Ramona Midkiff

Source: Center of Connected Health Policy

A focus around accessing substance use disorder (SUD) treatment via telehealth has strengthened during the course of the pandemic both in terms of policy and research. Some of the latest long-term federal policy developments around telehealth have centered around mental health and SUD services. In December 2020, Congress passed the Consolidated Appropriations Act (CAA) which included a change that allowed for the provision of mental health and substance use disorder services in the home without geographic limitations, if the patient had an in-person visit with the telehealth provider within six months prior to the telehealth service taking place. The Centers for Medicare and Medicaid Services (CMS) implemented that policy in their CY 2022 Telehealth Update to the Medicare Physician Fee Schedule, however these new policies and in-person visit requirements will not kick in until 151 days post-public health emergency (PHE), according to the latest federal legislation regarding remaining telehealth flexibilities. CMS also implemented some permanent audio-only allowances, stating the likelihood that mental health and SUD treatment provided via technology will continue post-pandemic and concern about cutting off people who receive those services. More information on the 2022 PFS can be found in CCHP’s Fact Sheet on the final rule. In addition, research has continued to increase specific to SUD and recently, a few new studies were released looking at the use and efficacy of telehealth for SUD, modalities most often used and related patient demographics, as well as telehealth impacts on SUD outcomes. Overall, the research shows an increasing importance in access to SUD treatment and an increasing importance of telehealth in ensuring such access.

A study published in the Journal of Rural Mental Health in March looked at services provided by a Pennsylvania federally qualified health center (FQHC) and how ensuring patients maintained consistent access to Medications for Opioid Use Disorder (MOUD), formerly referred to as Medication-Assisted Treatment (MAT), despite losing in-person options during the pandemic was found to be critical. Using chart review and data from both 2019 and 2020, the study sought to compare certain patient populations and calculate retention rates, ultimately finding that telemedicine is efficacious in retaining patients in MOUD with buprenorphine and that the general transition to treatment via telehealth only went well. Based upon the research, the authors suggest telehealth emergency expansions should be maintained post-pandemic.

Another SUD review recently published in the Annals of Internal Medicine looked at the efficacy of telehealth for SUDs within the context of 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for SUD management. The study found that adding telehealth options to SUD treatment can be beneficial, yet evidence was limited regarding any differences between whether in-person care or telehealth improved abstinence from alcohol or cannabis. Low-strength evidence was found that supports the ability of therapy via telehealth to have similar effects as in-person care in improving abstinences in multiple SUDs however, and that adding text messaging as a part of follow-up care can improve abstinence from alcohol.

As far as demographics, a study in the Journal of Addiction Medicine looked at patient characteristics related to OUD treatment via phone and live video from a SUD treatment site in a nonurban area of New York, finding that nearly 80% of visits were through live video and older patients and those with less education were found to have had more telephone visits. In addition, a KFF study showed that the amount of substance use outpatient visits delivered over telehealth varied by substance use condition. Using patient information from March-August 2021, the study found that nearly 30% of alcohol and opioid-related treatment was provided via telehealth, while 16% of stimulant related visits occurred via telehealth. The study also showed that mental health and substance use visits are growing overall, but especially via telehealth, highlighting that increasing demand and need for such services and the role telehealth can play in increasing that access. The findings showed that rural residents are more likely to use telehealth for mental and substance use disorder visits – 55% in comparison to 35% in urban areas – which the authors suggest shows the impact of provider shortages in rural areas.

Research around telehealth is becoming more prevalent and desirable, especially among policymakers looking at long-term telehealth laws. As more studies continue to be released, it is clear that comparisons between pre-COVID and during-COVID use of telehealth is valuable, as is comparing telehealth impacts across populations and types of treatment. Nevertheless, policymakers looking to utilize such research to justify long-term telehealth policy changes should keep in mind that the ability to generalize and apply specific findings across the healthcare system still likely remains limited until researchers are also able to assess the same expansion impacts in a post-COVID environment.

Source:  Becker’s Hospital Review

By:  Katie Adams, Georgina Gonzalez and Naomi Diaz

Telehealth usage has boomed throughout the pandemic, but many physicians are unsure about its sustainability. Here are three key reasons some physicians are reluctant to adopt the care delivery model.

Payer trouble 

Many states are relaxing COVID-19 restrictions and dropping public health emergency designations, moves that affect payers’ decisions on how to reimburse for telehealth services. Amid these changing policies, many hospitals say their telehealth programs are in limbo.

Physicians believe the biggest barriers to their use of telehealth are payer related, according to survey results released in March by the American Medical Association. The rollback of COVID-19 waivers, the lack of insurer coverage of telehealth services and low reimbursement were the top three obstacles identified in a survey of more than 1,500 physicians.

