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Ramona Midkiff

Aug 17
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Healthcare Looks to Telehealth to Address Physician Burnout, Stress

By News

In an industry plagued by burnout, hospitals and health systems are using telehealth to give providers virtual access to mental health counselors – and to make their jobs less stressful.

– Like any profession that deals in life and death, healthcare has a stress and burnout problem – to which telehealth could be the answer.

Physicians have the highest suicide rate of any profession, losing 300 to 400 of their colleagues a year, and their struggles with stress and depression have an adverse effect on the healthcare industry’s economic health – a 2019 study posted in the Annals of Internal Medicine found that burnout adds roughly $4.6 billion in costs each year.

Writing in the American Journal of Medicine, Scott Yates, MD, MBA, MS, FACP, of the Plano, Texas-based Center for Executive Medicine, says burnout affects roughly half of all physicians in practice, manifesting itself in medical errors, lower quality of care and higher costs. Furthermore, it’s a systemic issue, rather than an individual one, and COVID-19 certainly isn’t helping.

At a time when the coronavirus pandemic is putting extra pressure on care providers to reduce in-person visits, hospitals and health systems are launching telehealth platforms to put doctors and nurses in front of mental health support at the time and place – and on the device – of their choice. And they’re looking to telehealth to reduce the burden on providers by automating many of the tasks that are causing stress in the first place.

“The appeal of telemedicine isn’t just that it makes things easier (though it certainly can),” Adrian Rawlinson, MD, a California-based sports medicine specialist, explained in a column on physician burnout for the online journal Medium. “Telemedicine is a unique and necessary new approach to healthcare that allows providers the freedom to administer the care that works best for both them and for their patients, and it gives patients greater flexibility in managing their health.”

Using Telehealth to Help Providers in Peril

Although the COVID-19 pandemic cast the spotlight on provider stress and burnout, the issue has been around long before the virus appeared. And networks like Providence Health have already taken steps to address it.

The Washington-based health system, with more than 50 hospitals in eight states, rolled out its Telebehavioral Health Concierge program in January 2020, offering virtual care visits with a counselor within two days. They’ve since renamed it the Behavioral Health Concierge program and expanded its reach to include caregivers and family members in Oregon, California and Montana.

“We wanted to build something dedicated to caregivers,” says Josh Cutler, a licensed clinical social worker who helped launched the service. “Before and especially during (COVID-19), we have been at the center of an epidemic of burnout and suicide in healthcare. We needed to give (providers) something that would address that on their terms.”

Providence caregiver meets with Cutler for a telebehavioral health visit.
Providence caregiver meets with Cutler for a telebehavioral health visit.Source: Providence Health

Arpan Waghray, MD, a psychiatrist and chair of the health system’s behavioral medicine clinical practice group who joined Cutler in developing the program, says the platform not only connects with people in crisis, but can be used to provide health and wellness resources that help providers before they reach that crisis stage.

“You automatically equate mental health with mental illness, as opposed to mental health and wellness,” he says. “With this program, our goal was to move upstream and meet people where they are.”

That points to one of the strengths of an online program: Giving users the resources they need and the freedom to access what they need at their own pace. For those who don’t feel comfortable talking to someone else about their problems, a self-serve platform might be more effective.

“It’s very consumer-centric to do this, but it’s not very provider-centric,” Waghray says. “In some ways we have to adjust our thinking.”

Cutler notes that doctors and nurses are trained to give care, but often aren’t sure how or when to seek it themselves. They’re either uncertain of how to access help or embarrassed about needing it.

A telehealth platform makes it easier to find help, he says, and gives them the opportunity to connect discretely at the time and place of their choice.

“I can talk to people who are sitting at home or in their parked car,” he says. “It’s all about giving them the space to talk, and establishing that connection.”

Technology as the Cause and Solution?

While health systems and hospitals are using connected health platforms to connect stressed out staff with counselors, they’re also touting the value of telehealth in reducing stress. And that benefit has been around since well before COVID-19.

