News

Ehrhardt, S.C.–Ehrhardt Pharmacy owner and pharmacist Donna Avant, R.Ph., was recently named 2021 Pharmacist of the Year by the South Carolina Pharmacy Association in appreciation for exemplary leadership.

“Donna Avant is truly an extraordinary pharmacist,” said Kathy Schwarting, CEO of Palmetto Care Connections (PCC), a non-profit telehealth network headquartered in Bamberg, S.C. “Donna consistently goes above and beyond to serve the health care needs of Ehrhardt and the surrounding communities not only with prescriptions, but health screenings, chronic disease education and outreach.”

“In 2020, Ehrhardt Pharmacy partnered with PCC to offer telehealth services for their customers,” said Schwarting. “Bamberg Family Practice is currently providing telehealth visits to their patients at Ehrhardt Pharmacy, and Low Country Health Care System as well as S.C. Department of Mental Health plan to begin telehealth services at Ehrhardt Pharmacy soon. The telehealth program is just one example of Donna’s outside of the box thinking and dedication to helping her customers get the health care services they need. On behalf of the PCC Board of Directors and the PCC team, we congratulate Donna on the tremendous honor of being named South Carolina Pharmacist of the Year.”

A graduate of the University of South Carolina College of Pharmacy with a Bachelor of Science degree in Pharmacy, Avant has worked as a pharmacist for more than thirty-three years. Her work history includes pharmacist for Eckerd Drug in Walterboro, S.C.; Wal-Mart Pharmacy, filling where needed at various S.C. locations; Winn Dixie Pharmacy in Hampton, S.C., serving as district manager for more than 35 stores in three states; and pharmacist in charge at Wal-Mart Pharmacy in Barnwell, S.C.

In November of 2013 Avant became the sole owner and operator of Ehrhardt Pharmacy, LLC, a rural independent pharmacy in Ehrhardt, S.C. The pharmacy offers soda fountain with hand-dipped ice cream and home-made milkshakes, gift shoppe, home medical supplies, full-service pharmacy, and drive-thru. In addition, Donna and her staff provide a myriad of community services including: Summer children’s reading/crafting/lunch programs; HIV screenings; immunizations; blood pressure checks; hypertension counseling; free community vitamin program; and lifestyle change classes for individuals with diabetes and pre-diabetes.

For more information about telehealth at Ehrhardt Pharmacy contact the pharmacy staff at 803-267-2121.

Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in S.C. PCC received the National Cooperative of Health Network Association’s 2021 Outstanding Health Network of the Year award.

PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, serving as an advocate for rural providers and partnering with organizations to improve health care access and delivery for all South Carolinians.

July 14, 2021 – The Centers for Medicare & Medicaid Services’ proposed 2022 Physician Fee Schedule offers some good news for telehealth advocates.

The 1747-page draft, released this week, proposes to make permanent some provisions enacted years to address the coronavirus pandemic, while continuing most until at least Dec. 23, 2023 “so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 PHE (Public Health Emergency).”

CMS is proposing to eliminate geographic restrictions on telemental health coverage and to make the patient’s home an originating site, as long as patient and telemental health provider meet in-person within six months of beginning telehealth services and at least once every six months after.

“We are seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology,” the agency said in a press release. “We are also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to furnish a mental health service due to unavailability of the beneficiary’s regular practitioner.”

As for audio-only telehealth, CMS is proposing to amend its requirements for interactive telecommunications systems, which now focus on real-time, two-way, audio-visual telemedicine technology, to include audio-only telehealth when used for the diagnosis, evaluation or treatment of mental health issues in the patient’s home.

“CMS is proposing to limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of using, or does not consent to, the use of two-way, audio/video technology,” the agency said. “CMS is also proposing to require use of a new modifier for services furnished using audio-only communications, which would serve to certify that the practitioner had the capability to provide two-way, audio/video technology, but instead, used audio-only technology due to beneficiary choice or limitations.”

“CMS is also soliciting comment on: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not we should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) any additional guardrails we should consider putting in place in order to minimize program integrity and patient safety concerns,” CMS added.

In addition, CMS plans on expanding Medicare coverage for telemental health services delivered by federally qualified health centers (FQHCs) and rural health clinics (RHCs). Neither are designated by CMS as a distant site practitioner for telehealth, but the agency is proposing to allow coverage for mental healthcare services furnished by real-time telecommunication technology, including audio-only telehealth.

