Online Learning Initiative (Mobile Hotspots and Monthly Internet Service)
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.
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.
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.
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.”
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.
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.
The U.S. Department of Health and Human Services’ Health Resources and Services Administration awarded the grant.“The COVID-19 pandemic has certainly changed the way that health care is being delivered, and this grant will help us build on the progress that has been in made and implement telehealth in some innovative ways at rural pharmacies, churches and a tribal community resource center,” CEO Kathy Schwarting said.
Under the grant, PCC will expand its existing rural health network to establish the South Carolina Virtual Access Telehealth Network (SC VATN) by adding rural, independent pharmacies, Medical Ministries Inc., Pine Hill Indian Community Development Initiative and health care providers to the telehealth network services.
The purpose of the project is to expand access to care in the target communities by integrating the functions of network members, staff, and the board of directors to improve population health as well as individual health outcomes.
Network project activities will include: implementing telehealth services; specialty and primary care integration; improving coordination of services; implementing health information technology/exchange; and implementing programs to increase primary care workforce in rural communities.
Expected program outcomes include an improvement in quality of life among chronic disease patients, an improvement in blood pressure control among hypertension patients, an improvement in HbA1c in diabetes patients, and an improvement in knowledge and/or skills among pharmacists and providers.
The SC VATN will consist of 15 members.
Four of the members are rural, independent pharmacies: Ehrhardt Pharmacy in Ehrhardt; Giant Discount Pharmacy in Neeses, R&J Drugs in North; and Lee’s Inlet Apothecare in Murrells Inlet.
One is a non-profit organization, Medical Ministries, Inc., that operates clinics in three rural churches — Good Hope AME Church in Cope, Edisto Fork United Methodist Church in Orangeburg, and Bethel AME Church in St. George.
One is a tribal affiliated community organization, Pine Hill Indian Community Development Initiative.
Other members include Family Health Centers Inc.; CareSouth Carolina; Bamberg Family Practice; MUSC; USC School of Medicine; BlueCross BlueShield of SC; PRISMA Health; South Carolina Hospital Association and South Carolina Office of Rural Health.
Established in 2010, PCC is a nonprofit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in the state.
About Palmetto Care Connections
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