The American Telemedicine Association made physician well-being and stress reduction a cornerstone of its 2019 conference and exhibition in New Orleans. The effort was spearheaded by Peter Yellowlees, MD, a professor of psychiatry at the University of California at Davis and Chief Wellness Officer at UC Davis Health.

The kicker? At that time, the industry was looking at stress as a by-product of dealing with new technology, particularly electronic medical records platforms.

“We have not worked well with technology in the past,” Yellowlees said. “We’re actually causing poor care with the way we use technology,” he says. “We have to understand how to use it better.”

Causes of clinician burnout
Causes of clinician burnoutSource: AHRQ

“The main issue is documentation,” he said, pointing out that American doctors spend three times as much time documenting as do their counterparts in Australia and Europe.

But while older technology platforms – including telemedicine – may have been cumbersome, newer versions are smaller and more portable. Whereas providers once had to go to the technology, such as a nurse’s station or a computer in the office, they can now bring the technology with them as they make their rounds.

“The beauty nowadays is we’re freed up to do more of what we want to do,” he said.

The same applies to seeing patients. Providers who once had to jump through several different hoops to set up a telehealth visit can now connect with a patient on a laptop or smartphone from the comfort of their own homes. They can set schedules that fit better into their daily lives, setting aside time for family and for seeing patients.

“It actually is a much more egalitarian relationship,” says Yellowlees, who uses a telemedicine platform to see patients at home “Patients feel like this is a much more normal interaction.”

A connected care platform can also foster collaboration and teamwork, a cornerstone of the industry’s move toward value-based care and the patient-centered medical home. Through telemedicine, doctors and nurses can collaborate with each other, and with specialists, reducing stress on one provider and enabling different providers to handle the tasks more suited to them.

“Healthcare is increasingly a team game,” says Yellowlees. “The future (of the industry) lies in virtual care, and virtual care teams.”

How Telehealth Improves the Work-Life Balance

Aside from improving patient care and reducing costs, a selling point for the adoption of telemedicine technology has always been that it can help improve clinician workflows by reducing administrative tasks and giving them access to clinical decision support. This, in turn, allows the clinician to practice at the top of his or her license and focus on the patient.

One such example can be found in teleneurology.

Keith J. McAvoy, MD, the medical director of teleneurology for New Hampshire’s Dartmouth-Hitchcock Medical Center in Manchester, says a telemedicine platform that links neurologists at a central site, like Dartmouth-Hitchcock, to smaller hospitals across the region can reduce stress on doctors and nurses in those rural hospitals who have to transfer critically injured patients to a larger facility because they don’t have the skills or resources to treat on-site.

“Healthcare is increasingly a team game. The future (of the industry) lies in virtual care, and virtual care teams.”

“There are many of our spoke hospitals that have no neurology coverage at all, so we provide that neurology coverage,” he said of a network that provides on-demand services to close to a dozen locations in New Hampshire, Vermont and Maine, to a tune of roughly 800 consults a year.

McAvoy, speaking at a recent virtual conference coordinated by the Northeast Telehealth Resource Center and the Mid-Atlantic Telehealth Resource Center, said a telehealth platform gives providers in those spoke hospitals the resources and support they need to treat more patients, and it helps to reduce self-doubt and feelings of isolation.

The platform also gives neurologists more of an opportunity to expand their horizons and treat more patients – not only by administering emergency care to those suffering a stroke, but in offering specialist consults and follow-up services to any number of rural and remote locations.

That’s an often-overlooked benefit for a specialty that ranks in the top 5 in burnouts.

They “address many conditions without a known cure,” he said, which is often stressful. “Telling a patient that they don’t have a neurologic condition,” he added, is often the best part of being a neurologist.

Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Medical CenterSource: Dartmouth-Hitchock

Telehealth “has the potential for providing more dedicated and consistent care,” McAvoy says, which in turn improves outcomes for patients and perks up the providers.

“A happy neurologist means better care for the patients,” he added.

Another example can be found in eConsults.

