Ramona Midkiff

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.

August 05, 2020 – 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.

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.

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.

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.

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.

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.

A new telehealth bill in the US House of Representatives released late last week aims to make some of the telehealth expansions in Medicare that require a change in law permanent.  The bill would allow the Secretary to waive or modify any requirements associated with telehealth services during an emergency, disaster or a public health emergency and ending 90 days after its expiration.  It would also eliminate the requirement that the patient be located in a rural area in order to be eligible for reimbursement under Medicare as well as allow the patient to be located in their home, starting January 1, 2021.  FQHCs and RHCs would be added as eligible telehealth distant site providers.  Finally, the new House bill would require the Secretary of Health and Human Services, acting through the CMS Administrator to submit a report to congress on telehealth service utilization as well as assessment of benefits and barriers experienced during the emergency period.  This bill coincides with the publication of CMS Administrator Seema Verma’s latest Health Affairs Blog, which indicates that at least some of the administrative changes CMS has made to expand telehealth reimbursement could be made permanent. The blog indicates that as part of the CMS review, they are looking at “the impact these changes have had on access to care, health outcomes, Medicare spending and impact on the health care delivery system.”  Stay tuned for future updates from CCHP.

written by Gene Zaleski  at the Times and Democrat

A Bamberg-based telehealth network has received a federal grant to establish a virtual access telehealth network and expand access to health care delivery to select cities and towns in The T&D Region.

Palmetto Care Connections received a $300,000 Rural Health Network Development grant for each of three years to expand health care delivery of the rural underserved population in Orangeburg, North, Neeses, Cope, Ehrhardt, Murrells Inlet and St. George.

In a commentary in Health Affairs, CMS Administrator Seema Verma laid out the numbers for telehealth use by Medicare beneficiaries from March through June, and said the agency is still working on a plan for long-term coverage.

Healthcare industry groups are pushing congressional leaders to pass new legislation that will permanently expand telehealth flexibilities.

Action is needed to ensure patients and clinicians don’t fall off the “telehealth cliff” when the COVID-19 public health emergency ends, according to a letter (PDF) signed by 340 physician groups and industry associations.

If Congress does not act before the COVID-19 public health emergency expires, current flexibilities will immediately disappear, said the industry groups in a letter sent to Senate Majority Leader Mitch McConnell, R-Kentucky, House Speaker Nancy Pelosi, D-California, Senate Minority Leader Charles Schumer, D- New York, and House Minority Leader Kevin McCarthy, R-California.

Congress quickly waived statutory barriers to allow for expanded access to telehealth at the beginning of the COVID-19 pandemic, providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually.

RELATED: Providers to Congress: Patients will lose access to care without permanent expansion of telehealth

While federal agencies can address some of these policies going forward, the Centers for Medicare & Medicaid Services (CMS) does not have the authority to make changes to Medicare reimbursement policy for telehealth under the outdated Section 1834(m) of the Social Security Act, the groups said.

Organizations signing the letter include the American Academy of Family Physicians, the American Telemedicine Association, the Alliance for Connected Care, the Primary Care Collaborative, the American College of Physicians, AMGA and the College of Healthcare Information Management Executives

Technology companies also signed the letter including Epic, Cerner, Allscripts and Google.

Providers across the country have utilized recent policy flexibilities to scale delivery and provide older Americans, many for the first time, access to high-quality virtual care, resulting in 11.3 million beneficiaries accessing telehealth services in mid-April alone, according to the letter.

Additional flexibility has also allowed federally qualified health centers to deliver safe and effective care to underserved patient populations that have rated the service they received highly

Private health plans have also followed suit, and in response, telehealth adoption has soared—resulting in a 4,300% year-over-year increase in claims for March 2020, the groups said in the letter, citing data from Fair Health.

Taken as a whole, these temporary policy changes have allowed 46% of Americans to replace a canceled healthcare visit with a telehealth service during the pandemic.

“Virtual care has provided unprecedented access for patients, but it has become clear that uncertainty as to the future of telehealth under Medicare will halt or reverse further adoption and utilization—to the detriment of both patients and providers,” the groups wrote.

Congress must act to ensure that the HHS Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services.

RELATED: HHS official: ‘Cat out of the bag’ on telehealth but unclear what changes will stick

The healthcare groups said congressional leaders also have the responsibility to ensure that billions of dollars in COVID-19-focused investments made during the pandemic are not wasted and instead used to support the transformation of care delivery.

Here are the steps Congress should immediately take, according to the 340 groups:

• Remove obsolete restrictions on the location of the patient. The industry groups would like to see Congress permanently remove the current section 1834(m) geographic and originating site restrictions to ensure that all patients can access care at home and other appropriate locations. This would allow beneficiaries across the country to receive virtual care in their homes or a location of their choosing, where clinically appropriate and with beneficiary protections and guardrails in place.
• Maintain and enhance HHS authority to determine appropriate providers and services for telehealth. The HHS Secretary needs to have the flexibility to expand the list of eligible practitioners who may furnish clinically appropriate telehealth services. Similarly, HHS and CMS should maintain the authority to add or remove eligible telehealth services—as supported by data and demonstrated to be safe, effective, and clinically appropriate—through a predictable regulatory process that gives patients and providers transparency and clarity.
• Ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency. Congress should ensure that these facilities can offer virtual services post-COVID and work with stakeholders to support fair and appropriate reimbursement for these key safety net providers
• Make permanent HHS temporary waiver authority for future emergencies. The industry groups want HHS and CMS to have the authority to act quickly during future pandemics and natural disasters.