Telemedicine Holds Potential to Help Climate Change Center for Connected Health Policy May 4, 2021 MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. MobiHealth News is shining the light on a much-overlooked benefit of telemedicine: how it can help curb greenhouse gas emissions and thus help in the fight against climate change. The recent article highlights that the United States healthcare industry is a big contributor to carbon emissions, and although telemedicine doesn’t solve the problem, its increased use does lead the industry in the right direction. This has been proven in two research studies conducted on this very subject. The first study, published in the journal, PLoS One explores the carbon footprint of telemedicine and found that replacing in-person visits with telemedicine resulted in 40-70 times decrease in carbon emissions. They note in their conclusion that for telemedicine to make a significant difference, a paradigm shift is necessary where telemedicine is regarded as an ordinary part of health care rather than exclusively for those who lack access due to geography. The second study, conducted by the University of California Davis Health System, examined travel-related and environmental savings as a result of use of telemedicine appointments for outpatient specialty consultations at the university. They found that telemedicine consultations resulted in significant savings of total emissions and that their telemedicine program had a positive impact on environmental pollutants. CCHP also previously published a catalogue of environmental impacts studies, which included several international studies looking at this same issue and coming to the same conclusion regarding telemedicine’s positive impact on carbon emissions in the healthcare sector. As telehealth has become more widespread due to the COVID-19 public health emergency its not hard to imagine that telehealth will cement its place as a mainstream tool in healthcare as the authors in the PLoS study suggest. However, policy barriers have historically interrupted the growth of telehealth, and it is yet to be seen whether the end of COVID-19 will bring telehealth’s progress to a halt. In a study published in the journal Nature Climate Change, researchers found that as a whole, the temporary reduction in daily global CO2 emissions during COVID-19 saw a decrease by as much as -26% on average, but note that the impact of 2020 annual emissions depends on government actions and economic incentives post-pandemic, which will shape the path forward for decades. It will be important as entities such as the Centers for Medicare and Medicaid Services (CMS), the congressional budget office, state governments and others conduct their analyses on cost estimates for telehealth that they factor in savings to travel costs incurred through the use of telehealth and the implications for the environment. To learn more, see the full mobihealth news article featuring this important issue. Mobile Health News: https://www.mobihealthnews.com/news/telemedicine-came-rescue-during-covid-19-could-it-help-climate-change-too < Previous News Next News >

Telehealth's ‘great opportunity’ at community health centers Emily Olsen June 14, 2022 Ray Lowe, senior vice president and CIO at AltaMed Health Services, discusses his organization's move to virtual care at the start of the COVID-19 pandemic and how such care can evolve. See original video: https://www.healthcareitnews.com/video/telehealths-great-opportunity-community-health-centers < Previous News Next News >

AHA Statement Stresses Importance of Telehealth in CVD Care Yael L. Maxwell November 16, 2022 With ongoing challenges related to reimbursement, access, and acceptance, the writing committee offers potential solutions. Stressing the importance of telehealth in cardiovascular care, especially given its increased prevalence during the COVID-19 pandemic, a new scientific statement from the American Heart Association (AHA) outlines the current barriers to this type of care and offers some strategies for continued access. As in-person visits were shut down in the spring of 2020, many clinicians and patients turned to telehealth, with subsequent studies and surveys showing related gains in heart failure and nonemergent cardiovascular care. Other research showed that patients who were more likely to use telehealth tended to be younger and privately insured, have more comorbidities, and be from underrepresented racial/ethnic groups. As the pandemic has waned, however, reimbursement for telephone and video visits has been a larger concern. Earlier this month, the US Centers for Medicare & Medicaid Services (CMS) released its 2023 Physician Fee Schedule, which includes continued coverage for telehealth, but only for 5 months following the end of the public health emergency, which some say is not long enough for clinicians to make long-term plans and invest in necessary infrastructure. “This paper in a way summarizes the importance of telehealth and the benefits of telehealth in patient care,” writing committee chair Edwin A. Takahashi, MD (Mayo Clinic, Rochester, MN), told TCTMD. “Payment parity is so important in sustaining telehealth. So I hope that CMS and insurance companies will see the importance highlighted in this paper and reconsider their reimbursement plans with it.” What Is Telehealth? The statement, published online this week in Circulation, begins by defining the concept of telehealth, breaking it down into clinician-to-patient visits and clinician-to-clinician consults. The former includes real-time virtual visits, either video or audio, as well as digital communication, called eVisits, initiated by either the physician or patient. The latter includes both real-time virtual consults, which may also include the patient, as well as digital exchange of low-complexity medical information between clinicians, called eConsults, or second opinions on more-complex concerns. A final hybrid category includes remote monitoring for patients and predictive analysis for clinicians—both machine initiated. Takahashi and colleagues point out some commonly used telehealth tools for cardiovascular home monitoring, including machines for monitoring risk factors like blood pressure, weight, smoking, and diet; medication tracking apps and smart pillboxes for managing medication adherence; and tools like home EGC, pulse oximeter, and pulmonary artery pressure monitoring devices. While there are an undefined number of ways in which telehealth can be useful within cardiovascular care, Takahashi said it’s most effective in tracking disease progression for heart failure and CAD, improving stroke outcomes by decreasing time to diagnosis, and monitoring PAD progression, as well as preventing ulcers and tracking patients postoperatively. The paper outlines advances in telestroke, teleradiology, and telehealth in PAD management. Challenges and Potential Solutions Many challenges remain in order for telehealth to flourish in a nonpandemic era. In his experience, Takahashi said, the biggest barrier to using telehealth relates to “having patients accept it as a replacement for inpatient visits.” But overall, challenges like infrastructure—including broadband internet and hardware for patients—to complete telehealth visits as well as reimbursement stand in the way of telehealth use more generally, he said. “In order for people to adopt and use telehealth, people need to be able to bill for using it. Otherwise, it just is not sustainable.” The statement also stresses the importance that clinician attitude, biases, and acceptance play in the success of telehealth. Difficult to use technological platforms hindered by HIPAA-compliant encryption can also make it more difficult for clinicians to access telehealth appointments. Beyond increases in reimbursement for telehealth, the authors propose a few strategies for continued success. They advocate for government programs to improve broadband internet access across the country, more research to elucidate the specific benefits telehealth can have across the spectrum of cardiovascular disease care, and increased standardization for methods in assessing telehealth quality. “The COVID-19 pandemic improved the telehealth infrastructure through necessity but also uncovered systemic weakness, limitations, and inequities,” they conclude. “Further research into barriers for telehealth implementation and equitable execution are important to ensure the delivery of high-quality care for patients.” Yael L. Maxwell by Yael L. Maxwell Editor, Fellows Forum Yael L. Maxwell is Senior Medical Journalist for TCTMD and Section Editor of TCTMD's Fellows Forum. She served as the inaugural… Read Full Bio See original article: https://www.tctmd.com/news/aha-statement-stresses-importance-telehealth-cvd-care < Previous News Next News >

Celebrating 2021 National Rural Health Day Southwest Telehealth Resource Center Dec. 1, 2021 Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. Since 2010 the National Organization of State Offices of Rural Health has designated the 3rd Thursday in November as National Rural Health Day to celebrate the rural leaders and champions in rural communities. This year the Arizona Telemedicine Program and the SWTRC joined with the Arizona Rural Health Association and the Arizona State Office of Rural Health to kick it off in Arizona with a “2021 Mid-Year Rural Health Policy Roundup” webinar by Alan Morgan, CEO of the National Rural Health Association. This webinar streamed live to a national audience on November 15th and the recording and presentation slides are available at: https://telemedicine.arizona.edu/webinars/previous for on-demand playback. Each year the National Organization of State Offices of Rural Health selects a Community Star from each of the 50 states. The 2021 Community Star report, https://en.calameo.com/read/0045723395dc12ef8ac48, includes stories of how each Community Star is working to improve life in their rural community. Congratulations to all of the 2021 Community Stars! Matthew Probst, PA-C Chief Quality Officer and Medical Director El Centro Family Health Mathew Probst is the Chief Quality Officer and Medical Director for a Federally Qualified Health Center located Northeast of Albuquerque, New Mexico. Under his leadership, Mr. Probst was able to implement initiatives at the start of the pandemic which resulted in his county having one of the lowest fatality rates and one of the highest vaccination rates in the county. Read more about why Mr. Probst was featured in an award-winning documentary named The Providers: https://en.calameo.com/read/0045723395dc12ef8ac48 < Previous News Next News >