With the COVID-19 crisis expanding the ranks of the unemployed and pushing more and more people off their insurance plans, community health clinics, federally qualified health centers and rural health clinics all expect to see a surge in business. This puts pressure on clinic staff who already have a lot on their plates.

Expanded telehealth coverage for FQHCs and RHCs is one of the cornerstones of a legislative plan to continue telehealth’s momentum beyond the coronavirus. This would allow these providers to, among other things, use telehealth channels to seek specialist consults and support.

That’s what the MAVEN Project does. Launched in 2014, this Massachusetts-based group provides mentoring and consults to health clinics in high-stress, low-resource environments. Their services are free of charge, and their support group is comprised of retired and semi-retired physicians who want to give back to their profession.

“What we have are a group of physicians who are truly best in class, and want to share their skills with others.”

“They offer a wealth of knowledge and expertise and decades and decades of clinical experience,” Lisa Bard Levine, MD, MBA, the organization’s CEO, told mHealthIntelligence in 2018. “What we have are a group of physicians who are truly best in class, and want to share their skills with others.”

One of the guiding principles of the MAVEN Project is to help harried providers who need some advice or support.

“We’re here to give these providers support that’s really needed,” Levine says. “A lot of these primary care providers are newly trained, or working for clinics that struggle to provide necessary support for their physicians. A lot of them are realizing that this is a gray area in healthcare.”

Making Telehealth the Rule, Rather Than the Exception

While health systems like Providence Health create virtual care programs to care for the caregivers, telehealth advocates say the advances in telehealth coverage brought on by the COVID-19 crisis will, in the long run, reduce provider stress.

While the Centers for Medicare & Medicaid Services has released a proposed 2021 Physician Pay Schedule that increases coverage for certain services, Congress is dealing with dozens of bills – and pressure from a large lobbying group – that aim to make permanent many of the telehealth freedoms enacted during the ongoing public health emergency.

The hope among many is that using telehealth and mHealth tools will become second nature for care providers, resulting in improved workloads, reduced stress and a better work-life balance. And while using those tools to help their patients, they’ll also make us of them to help themselves when and where necessary.

“When it’s going right, all the technology disappears, and we have this connection,” says Cutler, at Providence Health, whose work has helped dozens – if not hundreds – of care providers address their health struggles. “This has been some of the most meaningful clinical work that I have done.”

Aug 13
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COVID-19: Here’s What CMS Will Do With the Temporary Telehealth Codes When the PHE Ends

By News
12 August 2020 Blog
Authors: Rachel B. Goodman Nathaniel M. Lacktman
Published To: Health Care Law Today Coronavirus Resource Center:Back to Business

The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed 2021 Physician Fee Schedule rule, enumerating the services CMS proposes to add (and remove) from the list of telehealth services covered under Medicare. This year’s list is unusually robust because CMS took into consideration all the telehealth services Medicare currently covers on a temporary basis due to the COVID-19 Public Health Emergency (PHE).

CMS grouped the telehealth services into three lists: 1) nine (9) codes that will become permanent; 2) seventy-four (74) codes that will be removed when the PHE expires; and 3) thirteen (13) codes to add to the list, but only on a temporary basis (CMS dubbed these Category 3 codes). Concurrent with the CMS proposed rule, the White House issued an Executive Order designed to enhance access to telehealth services under Medicare by charging CMS to create even more virtual care coverage opportunities.

This article discusses the new Medicare telehealth service code proposals specifically related to the Public Health Emergency. For a companion piece discussing CMS’ proposed 2021 changes for Medicare telehealth and virtual care generally, click here.

Telehealth services that will become permanent

CMS proposed adding nine codes to the list of telehealth services covered under Medicare, to remain covered even after the PHE ends. The codes are set forth in the table below.

Service Type HCPCS/CPT Codes 
Group Psychotherapy90853
Domiciliary, Rest Home, or Custodial Care services, Established patients99334-99335
Home Visits, Established Patient99347- 99348
Cognitive Assessment and Care Planning Services99483
Visit Complexity Inherent to Certain Office/Outpatient E/MsGPC1X
Prolonged Services99XXX
Psychological and Neuropsychological Testing96121

Keep in mind, these codes are already Medicare-covered telehealth services, albeit on a temporary basis under the PHE waiver rules. Subject to CMS’ final rule, these services are expected to be added, on a permanent basis, effective January 1, 2021.

