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Ramona Midkiff

Feb 25
Love0

Will Telehealth Payment Parity Be Permanent or a Passing Fancy?

By News

A recent study by Foley & Lardner indicates telehealth reimbursement will be on top of the agenda during the coming year, but will states, private payers and the federal government find an acceptable path to true payment parity?

By Eric Wicklund

– As federal and state lawmakers look to establish telehealth policy beyond the coronavirus pandemic, much of the conversation will focus on payment parity.

That’s the biggest take-away from a recent study of state telehealth commercial insurance coverage and parity laws by the Foley & Lardner law firm.

The study, the firm’s fourth, depicts a nation that had rushed to embrace telehealth roughly one year ago to better deal with the COVID-19 crisis, and was aided by federal and state emergency measures that improved access and coverage. Now lawmakers are grappling with the idea of making some or all of those emergency measures permanent to keep the momentum going.

“During the pandemic, health plans overwhelmingly changed their telehealth coverage and payment policies to encourage providers and patients to use virtual care alternatives to in-person treatment,” says Sunny Levine, an associate with the firm. “This was spurred in part by state and federal policy changes, and in part by health plan’s self-initiated decisions. Post-pandemic, health plans will continue to offer coverage of telehealth and virtual care services, although perhaps not as aggressively as currently seen.”

The path seems somewhat less rocky for some emergency measures. Nearly everyone agrees that telemental health should be permanently expanded to take on the growing issues of substance abuse, depression, stress and anxiety, while measures that expand telehealth coverage to clinics, health centers and the patient’s home are seeing widespread support. This also holds true for proposals to expand the types of providers able to use telehealth, such as therapists, social workers and home health workers, and coverage for remote patient monitoring and asynchronous telehealth.

Both Sarah Iacomini, an associate with the firm, and Alexis Bortniker, one of the firm’s partners, say state and federal actions to expand telehealth coverage will affect how private payers plot their strategies.

“Take a clinician attending to a patient with a chronic illness, for example,” says Iacomini. “They meet regularly, so it would be easier for the patient to adhere to a care plan by attending some visits via telehealth instead of only in-person. If that clinician is not guaranteed payment because the patient’s insurer doesn’t cover telehealth – or even if the private payer pays substantially less solely because the visit is virtual – then that clinician is less likely to offer telehealth to their patients.”

“A patient living in a state with coverage and reimbursement parity provisions, however, would not have their care plan compromised, as the law prevents the private payer from choosing to exert that financial pressure on the clinician,” she adds. “By enacting emergency laws, states also indirectly influence private payers because people who become used to telecommunicating with their healthcare providers will, in turn, exert demand on the insurance market to continue offering telehealth benefits even after temporary laws lapse.”

Meanwhile, the jury’s still out on how federal telehealth policy will evolve. The Centers for Medicare & Medicaid Services expanded some coverage in its 2021 Physician Fee Index, but those steps were small, and Congress hasn’t yet made its imprint on the debate with any action on bills that aimed to expand telehealth access.

“As a general matter, private payers followed Medicare’s lead on telehealth reimbursement during the pandemic, expanding access and increasing payment for providers forced to move to a telehealth model overnight,” Bortniker says. “Changes were broad. Decisions were sometimes hastily made in light of the unprecedented nature of the situation. As the months pass, and payers have more time to mine utilization data and assess the impact of the telehealth expansion, we will likely see payers to proceed in their own direction, straying from Medicare requirements where they are not applicable. Payers will develop their own policies and requirements for telehealth in order to manage costs and have better control over utilization, while still meeting network adequacy minimums.”

It could be that state actions help frame the national debate over reimbursement. Some telehealth advocates say payers should reimburse for telehealth services at the same rate as for in-person care, while others feel that payers should negotiate their own rates with providers.

The Foley & Lardner study shows that payment parity did increase during the past two years. In all, 22 states now have laws that specifically address telehealth reimbursement, up from 16 in 2019, and 14 states now mandate true payment parity, up from 10 two years ago.

Jaqueline Acosta, special counsel at the law firm, notes that 40 percent increase in states with parity laws is actually higher right now, because several states have enacted emergency measures for parity that only remain in effect for the duration of the public health emergency.

“While expansion of coverage for telehealth services is definitely positive, I believe states need to continue to shape informed and clear reimbursement policies for telehealth and digital health services,” she says. “This is a trend I hope continues.”

Nathaniel Lacktman, a partner with Foley & Lardner and chair of the firm’s Telemedicine & Digital Health Industry Team, says that issue will likely dominate state telehealth policy debate in the coming year.

“Payment parity laws were created in response to health plans paying for telehealth services at only a fraction of the rate the health plan pays for the identical service when delivered in person,” he says. “This can occur when a state enacts a broad telehealth coverage law, but fails to include any language regarding the reimbursement or payment of telehealth services. These laws are more intrusive into private contracting and opponents contend they can prevent immediate savings from telehealth by reimbursing telehealth-based services at a lower payment amount.”

But Lacktman also notes that states can design payment parity laws that give payers some leverage. In both Georgia and California, lawmakers set the base at equal coverage for both virtual and in-person services, then allowed payers and providers to negotiate alternate payment rates.

“Ideally, payment parity laws should not prevent the parties from negotiating for different reimbursement rates for telehealth vs. in-person services, so long as such negotiations are truly voluntary by the provider and not forced upon them,” he says. “Well-drafted payment parity laws can level the field for providers to enter into meaningful negotiations with health plans as to how telehealth services are covered and paid. Model payment parity laws should not eliminate opportunities for cost savings, and should allow health plans and providers to contract for alternative payment models and compensation methodologies for telehealth services, so long as those negotiations are voluntary.”

