A bill introduced this week on Capitol Hill would require the Health and Human Services Department to study how telehealth has been used during the COVID-19 pandemic, with a report due back one year after the emergency ends.
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The bill – the text for which had been received as of June 3 – joins a growing list of efforts to keep connected health programs and concepts front and center beyond COVID-19. Some states and payers have moved to make telehealth coverage permanent, while several members of Congress are lobbying Congressional leaders to extend regulatory freedoms for telehealth in areas such as children’s health and mental health.
Kelly’s bill, first noted by Politico at the beginning of the week, would direct HHS Secretary Alex Azar to oversee the study, which would include overall telehealth traffic, the different types of telehealth services offered to patients, the modalities used and the types of healthcare locations – hospitals, doctor’s offices, health clinics, the patient’s home, etc. – where care was delivered.
The bill, and many of the other actions taken so far, aim to establish new coverage policies for telehealth either before or soon after current emergency telehealth rules end. One particular target is the Centers for Medicare & Medicaid Services, which has issued a series of wide-ranging decrees aimed at expanding Medicare and Medicaid coverage during the pandemic.
“Data and information and research informs policy and resources, and that’s what we’re trying to do — gather as much information and really study the issue quickly before CMS regulations do run out,” Kelly told Politico this week.
A new Health Affairs article notes how community health centers have struggled to use telehealth before and during COVID-19, and offers advice to help CHCs embrace connected health in the future.
– Community health centers will need a good grasp of telehealth to survive both the coronavirus pandemic and what lies beyond.
That’s the take-away from a new article in Health Affairs, which notes the lack of telehealth adoption prior to COVID-19 and outlines three steps that should be taken to bring CHCs, which serve more than 28 million underserved Americans, up to speed with connected health.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
That strategy may be crucial. While federal and state governments have taken steps to boost telehealth adoption during the ongoing pandemic, CHCs, federally qualified health centers and rural health centers have in many cases struggled to use the technology because they hadn’t laid the groundwork prior to the pandemic. Meanwhile, with the nation in the midst of an economic slump and hundreds of thousands without jobs, these health centers will likely see a surge in traffic as more and more people lose their health insurance.
The Health Affairs article, written by June Ho-Kim of Brigham and Women’s Hospital (and a primary care physician at Upham’s Corner Health Center, a FQHC) and Eesha Desai and Megan Cole of the Boston University School of Public Health, points out that only 38 percent of the nation’s 1,330 CHCs were using telehealth in 2016, and two years later that number had only jumped to 44 percent.
Of the 56 percent not using telehealth in 2018, only one in every five was giving it any thought. And of the 44 percent using telehealth at that time, roughly 70 percent were providing telemental health services and 47 percent were using it for specialist consults – and only 30 percent were using telehealth for primary care and 21 percent were offering chronic care management services.
Furthermore, CHCs faced significant barriers to adoption telehealth. The top three were lack of reimbursement – prior to COVID-19, Medicare didn’t reimburse for telehealth services at these centers and didn’t recognize them as a distant site for telehealth delivery – lack of resources and lack of training. In rural areas, meanwhile, almost 20 percent didn’t have the broadband connectivity to support telemedicine technology.
The COVID-19 emergency changed that dynamic. With the pandemic reducing in-person care and putting the onus on remote care, CHCs saw their in-person visits plunge and were forced to lay off staff, reduce hours or even close. Federal and state governments responded with a barrage of emergency measures aimed at reducing the barriers to telehealth and boosting reimbursement.
“While an important first step, policy makers cannot simply infuse more funding to CHCs and expect them to withstand the challenges of the COVID-19 era,” the article points out.
It offers three “targeted strategies” for improved telehealth adoption:
Mandate payment parity for all telehealth services, not only during COVID-19 but beyond.
“Without commensurate reimbursement for telehealth, CHCs cannot maintain patient volume or make the long-term investments necessary to remain financially viable,” the article states. “A ‘ of paying CHCs a fixed payment per patient per month would give practices flexibility in how and where to treat the patient, although this may be politically and practically challenging. Meanwhile, payment parity has already been implemented and could simply be permanently codified into existing reimbursement schemes, giving providers the option to select the best mode of treatment without making financial trade-offs.”