As far as remote patient monitoring coverage goes, CMS said it is “engaged in an ongoing review of payment for E/M visit code sets.” Changes highlighted in the CMS press release don’t factor into RPM coverage, and RPM experts are still poring over the document to ascertain whether more coverage is on the horizon.

Comments on the proposed rules are due by September 13.

A five-year analysis of outpatient visits at a Pacific Northwest health system found that a shift to telehealth helped to dramatically reduce the amount of greenhouse gas emissions.

July 07, 2021 – New research from a trio of healthcare’s heavy hitters indicates telehealth is also good for the environment.

In what’s being billed as the first large-scale study in the US, researchers from Kaiser Permanente, Brigham and Women’s Hospital and Harvard Medical School are reporting that connected health platforms dramatically reduce greenhouse gas emissions, making those services as healthy for the environment as they are for patients.

The study, published online in The Journal of Climate Change and Health, attributes most of the results to the adoption of telehealth during the coronavirus pandemic, when in-person visits dropped sharply and both providers and payers limited their travel time. But the researchers noted that any telehealth service offers an opportunity to reduce stress on the environment.

“The rapid and widespread adoption of telehealth during the COVID-19 pandemic has had significant environmental health benefits, primarily through reduction in transportation-associated emissions,” the study concluded. “If the US healthcare system were to maintain or expand upon current levels of telehealth utilization, additional reductions in GHG emissions would potentially be achieved through impacts on practice design. Ambulatory visit carbon intensity would be an effective way to measure these changes.”

The researchers focused on Kaiser Permanente Northwest serving some 600,000 people in Oregon and southwest Washington. Working with colleagues from BID and Harvard, they tracked transportation-related greenhouse gas (GHG) emissions for outpatient visits – including primary care, specialty care and mental healthcare – from 2015 to 2020. In all, they charted 15.6 million outpatient visits, a 15.9 percent overall and an average increase of 3.2 percent per year.

That all changed with COVID-19, which saw in-person outpatient visits drop 46.2 percent in 2020, while telehealth visits – which had been growing 39.3 percent each year – surged 108,5 percent.

The researchers pointed out that the reduction in GHG emissions isn’t tied to a decline in healthcare visits, since those visits were still happening online. And they said changes in fuel efficiency or transportation mode share would have a minimal effect.

Likewise, the reduction in GHG emissions caused by a shift to telehealth outweighs any increase in emissions associated with the use of telemedicine equipment, either by patients at home or providers at hospitals and medical offices. And the study may even by underestimating GHG emission reductions, as it didn’t account for providers working from home during the pandemic.

As part of the study, the research team developed a new metric that will help future projects measure an outpatient facility’s environmental footprint.

While touted as the largest study of its kind, it isn’t the first to take into account the environmental benefits of telehealth.  Earlier this year, CommonSpirit Health, a Chicago-based network encompassing some 700 care sites and 142 hospitals in 21 states, issued an Earth Day press release estimating that its connected health platform had reduced announce GHG emissions in a year to equal 250,000 trees planted and more than 3,000 cars removed from roadways.

And in 2017, the American Telemedicine Association launched a task force, organized by then-president Peter Yellowlees, to study how telemedicine might be affecting climate change and global warming. The effort was spurred by a study from the University of California at Davis – where Yellowlees is a professor of clinical psychiatry – that found that its telehealth program saved patients and clinicians 5 million miles of travel over 18 years, amounting to about nine years in travel time and $3 million in costs, and helped UC Davis reduce nearly 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides and 5.5 metric tons of volatile organic compounds.

“Telemedicine and health information technology help save time, energy, raw materials (such as paper and plastic), and fuel, thereby lowering the carbon footprint of the health industry,” Yellowlees wrote in a 2010 paper titled Telemedicine Can Make Healthcare Greener. “By implementing green practices, for instance, by engaging in carbon credit programs, the health industry could benefit financially as well as reduce its negative impact on the health of our planet.”

At its June 17 Open Meeting, the Federal Communications Commission (“FCC”) adopted a Second Report and Order for its Connected Care Pilot Program, which provides administrative guidance that will enable award recipients to begin their pilot projects. On the same day, it announced its second set of projects awarded support through the Pilot Program.