How Telemedicine and Digital Therapeutics can Improve Orthopedic Care and PT Bill Siwicki October 11, 2022 A physical therapist and telehealth expert shows how the technologies can help patients, especially in disadvantaged populations, access the care they need and stick to a care plan. Minority and lower-income populations are less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do. Untreated musculoskeletal conditions can result in sedentary behavior that leads to or worsens co-morbidities, including diabetes, obesity, depression and opioid misuse. Access challenges are partly to blame. Disadvantaged populations face many barriers to care, including low referral rates, lack of Medicaid acceptance and transportation difficulties. Telehealth experts say that offering remote education and physical therapy to patients can improve access for vulnerable populations, including: ● Patients in rural communities who live far away from brick-and-mortar care facilities. ● Patients who cannot afford copays for doctor or outpatient PT appointments. ● Patients in urban communities whose mobility issues make leaving home difficult. ● Patients whose inability to take time off work or secure childcare limits in-person visits. ● Patients who speak English as a second language. Healthcare IT News interviewed physical therapist Bronwyn Spira, founder and CEO of Force Therapeutics, to discuss the challenges and opportunities surrounding this area of virtual care. Q. Why are minority and lower-income populations less likely to have orthopedic surgery – and more likely to experience poor outcomes when they do? A. Musculoskeletal disorders are extremely common in our country. At least 60% of American adults are affected by a musculoskeletal disorder, and more than 75% of those 65 and older are living with at least one musculoskeletal condition, which ranges from tendonitis to arthritis, degenerative disc disease, and chronic lower back pain. Lower-income and minority populations face multiple barriers to accessing the right healthcare and are typically less likely to utilize orthopedic care, which can result in significant functional impairment. Untreated musculoskeletal conditions also can result in sedentary behaviors that lead to or worsen comorbidities such as diabetes, obesity and depression. In one study of more than 7,000 individuals with arthritis, the incidence rates of developing disabilities in activities of daily living (ADL) over a six-year period were significantly higher for Blacks (28%) and Spanish-speaking Hispanics (28.5%) as compared to whites (16.2%). As I mentioned, disadvantaged populations often lack sufficient access to care, which can manifest in a few different ways. Many cannot afford the financial burden of co-pays, childcare, transportation, time off work or the out-of-pocket cost of receiving care when uninsured. The Commonwealth Fund found that 50% of low-income adults in the U.S. skipped at least one medical visit, test, treatment or prescription per year due to its cost. Patients with state-funded Medicaid and federally funded Medicare plans also encounter logistical barriers to securing musculoskeletal care, including lower referral rates to orthopedic surgeons. Orthopedic specialists are 13% less likely to accept new Medicaid patients than they are Medicare patients or those with commercial insurance plans. Lastly, more than a third of Americans (36%) have low health literacy, which can be defined as the degree to which individuals can obtain, process and understand health information. Older age, minority membership and low socioeconomic status are disproportionately correlated with poor functional health literacy in both urban and rural populations. Language barriers also impact care utilization and success rates, as individuals who cannot fully understand the directions they are given will not be able to adhere to a care plan. One study on healthcare utilization among Hispanic adults found that limited English proficiency contributes to the underuse of medical services. For all of these reasons, members of disadvantaged populations are far less likely to have orthopedic surgery to correct their musculoskeletal conditions. The data also indicates stark disparities in orthopedic care utilization among racial and ethnic minority groups. Researchers have found that even after adjustments are made for age, sex and income, Black patients are 30% less likely to receive a total hip or knee replacement than white patients. A systematic review of the literature reveals that members of minority populations who do have joint replacement surgery also are at a higher risk for early complications within the first 90 days, leading to higher hospital readmission rates. While there is no consensus as to the cause of these disparities, research suggests that multiple comorbidities, lower income, poor health literacy, provider bias and insufficient interventions are contributing factors. Q. How does offering remote education and remote physical therapy to patients improve access for vulnerable populations? A. First and foremost, remote education and physical therapy platforms reduce the need for patients to attend appointments in person. When hospitals, health systems and ambulatory surgical centers (ASCs) implement care management and remote monitoring tools, they set the stage for achieving greater health equity by removing some of the physical barriers to care. At the start of a surgical episode, for example, replacing preoperative in-person appointments with virtual education classes means that patients can get all the information they need to prepare for surgery without leaving the house. Educating patients about what they can expect for their surgery – including what outcomes are typical, and how long their healing will take – helps them set appropriate goals for their recovery. All remote education content must be tailored to the patient and their condition, and ideally should reflect their comorbidities, medication and social determinants of health, as these factors influence how a patient is likely to respond to treatment. Content should be delivered in the patient's native language, and should feature clear and easily understood directions. Engaging a care partner who can support the patient's recovery journey also can be extremely beneficial. Many patients find it helpful to return to valuable content as questions arise, and care partners can assist by reinforcing the care team's instructions along the way. Content also should be easily digestible and should arrive at the appropriate point in the patient's journey, so as not to overwhelm patients with too much information. For example, before surgery, patients need information about how long they will be out of commission and how to prepare their space for moving around with an assistive device. A few days after surgery, they need information on how to manage their swelling and control their pain. Many hospitals and ASCs also are offering patients the option of virtual PT to supplement or replace traditional outpatient PT, as remote therapy delivers similar results at a much lower opportunity cost for the patient. Randomized trials have shown that virtual PT produces similar outcomes to outpatient PT after total knee and hip arthroplasty procedures, as long as the virtual program is prescribed by the treating clinical team. In addition to the time savings involved, replacing traditional PT with remote PT can save patients hundreds of dollars in copays and convenience, as patients can complete the rehab in their own home at a convenient time. Q. How does telehealth technology serve as a digital bridge to, for example, patients who cannot afford copays for doctor or outpatient PT appointments, patients in urban communities whose mobility issues make leaving home difficult, patients whose inability to take time off work or secure childcare limits in-person visits, and patients who speak English as a second language? A. Digital therapeutics can help orthopedic teams build stronger relationships with their patients, especially those who are members of disadvantaged populations and who are likely to need additional support. Standardizing patient access to preoperative and postoperative education through remote technology can help practices correct against implicit bias and ensure consistent communication with all patient populations, including the 13% of Americans who speak Spanish at home. For patients living in rural communities, telehealth tools can close the access gap imposed by geography. For patients in urban areas, who may struggle to use public transportation or navigate the stairs in a fifth-floor walk-up, telehealth tools can mean the difference between skipping necessary appointments and following their care plan. Ideally, telehealth technology can serve as a digital bridge to connect vulnerable patients to their care teams. However, the infrastructure of any such tool must support all patient populations, including the 43% of lower-income adults without broadband services at home. In many low-income communities, insufficient access to a computer also hinders the use of digital care management and remote monitoring solutions. Applications must compensate for the digital divide in their system design to ensure content does not require internet access, which can be poor or non-existent in certain areas. Patients should be able to access their care plans via mobile device with a secure login. According to the Pew Research Center, 27% of adults living in households earning less than $30,000 a year are smartphone-only internet users. As disadvantaged populations are far less likely to own a tablet, laptop or desktop computer, telehealth tools must be mobile-friendly and SMS-enabled. Two-way text messaging between patients and clinicians is a proven health intervention tool, as patients are much more likely to read and respond to a text than an email. Direct messaging via telehealth platforms also can improve outcomes for disadvantaged populations. When postoperative patients have a question about their pain levels, they can text their care team for answers instead of making an unnecessary trip to urgent care or the ER – or simply ignoring the problem until later, when interventions are less likely to be successful. Research shows that providing a care management platform with direct messaging decreases readmission rates across musculoskeletal procedures. Q. On a personal note, how does telehealth help you, the provider, with all these challenges? A. Early on in my career as a physical therapist, I managed and founded a number of orthopedics and sports medicine clinics in New York. My colleagues and I were constantly frustrated by how basic patient challenges – from inadequate healthcare access to poor health literacy and a lack of motivation – impacted our patients' outcomes. Similarly, we had very little or no visibility into how patients were managing at home, and whether the patients were achieving the outcomes that mattered to them. There wasn't a reliable closed-loop connection that provided the data we needed to make the right care decisions. Many patients would drop out of a treatment regimen due to access or cost challenges. There often were protracted gaps in care, and by the time the patient returned for treatment, they had often regressed or developed complications. That period led me to believe that evidence-based remote therapy and education could play a pivotal role in helping disadvantaged populations follow their postoperative care plan. In the traditional system, clinicians spend much of their valuable time in preoperative education visits, repeating the same things over and over to patients who are not likely to retain the bulk of this information. After surgery, nurses and care coordinators then work overtime to return patients' phone calls and fill in the knowledge gaps for patients. Digital care management systems allow orthopedic practices to scale valuable in-person time by automating low-touch interactions, while identifying the patients who need targeted one-to-one intervention. With the benefit of technology, practices can create high-value, repeatable workflows to fully prepare patients for surgery by giving patients what they need to know as they need to know it. This phased, segmented approach to education has been proven to correct for the retention gap of in-person education. The addition of patient messaging and remote monitoring tools enables the delivery of patient-reported outcomes data and care plan progression feedback to be returned in real time to the care team, who then can intervene as necessary. Orthopedic practices are much less likely to miss a patient who has stalled in their recovery and is at a high risk of developing complications. When digital therapeutics are designed to be inclusive of all patient populations, they can transform the way we practice orthopedics to improve health equity. Twitter: @SiwickiHealthIT Email the writer: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication. See original article: https://www.healthcareitnews.com/news/how-telemedicine-and-digital-therapeutics-can-improve-orthopedic-care-and-pt < Previous News Next News >

The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Centers for Medicare and Medicaid Services Nov. 10, 2021 CY 2022 Physician Fee Schedule (PFS) policies for Medicare The Centers for Medicare and Medicaid Services (CMS) released its final CY 2022 Physician Fee Schedule (PFS) policies for Medicare last week. Unless otherwise noted, the policies will take effect on January 1, 2022. Much of the proposals published in July 2021 for public commentary remain intact, but CMS did make several modifications and clarifications. https://public-inspection.federalregister.gov/2021-23972.pdf < Previous News Next News >

Now is the time for doctors to shape what’s next on telehealth Tanya Albert Henry, Contributing News Writer, American Medical Assoc. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. More than a year and a half into this pandemic, medicine finds itself with a unique opportunity: A chance to rethink and overhaul the way care is delivered. Telehealth, which a minority of patients and physicians used prior to COVID-19’s emergence, is now a household word. And survey after survey shows that patients like the convenience, believe they are getting quality care and still feel connected to their physicians. Most physicians, too, have found telehealth to be a great way to connect with patients when appropriate. “There is no question at this point in time, when you think back on the past 18 months, it’s our opportunity to change completely how we deliver care,” according to Joseph C. Kvedar, MD, professor of dermatology at Harvard Medical School and the American Telemedicine Association’s board chair. Dr. Kvedar made that point during a virtual gathering as part of the AMA Telehealth Immersion Program. The boot camp event featured experts and stakeholders from around the country, who discussed the potential for long-term telehealth programs, raised the questions that need to be considered as telemedicine evolves, and examined the challenges that physicians and patients face moving forward. “I would urge you not to think of virtual video visits as the sky or the ceiling or the vision, but as the floor and the beginning, and the first step into what I would call a real hybrid world with digital-first, with digital tools for our patients where patients instinctively turn to a digital device when they need health care and go from there,” Dr. Kvedar said. The boot camp also included a panel discussion about health-at-home models and strategies, as well as breakout sessions on creating telehealth value in obstetrics and gynecology, and renal medicine. The Telehealth Immersion Program is part of the AMA STEPS Forward™ Innovation Academy , which enables physicians to learn from peers and experts and discover ways to implement time-saving practice innovation strategies. Many questions to answer Data may show that the percentage of telehealth visits as a whole are down compared with the beginning of the pandemic, but Dr. Kvedar said there’s another story to be told. Data from one large payer shows that telehealth is shifting from local physicians and health care organizations to national care providers. In April 2020, 96% of all telehealth claims were local, while national providers accounted for just 4%. One year later, the share of national-provider claims rose to 11%. One big question going forward, he asked, is who is going to deliver telehealth services? “Do we want our own doctors to be providing these telehealth services or do we want to go through a third party,” said Dr. Kvedar, co-chair of the AMA Digital Medicine Payment Advisory Group. “The good news is you will have access either way. But … we have to ponder how we want that to go, and I think we have a role to play in making those decisions or at least in influencing them.” Among the other questions that need to be answered going forward: How do you plan while facing payment uncertainty? What will it cost a practice to offer telehealth and what will make the most financial sense for each practice? How do you rethink calculations of overhead? What are the workforce implications? For example, what new roles will be needed to accommodate telehealth properly? How do you define when it will be best to see a patient via telehealth versus coming into the office? Advocate, advocate, advocate Dr. Kvedar asked the boot-camp attendees to send their elected officials a letter describing what has worked in telemedicine and what is needed. He also recommended talking to your human resource professional and health plan contact to let them know what you and your patients need to create a health system that works best. The benefits of expanded telemedicine are clear. Join physicians who are advocating to permanently expand virtual care coverage. https://www.ama-assn.org/practice-management/digital/now-time-doctors-shape-what-s-next-telehealth?smclient=9a5368e1-1650-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