Provide funding and guidance for telehealth adoption.
This includes hardware and software, broadband access and training, and ancillary systems to handle traffic on different channels, such as phone and video.
“Adding robust protocols and systems will allow for the successful implementation and scaling of telehealth,” the article states.
Provide support so that CHCs can reach vulnerable, underserved populations.
This would include funding for translation services and support for patients not familiar with the technology. Payers, meanwhile, should provide support for patient care navigators and waive any requirements that place geographic or original site restrictions on telehealth and that mandate audio-visual platforms.
Finally, local governments should offer mHealth devices to underserved populations and create internet hotspots and charging stations to improve access. Insurers could support these efforts with reimbursements through the Federal Communications Commission’s Lifeline program.
“COVID-19 may pose long-lasting damaging effects on CHCs and the patient populations that they serve,” Kim, Desai and Cole write. “Nonspecific federal and state funding will allow CHCs to survive; however, deliberate action is needed to enhance telehealth capacities and ensure long-term resilience.”
“By reorienting the goals for implementing telehealth, policy makers, payers, and providers can empower health centers to thrive into the future and meet the nation’s underserved patients where they are, even during the pandemic,” they conclude. “In the long run, telehealth can increase access and equity – but only if the right investments are made now to fill the gaps laid bare by COVID-19.”
A group of Senators is seeking more than $200 million in the next coronavirus relief bill to, among other things, expand telehealth programs at home and in schools to help children with behavioral health needs.
– A group of Senators is calling for increased funding for children’s behavioral health services, including telehealth programs, to meet the stresses caused by the coronavirus pandemic.
In a letter to Congressional leadership last week, the Senators asked for more than $200 million to be added to the next COVID-19 relief package, to fund several connected health programs and other efforts to help children at home.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
“Increasing funding for telehealth capacity and community-based care models can help accelerate children’s access to care they need right now,” the Senators wrote. “Telehealth is the mechanism for delivering most services via video and/or audio devices while virus mitigation efforts are in effect, and will likely remain so until providers and the public are confident that risk of virus transmission is minimal.”
The Senators pointed out that children are faced with new and unexpected challenges while schools are closed and they’re isolated at home with family. Because of the ongoing pandemic, they’re separated from friends and other social activities and struggling to comprehend what is happening.
“Improved use of telehealth will increase points of access and continuity for each child and family, allowing for the stronger familiarity, relationships, and trust necessary to achieve better outcomes,” they added. “Increased investment will also enable behavioral health professionals and providers to operate more effectively and be more accessible to match needs with care. Both community and school-based telehealth care models are recommended to address mental health and substance abuse concerns. Recent school closures have prompted a need to increase school-based telehealth services for access in all communities.”
With Congressional debate on the next care package, titled the HEROES Act, moving slowly, lawmakers have been calling attention to the need to support more connected health efforts in the legislation.
Last month, more than 30 House members asked that emergency regulations enacted during the pandemic to encourage telehealth expansion be kept in place “for a reasonable transition period following the COVID-19 emergency period to collect appropriate data to provide an adequate amount of time to determine which of those flexibilities should be continued permanently.”
In last week’s letter, the group of Senators is calling for additional funding for programs run by the Department of Education, Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA).
Their request includes $20 million for the Telehealth Network Grant Program, to expand school- and community-based telehealth networks and training, as well as various amounts for the National Child Traumatic Stress Network (NTCSN), the Children and Families Circles of Care Programs serving American Indian and Alaska Native communities, Project AWARE and the Graduate Psychology Education Program.
More funding would be directed toward Garrett Lee Smith Youth Suicide Prevention grants, pediatric mental healthcare access grants, student support and academic enrichment grants, and substance abuse prevention and mental health grants through children and family programs of regional and national significance.