Telehealth services that will be removed when the PHE expires

CMS proposed removing seventy-four (74) codes when the PHE expires. Although CMS temporarily allows the services addressed by these codes to be delivered via telehealth, CMS found no likelihood of clinical benefit after the PHE ends. Even with the development of additional clinical evidence, CMS believes these services are unlikely to satisfy Category 2 criteria to justify including on a permanent basis.;

Service Type HCPCS/CPT Codes 
Initial nursing facility visits, all levels (Low, Moderate, and High Complexity)99304-99306
Psychological and Neuropsychological Testing96136-96139
Therapy Services, Physical and Occupational Therapy, all levels97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507
Initial hospital care and hospital discharge day management99221-99223, 99238- 99239
Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent99468- 99472, 99475- 99476
Initial and Continuing Neonatal Intensive Care Services99477-99480
Critical Care Services99291-99292
End-Stage Renal Disease Monthly Capitation Payment codes90952-90953, 90956, 90959, 90962
Radiation Treatment Management Services77427
Emergency Department Visits, Levels 4-599284-99285
Domiciliary, Rest Home, or Custodial Care services, New99324-99328
Home Visits, New Patient, all levels99341- 99345
Initial and Subsequent Observation and Observation Discharge Day Management99217-99220, 99224- 99226, 99234-99236
While there are many codes slated for removal, this is only a proposed list. Stakeholders can submit comments and clinical data in support of making one or more of these codes permanent. However, barring any such compelling information submitted by telehealth industry advocates, we do not expect these codes to continue as telehealth services after the PHE expires.

New telehealth services during the Public Health Emergency (Category 3 codes)

CMS created a new category of codes designed for adding new Medicare-covered telehealth services, but on a temporary basis. Codes added this way would remain covered through the end of the year in which the PHE expires. For example, if the PHE expires in March 2021, these codes will remain Medicare-covered telehealth services until December 31, 2021. The reason for this unique approach is because CMS believes these codes have promise to be added on a permanent basis, but require additional data, real-world use experience, and feedback from stakeholders before CMS can make a final determination. CMS will not remove these codes concurrent with the PHE expiration because it wants to give the public an extra opportunity to gather data and submit requests to CMS, asking CMS to add some of these codes to the Medicare telehealth services list on a permanent basis.

The Category 3 codes demonstrate CMS’ openness to innovation and experimentation as it continues to expand coverage of virtual care services in the Medicare program. In short, Category 3 services are those likely to provide clinical benefit when furnished via telehealth, but for which there is not yet sufficient clinical evidence to evaluate making them permanent under existing Category 1 or Category 2 criteria. For a Category 3 service to become permanent, stakeholders will need to submit to CMS: 1) a description of relevant clinical studies that demonstrate the service, when furnished via telehealth, improves the diagnosis or treatment of an illness or injury, or improves the functioning of a malformed body part (including dates and findings of those studies); and 2) a list and copies of published peer reviewed articles relevant to the service when furnished via telehealth.

CMS proposed adding the thirteen (13) codes set forth below to the Category 3 list:

Service Type HCPCS/CPT Codes
Domiciliary, Rest Home, or Custodial Care services, Established patients99336-99337
Home Visits, Established Patient99349-99350
Emergency Department Visits, Levels 1-399281-99283
Nursing facilities discharge day management99315-99316
Psychological and Neuropsychological Testing96130- 96133

These codes are currently listed as Medicare-covered telehealth services for the duration of thePHE, but would be included on a more extended temporary basis, starting January 1, 2021. CMS is accepting public comment regarding whether any additional codes should be added to the Category 3 list.

