns raised by policymakers regarding patient choice or patients being “forced” to use telehealth and continuity of care concerns that continue to exist today. Overall, the number of states expanding telehealth policies increased. As noted in CCHP’s latest update to its 50 State Telehealth Policy Summary Report, Fall 2022, compared to its Fall 2021 update, three more state Medicaid programs are covering store-and-forward telehealth, five more states are covering RPM under Medicaid, and state Medicaid programs covering audio-only went up from 22 states to 34 states and DC. Additionally, three states have added payment parity requirements to their private payer laws. WHAT’S NEXT FOR 2023? As noted above, rumors have swirled around that there may be movement on the federal level to extend some of the telehealth waivers beyond the 151-day grace period, similar to what was proposed in the Cheney bill. However, it is likely that any such change will be included in a larger bill, such as the budget bill, rather than a standalone telehealth bill. There are also several outstanding issues that continue to not be addressed such as the registry for telehealth that the Drug Enforcement Administration (DEA) was to finalize regulations for in 2019. Some may recall that among the list of exceptions to allowing telehealth to be used to prescribe a controlled substance without the telehealth provider having examined the patient in-person included when a PHE was declared and the creation of a registry. For the registry, presumably once a provider is qualified to be on the registry, they need not have to meet any of the other narrow exceptions to prescribe via telehealth. That registry has never been created, though Congress had directed the DEA to finalize regulations by the end of 2019. On the state level, we likely can expect to see continued action around coverage, licensure, and professional regulations, as well as continued discussion around patient choice. During this past year, there has been increased discussions regarding “telehealth-first” health plans and the impact on patient choice. Whether policymakers take a more active role in regulating these plans remains to be seen, but the discussion around patient choice protections will continue. One thing is clear: the telehealth policy landscape is by no means “settled” as 2022 draws to a close. Outstanding questions around temporary policies still remain and even settled policies implemented a year or so ago have been tweaked in some states. To hear more about what's occurred in 2022, plus what we can anticipate for 2023, watch CCHP's newest short video. As we head into 2023 we can be certain that the telehealth policy landscape will continue to evolve and change, and we look forward to having you continue on this journey alongside CCHP. Have a Happy New Year and see everyone in 2023! Mei Kwong, CCHP Executive Director See original article: https://mailchi.mp/cchpca/cchp-leadership-provides-a-look-back-at-telehealth-policy-in-2022-yesthe-year-is-almost-over < Previous News Next News >

Citing Medicaid misery, 25 governors push for PHE's end in April Molly Gamble December 21, 2022 In a letter sent to President Joe Biden this week, 25 governors ask for the end of the COVID-19 public health emergency in April. HHS last renewed the federal PHE in October for another increment of 90 days — until January 11 — with the pledge to provide states with 60 days' notice if it decided to terminate the declaration or allow it to expire. Since those 60 days came and went without notice, states are operating under the assumption the PHE will be renewed for another 90 days and expire in April, unless extended again. "We ask that you allow the PHE to expire in April and provide states with much needed certainty well in advance of its expiration," the governors urged Mr. Biden in their Dec. 19 letter. The governors claim the PHE hurts states, largely through the Medicaid flexibilities costing states "hundreds of millions of dollars." Under the continuous coverage requirement of the Families First Coronavirus Response Act, state Medicaid agencies are barred from disenrolling people during the PHE — unless they request it — in exchange for an enhanced federal match. HHS estimates up to 15 million people will be disenrolled from Medicaid and the Children's Health Insurance Program when the PHE ends. "While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily," the governors wrote to Mr. Biden. "Making the situation worse, we know that a considerable number of individuals have returned to employer sponsored coverage or are receiving coverage through the individual market, and yet states still must still account and pay for their Medicaid enrollment in our non-federal share." The governors sent their letter a day before Congress released its omnibus spending bill, which contains working language for states to be able to start evaluating Medicaid enrollees' eligibility as of April 1 in a redetermination process that would take place over at least 12 months. The measure also calls for phasing down the enhanced federal Medicaid funding through December 31, 2023, though states would have to meet certain conditions during that period. The American Hospital Association advocated for the latest extension of the PHE in October, noting that the majority of the hospital members it polled said they still depend on the flexibilities provided by the PHE waivers to deliver care. The letter was initiated by Chris Sununu, governor of New Hampshire, and signed by the following: Kay Ivey, Alabama Mike Dunleavy, Alaska Asa Hutchinson, Arkansas Doug Ducey, Arizona Ron DeSantis, Florida Brian Kemp, Georgia Brad Little, Idaho Eric Holcomb, Indiana Kim Reynolds, Iowa Charlie Baker, Massachusetts Tate Reeves, Mississippi Mike Parson, Missouri Greg Gianforte, Montana Pete Ricketts, Nebraska Doug Burgum, North Dakota Mike DeWine, Ohio Kevin Stitt, Oklahoma Henry McMaster, South Carolina Kristi Noem, South Dakota Bill Lee, Tennessee Greg Abbott, Texas Spencer Cox, Utah Glenn Youngkin, Virginia Mark Gordon, Wyoming See original article: https://www.beckershospitalreview.com/finance/citing-medicaid-misery-25-governors-push-for-phes-end-in-april.html?utm_medium=email&utm_content=newsletter < Previous News Next News >