HHS Awards Nearly $55 Million to Increase Virtual Health Care Through Community Health Centers Dr. Maheu June 3, 2022 Virtual care has been a game-changer for patients, especially during the pandemic… This funding will help health centers leverage the latest technology and innovations to expand access to quality primary care for underserved communities. Today’s announcement reflects the Biden-Harris Administration’s commitment to advancing health equity and putting essential health care within reach for all Americans. n February, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded nearly $55 million to 29 HRSA-funded health centers. Funding was earmarked to increase virtual health care access and quality for underserved populations through telehealth, remote patient monitoring, digital health tools for patients, and health information technology platforms. This telehealth funding builds on over $7.3 billion in American Rescue Plan funding invested in community health centers over the previous year to help reduce the impact of the COVID-19 pandemic. Health centers quickly expanded their use of virtual health care to maintain access to essential primary care services during the pandemic. The number of health centers offering virtual visits grew from 592 in 2019 to 1,362 in 2022, an increase of 130 percent. The February telehealth funding will reportedly be used to enable health centers to sustain an expanded level of virtual health care and identify and implement new digital strategies. HRSA Administrator Carole Johnson added: Today’s awards will help ensure that new ways to deliver primary care are reaching the communities that need it most… Our funding will help health centers continue to expand their virtual work while maintaining their vital in-person services in communities across the country. The press release also explained that the more than 1,400 HRSA-supported health centers in this country serve as a national source of primary care for at-risk communities. They are community-based and patient-directed organizations that deliver affordable, accessible, and high-quality medical, dental, and behavioral health services to nearly 29 million patients each year. As of late January, health centers have delivered over 19.2 million vaccine doses, with 68 percent going to racial or ethnic minority patients. More than 90 percent of health center patients are individuals or families living at or below 200 percent of the Federal Poverty Guidelines (about $55,000 per year for a family of four in most states) and approximately 62 percent are racial/ethnic minorities. For more information: https://telehealth.org/hhs-awards-nearly-55-million-to-increase-virtual-health-care-through-community-health-centers/?smclient=f760e669-8538-11ec-83c8-18cf24ce389f&utm_source=salesmanago&utm_medium=email&utm_campaign=default < Previous News Next News >

Q&A: How retail healthcare, telehealth trends could evolve in 2023 Emily Olsen December 16, 2022 Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, discusses the future of virtual care and how emerging retail players will affect the industry. As another year shaken by the lingering COVID-19 pandemic ends, stakeholders are still exploring how virtual care trends that accelerated in 2020 will affect the healthcare industry long term. Though telehealth use spiked out of necessity during the early months and remains higher than pre-pandemic levels, utilization has slowed over the past two years. Meanwhile, big retail companies and pharmacies are offering more care options to patients. Sanjula Jain, senior vice president of market strategy and chief research officer at Trilliant Health, sat down with MobiHealthNews to discuss the future of virtual care, how big retail entrants will affect the industry, and the importance of care coordination between traditional health systems and emerging retail players. MobiHealthNews: What are some of your big takeaways from 2022 when you're thinking about telehealth, digital health and other tech-enabled care? Sanjula Jain: A big thing that I'm thinking a lot about is that patients aren't coming back to care, despite all the investments in more supply or access points, whether that be virtual care access points or new retail entrants or traditional urgent care. We've just had this huge mismatch between supply and demand. We're kind of post-vaccines; we have Americans returning to work to some extent. A lot of folks are going into an office a couple of days a week, folks are traveling, yet they're not going back to see their doctors. We've tried to make care more convenient and more accessible. And some of these new supply points are lower cost, and yet, they're still not engaging. I think there are many reasons for that. COVID scared away a lot of patients, and I think we're starting to see signs of more distrust in the healthcare system. And then cost and affordability, with a lot of the price pressures and inflation and recession discussions. That's going to continue to be a factor. There's a lot of health consequences for when patients don't actually engage in necessary healthcare. MHN: What do you think is the future of virtual care when you're looking at 2023 and beyond? Jain: The market for virtual care is a commoditized market. So, we're seeing that generally it's being used amongst a discrete subset of the population. And we have to think about, who are the individuals who like to use virtual care and what are they using it for? Primarily, as a health economist, I think a lot about substitute goods. We are seeing that virtual care is really only a substitute good for behavioral health. It's both a clinical and financial substitute, right? Clinically, having some distance between you and your provider in a behavioral health interaction is probably preferred when you're talking about your feelings and being very vulnerable. And there's no lab work or poking and prodding that actually needs to happen. So it's a viable clinical alternative. Financially, we've been talking a lot about payment parity. Because behavioral health interactions often don't need imaging and lab work, you're kind of making the same amount for an office visit that you are in a virtual care environment. For other use cases like primary care, we see that's not actually the case. The patient goes in for a virtual care visit, and then what really ends up happening is the physician says, "I need you to come in to get some imaging done or get some lab work done." The payment parity, despite the policy incentives to increase telehealth payment rates, it's not true parity. And so, that's why we don't see the full substitute effect. When you boil the ocean down, you see that the market for telehealth continues to be pretty discrete and concentrated to a handful of consumers. That's really where I think the future is, thinking about whether they will continue to use it. The data shows that, in the pandemic, we've seen this tapering. When Americans are given the option for in-person or virtual, they're still preferring to go in-person with that exception of behavioral health. So, I think the market is going to have to be more realistic about the total addressable market size in terms of discrete number of users, the number of visits per user, and then invest accordingly. I think that's a large part of why we've seen a lot of struggling amongst some digital health players, because I think they've overestimated the amount of utilization of virtual care modalities. But the number of discrete users just isn't up to par with what individuals had estimated it to be. MHN: Going back to those retail entrants, Amazon made a ton of news this year. Walgreens, CVS, Walmart — they're also boosting their care delivery operations. How do you think these moves will affect the healthcare industry overall? Jain: It ultimately comes down to, who is your customer or your consumer or patient persona? Who is Amazon actually going after? Who is their target patient population, and for what services? Amazon is really focusing on more low-acuity services, and health systems are particularly good at the higher acuity things like surgeries. What Amazon and other new entrants mean is that they provide the consumer with more care options. But it also creates a need to coordinate care better and create these really strong referral relationships. To go back to my earlier point about patients not coming back, of the patients we do see coming back, we're seeing them really seek out care in these low-acuity, commoditized care settings. They're going in for flu and strep, but they're not getting their screenings. It's going to be really important for groups like Amazon to coordinate with health systems to actually get patients to go follow up for those necessary services and figure out how to refer them out. MHN: How do you think the growth of these retail players will affect patients? Jain: I think it's a bit of a toss up. For some patients, they're going to view it as a better experience, because they can get what they want when they want it. But I think from a clinical perspective, it creates a lot of risks and challenges for the health of the patient. There really isn't someone owning the care or steering the patient through their healthcare journey. Have you gotten this lab workup? Have you gotten this mammogram? For some of these more retail players, it's consumer-directed. You can walk into urgent care and you can go to a telehealth visit, and it's really up to the consumer. But healthcare is complicated, and the average consumer may not have all the necessary information to go make those decisions. I think that there's a lot of positives to retail players in terms of catering to consumer preferences and providing care in a more convenient way. But for a lot of complex care, acute care — that every American is going to need at some point in their life — there is a little bit more fragmentation. MHN: Do you think there's an appetite among health systems to partner with Walgreens or CVS or Amazon and say, "If you see someone, send them to me when they need a cancer screening?" Jain: Absolutely. So, I actually just this week was with one of the health systems, talking to their leadership team. That's very much a conversation that is happening in the boardrooms — what is the right partnership structure with some of these new entrants and primary care providers? I think the challenge is, you could have those great partnerships. But ultimately, it's the consumer and the patient that's still having to make the decision. Are they going to follow up on those recommendations? Where are they going to go next? So, I think it's something that we're going to have to spend more time thinking about as an industry, how to coordinate that care for that patient over time, but with more choice and options in the market. See original article: https://www.mobihealthnews.com/news/qa-how-retail-healthcare-telehealth-trends-could-evolve-2023 < Previous News Next News >

KFF Report on Telehealth - Medicare Use Offers Future Policy Implications Center for Connected Health Policy June 2021 Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. More work will need to be done to further education around telehealth and ensure its availability to all communities. A Kaiser Family Foundation brief presents new information and analysis of Medicare beneficiaries’ utilization of telehealth using Centers for Medicare & Medicaid Services (CMS) survey data from between summer and fall of 2020 while CMS emergency telehealth expansions were in effect. Given the limitations around Medicare telehealth coverage pre-pandemic, many of these individuals had little experience with telehealth previously, offering an important perspective to inform ongoing telehealth policy considerations. For instance, while 64% of beneficiaries said their provider currently offers telehealth appointments, only 18% said their provider offered telehealth prior to the pandemic. However, nearly a quarter of beneficiaries said they don’t know if their provider offers telehealth appointments, with the percentage even larger among rural beneficiaries. Therefore, while expanded policies appear to have increased access to services via telehealth, more work will need to be done to further education around telehealth and ensure its availability to all communities. Additional findings from the study include: -Over 1 in 4 (27% or 15 million) of Medicare beneficiaries had a telehealth visit between the summer and fall of 2020 -The majority of Medicare beneficiaries (56%) used telephone only *Video was 28% *Both video and telephone was 16% -The share of Medicare beneficiaries who had a telehealth visit using telephone only was higher among: *Those age 75 and older (65%) *Hispanic beneficiaries (61%) *Those living in rural areas (65%) *Those enrolled in both Medicare and Medicaid (67%) The report also found that rural Medicare beneficiaries were less likely than urban beneficiaries to have a telehealth visit with a doctor or other health professional (21% vs. 28%, respectively). However, among Medicare beneficiaries with a usual source of care and whose usual provider offers telehealth, they found no significant difference between the share of rural and urban Medicare beneficiaries who had a telehealth visit (43% and 45%, respectively). They note this difference is likely driven by the fact that rural Medicare beneficiaries were more likely than urban Medicare beneficiaries to say they do not know if their usual provider offers telehealth (30% vs. 21%, respectively). Similarly, among Medicare beneficiaries with a usual source of care whose usual provider offers telehealth, they found that a larger share of Black and Hispanic beneficiaries had a telehealth visit compared to White beneficiaries (52%, 52%, and 43%). However, among the total Medicare population, the difference in the share of Black and White beneficiaries who reported having a telehealth visit was not statistically significant (30% vs. 26%), while a larger share of Hispanic beneficiaries than White beneficiaries had a telehealth visit (33% vs. 26%). They note that for Black Medicare beneficiaries, this result is likely related to the fact that nearly a quarter of Black beneficiaries overall (23%) say their usual provider does not offer telehealth appointments, compared to 12% of White beneficiaries and 15% of Hispanic beneficiaries. Looking forward, the authors suggest that since they found greater usage of telehealth amongst those with disabilities, low incomes, and in communities of color, the temporary expansions of coverage may be helping more disadvantaged populations access care. In addition, since most services are being provided via audio-only, they state going back to requiring two-way video could be a barrier for many subgroups of the Medicare population. As policymakers continue to request data on telehealth and consider making certain emergency policies permanent, many are looking to Medicare to lead the way, and this information further confirms the importance of maintaining access to all telehealth modalities in all communities, or risk potentially exacerbating existing disparities even further post-pandemic. Additional expansion and education of telehealth availability will continue to remain necessary as well. More information on the survey and analysis can be found in the full issue brief - https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/. < Previous News Next News >