“Permanence drives behavior,” Randy Davis, CIO at Sterling, Ill.-based CGH Medical Center, told Becker’s in February. “Institutions find it hard to commit resources to ingrain a workflow into the fabric of their organization when they believe the underlying policies and remuneration realities have all the longevity of a snowflake in April.”

Janice Devine, CIO at Greensburg, Pa.-based Excela Health, agreed, saying that rolling back telehealth coverage will have a significant negative effect on telehealth and force health systems to revert to the in-person model.

Tech woes

More than half of physicians said their patient population’s challenges with technology is an obstacle to telehealth, according to the AMA’s March study.

Many physicians are also frustrated with telehealth platforms’ inability to integrate interpreters for non-English-speaking patients and prefer using in-person visits for non-English speakers, according to an October study published in the National Library of Medicine. The study revealed other technology barriers as well, including lack of training on telehealth platforms and difficulty connecting more complex technology to telehealth platforms for non-tech-savvy patients.

Physicians have also expressed frustration about telehealth platforms’ limited interoperability with their hospital’s EHR system. Nearly 60 percent of clinicians said they were not able to access telehealth technology directly through their EHR system in a March 2020 study conducted by the COVID-19 Healthcare Coalition.

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Source: mHealthINTELLIGENCE

By Mark Melchionna

The implementation of telehealth had a significant impact on missed follow-up appointments among pediatric patients with tuberculosis infections (TBI), reducing the rate of missed visits by 11.1 percent, a study published in the journal Tropical Medicine and Infectious Disease showed.

TB infections occur in about a quarter of people globally. Although the percentage of individuals with TBI who develop an active case of the infection is much lower at 5 to 15 percent, some factors limit treatment, specifically for pediatric patients.

The study subjects received care at the Yale Pediatric Winchester Chest Tuberculosis Clinic and were younger than 18 years. The data collected for the study related to demographics and the number of missed appointments and therapy completions by each patient.

During the study period, the expansion of the clinic and the COVID-19 pandemic led to telehealth implementation for follow-up visits. Researchers evaluated the effect of telehealth on the clinic one year later.

Before implementing telehealth, 16.9 percent of TBI patients missed appointments between 2016 and 2019.

In 2021, after telehealth services were implemented, 54.2 percent of follow-up TBI visits took place virtually. The missed follow-up appointment rate for children with TBI declined from 16.9 percent to 5.8 percent.

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Source MEDPAGE TODAY

by Joyce Frieden, Washington Editor, MedPage Today

— Congress already extended the changes for 5 months and likely will extend them again, expert says

Source: Center for Connected Health Policy

CCHP has released a new updated telehealth billing guide as a follow up to its 2021 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services.

Click here for more info: https://www.cchpca.org/resources/

Source: The National Law Review

There have been several significant developments with regard to Federal government telehealth policy. These include the recently enacted appropriations bill funding the Federal government for the balance of the fiscal year, a Department of Health and Human Services Office of Inspector General data brief, the MedPAC annual report to Congress and statements by the Secretary of Health and Human Services.

Appropriations Law

On March 15, 2022, President Biden signed H.R. 2471, the “Consolidated Appropriations Act, 2022” [Public Law 117-103].  The new law authorizes the Telehealth Network Grant Program at the Health Resources and Services Administration (HRSA) to include providers of prenatal, labor care, birthing, and postpartum care services.

• H.R. 2471 contains provisions dealing with telehealth flexibility extensions.
• Removes geographic requirements and expands origination sites for telehealth services.
• Expands practitioners eligible to furnish telehealth services.
• Extends telehealth services for Federally Qualified Health Centers and rural health clinics.
• Delays the in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
• Allows for furnishing of audio-only telehealth services.
• Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during the PHE.
• Extends the flexibility allowing a high deductible health plan to cover telehealth benefit (for months beginning after March 31, 2022, through the end of 2022) pre-deductible and still qualify as a HDHP with a Health Savings Account.

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Source: CMS

Updated 01/05/2022

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth.

List of Telehealth Services for Calendar Year 2022 (ZIP)

Source: Center for Connected Health Policy

On March 15th President Biden signed the Consolidated Appropriations Act of 2022.  This bill will extend federal telehealth flexibilities for 151 days post-public health emergency (PHE), including PHE location, provider, and audio-only expansions, and includes new report requirements. A delay to the new in-person telemental health visit requirement in Medicare was also included for the same period of time.