NH Lawmakers Seek to End Telehealth Parity, Audio-Only Phone Coverage By Eric Wicklund January 28, 2021 New Hampshire lawmakers are debating a new bill that would eliminate payment parity for telehealth and coverage of audio-only phone calls, both of which were included in legislation signed into law last year. New Hampshire lawmakers are debating a bill that would revise the state’s telehealth rules to eliminate payment parity and coverage for audio-only services. HB 602, recently introduced by State Reps. Jess Edwards, Jason Osborne and John Hunt, seeks to roll back certain provisions of a telehealth bill signed into law by Governor Chris Sununu in July 2020, when the country was in the early stages of the coronavirus pandemic. New Hampshire was one of the first states to make permanent emergency measures that had been enacted months earlier to improve coverage for and access to telehealth services. The new bill takes aim at two provisions that have been producing a lot of debate: reimbursing care providers for telehealth services at the same rate that they’re paid for in-person care, and coverage for telehealth services delivered via and audio-only phone or platform. The bill strikes language from state law that compels private payers and Medicaid to reimburse providers “on the same basis as the insurer provides coverage and reimbursement for health care services provided in person.” It also excludes audio-only phones calls and faxes from the list of acceptable telehealth and telemedicine modalities. Spurred by the rapid adoption and success of connected health services during the COVID-19 public health emergency, some states have moved to make payment parity permanent, in particular for mental health and substance abuse services. Many others are keeping these emergency measures in place until the PHE ends and waiting for the federal government to establish a long-term policy. Payment parity for telehealth is a contentious issue. Those opposed to the concept feel the payer industry should be able to negotiate coverage with care providers. They also argue that telehealth services should be valued differently than in-person care. Those in favor of parity say reimbursement should be kept on a par with in-person care – at least for the time being – to give reluctant providers a reason to try telehealth and to spur widespread adoption. As for audio-only phone calls, telehealth advocates say they should be included in coverage because not everyone has access to reliable broadband connectivity or the resources to use or buy audio-visual telemedicine services. Opponents, meanwhile, say the phone isn’t an adequate platform to establish a doctor-patient relationship and provide proper healthcare services. Among those opposed to HB 602 is Scot Wilson, LCMHC, a licensed clinical mental health provider at Seacoast Mental Health Center in Portsmouth with a private practice in Concord. “If HB 602 is passed it will do nothing more than reduce the already sparse amount of services in New Hampshire,” he recently wrote in a post in Seacoast Online. “We will see an increase in wait times for hospital beds as we have more people unable to find a therapist. We will see individuals without access to the internet or the technology to allow telehealth via video to have access to necessary care. We will have more therapists decide that we cannot see people through telehealth because it is not financially viable.” < Previous News Next News >

Expansion of Telehealth Services Must Be Sustained Gerald E. Harmon, MD American Medical Association President July 2021 Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. The rapid growth and large-scale adoption of telehealth services over the past 18 months has allowed physicians to deliver a broad range of badly needed services to patients nationwide in an innovative, cost-effective manner. Now it’s time to cement that success by making permanent the temporary easing of restrictions that brought the full potential of telehealth into focus. Congress can brighten this picture by passing legislation already introduced into the current session that enjoys bipartisan support. Among other steps that need to be taken, the pending legislation—CONNECT for Health Act of 2021 (S 1512) and the Telehealth Modernization Act (HR 1332)—would strip away all geographic restrictions placed on telehealth services and allow Medicare recipients to receive this care in their own homes, rather than being forced to travel to an authorized health care center to receive it. Although this provision has been waived for the duration of the public health emergency trigged by the COVID-19 pandemic, the ability to provide telehealth services directly to patients regardless of their location will be lost unless Congress acts. Physicians and their patients who have witnessed firsthand the immense benefits and value of telehealth services must not be forced to stop using these widely available tools for better health simply because the pandemic is over. Telehealth has improved health care The benefits of telehealth are obvious. Telehealth enables physicians to strengthen continuity of care, extend access outside