Feb 24
Love0

No internet, no email. SC’s rural residents are struggling to get COVID-19 vaccines

By News

Edward Simmer, DHEC director, discussed ways to improve coronavirus vaccine distribution in South Carolina. By South Carolina Legislature

By Zak Koeske

Updated February 19, 2021 12:07 PM

The COVID-19 vaccine has been hard to come by in Barnwell County.

The small rural county of about 21,000 people on the state’s western border has one of the highest per capita rates of coronavirus infection in South Carolina and is one of eight counties in the state without a hospital.

Until this week, only one vaccine provider in the county outside the local health department had even received any doses, and it’s no longer taking appointments.

Desperate to procure more vaccine for his community in recent weeks, Barnwell Mayor Marcus Rivera reached out to local state lawmakers for help. Within hours, he received a call from the Medical University of South Carolina. The hospital wanted to hold a vaccination clinic in Barnwell to pilot its rural distribution process.

“Some way, some shape, some fashion, they got in contact with me and we made it happen,” Rivera said.

On a fortuitously dry day last week, a team from MUSC vaccinated more than 400 people in a Barnwell shopping center parking lot. The pop-up drive-through clinic serviced more people in about eight hours than any county provider had in the previous two months.

“It was great,” Rivera said afterward. “Absolutely amazing. With the amount of people we had come out, how fluid everything went, it was just seamless for everyone involved.”

The triumph of the recent clinic aside, Barnwell, like many rural parts of the state, continues to get far from an equitable supply of COVID-19 vaccine doses.

If vaccine were being distributed to counties based on their relative population, as the state Department of Health and Environmental Control is currently considering, Barnwell would have received nearly 3,000 doses by now instead of the roughly 200 it had gotten prior to last week.

Eliminating disparities in the state’s vaccination rates won’t be easy, but it is achievable, said Georges Benjamin, executive director of the American Public Health Association.

The first step, he said, is identifying the problem.

DHEC did that this week when it released an online dashboard with demographic data on who is being vaccinated and where they’re getting shots. The agency has yet to release data on where vaccine recipients live, but officials said they’re working on it.

The new demographic data shows that white residents are getting vaccinated at far higher rates than Black and Latino residents, and that urban centers with large hospital systems have been the primary recipients of COVID-19 vaccine.

DHEC’s data shows that more than 40% of the roughly 727,000 shots in arms to date have been administered in Charleston, Richland and Greenville counties, whose combined residents make up just 26% of South Carolina’s population.

By comparison, a total of 4,946 doses have been administered in the eight rural counties that lack a hospital, roughly a third of what would be expected were the vaccine being administered equitably.

The disparities are particularly vexing given the impact the pandemic has had on rural parts of the state. Despite having much smaller populations than South Carolina’s metro centers, COVID-19 has spread broadly through some of the state’s least populous counties and killed residents there at alarming rates.

Over the past three months, the rural counties of Marion, Marlboro and Union have suffered the highest COVID-19 mortality rates in the state, according to public health data.

DHEC officials this week acknowledged the vaccination disparities between urban and rural communities, which they partially attribute to large metro hospitals receiving the state’s initial vaccine doses, and said they were working to combat them.

“We’re giving a lot of vaccine in rural counties, but we’re still lagging behind,” newly appointed DHEC director Edward Simmer told lawmakers Tuesday during a House hearing on vaccine distribution. “If you look at our vaccine rates, we are doing better in large urban counties than we are in the rural counties. And we need to do better in the rural counties.”

Rural residents face barriers to vaccine access

Getting shots into the arms of rural South Carolina residents is tricky due both to the dearth of local COVID-19 vaccine providers and the infrastructure limitations that exist in many rural parts of the state.

Rural counties, especially ones without hospitals, may have only one or two providers activated to dispense the vaccine, mostly in very small quantities. Many rural providers — typically family medical practices, federally-qualified health centers and pharmacies — have received fewer than 1,000 doses total to administer.

Even doctors and nurses in Barnwell County had major problems getting vaccinated initially, said state Senate Minority Leader Brad Hutto.

“If you practice medicine in a county without a hospital, they weren’t deploying any vaccine to those areas,” said Hutto, an Orangeburg Democrat. “So, for example, doctors in Barnwell County were having to drive to Aiken County.”

When doses do find their way into rural counties, spotty broadband service — about 650,000 South Carolinians do not have high-speed internet access — and a lack of reliable transportation can make it cumbersome to schedule and keep an appointment.

Rivera, the Barnwell mayor, said he heard from many residents who struggled with the tedious registration process, which, at least initially, required internet access, a working email address and the patience and tech-savvy to navigate a confusing federal sign-up system that even DHEC officials have roundly criticized.

Community members also have been forced to compete with those from outside the county for the limited number of local vaccination appointments, which has sometimes resulted in non-residents snatching up slots and leaving Barnwell residents in the lurch, he said.

“I don’t want to not welcome people coming in,” Rivera said, “but I want to make sure that if we’re having an event locally that our local residents get first dibs on the vaccinations.”

Technology issues also have tripped up residents trying to schedule vaccination appointments in Newberry, a rural county of about 38,000 people located 80 miles north of Barnwell.