The letter was signed by US Senators Robert Casey Jr. (D-PA), Chris Murphy (D-CT), Brian Schatz (D-HI), Chris Van Hollen (D-MD), Jacky Rosen (D-NV), Debbie Stabenow (D-MI), Maggie Hassan (D-NH), Kamala Harris (D-CA), Catherine Cortez Masto (D-NV), Chris Coons (D-DE), Elizabeth Warren (D-MA), Jack Reed (D-RI), Tom Carper (D-DE), Dianne Feinstein (D-CA), Tina Smith (D-MN), Edward Markey (D-MA), Richard Blumenthal (D-CT), Ron Wyden (D-OR), Tammy Baldwin (D-WI), Amy Klobuchar (D-MN) and Michael Bennet (D-CO).
The effort isn’t without precedent. In the fall of 2019, more than 60 schools in Florida’s Panhandle region were equipped with telehealth stations to help returning students who’d been affected by Hurricane Michael. And several states have moved to expand telemental health services in schools to address the growing numbers of students needing access to therapy and prevent school violence.
Several South Carolina health systems are offering telehealth options to the public. These options are available to anyone experiencing COVID-19 symptoms in South Carolina. In order to access the free consult, use the promo code COVID19.
Augusta University Health System is offering virtual screenings through video visits with health providers for the Central Savannah River Area, which includes Aiken, Edgefield and McCormick counties in South Carolina. Visitors only need to follow a two-step process to choose a provider and start a video visit.
Coastal Pediatrics is conducting curbside testing in the Lowcountry for children experiencing COVID-19 symptoms. New and existing patients who have a fever, coughing and shortness of breath should call 1-843-573-2535 to schedule an appointment. Curbside testing takes place at Coastal Pediatrics’ West Ashley or Summerville locations.
Cooperative Health, formerly known as Eau Claire Cooperative Health Center, is offering telephone screening for COVID-19. Depending on the results, you may be scheduled to visit a drive-thru testing site in Hopkins, Little Mountain, Pelion or Winnsboro. Call 1-803-722-1822 for a screening; those meeting screening requirements will be scheduled for testing.
Doctors Care is offering a telemedicine drive-thru option in South Carolina through its “Doctors Care Anywhere – Virtual Urgent Care” app. The patient clicks a link to sign up to be seen online by a provider, who can refer them for drive-thru testing (if needed) at Doctors Care’s Cayce, SC location. Doctors Care Anywhere is available 8 a.m. to 7 p.m. Monday – Friday and 9 a.m. to 4 p.m. Saturday and Sunday.
Liberty Doctors is offering COVID-19 screening via telehealth. Based on your screening, we may direct you to one of our locations for COVID-19 testing. Please visit www.libertydoctors.com/telehealth for more information and to request a virtual visit.
Piedmont Family Practice is offering telehealth visits for COVID-19 screening. Depending on the results of your screening, you may be scheduled to visit the facility for COVID-19 testing as supplies are available. This is done in the parking lot as patients wait in their cars. For more information, please visit www.piedmontfp.com or call (864) 845-3331. Office hours are 8 a.m.-1 p.m. and 1 p.m.-5 p.m. weekdays, telemedicine only Saturdays and closed Sundays.
Sandhills Medical Foundation Inc. is offering telephone screening. Depending on the results, you may be scheduled to visit a drive-thru testing site in Camden. Call 1-877-529-4339 to register, for appropriate screening and instructions. Phone lines are open 8 a.m. to 5 p.m. Monday – Friday.
Self Regional Healthcare is offering telephone screening for residents in Greenwood, Laurens, Edgefield, Abbeville, McCormick, Saluda, and Newberry counties. Call the COVID-19 Screening Line at (864) 725-4200.
– It’s been said, rightly and tragically so, that it took a pandemic to prove the value of telehealth to the American healthcare system.
As health systems and hospitals adjust their workflows to deal with the coronavirus pandemic, they’re learning some valuable lessons on how to best use connected health technology. With in-person care reduced to emergencies and an emphasis on keeping patients and providers separated, they’re using telemedicine platforms and mHealth devices – including the telephone – to deliver care.
And they’re planning beyond the COVID-19 crisis, with telehealth front and center.