of normal clinic hours, and ease the impact of clinician shortages in rural areas and among underserved populations. By increasing the quantity and quality of communication between patients and physicians, telehealth has strengthened the trust that lies at the center of this relationship. Telehealth can slice overall health care costs by helping physician practices and health care systems better manage diabetes, heart disease and other chronic illnesses while increasing the overall quality of care and patient satisfaction. This technology can also prevent patients from delaying care for conditions that, if undetected and untreated, can trigger emergency department visits or lengthy hospital stays. Wide-ranging case-study examples of the comprehensive value that virtual care can provide are featured in the AMA’s Return on Health research issued in May. And let’s not forget the value of telehealth services to patients with impaired mobility, the immunocompromised, frail or elderly individuals who require the aid of a caregiver to travel, and those who cannot arrange the transportation or child care they need to receive care. The enhanced opportunities telehealth affords to assess the impact of patients’ social determinants of health lays the groundwork for better treatment and improved health outcomes for historically marginalized and minoritized communities. The widespread expansion of telehealth services we have witnessed serves all of these patient populations and others in an efficient and cost-effective manner that must be sustained. While the Centers for Medicare & Medicaid Services has expanded its coverage for telehealth services during the pandemic, only action by Congress will ensure that Medicare beneficiaries will enjoy full access to those services once the pandemic is behind us. The expansion of telehealth covered by Medicare at payment parity with in-person services during the COVID-19 public health emergency includes more than 150 services, including emergency department visits, hospital admissions and discharges, critical care and home care, to name just a few. Offering this equivalency remains a critical factor in ensuring that physician practices can cover the additional costs tied to virtual care provision. How we support greater telehealth adoption Our AMA’s commitment to telehealth technologies grows stronger each day. For example, our Telehealth Immersion Program helps individual physicians, physician practices and health systems expand and optimize telehealth services through interactive peer-to-peer training sessions, curated webinars, clinical best practices, virtual care boot camps and other assets. Additional resources, including a Telehealth Quick Guide, Telehealth Playbook, and STEPS Forward™ telehealth training module, are just three more examples among many available on our website. The Digital Medicine Payment Advisory Group is a collaborative initiative convened by the AMA to help integrate digital medicine technologies into clinical practice by knocking down barriers to widespread adoption while zeroing in on comprehensive solutions for issues with coding, reimbursement, coverage and related factors. The mission of this diverse cross section of nationally recognized digital medicine experts includes: Reviewing existing code sets—particularly CPT® and HCPCS—to ensure they accurately reflect current digital medicine services and technologies. Assessing factors that affect the fair and accurate valuation of services delivered in this manner. Providing information and clinical expertise that promotes widespread coverage of telehealth, remote patient monitoring and all other digital medicine services, including increased transparency of services covered by payers and improved enforcement of parity coverage laws. The expansion of physician-based telehealth services in 2020 ranks as one of the most important advances in health care delivery in many years. Allowing this progress to slip from our hands because of outdated and arbitrary restrictions will result in higher costs and poorer health outcomes for patients everywhere. The decisions made and the policies adopted in the near future will shape the direction of telehealth services for many years to come. We urge Congress and the Biden administration to take the steps necessary to build on the progress in virtual care we’ve made thus far while laying the foundation for greater innovation going forward. < Previous News Next News >

States Expand Medicaid Reimbursement of School-Based Telehealth Services Center for Connected Health Policy June 2021 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. The National Academy for State Health Policy released a report last month on how states are increasing Medicaid coverage of school-based telehealth during COVID-19, as well as assessing which services can be effectively delivered via telehealth and how to best support equitable access to services via telehealth for students. The authors found that 49 states currently have policies allowing Medicaid reimbursement of telehealth in schools – 24 had existing policies, 31 recently expanded policies during the pandemic, and at least four states have indicated they may make the changes permanent. As far as services, the brief showed that most states cover audiology and speech-language therapy via telehealth, although behavioral health services had the greatest expansion and providing telemental health they found to be a recognized best practice. Half of all states cover individualized education program (IEP) plan services or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services as well. The report also suggests that moving forward states should explore federal funding opportunities to expand technology and broadband access for students facing disparities in access to care. < Previous News Next News >