Trends in Telehealth Prescription Laws Kirin Goff, Southwest Telehealth Resource Center July 2021 New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. States across the country are proposing or enacting legislation that supports making the increased access to telehealth that occurred during the pandemic permanent. However, many states seem to struggle with how to appropriately regulate remote prescribing requirements as there is wide variation in approaches and priorities emerging in these proposed and new laws. The most common approach is to carve separate requirements for controlled substances, and then clarify if and under what circumstances they can be prescribed via telehealth. Notably, concerns about addiction and access to mental healthcare are becoming increasing prevalent in telehealth legislation. Some states are attempting to address the latter by specifically expanding telehealth to meet these needs, including allowances for remote prescriptions. The Worsening Drug Epidemic As the COVID-19 pandemic took center stage, substance use also increased. Preliminary estimates indicate that in the first eight months of 2020, drug overdose deaths increased by 48.1% in Arizona and 46.8% in Colorado, compared to same period in 2019. In the U.S. as a whole, drug overdoses increased by 27% between September 2019 and August 2020, compared to the previous twelve months (all data are based on Commonwealth Fund examination of provisional data from CDC’s National Vital Statistics System). As more Americans become personally impacted by the opioid epidemic, opinions about drug policy seem to be shifting. In lieu of strict regulatory measures, harm reduction is becoming more mainstream, and approaches seem to increasingly favor policies that improve access to care for substance use disorders. For example, the American Medical Association put out an issue brief supporting policies that employ evidence-based harm reduction policies and “remove existing barriers for patients with pain to obtain necessary medications…[including] arbitrary dose, quantity and refill restrictions on controlled substances.” Controlled Substance Prescription Arizona has addressed this issue most directly and comprehensively by enacting HB 2454. This law allows providers to prescribe Schedule II drugs, which are defined as drugs with high potential for abuse, such as Vicodin, methadone, and OxyContin, via audio-visual examination and delegates review for more detailed requirements to a newly created Telehealth Advisory Committee. The committee will “review national and other standards for telehealth best practices and relevant peer-reviewed literature” and establish best practices for providers to follow. This committee must include several experts in behavioral health and substance use, indicating that optimal ways to regulate prescribing controlled substances are a high priority. In other Southwestern states, the majority of recent bills on the topic focus on cannabis. For example, New Mexico’s medical marijuana law (HB 2) allows providers to determine medical marijuana qualification via telehealth. Likewise, Utah recently passed a bill (SB 170) allowing for medical marijuana renewal via telehealth examination, although it still requires in-person exams for initial recommendations. Research and Access to Care Healthcare access issues are also of primary concern, and telehealth is seen as a potential solution, particularly in rural areas. For example, New Mexico prioritizes gathering evidence about cannabis by requiring an annual report evaluating the needs of patients who live in rural areas, subsidized housing and Indian nations, tribes or pueblos. While it does not refer to telehealth specifically, it is a clear consideration for non-urban populations. Likewise, Utah attempted (HB 36) to extend the term of a grant for research about how telehealth can improve access to mental health care, particularly for underserved populations. The range of proposed and enacted laws reflects a lack of evidence as well as differing ideologies among legislators. It is unusual for such substantial changes to the legal framework to occur so quickly – without more incremental steps and without a significant body of experience and precedent to glean from other jurisdictions. Arizona’s HB 2454 provides an innovative approach to remote prescribing by providing both access and data, which will be key to watch as states continue to pass telehealth legislation. < Previous News Next News >

Libraries Add Telehealth to the Rural Communities They Serve Mari Herreras October 20, 2022 In the early days of the Covid pandemic, Dianne Connery realized something needed to be done for people in her rural Texas community to help connect folks to their medical appointments. Connery, director of the Pottsboro Area Library in Pottsboro, Texas, said it started when one woman with pulmonary disease came to the library for help, desperate to meet with her doctor but too high risk to come to his office—a two-hour drive south to Dallas. “Libraries are such perfect places for this because often we have the fastest internet in town, and we are used to helping people with technology,” Connery said. Connery and her fellow librarians sprang into action—creating a private space in Connery’s office with her laptop that had a camera. That gesture allowed the woman to meet with her doctor and go over recent MRI results. “I had never lived in a rural town until 2010 and didn’t realize how hard it is to access digital technology. You need a solid infrastructure for robust internet. Rural communities like ours don’t have that,” she said. From that first telehealth appointment in Connery’s office grew the library’s telehealth program that’s received national recognition. However, it never would have happened without Connery, with support from the town council, having fiber installed to support a teen eSports program long before the start of the pandemic. More community members used Connery’s office those early telehealth appointments, but through a National Library of Medicine grant and a community appeal, she was able to create a private appointment space from an old junk room and purchase the needed hardware and equipment. The next step was a unique partnership she developed with the University of North Texas Health Sciences Center to pair patients with the medical providers they needed. People can be seen two days a week for those using Medicare and Medicaid. Another day of the week is reserved for behavioral health appointments and another day is reserved for folks seeing their regular health providers. Connery’s work on the telehealth program doesn’t end there. The American Heart Association recently provided her library with blood pressure kits members of the community can check out. They also received a grant to hire a community health care worker to do outreach and education at the library and community spaces like the American Legion and the VFW. Now she’s focused on developing a digital literacy curriculum with the help of a three-year grant that helped her hire a digital navigator. Connery said she’s excited to see other rural libraries in Texas start telehealth programs but hopes more funding loops back to libraries desperate for increases in their own budgets. Connery is part of a national consortium of libraries who meet monthly to discuss telehealth programming—a growing interest in other rural communities beyond her Texas borders. Last month, a new telehealth program recently launched at two rural Pima County Library branches in Ajo and Arivaca—the first of its kind in Arizona—allowing folks with transportation or internet issues access to their doctors without having to drive several hours across the desert to nearby Tucson. “A huge sense of relief,” is how one Ajo resident recently described her experience that helped her connect with her primary care doctor in Tucson about worrisome symptoms she experienced after recovering from Covid. At the Salazar-Ajo Library she was able to collect the vitals her doctor needed using equipment provided by the library. And in the privacy of the library’s meeting room, she met with her doctor via a laptop and the internet provided by the library to go over her symptoms and vitals. “Being able to take my vitals and provide those to my doctor seems really important,” the Ajo resident said. “… while I was on my call with her, she had me do my vitals. We started with the blood pressure cuff, and how to apply it. Then my oxygen with the pulse rate oximeter.” The end of the appointment her doctor determined that the symptoms were not uncommon for someone who has had Covid, allowing the Ajo resident some relief and a better understanding of her recovery. Daniela Buchberger, Pima County Library’s Ajo branch managing librarian, said the new program, Health Connect, provides a private room for telehealth medical appointments. Inside is a laptop with a camera and equipment needed for a patient to take their own vitals: a digital scale, a thermometer, a blood pressure cuff, and a pulse rate oximeter. A patient will need to have the link provided by their doctor, usually via email. Library staff, due to privacy restrictions, aren’t going to be able to help someone log-on or use the equipment although the patient can bring someone with them to their appointment in the study room. Each library has written instructions on laminated cards as well as easy-to-follow visuals to help guide their experience. According to the Pima County Library, Health Connect is made possible by the Arizona State Library, Archives, and Public Records, a division of the Secretary of State, with federal funds from the Institute of Museum and Library Services. It is a joint effort between the Library, Pima County Health Department, University of Arizona’s College of Nursing, the Arizona Telemedicine Program, and United Community Health Care. "Access to telehealth is essential for people to get the care they need when traveling to an in-person visit isn't possible,” said Ken Zambos, program manager for Workforce and Economic Development in Pima County. “By providing this service, the library is providing access to equipment that transforms healthcare delivery and positively affects healthcare outcomes." Buchberger said a library card isn’t needed to use the room. However, reservations are needed and available in hour and half increments. Each person using a room is expected to clean all equipment after use with alcohol wipes provided. A fan in the room will be used to provide white noise to help with privacy as much as possible. “We may not have as much traffic as other libraries, but we are an important part of the community. The library is free, so is the internet,” Buchberger said. “Not everyone here has a car or a computer, but they have us.” About the Author Mari Herreras is the newest member of the Arizona Telemedicine Program and Southwest Telehealth Resource Center teams, serving as Communications Manager. She has worked in marketing and communications in publishing and nonprofits, as well as an award-winning journalism career for community and alternative newsweeklies in Tucson, Los Angeles, Seattle, and Wenatchee, Washington. See original article: https://southwesttrc.org/blog/2022/libraries-add-telehealth-rural-communities-they-serve < Previous News Next News >