Nearly two weeks after receiving its first 400 vaccine doses, the Emmanuel Family Clinic in Newberry had administered exactly one of them, and that was to an employee, office manager Debra Cleveland said.

“We’ve had shots and weren’t able to give them,” said Cleveland, who explained that many clients struggled to make heads or tails of the Vaccine Administration Management System, or VAMS, the federal portal used to book appointments.

“We have patients who can’t read or write, who speak another language, elderly people who don’t have a computer in the house and don’t have cell phones, and they’re supposed to have an email to (register).” she said.

Fearing the spoilage of their vaccine doses, which had to be administered within 30 days, Emmanuel worked with DHEC and the U.S. Centers for Disease Control and Prevention to come up with a solution that would work for their clients.

Rather than making patients go through the registration process online, Emmanuel was given permission to take patient information over the phone or in person and enter it into VAMS for them, Cleveland said.

Within two hours of switching to the manual registration process on Feb. 9, Emmanuel had already processed and vaccinated 20 people, she said. Now 10 days later, the clinic has administered 325 of its 400 doses, according to DHEC.

“I’m having to put a lot of information in instead of the patients,” Cleveland said. “But if that’s what it takes, that’s what it’s going to take.”

Barnwell officials and MUSC also developed a workaround in advance of last week’s clinic to ensure local residents received vaccination priority.

Rather than posting information about the clinic on the MUSC and DHEC websites, officials shared the sign-up link only with community leaders and on local social media pages so residents from outside the county would be less likely to take appointments away from Barnwell residents.

Rivera said he also reached out to a local senior center about the clinic and encouraged its director to register interested residents.

“We tried to be proactive about it so when we had the opportunity, we jumped on it,” he said.

While some non-Barnwell residents found out anyway, including one whose son drove her about 50 miles from North Augusta to take advantage of the opportunity, most of those vaccinated were locals.

“I think I recognized everybody that came through that vaccination site for the time I was there,” Rivera said.

DHEC working to expand rural vaccine access

In addition to working with rural communities to help smooth over technology and access issues, DHEC has also expanded the number of vaccination clinics it’s holding in rural areas.

As of last week, the agency had vaccinated nearly 10,000 people at 79 separate events in predominantly rural counties, spokeswoman Laura Renwick said.

DHEC primarily holds its clinics at the health departments it operates in each county, but it has also held “mobile events” at recreation centers, churches and schools across the state.

The agency has delivered doses at dozens of such events in the past two weeks alone, including at a McCormick County church, a Marion County gymnasium and a Dillon County wellness center.

“We know a lot of our folks, especially 65 and over, do not have internet, do not have easy transportation,” Simmer said. “And that’s why we’re looking to things like these mobile units to get it out into communities where people are, to make sure that we’re maximizing equitable access to the vaccine.”

DHEC also continues to push out more vaccine doses and ancillary supplies such as gloves, Band-Aids and face shields to rural providers each week. As of Tuesday, it had activated more than 100 rural health clinics and federally qualified health centers in underserved areas across the state, Simmer said.

The agency also is planning to staff up to 46 teams to work with county health departments and assist vaccination efforts statewide, especially in rural and underserved areas. Renwick said the teams would be independent of health department staff and would rove between counties to improve access in all corners of the state.

DHEC also wants to connect with local leaders and trusted community organizations to make inroads in rural parts of South Carolina, where a greater proportion of residents are assumed to be skeptical about getting the vaccine.

A recent Kaiser Health News survey found that rural residents and Black adults — who comprise a significant chunk of South Carolina’s rural population — are among the groups most hesitant to get vaccinated.

“(Rural residents are) much more likely to listen to the people that they know and trust, and that’s going to be the people in their local community,” Simmer said Tuesday. “We want to get those folks engaged with us, get them on the team, educating folks about the vaccine, (and) when they’re eligible, have them getting the vaccine publicly, so the folks who look up to them for guidance know it’s the right thing to do as well.”

To build confidence in the safety and efficacy of the vaccine, state health officials have participated in more than 80 public speaking engagements since November, including virtual meetings with faith-based groups and interviews with Spanish language news outlets, Renwick said.

Going forward, DHEC plans to develop testimonials and public service announcements to encourage vaccination against COVID-19 and also is working with South Carolina businesses and nonprofits, including Columbia-based Hold Out the Lifeline, to target African American churches and community groups with pro-vaccine messaging, Renwick said.

“I’ve been going out into the community, even in the few days I’ve been here, our teams have been doing that,” Simmer said. “And we can educate the community leaders and our partners can educate the community leaders, and then let the community leaders take the message from there.”

Communication an issue for DHEC, rural officials say

But the agency’s communication with rural leaders and vaccination providers hasn’t always been consistent, some said.

Barnwell officials said DHEC’s repeated failure to notify them before holding clinics in their county has prevented adequate promotion of the events and may even have precluded local residents from participating in them.

The day before MUSC vaccinated hundreds of Barnwell area residents in the parking lot of a Cricket Wireless store last week, DHEC held its own clinic at the county health department, unbeknownst to city and county leaders.

“We had no notice that that event was even going on,” said Rivera, who added it was the second time in recent weeks that DHEC held a vaccination clinic in the community without telling him.

Barnwell County Administrator Tim Bennett was so annoyed at being kept out of the loop that he posted about the fiasco on the county’s official Facebook page.

“Would have loved to have known this,” he wrote Feb. 9, upon learning DHEC was just wrapping up a clinic at the local health department and that all the slots for two upcoming COVID-19 vaccination events in Barnwell were already booked. “I guess we missed the email?!?”