Zoom's Head of Healthcare Talks the Future of Telemedicine Bill Siwicki, Healthcare IT News August 2021 Heidi West discusses telehealth/hybrid in-person care, the communities that could suffer without virtual care and the remaining obstacles to mainstreaming telemedicine. Telehealth continues to be a priority for the healthcare industry. It has proven itself throughout the ongoing COVID-19 pandemic. Recent Zoom research found that in the U.S., 72% of survey respondents want to attend healthcare appointments both virtually and in-person post-pandemic, demonstrating the clear need for telehealth as an option for this hybrid approach to healthcare. Despite the success of telehealth during the last year and a half, some have questioned its broader use as healthcare returns to in-person office visits. However, this reversal could put certain communities and demographic populations at a disadvantage, such as those in rural areas or ones without reliable transportation. Healthcare IT News sat down with Heidi West, head of healthcare at Zoom, to discuss telemedicine's future, hybrid in-person/telehealth care, communities that could be hurt without virtual care, and challenges to telemedicine becoming fully mainstream. Q. Telemedicine visits have tapered off some since their pandemic peak in 2020. Will telemedicine remain popular? If so, what will drive its continued popularity? A. During a year full of stay-at-home mandates and concerns about public safety, it makes sense as to why we saw such a sharp increase in the use of telemedicine solutions – virtual care offerings made it possible for us to get the help we needed while largely staying out of harm's way, and protecting ourselves and loved ones. Yes, there will always be a need to provide in-person care – surgical procedures, imaging and specific hands-on care still will require actual office visits. However, the opportunity for telemedicine is tremendous, and physicians should consider a virtual-first mentality to support the convenience and safety of the patient. Some forms of medical care can easily be managed over virtual platforms, and by continuing to be available virtually, providers can reach new audiences, regularly track existing ones and even grow stronger patient-provider relationships than before. One area that is particularly well-suited for this is psychiatry and psychotherapy. With online therapy, providers can meet with patients far from their physical office space, opening up opportunities to take on new business outside of the immediate neighborhood, as well as meet with patients at different times, since travelling will not need to be taken into consideration. There also is untapped potential for video communications and telehealth platforms to help aid and enhance group therapy experiences. Studies have already shown higher demand for online group therapy and fewer no-shows among the participants who sign up for sessions. We also will see some medical practitioners such as nutritionists and dermatologists continue to use telehealth solutions in their practices. There are many cases in which doctors in these fields can provide expertise and recommendations to patients via video conferencing in the same way they would in person. Telemedicine will continue to bring a level of flexibility and accessibility to the patients that need it in these realms, and it will only continue to grow as we become an even more digitally connected society. Q. In your recent study, the clear majority of consumers want both virtual and in-person care. This seems to show a need for telehealth as an option for a hybrid approach to healthcare. What will this hybrid look like, more specifically? A. We will see this hybrid approach combine the best of both the physical and digital worlds to offer an incredible experience. Generally, we'll see more primary consultations conducted via virtual platforms, with providers then asking patients to come in or engage with a specialist either remotely or in person as needed. This provides a greater number of patients with a greater level of convenience. Because of the pandemic, there also has been a heightened awareness and preference to manage post-acute care and chronic conditions at home. Providing accessibility to care in the home will be one of the greatest growth areas for telehealth. We'll likely see more outpatient care or physical rehab programs conducted over video calls for patients who have recently undergone surgery and are resting at home. New hybrid experiences also will improve information sharing and precision among doctors in their respective fields. Rather than waiting for hours across time zones for emails to be read and sent about a specific case, videoconferencing can allow doctors that are physically in a room examining a patient to digitally share information with consultants or experienced professionals outside of the room – or even in other parts of the world – in real time. Additionally, no longer do smaller hospitals or doctor's offices have to solely rely on experts in or near the local community – the talent pool for a given procedure or evaluation vastly expands when video conferencing is a part of the equation. Q. While telehealth has indeed been very successful amid the pandemic, some experts have questioned its broader use as the industry returns to in-person care. You've said this reversal could put certain communities and demographic populations at a disadvantage, such as patients in rural areas or without reliable transportation. Please elaborate. A. Yes, a great deal of the population lacks the accessibility to