Workers Report Burnout Due to Healthcare Cybersecurity Concerns Jill McKeon Oct. 6, 2021 Three-quarters of industry professionals reported having healthcare cybersecurity concerns about protected health information being communicated via unsecured communication devices. Physician burnout was a growing problem prior to the pandemic, but other healthcare professionals are reporting significant levels of burnout as well, according to a survey conducted by Spok. Over 50 percent of IT staff and contact center staff reported feeling a considerable level of burnout. Meanwhile, over 60 percent of clinical executives reported feeling “a great deal” of burnout since the pandemic. Healthcare professionals overwhelmingly agreed that the risk of clinician burnout is a public health crisis “that demands action by healthcare institutions, governing bodies, and regulatory authorities.” Many credited complicated technologies and poor technological integration as some of the leading factors in clinician burnout. The research suggested that improved communication tools could lessen the risk of clinician burnout. “Survey respondents seem to agree that improving communication technology could help address the risk of burnout through increasing efficiency of workflows, improving exchange of data between care members, and adopting mobile technologies,” the study explained. COVID-19 reshaped many aspects of care delivery, and also highlighted the need for secure communication technologies that can simultaneously comply with HIPAA and seamlessly integrate into an organization’s operations. Just over 80 percent of surveyed healthcare workers reported believing that COVID-19 played a role in protected health information (PHI) being communicated via unsecured or personal communication tools. Researchers surveyed over 200 healthcare executives, physicians, IT personnel, nurses, and contact center representatives about the state of communication in their organizations. Results revealed that the COVID-19 pandemic not only caused significant healthcare worker burnout, but also shifted resources away from valuable cybersecurity initiatives. “With security and privacy issues on the rise in 2021, perhaps it’s not unexpected that survey respondents are concerned,” the survey report stated. “Looking ahead, hospitals and health systems may need to bolster initiatives to meet HIPAA standards for PHI protection and to avoid noncompliance, reputational harm, and serious financial penalties. It could also signify the need for health systems to have in place an advanced, HIPAA-compliant critical communication solution.” All industries have become increasingly reliant on communication technologies, especially during the pandemic when mobile communication devices became the primary method of communication for many workplaces. Smartphones have remained the number one most supported device in healthcare since 2012, as in-house pager use continues to decrease. However, pagers still play a key role in care team communications. Most respondents reported that their organization’s budget constraints continue to prevent them from updating their outdated communication devices. In addition, the complexity of meeting HIPAA requirements and insufficient leadership support are major obstacles in advancing a healthcare organization’s internal communication tactics. Implementing new communication tools also presents new cybersecurity risks and calls for enterprise-wide training programs. Just under half of respondents reported that their teams paused outstanding IT communication projects during the pandemic. While 43 percent of respondents expected to resume these projects within the next six months, the rising prevalence of the Delta variant may alter that timeline. < Previous News Next News >

Remote Patient Monitoring: Benefits, Barriers, and Billing Center for Connected Health Policy August 2021 Remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. Last month, the California Health Care Foundation (CHCF) released a new report, Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know, which looks at remote patient monitoring (RPM) policy considerations and how RPM can improve chronic condition care and prevention. The CHCF report focuses on RPM’s use specific to safety-net providers given system constraints particularly limiting chronic illness management to those patient populations. They note that in California, avoidable hospitalizations are highest for Medicaid beneficiaries and that almost 700 hospitalizations per 100,000 people could be prevented through better access to care and more effective chronic care management. In addition, they discuss that providers have seen how telehealth can improve treatment of diabetes, hypertension, and heart disease, as well as mortality and quality of life. RPM specifically has shown benefits for older patients and those facing barriers such as lack of transportation to care. Nevertheless, as discussed in the report, technological issues and strict reimbursement policies remain barriers to RPM utilization. The report also offers potential best practices for providers considering RPM adoption. RPM Basics and Benefits As noted on CCHP’s state and federal RPM policy tracking page, RPM is considered to be the collection of a wide range of health data from the point of care, such as vital signs, weight, and blood pressure measurements. The data is then transmitted to health professionals in facilities such as monitoring centers in primary care settings, hospitals and intensive care units, as well as skilled nursing facilities. The CHCF report gets into various RPM benefits found within the authors’ research across all settings, including how RPM maximizes use of the entire care team and enhances quality of care and outcomes, as well as how it can improve costs of care. Focus group information gathered for the report also showed that patients feel empowered when able to track trends related to their health information through RPM, becoming more engaged and also more willing to change treatment plans when related to the monitoring information. Other research cited found benefits specific to vulnerable populations, including high adherence and successful self-management education to high-risk and low-income populations. Examples were also provided showing that RPM can give patients, especially those that are Spanish-speaking, an overall sense of support. RPM Barriers Despite the evidence on its benefits, as mentioned previously, RPM is not widely used as a modality of care in the safety net, largely related to a number of technological and reimbursement policy barriers. For instance, ensuring that devices can integrate into electronic health records (EHRs) and that data is seamlessly shared and uploaded is crucial, but often costly. Some technological options also don’t offer an ability to be alerted to new and concerning information in a timely manner. Instead, the report discusses how often lower cost options include devices that are not directly connected to EHR systems and involve patients manually reporting measurements through a patient portal or by text message. The study also cites how many patient groups within the safety net population struggle with lack of broadband connectivity as well as digital literacy issues, which also highlights the need to cover phone and text communication modalities. As the authors note, without additional certainty around RPM reimbursement, providers are limited in properly assessing associated costs and savings to be able to provide RPM related services, especially within the safety net. State Medicaid RPM Reimbursement CCHP’s recent state telehealth policy tracking shows that twenty-seven states now have some form of reimbursement for RPM in their Medicaid programs. Many of the states that offer RPM reimbursement also have a multitude of restrictions associated with its use. The most common of these restrictions include only offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected. One state (Ohio) has reimbursement only for specific remote physiologic monitoring codes modeled after Medicare reimbursement. In California under newly enacted legislation AB 133, the Department of Health Care Services (DHCS) may authorize the use of RPM as an allowable telehealth modality under its Medicaid program. However, the language states that DHCS will establish a new undetermined fee schedule for it and likely limit covered services and providers eligible for RPM reimbursement. More details on AB 133 can be found in CCHP’s newly released fact sheet on California health budget agreement and all of its telehealth components. Medicare Remote Physiological Monitoring (and proposed RTP) Reimbursement As far as Medicare RPM reimbursement in the Centers for Medicare & Medicaid Services (CMS) proposed 2022 PFS they are suggesting the addition of five new CPT codes for remote therapeutic monitoring (RTM): *989X1: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment *989X2: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days *989X3: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days *989X4: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes *989X5: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes According to CMS, the RTM codes are similar to the seven Remote Physiological Monitoring (RPM) codes they have included over the past few years with a couple of differences which are primarily related to the particular equipment being used and data collected, and which providers can directly bill for these codes. For instance, RTM codes are proposed to monitor health conditions and allow non-physiologic data to be collected, including self-reported and digitally uploaded information, though devices for both RTM and RPM must meet the same Federal Drug Administration (FDA) definition of medical device. CMS is soliciting comments on the types and costs of devices that may be used for RTM services under the proposal. In addition, RPM services have been considered to be evaluation and management (E/M) codes which cannot be billed by certain providers, while RTM codes are considered to be general medicine codes. Additional details are still to be determined and questions remain related to billing and code construction that stakeholder comments can hopefully lead them to clarify after the comment period on the proposed PFS closes on September 13, 2021. Details on the other items in the proposed 2022 PFS can be found in CCHP’s fact sheet, explainer video, and slide deck. RPM Adoption Guidance Barriers in mind, the CHCF report suggests providers look to incorporate RPM into programs and workflows prior to considering the use of a specific technology, highlighting a number of considerations and ways providers can assess how to utilize RPM and adopt it consistent with best practices and existing policies. The guidance recommends to those considering starting an RPM program includes: Use RPM as a tool within a wider program, such as on top of an existing chronic disease management or diabetes educational program Invest in organization-wide adoption and management to ensure deployed at scale Identify key performance indicators to prioritize specific populations and results, such as no-show rates and clinical outcomes Estimate enrollment and overall costs, potential partnerships with other health centers Incorporate cultural responsiveness and solutions designed for patients with physical limitations Looking Forward As best practices continue to emerge and interest and understanding increases around use of telehealth modalities, including RPM, hopefully coverage consistency, and clarity, can increase as we move forward. Given existing variance amongst the states and the use of two different terms by the federal government for just this one type of modality – which they consider separate from telehealth – it will remain important moving forward to continue to highlight the benefits of telehealth and how they can outweigh any concerns necessitating the need for such strict and confusing policies that vary by each telehealth modality. For more details on the report’s RPM findings, please download it here - https://www.chcf.org/wp-content/uploads/2021/07/RemotePatientMonitoringSafetyNetNeedKnow.pdf. To track the ever-evolving telehealth landscape, please utilize CCHP’s policy finder - https://www.cchpca.org/new-mexico/ < Previous News Next News >

Pandemic broadens NMDOT’s outlook to lay groundwork for a connected future By NMDOT February 8, 2021 “The pandemic forced New Mexico to rely heavily on internet access, making broadband even more essential,” SANTA FE – The New Mexico Department of Transportation is committed to helping build out the information highways in New Mexico to connect rural communities to vital digital resources while enhancing mobility and safety on state highways. “The pandemic forced New Mexico to rely heavily on internet access, making broadband even more essential,” said Transportation Secretary Mike Sandoval. “Digital expansion has been a passion project of the department for a while, but the urgent need for telecommuting, distance learning and telemedicine has fueled the drive to make internet access for every New Mexican a reality.” The DOT is looking ahead at what it would take to piggyback fiber optic infrastructure with current and future road construction projects to achieve dig once practices and help make future broadband expansion projects more welcoming for industry partners. Additional fiber infrastructure would also enhance the department’s Intelligent Transportation Systems (ITS) which allows DOT to install additional digital message boards, cameras, and weather sensors, to provide real-time road condition information through the NMRoads application. “As existing roads are reconstructed, there’s an opportunity to install fiber conduit while the road is torn up, so you’re not digging twice, which minimizes the impact on the environment,” said Sandoval. “Building both literal and digital highways will provide innovative, sustainable infrastructure that serves the entire state.” NMDOT is also partnering with the New Mexico Economic Development Department (NMEDD) to conduct a stratospheric broadband infrastructure assessment which will not only evaluate the connectivity opportunities for rural New Mexico, but also identify the same prospects for the state’s transportation needs. “We have a long way to go, but the department is gathering data and taking the necessary steps to ensure DOT plays a significant role in broadband accessibility,” adds Sandoval. < Previous News Next News >