The telehealth components in the legislation include:

• Telehealth Flexibility Location – Geographic & rural exceptions to allow for any site including the home to continue for 151 days after the PHE ends – no facility fee for these sites
• Telehealth Flexibility Provider Type – Adds occupational therapists, physical therapists, speech-language pathologists, audiologists, and federally qualified health centers (FQHCs) and rural health clinics (RHCs) to eligible provider list for 151 days
• Audio-Only – Continue to allow for the 151-day extension period
• In-person visit requirement for telemental health – Delay requirement until after the 151 days extension
• Use of telehealth for recertification of eligibility for hospice care – Continue to allow for the 151-day extension period
• New Reports
  • MedPAC report due June 15, 2023 to Congress, includes looking at payment policy for telehealth for FQHC and RHC’s
  • Beginning July 1, 2022, Secretary of Health and Human Services must publicly publish on quarterly basis data on Medicare claims on telehealth services including utilization and beneficiary characteristics
  • By June 15, 2023, Office of Inspector General to submit to Congress fraud, waste, and abuse report on program integrity

Funding opportunities that could be put toward telehealth are also included in the legislation, including funding for rural hospital programs and telehealth networks, in addition to grants that will establish or sustain mobile teams or enhance access through telehealth.

While the resources and extensions in the agreement are promising, they signify that conversation around permanent telehealth policies are far from over. For more information, please review the Consolidated Appropriations Act of 2022 in its entirety. For a helpful breakdown of the bill and its telehealth components, access CCHP’s Consolidated Appropriations Act of 2022 Chart.

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MedPAC Report Recommendations Related to Telehealth Data

Last week the Medicare Payment Advisory Commission (MedPAC) released its March 2022 Report to Congress: Medicare Payment Policy. The report covers a variety of Medicare payment issues and recommendations, including suggestions related to gathering more information regarding the delivery of care via telehealth from providers. In particular, MedPAC recommends the Centers for Medicare & Medicaid Services (CMS) require clinicians to use an audio-only claims modifier in order to track modality specific information, and that home health agencies (HHAs) and hospice providers be required to report the provision of telehealth on Medicare claims. The rationale behind the recommendations is that more data is needed to truly understand the impact of telehealth on quality, cost, and access to determine the accuracy of payments. The amount of time necessary and sufficient to collect and complete such evaluations is unaddressed in the report. As the federal government postpones permanent policy changes in exchange for limited extensions, it is important that policymakers consider the time it will take to effectively assess the delivery of care via telehealth using additional data.

The main telehealth issues of focus within the MedPAC report include that currently, there is a lack of consistency restricting the ability to track audio-only and telehealth visits by certain providers. For instance, some telehealth expansions have been made permanent for HHAs, which MedPAC suggests significantly expanded their telehealth programs during the pandemic. While the HHAs were supposed to report the costs of telehealth services on their Medicare cost report, there was no requirement to report any other information about telehealth use related to frequency, duration, modality, or which beneficiaries received such services. The same limited information applies to hospice providers.  MedPAC offered that operationalization of this data reporting component could be achieved through the use of a claims modifier as long as CMS permits the use of telehealth services in the hospice setting.

Other telehealth findings provided in the report include:

• Beneficiaries’ access to care is comparable to privately insured individuals and that during the past year, half of beneficiaries accessed clinicians via telehealth
• Nearly half of Medicare beneficiaries used telehealth at least once in the past year
• Audio-only telephone visits were most common – 37% of elderly Medicare beneficiaries used audio-only
• Interactive video visits were used by 23% of Medicare beneficiaries
• 86% of beneficiaries were satisfied with their telehealth visits and around half wanted to continue using telehealth post-pandemic

MedPAC states that their recommendations related to telehealth data collection should apply regardless of whether Medicare covers these services temporarily or permanently. However, it will be difficult to collect helpful data on telehealth without maintaining coverage and access for telehealth. As MedPAC notes, without more information their ability to understand the role that telehealth has played during the public health emergency (PHE) is limited, as is the ability of policymakers in determining post-PHE policy changes. The report also reiterates a policy option they provided to Congress in their March 2021 report, in which they suggested CMS continue to cover telehealth after the PHE for a “limited period” such as one to two years after the PHE ends to allow for gathering of additional evidence on the impact of telehealth to determine permanent telehealth payment policies. Meanwhile, President Biden signed the Consolidated Appropriations Act of 2022 last week which extended telehealth expansions for just five months after the end of the PHE, raising questions related to how that timeline was determined and if it will be sufficient to address remaining concerns and questions related to long-term telehealth policies.

Please review the MedPAC report for additional details on their findings and recommendations.

Source: Channel 7 WSPA

SPARTANBURG COUNTY, S.C. (WSPA) – Internet access may improve soon in rural areas of Spartanburg County. The County Council voted Monday to spend $4 million in American Rescue Plan funding to expand broadband access in rural areas.

“We learned, during the pandemic, how lacking we were in broadband when you get outside the municipalities,” said Councilman David Britt.

The county will now select a broadband carrier to work with, which will put up an additional $10 million to make this project happen. The carrier will then survey the areas and decide how to install the technology.

“This infrastructure is almost comparative to electricity in the 1920s,” said Councilman Justin McCorkle.

“There are lot of people spending a lot of time at home who need this service that we don’t provide in these rural areas, and they can’t afford to do it,” added Councilman Bob Walker.

The county estimates this project will provide internet access to more than 3,500 homes.

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