Bennett said he felt better about the situation after emailing with a DHEC official the next day, but he stressed the need for the agency to improve in its communication.

“Help us help you get the good word out that DHEC is doing the dead level best it can to get shots in people’s arms,” he said he told the agency official. “DHEC needs to communicate, at least to our county, that shots are being done in our county. That’s good news, and to get that just by happenstance was pretty frustrating and exasperating.”

Renwick, the DHEC spokeswoman, said the agency typically reaches out to county officials when support or assistance is needed at local vaccination events, but did not explain why that apparently had not happened on multiple occasions in Barnwell.

She added that since last March, DHEC staff have attended weekly meetings with county administrators and emergency managers from around the state for the sole purpose of discussing local-level information.

Calhoun County EMS director Crystal Youmans said she also has struggled to get answers from health officials about vaccine issues in her county.

Youmans said she’s been approved to have the county EMS headquarters serve as a vaccine provider, but has yet to get any doses from DHEC to administer.

“The biggest struggle has been the communication with DHEC,” she said. “I’ve sent numerous emails to them and a lot of them have fallen without responses.”

Youmans said the agency told her the EMS building would not be activated until the state received additional vaccine supply, but has yet to give her an idea of when that might occur or answered her questions about how the allotment process would work.

For the time being, Calhoun County has only one vaccine provider, a family medical clinic that has administered fewer than 400 doses to date, and residents are aching for more vaccination options.

“We get called and asked frequently about when we’re going to be giving the vaccine,” Youmans said. “We’ve made it known that as soon as we’re allowed, we will do it.”

Graham Adams, CEO of the South Carolina Office of Rural Health, said he believes there is a role for the mobile units DHEC uses to fill vaccination gaps in rural counties, but said the agency shouldn’t lean on them at the expense of local providers that are able to administer vaccines.

“In my opinion, mobile units can fill in a gap when there are not enough local providers available, but we should be careful not to put mobile units in communities where there are local health care providers willing and ready to participate in the vaccine administration,” he said. “There are still rural providers that have enrolled, but not been activated, and should be activated in order to ensure that we have adequate access points in rural communities.”

Adams commended DHEC for working to ensure COVID-19 vaccine flows into all nooks and crannies of the state, but said he wants to see the agency develop a more coordinated system so efforts aren’t duplicated, as appears to have been the case recently in Barnwell and as happened with COVID-19 testing sites earlier in the pandemic.

“What I think can be improved is to have a broader coordination system among all hospitals and health care providers, so that we are not duplicating vaccination efforts in the same community, on potentially the same day,” he said.

Vaccine supply remains the limiting factor

Until the state starts receiving enough vaccine each week to meet demand, it is unlikely to overcome the COVID-19 vaccination disparities in rural areas, Sen. Hutto said.

Hutto said he wasn’t satisfied with the pace of rural vaccinations, but also recognized the difficulty of reaching rural residents and understood that vaccine supply is the limiting factor.

“It’s not a lack of willingness in rural areas to do it,” he said. “If we had enough vaccine, you could hold an event like (the one in Barnwell) in every rural county tomorrow.”

South Carolina’s vaccine allotment has increased steadily over the last month, reaching 80,000 first doses this week, and is expected to increase another 23% next week to nearly 100,000 doses, White House officials said Tuesday.

While that would represent a more than 50% increase in supply since mid-January, it would still fall well short of meeting demand.

About 40% of the nearly 1.3 million people in Phase 1a have received a single shot and only 14% are fully vaccinated, DHEC said.

While it may be some time before South Carolina is awash in vaccine doses, Hutto said it is critical that DHEC begin consulting with rural mayors, council members, faith leaders and representatives from historically Black colleges and universities so the agency can promptly and equitably push vaccine out to rural areas as soon as it has the capacity.

“When they get enough vaccine and want to have an event at a church in Denmark or Greeleyville, they need to already know who the contact is,” he said. “I hope they’re already doing the groundwork for when they get the vaccine, where they’ll hold events and who they contact.”

If DHEC officials make the right connections on the ground, Hutto said they should not have trouble filling up clinics in the furthest reaches of the state.

“The little towns and communities will be able to produce the lines,” he said.

Until that happens, Rivera and other local leaders will need to continue taking matters into their own hands to ensure their residents receive their fair share.

“I honestly think that leadership needs to voice their opinions, their concerns of their citizens and make sure they hold those who represent them’s feet to the fire,” the Barnwell mayor said. “And I think if you sit back and you sit on your hands, you’re going to really be forgotten about, especially now with the demand being what it is for COVID vaccinations.”

 

Feb 24
Love2

The 117th Congress Signals a Focus on Telehealth with a Series of Telehealth Expansion Bills

By News

With the 117th Congress being sworn in last month and a new administration taking office, the first quarter of 2021 saw a number of new and re-introduced telehealth bills. While the pieces of legislation range in scope, nearly all are related to telehealth coverage and the impact of COVID-19 on healthcare utilization. The majority of these bills are bipartisan and suggests there is a growing appetite for federal action on telehealth in both parties.