Telehealth's importance grows amid coronavirus pandemic Rick Ruggles March 12, 2022 The coronavirus compelled doctors to see patients in new ways, and one of those is through a computer monitor, miles away from the patient. The pandemic placed greater emphasis on telehealth, which has been around for years but was put to use urgently when the coronavirus spread in early 2020. Officials with Medicare, the government-sponsored insurance for senior citizens, also increased the number of the occasions in which telehealth could be covered during the pandemic. Whether vast telehealth use and broad insurance coverage for it will continue isn’t certain, those who know the benefits of telehealth say it has proved itself and is here to stay. “It’s become part of life,” said Sharon V. Nir, administrative director of strategic operations with Albuquerque-based Lovelace Medical Group. “I do think it’s the new world.” Lovelace created an extensive program in March 2020, with the arrival of the coronavirus, to make remote visits available to patients and doctors through laptop computers, iPads, cellphones and desktops with cameras and microphones. Presbyterian Healthcare Services, Christus St. Vincent Regional Medical Center, University of New Mexico Health, La Familia Medical Center and most other medical systems also increased their use of telehealth. Santa Fe Preparatory School teacher Brad Fairbanks went head over handlebars on his bicycle last month, breaking a collarbone and three ribs. He spent time in an emergency room, but his follow-up visits with his family physician, Dr. Carl Friedrichs of Presbyterian Medical Group, were done remotely. Fairbanks, 61, said the follow-up appointments and pain medication assessments were as effective by videoconference as they would have been in person. “This was the first time I’d done telehealth,” said Fairbanks, the performing arts chairman at his school. “Yes, it worked great.” He said the accident happened at a bad time, with his students preparing to put on the show 9 to 5 The Musical. He missed four days of work and two rehearsals and had to participate in two other rehearsals by Zoom technology. Friedrichs said there is plenty that can be accomplished in a telehealth appointment. “The patient has the choice,” he said. “It’s an extra tool for patients.” In a big state like New Mexico with vast rural expanses, it makes sense to lean on telehealth, he said. “This is a state that has limited medical resources.” Videoconferencing can’t be used for everything, of course. Annual physicals and diagnoses requiring the doctor to lay hands on the patient must be done in person. Blood draws for lab work require a visit, although the result of that lab work can be covered in a virtual appointment. And some patients aren’t at ease with the technology. But telehealth gives patients in rural areas and those who struggle to find transportation the chance to get some of their services done by videoconference. And when the highly contagious coronavirus roared through the world, patients who were reluctant to visit the doctor’s office had an alternative. Christine and Ed Shestak of Albuquerque have had about four videoconference appointments apiece through Lovelace since the start of the pandemic. “For routine things, it just kind of minimizes the risk of picking up anything anybody else might have” in the doctor’s office, said Christine Shestak, 69. She recalled when she took her children to the pediatrician many years ago, kids would cough, noses would run and children would share toys in the waiting room. Telehealth is a solution, she said, and if she has the flu, she doesn’t have to carry it into the clinic and possibly infect others. Ed Shestak, who will soon be 70, said he has hearing aids and sometimes struggles to absorb everything if there is background noise in the doctor’s office. At home, he puts on headphones for his virtual visits. “I can hear and understand better,” he said. Naturally, insurance coverage of telehealth is complicated. Before the pandemic, Medicare coverage for telehealth generally favored rural patients and also included some specific conditions such as end-stage renal disease and strokes. But when the coronavirus forced patients to work from home and limit travel, the Centers for Medicare & Medicaid Services expanded coverage on an emergency basis to patients in cities, to a wider variety of medical practitioners and for a broader set of reasons. Telehealth used by primary care doctors boomed. Specialists in psychology, the digestive tract, lungs and heart also saw increased use of telehealth. The federal government reported in December that Medicare-covered telehealth visits leaped from 840,000 in 2019 to 52.7 million in 2020. Presbyterian spokeswoman Amanda Schoenberg said scheduled telehealth visits with Presbyterian Medical Group went up by 100 times from 2019 through 2021. Medicare will continue to cover many of those services at least through 2023 while officials evaluate the system. Tennessee-based Baker Donelson law firm says on its website new Medicare provisions also permanently removed geographic restrictions on telehealth for diagnosis, evaluation and treatment of mental health disorders. Stetson Berg, chairman of the New Mexico Telehealth Alliance, said Congress will have to pass laws to cement much of the coverage that was added on an emergency basis during the pandemic. Berg said state law in New Mexico has provided some of the most progressive private insurance coverage of telehealth and has served as a “shining star” in the field for close to 10 years. New Mexico was ahead of the game in part because it is so rural, he said. Other states are catching up. In the journal Annals of Internal Medicine, researchers reported last month that analysis of 38 studies showed videoconferencing “generally results in similar clinical effectiveness, health care use, patient satisfaction, and quality of life as usual care for areas studied.” Those studies were limited to “patients seeking care for a limited set of purposes,” the report added. Christus spokesman Arturo Delgado wrote in a text message that virtual visits “are appropriate for most evaluations. Conditions that can be evaluated include anything from a cough or a cold to more complicated conditions like diabetes or heart disease.” Jasmin Milz Holmstrup, a spokeswoman for La Familia Medical Center in Santa Fe, said the use of telehealth increased considerably at her institution from 2020 to 2021. “It’s an effective way to see patients who have non-urgent needs,” she said. University of New Mexico Health said the institution “utilized all available options to continue to provide patient care, including telehealth. This was a successful way to ensure patients continued to receive care and access to a provider.” Prep teacher Fairbanks said his students prepared for the play while he was “in my recliner, all banged up.” The shows took place March 3 to March 6 and the medical appointments by telehealth and attendance of rehearsals by Zoom didn’t pose a problem. His students came through. “It worked out,” he said. “And the kids stepped up.” < Previous News Next News >

Telemedicine and diagnosis Adriana Albini September 27, 2022 The adoption of telemedicine and its range of applications grew exponentially in the early days of the Covid-19 pandemic, and the general consensus now is that it is here to stay, albeit perhaps with a more hybrid bias of in-person and remote visits. Telediagnosis, or TeleDx, i.e., the identification of a disease at a site remote from the patient, has expanded to include primary care, revolutionising the way in which patients and doctors communicate with each other and establish rapport. It is still early days to fully evaluate the effect of virtual vs in-person visit on diagnostic error, but there are guidelines for health professionals to conduct effective virtual examinations, and many best practice examples, both in terms of ways to gather information from the patient (from wording of questionnaires to digital records, home environment, and so on) and technological innovations. In cancer care, pathology plays a central role in the final diagnosis upon which clinicians will develop treatment for their patient, and remote pathology can offer many advantages, such as easier access to pathology experts, consultation among specialists, timely and secure availability of images, and so on. Up until the 1990s, pathologists worked almost entirely within the constraints of the analogue world, with physical glass slides and microscopes. Some attempts were made at capturing virtual images of slides through a tiling method, which was time consuming and prone to error, as it required accurate placing and extensive stitching together of images. But at the end of that decade, engineer Dirk G. Soenksen (founder, and CEO of Aperio) devised a much more efficient system based on a linear scanner, the ScanScope, that allowed for tightly focussed and fast slide image capture, opening a new era for the practice of pathology. Whole slide imaging, or WSI, was first employed in education and research but in recent years, with the improvement of its technology, it has received regulatory approval by the FDA and around the world for diagnostic use as well. The potential for feeding AI algorithms to provide diagnostical support is massive, as virtual slides are accumulating fast and standardised databases are being built. “Telemedicine in Cancer Care Continuum: implementation and integration”, was an online conference developed by the SPCC in collaboration with the American Society of Clinical Oncology (ASCO), which took place on 6-7 May 2022. In his presentation, Liron Pantanowitz, Professor of Pathology, and Director of Anatomical Pathology at the University of Michigan, talked about telepathology in both its non-acute and acute settings, focussing more extensively on the latter. The term ‘telepathology’ was coined by Ronald S. Weinstein in 1986, after he organised the first public event of satellite-enabled dynamic-robotic distant pathology, but the very first live telepathology ever performed dates as far back as to 1968. Massachusetts General Hospital set up a two-way television link with Boston’s Logan Airport that enabled doctors at the hospital to remotely study blood smears, urine samples and X-rays for patients at the airport, and even listen to their heartbeat with an electronic stethoscope. However, as in the case of telehealth in general, the adoption of digital pathology had to wait until the Covid-19 pandemic to be widely implemented. To facilitate continuity of healthcare while social distancing, certain restrictions were lifted, such as CLIA in the US, allowing pathologists to work from home and sign out cases. The first use of telepathology Prof. Pantanowitz looked at was for frozen section consultation. There are several challenges when a pathologist is asked to provide an intraoperative consultation. The pathology specimen is fresh, not easy to cut. The frozen section itself is difficult to prepare and is often filled with artifacts. These artifacts not only make it hard to read the glass slides but can compound the problem when using digital images. The turnaround time needs to be rapid. Usually, pathologists strive for less than 20 minutes to provide the surgeon with an answer. And they are under serious diagnostic pressure because if they get it wrong, it is difficult to reverse the surgical decision that has been made based on their diagnosis. Over the past 54 years different modes of practising telepathology have been developed. A pathologist on site can take static images, which is easy but too time-consuming. There is also video microscopy, live streaming from one pathologist to another. If there is no pathologist present on site to read the slides, there are systems such as robotic microscopy, where the pathologist can remotely take control of the functions on a microscope, such as navigation and focus. And there is also Whole Slide Imaging, which is the entire digitization of a slide to be remotely reviewed. Thanks to advancements in technology, hybrid devices are now available from many vendors with robotics and Whole Slide Imaging functions in one scanner. See full article: https://cancerworld.net/telemedicine-and-diagnosis/ < Previous News Next News >