How to submit comments to CMS

Providers, technology companies, entrepreneurs, and advocates interested in telemedicine and digital health should consider submitting comments to the proposed rule anonymously or otherwise via electronic submission at this link. Alternatively, commenters may submit comments by mail to:

  • Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, P.O. Box 8016, Baltimore, MD 21244-8016.
  • Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 (for express overnight mail).

If submitting via mail, please be sure to allow time for comments to be received before the closing date. CMS is soliciting comments on the proposed rule until 5:00 p.m. on October 5, 2020.

Conclusion

The proposed changes for 2021 demonstrate CMS’ commitment to expanding meaningful patient access to care via telemedicine and digital health technology, both during the PHE and beyond. CMS is developing a post-pandemic strategic plan for telehealth, and industry advocates, entrepreneurs, and healthcare providers can use this moment to share their recommendations, ideas, and suggestions during the public comment period. This feedback—both policy ideas and by submitting clinical studies and concrete data—will be vital to CMS’ continued ability to improve and innovate under the Medicare program.

 

Aug 11
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New Telehealth Bill Seeks Funding for Broadband Expansion Programs

By News

By Eric Wicklund on

A new bill before Congress aims to increase funding for telehealth expansion programs that target improved broadband connectivity.

The Accelerating Connected Care and Education Support Services on the Internet (ACCESS the Internet) Act, introduced this past week by Senators Joe Manchin (D-WV) and John Cornyn (R-TX), proposes to add $400 million to Federal Communications Commission’s COVID-19 Telehealth Program, which was shut down last month after exhausting its $200 million allocation through the CARES Act. It would also set aside another $100 million for the Department of Veterans Affairs to expand connected health access for veterans in rural and underserved areas.

The bill targets a significant barrier to telehealth expansion in rural and remote areas of the country. Healthcare providers can’t extend programs and services into these areas – and residents can’t use them – unless they have access to reliable and uninterrupted broadband.

“The current COVID-19 pandemic has shone a new light on the broadband issues in West Virginia and across rural America,” Manchin said in a press release. “Americans and West Virginians have had to adjust to a new way of working, learning, and living from home due to the COVID-19 pandemic and for most people, this change relies on accessible, reliable broadband which many rural Americans do not have.”

“This commonsense bill could help our children, Veterans and families access reliable broadband to pay their bills, complete their homework, and keep up with doctor’s appointments,” he added.

The bill would also add $1.3 billion to the Department of Education to boost distance learning service and give $200 million to the Institute for Museum & Library Services, with at least $1.6 million set aside per state, to improve Internet connectivity in libraries in low-income and rural areas.

The FCC’s COVID-19 Telehealth Program has been a hot topic on Capitol Hill in recent months. Created out of the CARES Act in March, the program provided funding for 539 programs in 47 states, Washington DC and Guam before running out of funding in July. At the time, FCC Chairman Ajit Pai said the agency would follow up with a study on how well the program accomplished its goals.

There have been a few attempts to keep that program going. In April, the American Telemedicine Association petitioned Congressional leaders to add $300 million to the program, and in July US Reps. Abigail Spanberger (D-VA) and Dusty Johnson (R-SD) introduced a bill to add $200 million to the program through an FY 2020 supplemental appropriation, following up on a letter to Pai that was signed by more than 40 members of Congress.

The VA’s telehealth and mHealth programs haven’t gone without notice, either. Earlier this month, US Reps. Susie Lee (D-NV) and Jim Banks (R-IN) introduced the VA Telehealth Expansion Act, which aims to give the VA Secretary more authority to enter into new partnerships and expand existing deals that support connected health access for veterans. It would create a grant program to facilitate those partnerships, and would give special emphasis to programs that help veterans in rural or underserved parts of the country.

In June, the VA announced that the coronavirus pandemic had created a surge in business for the agency’s three-year-old connected health platform, including a 1,000 percent increase over the usual traffic recorded on the VA Video Connect mHealth app.