Some of the more comprehensive bills are reintroduced versions of legislation proposed in the 116th Congress. The Protecting Access to Post-COVID-19 Telehealth Act of 2021 (HR 366) was introduced by a bipartisan group in late January to permanently expand many of the temporary telehealth flexibilities and expansions allowed during the Public Health Emergency (PHE). A version of this bill that was introduced in July 2020 never made it out of committee. HR 366 addresses a number of key flexibilities:

  • Eliminates Medicare’s geographic restrictions starting on Dec. 31, 2021
  • Allows the home as an originating site for all eligible services starting Jan. 1, 2022
  • Grants the Department of Health & Human Services permanent disaster waiver authority to expand telehealth
  • Authorizing Centers for Medicare & Medicaid Services (CMS) to reimburse for telehealth 90 days after the PHE is rescinded.
  • Require the Department of Health & Human Services to conduct a comprehensive study on telehealth utilization, costs, and geographic disparities.
  • Allow FQHCs and RHCs to bill as distant site providers and clarifies that telehealth services includes a rural health clinic or FQHC service that is furnished using telehealth to the extent that payment codes correspond to the service.

On the Medicare front, HR 366 would be a major shift from business as usual prior to the pandemic since beneficiaries would now be permitted to receive telehealth services from their homes regardless of the rural or urban designation once fully implemented.

Another similar bill introduced by Rep. Roger Williams (R-TX), HR 341, would also remove the originating site requirements beginning on the first day of the emergency period while also permitting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to be reimbursed as a distant site provider of telehealth services for any service furnished after the emergency declaration. The bill also clarifies that costs associated with the delivery of telehealth services by a FQHC or RHC serving as a distant site shall be considered allowable costs for purposes of the prospective payment system and any applicable payment methodologies. Additional changes introduced in HR 341 include permanently waiving CMS’ face-to-face visit requirement between home dialysis patients and physicians as well as allows the use of telehealth to conduct a face-to-face encounter for the recertification of eligibility for hospice care during any period beginning on or after the first day of the emergency period, and encourages use of telecommunications systems for home health services. A previous version of this bill introduced in the 116th Congress included a sunset of September 2025 for these expansions.

Congressional lawmakers also indicated they might take action on interstate licensing regulations with two bills designed to make it easier for providers to deliver care across state lines during the pandemic. The Equal Access to Care Act (S. 3993) was first introduced in June 2020 and would temporarily allow providers who are licensed and legally authorized to provide care in their primary state to practice telehealth with a patient located in another state. The law would remain in effect until 180 days after the PHE is rescinded by the President. More recently, lawmakers reintroduced the Temporary Reciprocity to Ensure Access to Treatment Act (TREAT) as HR 708, along with a similar Senate bill S 168. Although the text of HR 708 and S 168 has not been made available, text from the previous version of the bill suggests it is nearly identical in scope to the Equal Access to Care Act with the exception that HR 708 would grant HHS authority to unilaterally create similar temporary licensure regulations in the event of future emergencies. Both pieces of legislation would bring clarity to the United States’ patchwork of licensure laws, which are primarily established by state medical or other professional boards.

CCHP is tracking additional federal bills, however many of them do not yet have published text associated with them. They are listed below along with the bill’s official description/title:

  • HR 937: Amends title XI of the Social Security Act to integrate telehealth models in maternity care services, and for other purposes.
  • HR 726: Authorizes the Secretary of Health and Human Services to award grants to eligible entities to conduct diagnostic testing for COVID-19, and related activities.
  • HR 596: Increases the ability of nursing facilities to access telehealth services and obtain technologies to allow virtual visits during the public health emergency.
  • HR 318: Amends title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID-19 emergency period, and for other purposes.

Finally, a draft of the next COVID relief bill titled the ‘American Rescue Plan Act of 2021’ was recently released.  The bill draft contains several grant and pilot opportunities that would fund delivery of healthcare via telehealth or expand telehealth infrastructure. These include the following:

  • Emergency Grants for Rural Health Care – Pilot program under the Secretary of Agriculture to help facilities increase telehealth capabilities, including underlying health care information systems (among other items).
  • Funding for Indian Health – $140,000,000 for information technology, telehealth infrastructure and the Indian Health Services electronic health record system.
  • Funding for Community-Based Funding for Local Behavioral Health Needs – Funds can be used to provide mental and behavioral health services to individuals with mental health needs as delivered by behavioral and mental health professionals utilizing telehealth services.
  • Emergency Assistance to Families through Home Visiting Programs – Entities can use funds to serve families with home visits or with virtual visits that may be conducted by the use of electronic information and telecommunications technology, in a service delivery model described in 511(d)(3)(A).
  • Grants to support survivors of sexual assault – Funds to be used to assist rape crisis centers in transitioning to virtual services and meeting the emergency needs of survivors.

Stay tuned to CCHP’s March newsletter for further details. To keep up to date on all the bills CCHP is tracking, regularly check our legislative and regulatory tracking tool.

Feb 23
Love0

Women’s telehealth services offered at some rural Charleston County libraries through new partnership

By News

by:

CHARLESTON COUNTY, S.C. (WCBD) – Telehealth services for women are coming to some libraries in rural Charleston County.

The Charleston County Public Library is partnering with the WISE (Women in the South-East) Telehealth Network to provide women’s healthcare services in a virtual format.

According to a press release Monday, the goal is to improve women’s health and well-being by providing preventive care through telehealth at local libraries and connecting women to comprehensive health services.

“Our branches in rural areas of the county already serve as essential community hubs, providing resources to support education, literacy, and workforce development,” said Devon Andrews, CCPL Associate Director, Community Engagement. “We are thrilled to connect women in these rural areas with WISE, helping them access high-quality healthcare and providing them with a variety of resources to improve women’s health and well-being.”