Controversy about Eliminating Telephone Telehealth Coverage By Dr. Maheu April 7, 2021 Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. A study published in the Journal of the American Medical Association focused on telehealth use among the low-income population in California. The study included data from outpatient primary care and behavioral health visits from February 2019 to August 2020 at forty-one federally qualified health centers representing 534 locations in California. The study showed that, with regards to primary care visits, 48.5% of visits occurred via telephone, 48.3% occurred in person, and 3.4% occurred via video. For behavioral health visits, 63.3% via telephone, 22.8% in person, and 13.9% via video. The study’s key finding was that most telehealth appointments during the pandemic period were conducted over the phone. “Eliminating telehealth coverage for audio-only telemedicine visits would disproportionately impact underserved communities,” according to Lori Uscher-Pines, the study’s lead author. “Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth,” she said. “These are important considerations for policymakers if telehealth continues to be widely embraced in the future.” Since the use of telehealth expanded due to COVID, few studies have examined differences in the use of telehealth modalities. However, one federal agency estimated that 30% of telehealth visits had involved phone therapy sessions alone during the pandemic. According to the study, telehealth visits delivered via over-the-phone therapy peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits. Before the pandemic, many definitions of telehealth excluded phone therapy visits, and private insurers or the government rarely reimbursed them, the study authors noted. Some payers, including the Centers for Medicare and Medicaid Services, have indicated they may stop telehealth coverage reimbursement for phone therapy sessions when the pandemic ends. Read more about previous rulings for COVID-19 Telephone Telehealth Reimbursement. “There are some concerns that telephone visits could result in fraud, abuse, and unnecessary and lower-quality care. Although these concerns are important to assess, eliminating telehealth coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of the clinics to meet patient needs” stated Dr. Uscher-Pines. The Reality of Professionalism and Telephone Therapy It seems a bit dramatic to point out that telephone therapy can be more subject to fraud and abuse when it actually is often the only lifeline for many people in distress during the pandemic, and beyond. Fraud and abuse can potentially exist everywhere. The real question is whether the professional has bothered to learn how to properly use the telephone for clinical interventions – or if they are making it up on the fly. Unfortunately, although a clear evidence base exists for telephone-based interventions, very few professionals have received adequate training, and more likely, no professional training to use only the telephone to deliver services to a patient or client. They may not have yet realized that a good in-person clinician is not the same as a good telephone therapist, regardless of intention or need. This point can be clarified quite readily by looking at the case of the alcoholic therapist-in-recovery who now decides to offer therapy for alcohol use. Assuming of course that the therapist has excellent therapy skills to start, the therapist’s history with alcohol can actually interfere with their functioning as an addictions therapist, narrowing perspective with unchallenged assumptions related to etiology, treatment options, and/or prognosis. This is why the professional standard for qualifying alcohol therapists is not one’s prior experience with alcohol, but rather, a course completion certificate or certification in alcohol interventions. Even a good (or great) in-person therapist approaching telephone telehealth without training is likely to overestimate the quality and/or effectiveness of their communications. If one does read the literature about telehealth in general and telephone therapy in particular, it is very clear that professional training in order. In fact, most published studies directly call for clinicians to get such training for telehealth and telephone therapy as well. The Telephone Telehealth Evidence-Base The research in telehealth, in general, has also been quite clear that therapists who have received training are more likely to use the medium correctly to deliver outcomes that are not only comparable to in-person care but also to minimize frustration in both themselves and their clients/patients and feel more confident about how to protect the privacy of the exchange. In 2018, after conducting a systematic search for articles published over a 25-year period (January 1991–May 2016), Coughtrey & Pistrang published a study of 14 studies that concluded that “telephone-delivered interventions show promise in reducing symptoms of depression and anxiety.” This conclusion is warranted, given that much of the Similarly, in 2020, Castro and colleagues published a meta-analysis looking at 10 studies looking at treatment adherence to telephone therapy for depression. In general, they showed beneficial effects on depression severity when compared to control conditions. However, in these and other published reports showing the effectiveness or adherence rates related to telephone telehealth, treatment models are typically highly manualized. That is, they do not consist of free-form, open discussion common to many psychotherapeutic approaches. Therapists in such studies tend to follow very strict procedural dictates, and often, the recipient of care is given written materials and assignments that coincide with specified topics for each meeting. Conducting a mid-pandemic online qualitative survey of mental health care professionals in Netherlands, Feijt and colleagues (2020) reported, “Regarding the mediated nature of communication, the most frequently reported challenge concerns the lack of nonverbal signals that practitioners normally use in face-to-face communication, such as posture and hand movements, but also general demeanor, including smell. Practitioners find it more difficult to connect with their client or clearly communicate their intended message. This is even stronger when sessions are conducted by telephone when there is only audio to rely on.” Such a conclusion seems warranted, given that in-person training often teaches practitioners to rely on visual stimuli to render a diagnosis, develop and deliver a treatment plan. In evidence-based telehealth professional training, and especially in competency-based certificate programs of professional training, many of these issues can be addressed using protocols that are tailored to the clinician’s specific client for one’s patient population, setting, state, and professional requirements. On the other hand, clinicians who use communication technology without professional training are likely to be as confused by the online delivery of healthcare as someone accustomed to using a handset telephone who now is handed a smartphone to make a simple call. Therapist Vulnerability in Telephone Telehealth? Assessing a client or patient’s emotional state from voice alone can be problematic, particularly if the professional’s prior telephone habits involve multitasking. As discuss by Hilty, Randhawa, Maheu, McKean, Pantera & Mishkin (2020), distractions are the #1 problem with digital interventions. Don’t we all multitask when on the phone? Where then does distractibility leave the busy professional who typically multi-tasks during telephone therapy? Professionals who allow their workspace to be impinged by devices that regularly emit incoming messages, beeps, flashing lights, and other forms of alerts will likely find it difficult to stay focused on the voice input they now are attempting to use to deliver the same standard of care as in-person. Some therapists even so boldly encourage their clients and patients to “take a walk” while they themselves stroll about their neighborhoods or other local public areas while offering telephone therapy. All the while, these professionals profess to be delivering the same standard of care as when the client is seated in front of them, in a closed room. Could these realities be used to discredit an earnest professional who is attempting to deliver quality care via telephone therapy to people in need? Telehealth Service Delivery is Not Intuitive Telehealth service delivery is not intuitive, regardless of one’s experience in person or the need of the client. Faulty assumptions, lack of knowledge, undeveloped skillsets, and naive attitudes can lead to preventable error and potential harm. Pierce, Perrin, & McDonald (2020) stated, “Organizations interested in encouraging telepsychology use should adopt policies supporting the use of telepsychology and provide adequate training to do so.” Such calls for training are common to published reports and mimic those of telehealth in general for more than two decades. In 2000, Maheu and Gordon reported the results of an extensive survey assessing psychologist’s assumptions regarding the legal and ethical requirements for telehealth. Fourteen years later, a similar article was published by Maheu and a larger team of researchers who assessed roughly the same variables. In the 2020 study, two-thirds of clinicians endorsed items suggesting that standard legal and ethical mandates don’t apply to telehealth delivery of psychotherapy (Maheu & Gordon, 2000). In a more extensive survey, Glueckauf, Maheu, Drude, Wells, Wang, Gustafson & Nelson (2018) showed that the number had decreased to one-third. The disturbing fact is, however, that while two-thirds of clinicians endorsed items suggesting an awareness of legal and ethical mandates, it cannot be assumed that those clinicians understood how those mandates apply to their everyday telehealth practices. Where does this leave the average clinician who has no or minimal telehealth training, yet is confident that they are delivering quality care because they “feel good about it” and because it is “needed?” Therapists too are vulnerable to emotional reasoning… Courtroom Realities of Telephone Therapy Knowing how litigating attorneys work, it is quite conceivable that opposing counsel in a lawsuit against a therapist would wield several such recently published telehealth articles in the direction of an unwitting therapist who blithely offers telephone therapy without the proper documentation to prove that they indeed were actually trained in evidence-based telephone telehealth. Perhaps the CIVID emergency would tempter such accusations, depending on the circumstance. Hopefully so. However, the worrisome issue at hand is that most clinicians have never been taught the reality of what actually happens in courtrooms. Such training can be a difficult awakening. To help our readers better understand the issues involved with delivering clinical care in an area where there is a lack of professional training, we will make you privy to a training video that we regularly show in our 2-day certificate training programs. It features Attorney Joe McMenamin demonstrating his litigation skills as a prosecuting attorney for the defense in a “mock deposition.” In this video, he demonstrates exactly how a prosecuting attorney would “prepare” their case against a witness’s testimony for a trial wherein the therapist is being sued by an angry client. The video is painful to watch. Our only solace at TBHI is that Mr. McMenamin has not only worked for decades as a prosecuting attorney for the defense, but he is also a physician. he understands and shares the ethos of many healthcare professionals, and has worked these many years to defend us in court. That’s his motivation for working with TBHI for decades to develop training materials and peer-reviewed books and articles – to help professionals who are poorly informed of what can happen when one is led by the unbridled desire to help rather than a firm grounding in telehealth theory and practice. Caveat While this type of cross-examination wouldn’t happen to professionals who deliver telephone therapy during the pandemic because we are currently in a state of national emergency, but if telephone therapy were to be approved long-term, this is precisely the type of rigor that would be expected of professionals delivering professional services to people in need. As all licensed professionals know, there is a high bar for the delivery of professional services. Practicing licensed healthcare professional in the United States or Canada as well as in many other countries isn’t something one does in the same manner as they would if they were talking to a family member on the phone, multitasking, opening email, glancing at texts, perhaps outside strolling about the park — while the other party probably is also multi-tasking and/or strolling about as well. When we share the video below, please use this information to extrapolate how a skilled professional needs to be able to defend the amount of training they have obtained in any new area of practice including phone therapy sessions alone when a litigating attorney has them on the witness stand. Please note, we at TBHI are not saying this process is fair or right. It simply is reality. Courtroom Realities of Telehealth Malpractice Before watching, please let us explain what is happening in the video. First, this is one of the many training videos that we typically share with our training audiences. You will see how the attorney discredits the psychologist who is named “Dr. Joanne Johnson,” acted by Dr. Marlene Maheu for purposes of this role-play. The cross-examining attorney is Mr. Joe McMenamin, who is indeed a litigating attorney and physician in real life. He, however, defends practitioners in court rather than a prosecuting attorney, which he depicts in this audio lesson. However, having litigated against attorneys who prosecute, he is in a unique position to show you exactly what happens in court, should you ever have the misfortune of experiencing it firsthand. The interactions portrayed in the audio recording are abbreviated because Dr. Johnson provided additional information rather than doing as witnesses are instructed, and that is to give yes/no answers when possible, and offer as little as possible unless directly asked. You will see that Dr. Johnson actually offers a fair amount of information to get to the point of the demonstration. Upon experiencing the agony of witnessing such an exhaustive exchange, but in real life, it would behoove you to obtain the advice of a defense attorney about offering as much information as is depicted. The purpose of the demonstration, in this case, was to show you what a skilled litigator can do to disarm a well-intentioned professional during a deposition. The attorney goes on to explain his rationales, strategies, and how opposing counsel (which he is role-playing) would generally use the information gathered to discredit the plaintiff in court. This first training video is 37 minutes in length. TBHI Position on Telephone Therapy Just to be clear, TBHI is in complete support of phone therapy sessions alone for all clients and patients who need or are interested in such healthcare. However, having been the Chair of the CTiBS Committee on Telebehavioral Health Competencies, the Founder of TBHI is acutely aware of the lack of competence in psychotherapists who deliver such care. Clinicians do not typically know how much they don’t know about using the technology until they start a serious course of telehealth training. Only then do they realize how many basic assumptions are incorrect and many of the strategies that they learned in school now need to be re-considered to meet legal and ethical standards. All untrained professionals then are encouraged to consider serious telehealth training if they wish to be competence and legally and ethically compliant with the evidence base. References Castro, A., Gili, M., Ricci-Cabello, I., Roca, M., Gilbody, S., Perez-Ara, M.A., Seguí, A. & McMillan, D. (2020) Effectiveness and adherence of telephone-administered psychotherapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 514-526, ISSN 0165-0327,https://doi.org/10.1016/j.jad.2019.09.023. Coughtrey, A. E., & Pistrang, N. (2018). The effectiveness of telephone-delivered psychological therapies for depression and anxiety: a systematic review. Journal of telemedicine and telecare, 24(2), 65-74. Feijt, M., de Kort, Y., Bongers, I., Bierbooms, J., Westerink, J., & IJsselsteijn, W. (2020). Mental health care goes online: Practitioners’ experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychology, Behavior, and Social Networking, 23(12), 860-864. Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205. Hilty, D. M., Randhawa, K., Maheu, M. M., McKean, A. J., Pantera, R., & Mishkind, M. C. (2020). A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care. Journal of Technology in Behavioral Science, 1-28. https://doi.org/10.1007/s41347-020-00126-x Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice, 31(5), 484. Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Demographic, organizational, and clinical practice predictors of US psychologists’ use of telepsychology. Professional Psychology: Research and Practice, 51(2), 184. Link: https://telehealth.org/telephone-telehealth/?utm_source=ActiveCampaign&utm_medium=email&utm_content=New+COVID-19+FCC+Telehealth+Grant+%7C+TBHI+Telehealth+News+4%2F14%2F21&utm_campaign=April+13th+Newsletter&vgo_ee=L60XUD6gIFzXzaAzbkkf6r35hO7C%2FF3J%2FgQB9Uu3XAY%3D Previous rulings for COVID-19 Telephone Telehealth Reimbursement: https://telehealth.org/reimbursement-covid-19-telephone/ < Previous News Next News >