Tagged Broadband Internet,  Coronavirus,  Department of Veterans Affairs,  mHealth Adoption,  mHealth Strategies,  Rural Healthcare,  Telehealth Strategies,  Telemedicine Strategies
Aug 10
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Senators Eye Telehealth Licensure Freedom During COVID-19 Emergency

By News

A bill introduced this week would allow healthcare providers in good standing to use telehealth to treat patients in any state during the coronavirus pandemic.

 

– A new bill before Congress takes aim at one of the bigger barriers to telehealth expansion: interstate licensure.

Senators Chris Murphy (D-CT) and Roy Blunt (R-MO) this week unveiled the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, which would enable healthcare providers in good standing to use connected health to treat patients in any state during the coronavirus pandemic.

“The COVID-19 pandemic has created unique challenges for our health care system, like reaching patients who are advised to avoid clinics and hospitals, allowing students to continue care when they’re away from campuses, or speeding reinforcements to areas with a high number of cases,” Blunt said in a press release. “The TREAT Act responds to those challenges by increasing flexibility for providers to care for patients wherever they are. The bill maintains all the safeguards patients should expect, while eliminating bureaucratic hurdles that impede access to care. It’s the right approach to make sure we keep people connected with their providers and allow frontline workers to lend support in areas where they’re needed most.”

Current guidelines require providers to have licenses in each state in which they practice, a costly and time-consuming issue for health systems that span several states and telehealth services that reach patients regardless of where they’re located. It’s a hotly debated issue, with some supporting the current practice, some supporting licensure compacts that span several states or regions, and some even suggesting one license for the entire country.

Some states have relaxed their guidelines during the ongoing COVID-19 crisis, but telehealth advocates note the process is still very confusing, with each state having its own rules. And those emergency measures will end with the emergency.

Providers sanctioned by the Department of Veterans Affairs already have the ability to use telehealth to treat veterans in any state. That freedom was included in the Veterans E-Health & Telemedicine Support (VETS) Act, which was passed in 2017.

The bill would give Health and Human Services Secretary the authority to phase out the service over a six-month period after the coronavirus ends and launch it again in future emergencies. It would also require the provider to obtain oral or written permission from the patient before using telemedicine or mHealth technology, and give each state the authority to pursue investigations or disciplinary actions on any provider who has practiced in that state under the reciprocity measure.

“COVID-19 has hammered our already fragile health care system, and the last thing our frontline workers need is more bureaucratic red tape. We should be doing everything in our power to make sure any health care provider, in good standing and with a valid license to practice medicine, can provide services in any location throughout the pandemic,” Murphy said in the press release. “That’s why we are introducing the TREAT Act, which provides a temporary uniform licensing standard so health care workers can help those in need, including through telehealth, regardless of the patient’s physical location. With over 150,000 Americans dead and millions more infected, we must be all hands on deck to contain COVID-19.”

The bill is quite similar to the Equal Access to Care Act, introduced in June by Senators Marsha Blackburn (R-TN) and Ted Cruz (R-TX), which would allow a provider in any state to use telehealth to treat a patient in any location for up to 180 days after the national emergency.

And it’s one of dozens introduced to Congress over the past few months that address expanding telehealth access and coverage – including the TREATS (Telehealth Response for E-prescribing Addiction Therapy Services) Act, introduced in July, which aims to expand the telehealth platform for substance abuse treatment.

The bill has a considerable list of supporters, including the American Hospital Association, American College of Physicians, American Medical Group Association and dozens of high-profile hospitals and health systems.

Aug 10
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Telemedicine is booming — but many people still face huge barriers to virtual care

By News

By Juliet Isselbacher

August 5, 2020

 

As Covid-19 drives many patients away from in-person care and toward virtual visits, experts warn that the nation’s most vulnerable members may be shut out of the booming telehealth business.

Federal policymakers temporarily relaxed regulations to make it easier to provide virtual care during the pandemic, fueling a shift toward telemedicine that has become so popular among patients and providers that there are now a number of proposals to make the changes permanent. Just this week, President Trump signed an executive order that would permanently extend some of those policies.

But a pair of new studies published this week show that there are barriers to virtual visits that regulatory changes alone can’t fix.