Expanding – Temporarily – the Telehealth Playing Field
At the onset of the pandemic, state and federal regulators moved quickly to reduce the barriers to telehealth adoption, understanding that these new tools could speed access to care while protecting healthcare workers.
The Centers for Medicare & Medicaid Services (CMS) launched several emergency initiatives that expanded Medicare and Medicaid coverage, including increasing the types of providers able to use telehealth, allowing providers more freedom to use different modalities – such as remote patient monitoring and phone-based services – and expanding the number of sites qualifying for coverage to include homes, federally qualified health centers, and rural clinics.
State regulators added their own emergency directives, expanding Medicaid coverage, enabling more care providers to use telehealth, requiring private payers to cover telehealth services and, in some cases, tweaking the rules to allow out-of-state providers to use telehealth to treat residents and providers in the state to treat residents of other states.
Other federal agencies took action as well. With Congress passing and President Trump signing into law a series of coronavirus relief bills, Washington opened the purse strings for a number of telehealth projects. The Health and Human Services Department dished out a number of grants and awards, while the Federal Communications Commission launched its own $100 million COVID-19 Telehealth Program, aiming to support broadband expansion projects that pushed new telehealth services into rural areas where connectivity isn’t great.
“Telehealth has been the missing element to how we deliver healthcare,” says Mei Kwong, executive director for the Center for Connected Health Policy, one of a handful of organizations that have been keeping track of telehealth use during the pandemic. “But now people are familiar with it. They now have the experience and will want to see it used more often.”
The U.S. Food and Drug Administration has authorized an at-home sample collection kit that can then be sent to specified laboratories for COVID-19 diagnostic testing. Specifically, the FDA issued an emergency use authorization (EUA) to Everlywell, Inc. for the Everlywell COVID-19 Test Home Collection Kit. Everlywell’s kit is authorized to be used by individuals at home who have been screened using an online questionnaire that is reviewed by a health care provider. This allows an individual to self-collect a nasal sample at home using Everlywell’s authorized kit. The FDA has also authorized two COVID-19 diagnostic tests, performed at specific laboratories, for use with samples collected using the Everlywell COVID-19 Test Home Collection Kit. These tests have been authorized under separate, individual EUAs. Additional tests may be authorized for use with the Everlywell at-home collection kit in the future, provided data are submitted in an EUA request that demonstrate the accuracy of each test when used with the Everlywell at-home collection kit.
“The authorization of a COVID-19 at-home collection kit that can be used with multiple tests at multiple labs not only provides increased patient access to tests, but also protects others from potential exposure,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “Today’s action is also another great example of public-private partnerships in which data from a privately funded study was used by industry to support an EUA request, saving precious time as we continue our fight against this pandemic.”
Today’s EUA for the Everlywell COVID-19 Test Home Collection Kit permits testing of a sample collected from inside the patient’s nose using the authorized self-collection kit that contains nasal swabs to collect a sample and a tube filled with saline to transport the sample back to a specified lab. Once patients self-swab to collect their nasal sample, they will ship the sample overnight to a specific CLIA-certified lab that is running one of the in vitro diagnostic molecular tests authorized under a separate EUA for use with the Everlywell at-home sample collection kit. The labs authorized to test specimens collected using the Everlywell at-home collection kit are Fulgent Therapeutics and Assurance Scientific Laboratories. Results will be returned to the patient through Everlywell’s independent physician network and their online portal.
This announcement follows two recent EUAs for diagnostic tests that also use at-home specimen collection: one that uses a sample collected from the patient’s nose with a nasal swab and transported in saline and another that permits testing of a saliva sample collected by the patient at home. Everlywell’s EUA request leveraged data from studies supported by The Bill and Melinda Gates Foundation and UnitedHealth Group to demonstrate stability of specimens during shipping. The data from these studies are freely available to support other EUA requests, alleviating each test developer of the burden of recreating the same study.
The Everlywell home-collection kit is currently the only authorized COVID-19 at-home sample collection kit for use with multiple authorized COVID-19 diagnostic tests. The kit and associated tests are available by prescription only.