Leaders with the Charleston County Public Library say their rural branches will increase healthcare access and address health disparities through direct provision and referral, offering care management, and connecting women to available community and social services.

They say the project is made possible by funding from the South Carolina Center for Rural and Primary Healthcare and a partnership between the Medical University of South Carolina, Charleston County Public Library, the S.C. Department of Health and Environmental Control, and the College of Charleston.

“During the COVID-19 pandemic, women have disproportionately had to assume responsibilities for childcare and drop out of the work force. Our goal is offer opportunities for women to interact with providers without having to arrange childcare for a clinic visit,” said MUSC OBGYN, Dr. Gweneth Lazenby. “This initiative will offer women-centered care that will increase access to healthcare, early intervention services, continuity of care, and availability of resources through telehealth.”

Women can find the WISE Telehealth Network from 9:30 a.m.-4:30 p.m. at the following local libraries in the rural Lowcountry:

Mondays and Tuesdays at St. Paul’s/Hollywood Library (5130 HWY 165, Hollywood, SC 29449)

Wednesdays at McClellanville Library (222 Baker St., McClellanville, SC 29458)

Thursdays at a variety of rural locations through the CCPL Mobile Library.

Fridays at Edisto Island Library (1589 WHY 174, Edisto Island, SC 29438)

Women seeking a telehealth appointment or more information about the WISE Telehealth Network can contact Amy Chang, Community Health Worker at 843-408-3335 or [email protected] or visit https://www.ccpl.org/telehealth.

Feb 23
Love0

F.C.C. Broadband Plan Includes $50 Monthly Subsidy for Millions

By News

Credit…T.J. Kirkpatrick for The New York Times

By Cecilia Kang

The acting chairwoman of the Federal Communications Commission on Monday announced a proposal to use $3.2 billion in emergency funds to significantly subsidize broadband service for millions of households, an attempt to narrow the digital divide that has punished low-income families during the pandemic.

The chairwoman, Jessica Rosenworcel, announced that under her proposal, qualifying households would receive $50 a month in discounts for high-speed internet service. The discount would be $75 for households on tribal lands. Ms. Rosenworcel sent the proposal to the other three commissioners for a vote, but did not specify when that vote would take place for the program, which is called the Emergency Broadband Benefit.

Congress allocated the money last December as part of a Covid-19 relief bill. The money will be available to households at or 135 percent above the poverty line, those who qualify for free and reduced school lunch, or have experienced substantial loss of income since Feb. 29, 2020.

At least 14.5 million homes do not have access to high-speed internet. For many families, particularly in urban and suburban areas, the high cost of broadband has prevented them from acquiring the service. The consequences of the digital divide during the pandemic have been severe. Children have been cut off from online learning and adults have been unable to work from home or find vital health information.

“No one should have to choose between paying their internet bill or paying to put food on the table,” Ms. Rosenworcel said in a statement. “With the help of the Emergency Broadband Benefit, we have a new way for households to access virtual learning, for patients to connect to telehealth providers, and for those struggling in this pandemic to learn new online skills and seek their next jo

The digital divide has been one of the most stubborn problems for the federal government. Though federal subsidies worth over $8 billion are allocated each year to internet service providers to bring broadband to every American home, the adoption and access rates have improved at a crawl. Broadband maps, for instance, notoriously overcount how many households have access to the service. If an internet service provider such as Verizon or Comcast reaches just one home in a census block, the entire block appears connected on federal maps — even when in reality all homes aren’t given the option of broadband.

Last week, Ms. Rosenworcel announced a task force to study the agency’s tracking of broadband access data.

 

Feb 17
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Debra Berlyn: Telehealth is Here Today and Here to Stay

By News

Broadband Breakfast

By:  

The COVD-19 pandemic has been an extremely difficult time for everyone and has led to the implementation of major changes in our daily behaviors. In order to overcome this adversity and adapt to living in a new age, great innovations have been advanced.

New tech devices and programs have offered many solutions to help solve some of our struggles during this pandemic and raise our spirts.

The pandemic has also highlighted how technology supports consumers who are homebound or living distant from essential services.  In a post-pandemic environment, we can already predict that many consumers, particularly older adults, will continue to rely on many tech services they have adopted during COVID-19.  Services such as online shopping and telehealth have been particularly indispensable during this era of stay-at-home orders, social distancing and quarantine.

The benefits of telehealth options for all consumers have been demonstrated during this pandemic. Telehealth has replaced many routine doctor’s visits, has been used for setting-up COVID testing appointments, and conducting all too critical mental health sessions during periods of isolation. It has also served to keep medical workers safe during the pandemic.

According to a Center for Disease Control report, there was a “154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019….”

During the emergence of COVID-19, both a majority of doctor’s offices were closed, and their patients were staying in their homes.  Options for medical appointments were limited to a telehealth visit only, and while most medical offices reopened with safety protocols in place, many consumers opted to continue with telehealth medical appointments.

The reduction of red tape and the number of doctors who quickly adapted to virtual services was one of the greatest developments of 2020; however, only those who have adequate access to broadband internet are able to take advantage of this tool, leaving out the unconnected population.

As we contemplate permanent integration of virtual care into our medical health system, we must acknowledge that consumer demand for telehealth requires access to ubiquitous high-speed broadband. In 2021, policymakers need to take aggressive steps to deliver broadband to those who do not have access, or who are unable to afford the service.