“The temporary reform due to Covid allowed telemedicine visits from a patient’s home, but it presumed that patients had access to the technology to engage in those visits,” said Eric Roberts, a health policy researcher and at the University of Pittsburgh and a co-author of one of the papers. “We’re showing that there’s a substantial number of Medicare beneficiaries who lack access to that technology.”

The paper, published in JAMA Internal Medicine, found that 1 in 4 Medicare beneficiaries were stranded on the far side of the digital divide in 2018, with neither a home computer with a high-speed internet connection or a smartphone with a wireless plan.

One way to potentially narrow that gap, according to the authors: expand the federal Lifeline program, which subsidizes phone and internet services for impoverished families, to cover more low-income Medicare beneficiaries.

They cautioned, however, that the program is limited and does not pay for devices themselves. Yet another problem is that people who can afford devices aren’t always able to use them.

Aug 03
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Sen. Graham, PCC and medical leaders discuss broadband and telehealth in SC

By News

U.S. Senator Lindsey Graham met with medical professionals at the USC School of Medicine today to discuss the benefits of telemedicine and its expansion throughout South Carolina. Mark Sweatman, MUSC Director of Government Relations and Secretary to the Board of Trustees; Kathy Schwarting, Palmetto Care Connections CEO; Senator Graham; Meera Narasimhan, MD, DFAPA, Associate Provost Health Sciences USC, Professor and Chair Department of NeuroSciences and Behavioral Science, USC School of Medicine; Ken Rogers, MD, Director of SC Department of Mental Health; and Mark Wess, MD Chief Medical Information Officer at Prisma Health attended. This week, Senator Graham and Senators Mark Warner (D-Virginia) and Tim Scott (R-South Carolina) will introduce legislation to allocate $10 billion to help governors across America speed up the deployment of broadband in areas where there is greatest need.

Aug 03
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Sen. Graham to visit UofSC and Prisma Health to speak about telemedicine

By News

COLUMBIA, S.C. (PRESS RELEASE) – U.S. Senator Lindsey Graham (R-South Carolina) will visit the University of South Carolina School of Medicine and Prisma Health this afternoon starting at 12:30.

Officials say he will discuss the future of telemedicine, the benefits it offers, and how to expand its use throughout South Carolina.

The event starts at the Dean’s Board Room at UofSC’s School of Medicine building on the Third Floor at 3555 Harden Street Extension.

Senator Graham will also introduce the Governors’ Broadband Development Fund with Senators Mark Warner (D-Virginia) and Tim Scott (R-South Carolina) this week.

According to his office, the legislation allocates $10 billion to help governors across America speed up the deployment of broadband in areas where there is the greatest need.

Governors can use these funds to support schools and hospitals, and provide broadband access to rural America.

Graham noted that based on available data, an estimated 650,000 South Carolinians lack broadband access.

Jul 27
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Legislators and healthcare orgs rally in favor of bipartisan telehealth bill

By News

By Kat JercichJuly 23, 2020
The House bill, introduced last week, would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare, a broadly popular provision.

Several healthcare organizations and elected officials came together on Thursday in support of legislation safeguarding access to telehealth after the pandemic.

“We have seen the positive impact of telehealth across the nation,” said Jen Covich Bordenick, CEO at eHealth Initiative.

The temporary waivers issued by the U.S. Department of Health and Human Services, said Bordenick, have allowed individuals suffering from COVID symptoms to get virtual treatment. But the waivers have fulfilled another important function: “It’s allowed individuals to manage their non-COVID treatment,” such as cancer treatment, mental health care and diabetes management.

“The issue is that these waivers are temporary,” Bordenick explained. “All of that access is at risk of disappearing” if action isn’t taken now.

This past week, a bipartisan group of House representatives – all of whom were present on the call – introduced the Protecting Access to Post-COVID-19 Telehealth Act.

The legislation would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare; authorize the Centers for Medicare and Medicaid Service to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency; and enable the HHS to expand telehealth in Medicare during all future emergencies and disasters; among other provisions.