Telehealth Remains Key Modality for Behavioral Healthcare Delivery eVista December 19, 2022 A Michigan-based provider leveraged a telehealth solution to expand critical access to behavioral healthcare as demand for these services skyrocketed during the COVID-19 pandemic. After reaching new heights during the first year of the COVID-19 pandemic, telehealth use is leveling off in several clinical care areas. But there is one prominent exception: behavioral healthcare. Healthcare stakeholders are continuing to flock to telehealth for behavioral health services. An analysis of data from January 2020 to March 2022 shows that mental health conditions were the most common telehealth diagnoses at the national level. In addition, data shows that amid a drop in overall telehealth use since 2020, telemental healthcare has grown. In the first quarter of 2019, 32.4 percent of all telehealth visits were related to behavioral healthcare, according to a market research report. That figure jumped to 59.9 percent by Q1 2022. This data, along with the ongoing mental health crisis in America, signifies the importance of providing virtual care options for behavioral healthcare. At Michigan-based Easterseals MORC, telehealth has been integral to behavioral healthcare delivery since 2019. Then, amid the pandemic, the organization saw its virtual visit volumes skyrocket, and they continue to show no signs of slowing down. "We went from 25 telehealth users before the pandemic to 300," says Clarissa Hulleza, Chief Information Officer of Easterseals MORC. "Those numbers are still going up. We're not seeing any decrease." WHY THE ORGANIZATION IMPLEMENTED TELEHEALTH Easterseals MORC, an affiliate of the national Easterseals organization, serves over 21,000 individuals annually. It provides a wide array of behavioral health services, including therapy, psychiatric care, and substance abuse treatment, as well as long-term care for those with intellectual and developmental disabilities. In 2019, the organization decided to implement a telehealth solution. One of the key goals of the move was to expand access to behavioral healthcare across the state. “The reason we pursued a telehealth solution was so that people who couldn't get to us regularly or at all, could be provided the opportunity to still receive care," says Hulleza. "We serve all of Michigan, and not all of Michigan has access to transportation, or maybe their closest local provider is 20 miles away. So, it was really creating more opportunities for access." Additionally, telemedicine was already becoming popular as a mode of physical healthcare delivery, prompting behavioral healthcare providers to catch up. "It was one of those, 'well, why aren't we doing the same?'" Hulleza says. Easterseals MORC partnered with eVisit to launch a telehealth pilot program in May 2019. A little under a year later, the COVID-19 pandemic hit, compelling providers across the country to rapidly scale up their telehealth programs. According to Hulleza, already having a telehealth solution and vendor partnership in place enabled Easterseals MORC to expand virtual care use seamlessly. "I would say that the absolute benefit was that we never had to close our doors," she adds. "In a time that people needed behavioral healthcare the most, we were able to provide it." IMPLEMENTATION CHALLENGES AND KEY LESSONS LEARNED Easterseals MORC leverages telehealth for nearly all of its services, including case management, one-on-one and group therapy. The organization even provided Applied Behavior Analysis (ABA) therapy virtually, which aims to improve social behaviors using interventions. But implementing a telehealth solution for behavioral healthcare has its challenges. For Easterseals MORC, those challenges ranged from clinician training to technology issues among those receiving services. Clinicians were not only providing care in a new way, they also had to become tech support in helping those they served navigate the new technology. Training is a critical aspect of telehealth technology implementation. If training is not provided proactively, it can result in clinicians avoiding virtual care use as they might find it difficult and overwhelming. “Pilot testing the solution before a full rollout was critical to ensuring that clinicians had adequate training to use the technology and that workflows were not negatively impacted,” Hulleza says. Partnering with the right vendor was a vital aspect of this effort, as the vendor was able to provide clinician training resources as well as suggest new policies and processes required to promote and support the telehealth program. “Ultimately, we selected our vendor because we were looking for a partnership that would improve the overall behavioral healthcare delivery experience. This meant that we needed a tool that offered more than a two-way video solution — one that integrated with, and empowered, the clinical workflow with value-added technology,” Hulleza shares. “There were multiple tools in the marketplace that solved the video connection challenge, but Easterseals MORC was looking to do more than simply move the clinical interaction to a video screen.” Further, choosing the right partner and then piloting the telehealth solution allowed the organization to test the supporting technology infrastructure before a full rollout. Easterseals MORC tested laptop specifications and made sure the solution worked equally well on different devices, including mobile phones and tablets. "We even went as far as making sure our bandwidth at all of our locations was increased so that if we had 20 people doing telehealth at the same time, there wouldn't be any degradation in services," Hulleza says. On the side of those receiving services, Easterseals MORC had to consider the digital divide facing its population. "[The people we serve] don't always have the newest phones, the best bandwidth," she says. "They don't have the luxury of going to a bedroom and closing the door. They might have shared living arrangements. We had to make sure we were accommodating all of those things." To address individuals' technology access needs, the organization applied for various grants and used those to provide iPads and iPhones with built-in data plans. Another essential aspect of closing the digital divide is identifying the viability of an individual to receive services via telehealth. Easterseals MORC uses a checklist tool provided by the telehealth vendor to identify these individuals and the barriers they face. "Do you have a private place? Do you have a microphone? What model phone do you have or mobile device?" Hulleza adds. "The tool goes through all of these questions and allows providers to evaluate if telehealth is an option." Easterseals MORC plans to solidify telehealth as a key behavioral health delivery mechanism within its business. It is unclear if Congress will make the temporary telehealth flexibilities enacted during the pandemic permanent — but for Hulleza, there is no going back. "I absolutely want to grow telehealth here," she says. "The need amplified because of the pandemic, but telehealth was going to exist for our organization even if the pandemic didn’t happen." ____________________________ About eVisit eVisit is an enterprise virtual care delivery platform built for health systems and hospitals. It delivers innovative virtual experiences in care navigation, care delivery, and care engagement, improving margins at scale without sacrificing quality or patient and provider satisfaction. eVisit works seamlessly across enterprise service lines and departments to improve outcomes, reduce costs, and boost revenue. Based in Phoenix, Ariz., eVisit helps healthcare organizations innovate and succeed in today’s changing healthcare market. See original article: https://mhealthintelligence.com/news/telehealth-remains-key-modality-for-behavioral-healthcare-delivery < Previous News Next News >

CONGRESS UNVEILS TWO YEAR EXTENSION OF TELEHEALTH FLEXIBILITIES – AS URGED BY THE ATA AND ATA ACTION – AS PART OF OMNIBUS BILL The American Telemedicine Association December 20, 2022 Today, the American Telemedicine Association (ATA) and ATA Action express their gratitude to the U.S. Congress for unveiling a bipartisan, bicameral omnibus appropriations bill that includes a two-year extension for Medicare telehealth provisions put in place during the COVID-19 public health emergency (PHE). The omnibus package also includes a two-year delay in implementing the Medicare telemental health in-person requirement, a two-year extension of the safe harbor to offer telehealth in High Deductible Health Plans (HDHPs) with Health Savings Account (HSAs), and a two-year extension of the Acute Hospital Care at Home Program. Congress is expected to vote on the omnibus bill and send it to President Biden to be signed into law within the next week. The omnibus did not include a comparable extension past the end of the PHE of the Ryan Haight in-person waiver for the remote prescription of controlled substances. However, the legislation does include language directing the Drug Enforcement Administration (DEA) to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued and the procedure for obtaining the registration. “The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients. Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future,” said Kyle Zebley, senior vice president, public policy, American Telemedicine Association, and executive director, ATA Action. “We asked Congress and they listened. We are truly grateful for their staunch support of telehealth. It’s now time to swiftly bring this bill to the President, for passage into law before year-end.” Stakeholder Letter to Congressional Leadership – Urging Extension of Telehealth Flexibilities Stakeholder Letter Urging Congress to Act on the Telehealth High Deductible Health Plan Safe Harbor Tax Provision ATA’s Recommendation’s for Acute Hospital Care at Home Program Stakeholder Letter Urging the DEA to Act on the Prescription of Controlled Substances via Telehealth Before the PHE Expires “We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services. Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction. “The ATA and ATA Action are delivering on our promise, to advocate for permanent access for telehealth services and today marks a significant milestone towards that goal. But the hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff.’ Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.” About ATA Action ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 company and an affiliated trade organization of the ATA. About the ATA As the only organization completely focused on advancing telehealth, theAmerican Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models. See original article: https://www.americantelemed.org/press-releases/congress-unveils-two-year-extension-of-telehealth-flexibilities-as-urged-by-the-ata-and-ata-action-as-part-of-omnibus-bill/ < Previous News Next News >