The $900 billion-dollar COVID Relief package approved by Congress in the final days of 2020 provides $7 billion to increase access to broadband. In addition, Telehealth expansion is included within the broadband funding priorities. The package more broadly includes overall support for these initiatives, with funding for:

  • Expanding telehealth access to mental health services for Medicare patients
  • Closing rural telehealth gaps to provide increased funding to the Health and Human Services agency’s Health Resources and Service Administrations pilot project for Telehealth Centers of Excellence, to access broadband capacity available to rural health providers and patient communities
  • The Federal Communications Commission to support the efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

The FCC has made a broad commitment to telehealth programs, initially under the leadership of Chairman Ajit Pai, and now in the most capable hands of Acting Chairwoman Jessica Rosenworcel. The Chairwoman recently visited the Washington, D.C., Whitman-Walker Clinic, which provides community-based health and wellness services specializing in LGBTQ and HIV care.

Rosenworcel said: “Through expanded and affordable access to broadband for all, organizations like Whitman-Walker and clinics around the country can continue to grow their telehealth efforts to support their communities.”

The Acting Chair is committed to closing the digital divide and sees access to telehealth care services—especially for underserved and marginalized communities—as a top priority. The FCC has initiated a number of COVID-19 Telehealth Programs and the Connected Care Pilot Program to focus on implementing innovative telehealth initiatives.

Telehealth has met the demand of health care management during the pandemic and has become particularly essential for older adults unable to leave their homes for medical visits.  It is vital that programs and policies supporting this technology continue to be a significant priority. In addition, access and affordability of high-speed broadband must be ubiquitous and affordable for all.

Debra Berlyn is executive director of the Project to Get Older Adults onLine (Project GOAL), and president of Consumer Policy Solutions, a firm centered on developing public policies addressing the interests of consumers and the marketplace. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to [email protected]. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC. 

Feb 16
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Jim Clyburn to reintroduce broadband expansion bill

By News

WASHINGTON, D.C. — U.S. House Majority Whip Jim Clyburn of South Carolina is seeking to connect the whole country to the information superhighway.

A story from Cablefax.com indicates that Clyburn, a Democrat serving a large portion of the central eastern part of the state, including a part of Florence County and all of Williamsburg County, is preparing to reintroduce the Accessible, Affordable Internet for All Act within the next few weeks.

Minnesota Sen. Amy Klobuchar is expected to reintroduce an identical bill in the Senate.

Clyburn and 11 Democrats introduced a similar bill in 2020.

The previous bill called for $100 billion for infrastructure building, $80 billion for deployment of infrastructure, and $5 billion to finance deployment. The previous bill also called for discounts for qualifying people and grants for the expansion of broadband.

Feb 11
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Primary Care Needs Telehealth Reimbursement, Targeted Relief

By News

From continued telehealth reimbursement to more targeted federal relief, primary care practices need payment reform to survive the second year of the COVID-19 pandemic.

 By Jacqueline LaPointe

 

– Better-targeted federal relief, continued telehealth reimbursement, and help acquiring personal protective equipment are some ways primary care providers can maintain financial stability as the country enters the second year of the COVID-19 pandemic, industry experts are saying.

An already underfunded area of medicine, primary care has faced significant financial challenges throughout the first year of the pandemic, explained experts from the Robert Wood Johnson Foundation and Urban Institute in a new brief.

Funds from the federal government and telehealth reimbursement parity were key to surviving empty waiting rooms, higher PPE costs, and other changes in operations during the pandemic. However, experts found that policymakers still have much to learn from these sources of support.

“COVID-19 has created enormous challenges for primary care providers that could result in long term changes in the delivery of care,” Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an emailed statement. “We need to find out what practices need to succeed in this environment, and devise policies to help support this foundational part of our health care system.”

The Provider Relief Fund, for example, did little to help independent primary care practices, the brief explained.

Established by the Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020, the Provider Relief Fund (PRF) has given hundreds of billions of dollars in grants to healthcare providers. But the government’s distribution methods have favored large hospitals and health systems, leaving most practices with relatively small payments from the initial, automatic distribution.

Instead, primary care practices relied more on Paycheck Protection Program funding and advanced Medicare reimbursements, the brief found. But again, hospitals received more upfront Medicare reimbursements, which were essentially zero-interest loans if repaid in time, compared to physicians.

“Future outlays from the PRF should ideally be better targeted than past payments, in order to support those providers most in need,” the brief stated.

Additionally, federal support is likely needed to ensure primary care practices can access sufficient PPE and meet the demand for increased telehealth and audio-only services.

The brief found that practices shifted rapidly to telehealth and other modes of care delivery when delivering in-person care was not feasible or safe, and that transition was relatively seamless according to the practice leaders interviewed for the brief.

But practices could not have been successful with telehealth implementation if not for federal support for reimbursement from the CARES Act.

“Respondents generally felt that their shift to telehealth as a significant portion of their interaction with patients was only viable because of altered payment rules and increased reimbursement for telehealth services,” the brief stated.

However, the reimbursement policies are only temporary and private payers who jumped on the bandwagon can pull the plug on telehealth reimbursement parity at any time in most states. Additionally, only one state has required payers to waive cost-sharing requirements for telehealth visits during the emergency period although many payers have elected to adopt the policy internally.

The latter policy has particularly supported practices, according to a Massachusetts respondent, who described deductibles as “killing” practices financially even before the pandemic.

Primary care practices are already planning the future of telehealth now that they have implemented the technology to facilitate visits and have a better understanding of how telehealth can fit into appropriate care delivery.