“It’s a pretty exciting time for telehealth,” said Rep. Mike Thompson, D-Calif. “There’s a lot of enthusiasm for doing this.”

“Telehealth has proven vital to supporting the continuity of care,” agreed Rep. Doris Matsui, D-Calif.

Legislators and supporters pointed to the need to expand internet access around the country, with some saying there could be no expansion of telehealth without it.

“Telehealth must be accessible to everyone,” said Thompson. “Right now, it isn’t … We can’t allow telehealth to leave anyone behind.”

Rep. David Schweikert, R-Ariz., said more data is also needed – including from providers – about the costs of telehealth.

Without that kind of information, he said, “we’re actually sort of groping in the dark.”

American Telemedicine Association CEO Ann Mond Johnson called the originating and geographic site requirements, which have historically restricted eligible telehealth areas for reimbursement, “arbitrary barriers.”

As she noted, CMS has acknowledged that “urban beneficiaries experience barriers to care, and telehealth can help overcome these barriers for both urban and rural patients.”

“Telehealth is not new. We know telehealth can help transform our health care system,” she added, pointing to support from hundreds of stakeholders in favor of safeguarding telehealth access.

Hal Wolf, president and CEO of HIMSS (Healthcare IT News‘ parent organization) agreed that access to care is both a “rural and urban challenge.”

A 20-minute visit, from a clinician’s perspective, can, for some patients, be an “all-day affair,” he pointed out – whether that’s because they had to drive for two hours across the desert or sit in traffic on a city bus.

Wolf also pointed out that the recent bloom in telehealth is rooted, in part, in the government’s electronic health record incentive program and meaningful use.

“I cannot even imagine what a physician would do if they had to talk to a patient on the phone and they didn’t have an electronic medical record to pull up the information,” Wolf said.

The looming physician shortage, will require providers to think outside the box in terms of what care looks like – making telehealth even more important, including after the pandemic, said attendees.

Yet some providers are still hesitant to make infrastructure investments because of the uncertainty of the current moment, they noted.

Any new policies must do more than simply extend temporary waivers, said Krista Drobac, partner at Sirona Strategies.

“Why are you [as a provider] going to invest in changing workflow, educating patients on the value of telehealth, doing all that work, not knowing if this is going to end … in 2021?” she said.

She also pointed out that many state governments have also been in limbo waiting for the federal government to take action.

“We need to work together,” said Drobac. “We have an unprecedented opportunity to go big.”

Jul 22
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Harvard COVID-19 Telemedicine Visit Data Shows Peak Use in Mid-April

By News

Since March, researchers at Harvard University and Phreesia, a health care technology company, have been tracking and analyzing data on changes in visit volume and use of telemedicine for 50,000 providers who are Phreesia clients.  Visits were captured from February 1 through June 20, 2020. A visit was counted if it was in the practice’s scheduling software and the patient was “checked in.”  The data excludes any new Phreesia clients who joined after February 15th, 2020.

In late June, the researchers released the third update to their findings, reflecting trend data since March.  Key findings from their previous two reports included that there was a 60% decline in ambulatory care visits when the pandemic began, which continued into the end of April.  In mid-May, data suggested that a rebound was beginning. Researchers note in this latest report that while visit numbers have rebounded, they are still substantially lower than before the pandemic.

For telemedicine visits specifically, researchers were able to identify those based on notes regarding appointment type or location made in the scheduling software. Telemedicine included both telephone and video visits in this study. Not surprisingly, starting in March, as in-person visits dropped, telemedicine visits increased rapidly. Since a peak in mid-April, telemedicine use has begun to decline, though levels remain higher than prior to the pandemic.  Telehealth utilization data tracking numbers from Fair Health also show similar spikes in utilization in April.

The researchers acknowledge some of the study limitations, including that some visits may not have been captured in the software, especially unscheduled telephone encounters.  Additionally, early in the pandemic, processes were still being created to designate telemedicine visits within the scheduling software, which may mean that some of that data was not initially captured.  See the full study findings for more detailed information.

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