Today’s authorization is limited to the Everlywell COVID-19 test for at-home collection of nasal swab specimens for analysis by COVID-19 diagnostic tests specifically authorized under separate EUAs for use with specimens collected with the Everlywell at-home collection kit. It is important to note that this is not a general authorization for at-home collection of patient samples using other collection kits, swabs, media, or tests, or for tests fully conducted at home.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
– With the coronavirus pandemic putting a strain on mental health services, a group of lawmakers is asking Congress to give telehealth more time to prove itself.
In a May 21 letter to Congressional leadership, 32 House members are asking that ongoing emergency efforts to relax telehealth regulations during the pandemic be continued “for a reasonable transition period following the COVID-19 emergency period to collect appropriate data to provide an adequate amount of time to determine which of those flexibilities should be continued permanently.”
The order would be included in the next COVID-19 relief bill, the lawmakers said.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
“Telehealth is proving to be an extremely successful approach in ensuring that patients are receiving mental health and addiction care during this trying and unprecedented time, and we applaud the Centers for Medicare and Medicaid Services (CMS) for expanding behavioral telehealth flexibilities, and ultimately increasing access to these essential services,” the letter states. “In particular, we are grateful that CMS is providing broader coverage of behavioral telehealth services, which has helped expand access to many individuals in rural and medically underserved areas, and allowed individuals to receive these services in their home.”
To meet the rising demand for telemental health services, federal and state agencies have enacted a number of emergency declarations since March to expand access to and coverage of connected health platforms. While expanding the number of providers able to use telehealth and including locations such as the home as distant sites for telehealth, they’ve also expanded coverage to audio-only phone and some video chat platforms that had previously been banned.
These relaxed rules are set to expire when the national emergency is declared over, but there’s a groundswell of support to extend some of the declarations so that the healthcare industry can continue to expand telehealth. Advocates also want more time to build a body of evidence to support telehealth adoption.
“The mental health of each American is vital to the overall health of our nation. Without proper access to care, we are doing a disservice to those most in need,” US Rep. Tom Emmer (R-MN), who drafted the letter with US Rep Paul Tonko (D-NY), said in a press release. “The mental telehealth care offered during the COVID-19 pandemic is an important step towards providing more access and quality care for individuals in need, and it’s important that these services continued to be offered following this high-stress time. Telehealth is the future of health care, and we must begin to integrate it when appropriate in order to serve everyone where they are.”
In particular, the lawmakers are asking that CMS continue to cover audio-only phone services to help people living in areas with poor internet connectivity or without access to smartphones or video-based online platforms.
“Without regular access to behavioral health services, we are concerned that thousands of individuals will be seeking emergency care, with many turning to substance misuse or suicide risks,” the letter concludes. “Telehealth is proving to be a successful means in bridging this gap of care, and it is critical that once the COVID-19 pandemic subsides, access to behavioral health services does not.”
Among those supporting the letter are Mental Health America, the National Association for Behavioral Health, the National Council for Behavioral Health, the American Psychological Association, the American Society of Addiction Medicine and the American Foundation for Suicide Prevention.
Enabling access to care during the pandemic is our main priority at BlueCross BlueShield of South Carolina. According to recent data from the Blue Cross Blue Shield Association, 75% of Americans with behavioral health conditions are continuing therapy services during the COVID-19 pandemic because of the prevalence of telehealth and other digital health services.
“We have seen our members embrace telehealth options when seeking care for mental health conditions and, by adding more than 800 behavioral health providers to our telehealth network, we have significantly expanded our telehealth access to behavioral health services.” — Dr. Matthew Bartels, MD, CPE, FAAP, vice president and chief medical officer at BlueCross BlueShield of South Carolina
– The Federal Communications Commission has approved funding from the COVID-19 Telehealth Program for an additional 43 healthcare providers, though some lawmakers are questioning when any of those providers will get the money.
The latest group of award recipients – the seventh such group – brings the total to 132 providers in 33 states and Washington DC. To date, the FCC has earmarked a little more than $50 million from the $200 billion fund in roughly one month.
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
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