The Connected Care Pilot was established in April 2020 to make up to $100 million in Universal Service Fund support available over three years for selected projects to defray costs for projects that will bring broadband connectivity and other connected care information services to eligible health care providers. The program is primarily aimed at supporting services that will benefit veterans and low-income patients. It is a longer term initiative than the short-term COVID-19 Telehealth Program designed to provide financial support for telehealth services, which are expected to remain in demand after the pandemic fully abates.

Second Report & Order

The Second Report and Order, which was released on June 21, 2021, builds on the administrative framework the FCC laid out when it established the Pilot Program and a September 2020 Public Notice that provided initial guidance to applicants. It specifically gives participants guidance on eligible services, funding rules and procedures, and data reporting requirements so they can begin their projects.

• Eligible Services – The FCC previously established that the Pilot Program will cover up to 85% of the costs for eligible services, which include patient broadband Internet access services, health care provider broadband data connections, connected care information services, and certain network equipment. Health care providers are required to cover the remaining 15% of the costs and any ineligible expenses. The Second Report & Order clarifies that the Pilot Program will reimburse network equipment purchases necessary to make already-available broadband services functional and to enable health care providers to make connected care information services functional, even if the Pilot Program is not directly supporting the costs of those services. The equipment must be purchased either because of an increase in Internet traffic caused by the connected care services or because the equipment would be primarily used for connected care information services. This approach is more expansive than the Rural Health Care Program’s reimbursement framework. Pilot Program funds cannot be used to support network deployment, internal connections, or connectivity between health care provider sites, and are also prohibited for end-user connected devices, medical equipment, health care provider administrative costs, personnel costs, and other expenses.
• Funding Rules and Procedures – The Pilot Program’s funding rules and procedures largely mirror those of the Rural HealthCare (“RHC”) Program. Participants need to follow the same competitive bidding rules for the services they are seeking to procure, including rules to ensure the bidding is fair and open and the requirement to select the most cost-effective option. Participants will also need to submit a Request for Funding to the Universal Service Administrative Company (“USAC”), which will evaluate service eligibility and issue a funding commitment decision. Just as with the RHC Program, Pilot Program participants will be able to make site and service substitutions. One notable difference is that the Pilot Program will not follow the typical July 1 to June 30 funding period, and participants will instead need to follow dates and deadlines provided by the FCC or USAC in correspondence or on their websites. The FCC also waived the procedural rule established in the First Report & Order that invoices be submitted monthly, which the agency thought might pose an undue administrative burden for some Pilot Program participants and would be difficult to enforce. Participants can only submit invoices for eligible expenses incurred within three years from the date their projects first begin service and no later than June 30, 2025.
• Data Reporting Requirements – Pilot programs established by the FCC often become permanent if they are successful, and as part of the Connected Care Pilot Program, the FCC will study how connected care can become a permanent part of the Universal Service Fund. To this end, the FCC established three goals for the Pilot Program—determining how USF support can be used to: (1) improve health outcomes through connected care; (2) reduce health care costs for patients, facilities, and the health care system; and (3) support the trend towards connected care everywhere. To help evaluate the Pilot Program, the Second Report & Order directs participants to submit three annual reports to the FCC with anonymized, aggregated data. The final report must summarize final results and include explanations of whether the goals of the participant’s project were met and how the project served the FCC’s Pilot Program goals. The FCC’s Wireline Bureau will use the data to prepare a final report at the conclusion of the Pilot Program.

Award Recipients

The Connected Care Program is open to eligible rural non-profit and public health care providers and such non-rural providers that are part of a consortium, including post-secondary educational institutions, community health centers, local health departments or agencies, community mental health centers, not-for-profit hospitals, rural health clinics, skilled nursing facilities, and consortia of health care providers consisting of one or more of these entities.

From the over 200 Pilot Program applications the FCC received, it has so far awarded over $57 million in funding for 59 pilot projects in 30 states plus Washington, DC, leaving nearly $43 million for future project selections. The FCC announced its initial set of 14 projects, awarding $26.5 million in support, on January 15, 2021, and the second set of 36 projects, requesting $31 million in support, on June 17, 2021. It has prioritized projects that will serve a high number of patients in the veteran and low-income populations, serve areas most in need of support for connected care, treat many of the health conditions targeted by the program, and use products and services eligible for support.