Patients have also taken to virtual care and many have started to demand telehealth appointments, even too much in some cases according to some practice leaders.

However, respondents reported that some private payers are already scaling back telehealth reimbursement rates and reinstating cost-sharing requirements. This is leading to concerns among practice leaders that telehealth will not be financially stable.

Practice leaders also voiced concerns about payers encouraging patient use of telehealth-only providers even though these providers may not be invested in the long-term health of a patient and can result in overutilization.

Continued support for telehealth reimbursement would help struggling practices maintain patient volumes in the event of more COVID-19 waves as well as with sustaining care transformations beyond the pandemic.

Additionally, policymakers should address increasing levels of clinician and staff burnout to strengthen primary care, experts stated.

These policy considerations could help to support vaccination efforts.

A new survey from the Primary Care Collaborative, Larry A. Green Center, and 3rd Conversation found that primary care continues to be untapped as the government struggles to administer COVID-19 vaccines. In fact, eight in ten primary care practice leaders surveyed said their organization is ready and willing to assist with vaccine distribution despite ongoing staffing shortages.

However, 44 percent of respondents also reported that local health systems are getting the vaccine, while smaller and independent practices are not.

“Primary care can play a major role in targeting and encouraging their patients to get vaccinated, particularly people with chronic conditions, the elderly, and people who are hesitant to get vaccinated,” Ann Greiner, President and CEO of the Primary Care Collaborative, said in an announcement. “Patients trust primary care, and trust is a major factor in our ability to help patients overcome vaccine concerns.”

Feb 11
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Telehealth Experiences Big Boom In Era Of Social Distancing

By News

Co-Founder & Co-CEO of hear.com, the largest online retailer of hearing aids in the world. Driven to help people hear well to live well.

By:  Paul Crusius at Forbes

Rapidly changing the landscape of healthcare, telehealth has gained widespread popularity in the past few years, giving millions of people around the world the ability to meet with their medical professionals from home via their computer, tablet or smartphone. And never has it been more necessary than it is now.

Telemedicine isn’t anything new. In fact, The National Center for Biotechnology Information reports that the initial form of it was first used in the 1950s and ’60s. But chances are, like many others, 2020 may have been your first hands-on experience with it.

According to Medical Economics, a recent study by Doctor.com showed that telehealth appointments were up 33% at the beginning of 2020 from 2019. Obviously, that percentage will have skyrocketed after last year’s pandemic statistics are folded in. As the leader of a global online hearing care company, I can attest to the fact that one of the areas that had to expand quickly to offer a telehealth solution was hearing care. Many medical professionals and organizations that hadn’t already made the shift to offering virtual medicine prior to Covid-19 found themselves scrambling in 2020 to figure out how to quickly and safely expand their service model.

Believing that teleaudiology was part of the future of hearing care, we’ve been experimenting with our virtual experience for the past five years. We found the hearing care environment in Asia was a great place to focus our early energy, as there was a shortage of audiologists and it was difficult for customers to travel to the limited locations. At the same time, in other markets, we discovered that customers weren’t comfortable receiving care or being seen on video. But in 2020, that changed, even for customers aged 60-plus. Perhaps the experience of using tools like FaceTime and Zoom to connect with their grandkids helped pave the way and break down those barriers.

Telehealth allows licensed providers to conduct certain tests virtually so that the patient never has to leave their home. Not only does this ensure the safety and health of the patient — notably during the age of social distancing — it also allows people all over the world who don’t have transportation or easy access to certain types of care to obtain the same level of care at home. While this was a big issue long before this pandemic, Covid-19 just happened to shine a brighter light on the issue.

Facing Telehealth Challenges Head-On

While I’m thrilled that providers can now use telehealth to help bridge the gap for those who need it most, there are still some challenges when it comes to serving a global community. We identified the following as two major hurdles early on. Other telehealth providers will likely face the same and need to implement solutions to ensure those who need care are never without access.

• Internet connectivity is one of the largest challenges telehealth providers around the world face today. Unfortunately, from a patient perspective, not everyone has access to high-speed internet and Wi-Fi to be able to connect from home. One way to tackle this across the globe is to send tablets that connect directly to cell service through the local wireless network, rather than operating solely through WiFi. This has been our approach, and our IT department is also able to remote into the tablet while the customer is using it to help them identify the best connection.

• The reality of telehealth is that some medical concerns do require in-person visits. There is an obvious loss of physicality with remote solutions where the doctor can’t touch or feel, or as in our industry, conduct certain aspects of a hearing test in person. For example, a comprehensive hearing exam requires a specialist to look inside your ear canal. Therefore, telehealth companies must create solutions that allow partner providers to conduct certain tests through tablets and digital tools that can be sent to customers in advance of their appointment.

We’ve discovered that by mirroring in-person visits as much as possible, telemedicine customers actually have more success from the comfort of their own homes. They’re more comfortable physically, allowing them to relax and open up to the provider. We continue to research and implement new ways to help everyone get access to the care they need to live well.

Health providers must be able to provide ease-of-use for consumers in order for them to feel comfortable and for remote solutions to be successful. By offering a telehealth solution and removing health care barriers — lack of transportation, distance to care, appointment wait times, travel time, fear of being exposed to sick patients — I believe people around the world will feel encouraged and motivated to pursue care at a faster rate in the years to come, so they can protect themselves and their loved ones. Telehealth truly is the future of care.

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