healthcare in the same ways that people in affluent and urban areas often have. Urban dwellers generally come across a greater number of doctors' offices, specialized care facilities and treatment options, whereas those on the outskirts or those without reliable transportation have limited choices in when and who they see as medical issues arise. The evolution of telehealth and its swift adoption during the pandemic gave many communities access to doctors and other medical professionals that they normally wouldn't be able to see. As an example, before committing to buying an expensive plane ticket and hotel room in order to see a specialist in a city far away, a patient in a more rural area can join a video conference to discuss any issues with the specialist ahead of time and determine if the trip is truly needed. This saves both parties time, money and peace of mind. Certain demographic populations also have seen the positive effects of virtual care in a way that wasn't as prevalent before the pandemic. For example, minority race groups and people of color oftentimes have difficulty finding therapists or psychiatrists that understand or align with their cultural beliefs. However, the proliferation of online therapy sessions during the pandemic has drastically changed this. Virtual health services have allowed patients to find and connect with the mental health professionals that have academic, personal and professional backgrounds that align with their existing values and beliefs, even if the practitioner lives outside the immediate region of the patient. For the first time, many marginalized groups are getting the care they need from people they trust and connect with on a deeper level. Removing telehealth as an option for care also removes a great deal of accessibility for people in similar situations to the above, or those who previously were not able to nor offered an opportunity to get the care they needed. Losing these options could mean driving a greater divide between socioeconomic groups and regions throughout the U.S. Lastly, and conversely, many physicians need to consider the increased competition threatening their patient population by not prioritizing digital health solutions. Between direct-to-consumer telehealth apps being developed daily, and retail health becoming more prevalent, there is a significant risk to not offering virtual care. Doctors and other providers could lose their patients to other companies and practices that are ahead of the curve. Q. What are remaining challenges to telemedicine being fully mainstream, including permanent reimbursement? How will healthcare provider organizations overcome these challenges? A. There are a couple of challenges that come to mind. The first that inhibits a large portion of the global population from widely leveraging telemedicine is lack of Internet connection. Without broadband and easy access to the web, telemedicine is nearly impossible. In time and with strong partnerships with Internet service providers and telecommunications organizations, the two industries will be able to offer greater accessibility to consumers and potential new patients. The second is the issue of reimbursement. There still is a lengthy discussion to be had about if payers should be required to reimburse for a telehealth appointment or service the same as they would for an in-office one. Some view a virtual care experience as less valuable and therefore, financially, worth less, as well. Providers and payers must work with legislators to combat this notion, and instead recognize the importance of telehealth, focusing on the needs of the consumer and potential to actualize value-based care. Virtual healthcare services will only continue to proliferate due to consumer demand and market competition. Regardless of reimbursement structure, the requirements and advancements in telehealth will dictate continued interest and opportunities. < Previous News Next News >

Telehealth Mini-Grants NM BHSD March 16, 2021 BHSD would like to announce the release of funding in the form of telehealth mini-grants. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us To CYFD and BHSD Non-Medicaid Providers: Dear New Mexico Providers: BHSD would like to announce the release of funding in the form of telehealth mini-grants. When the COVID-19 public health emergency ends, BHSD will no longer be able to support behavioral health providers who are delivering behavioral health services through telehealth systems that are not HIPAA compliant. We are now offering funding to help providers come into compliance so that critical behavioral health services will not be disrupted. If your agency is currently delivering services using the telephone and/or another non-HIPAA compliant system, this grant could help you make the transition. BHSD is seeking letters of interest that respond to this question: what is your current telehealth system, and what do you need to become HIPAA compliant? Funding is available in amounts of up to $50,000 per agency, and all work must be completed by the end of 2021, which is when the PHE is currently set to expire. Letters of interest should include: • Specific hardware and/or software and costs • Training for staff and administrators and costs • Anticipated changes to practice model • How many practitioners/staff members do you expect to train • How many clients do you anticipate serving with your new system • Timeframe for making changes BHSD will expect any agency that receives funding to report back on progress made on each of these points. Deadline for receipt of letters of interest: 5 pm April 9, 2021 Please send letters of interest to: Cynthia Melugin at cynthia.melugin@state.nm.us < Previous News Next News >