Telehealth claim lines increased 4,347% nationally from March 2019 to March 2020, growing from 0.17% of medical claim lines to 7.52% over that time, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker.
The data represents the privately insured population, excluding Medicare and Medicaid. In an indication that the growth was related to the COVID-19 pandemic, the increase was even greater in the Northeast, where the pandemic hit hardest in March. Telehealth claim lines grew 15,503% in the Northeast, from 0.07% of medical claim lines in March 2019 to 11.07% a year later.
Telehealth had already been growing in recent years, but even faster growth has been predicted as a result of COVID-19. The technology permits healthcare services to be delivered without in-person contact, reducing the risk of disease transmission, and frees up in-person resources for COVID-19 patients. And with fewer elective procedures occurring around the country due to widespread restrictions, the telehealth share of total medical claim lines was expected to increase.
The platform’s growth from February 2019 to February 2020, before the rapid escalation of the pandemic in the U.S., was substantially lower. Nationally, the increase as a percentage of medical claim lines in that period was 121%; in the Northeast it was 174%.
The Northeast was far and away the region that saw the highest increase in telehealth usage, but significant increases also occurred in the West, where the increase as a percentage of medical claim lines was 1,986%. In the Midwest it was 2,842%, and in the South, 3,427%.
WHAT’S THE IMPACT?
Other notable findings from the Tracker concerns diagnoses. From March 2019 to March 2020, acute respiratory diseases and infections decreased as a percentage of telehealth claim lines nationally and in all regions except the West.
In March, there is typically a drop from February in acute respiratory diagnoses as a result of the seasonality of influenza, but this drop from March to March may indicate that many people with acute respiratory symptoms, fearing they had COVID-19, preferred this year to see a physician in person.
Nationally, hypertension was one of the top five telehealth diagnoses in March 2020, whereas it was not in March 2019, or even in February 2020. Increased issues with blood pressure for people with hypertension may be related to increased stress during the pandemic. Another factor may be increased telehealth-monitoring of patients with hypertension so they do not need to go into the physician’s office to be monitored.
THE LARGER TREND
In March, the Centers for Medicare and Medicaid Services allowed for more than 80 additional services to be furnished via telehealth and for providers to bill for telehealth visits at the same rate as in-person visits.
The waivers will expire at the end of the pandemic, but CMS Administrator Seema Verma said recently that some would remain. Also, bipartisan support in Washington for telehealth suggests that some of the changes may become permanent, contingent on new legislation that would have to be crafted and passed by Congress.
⚕#Telehealth has the potential to change the face of health care as we know it – but what about access to remote health care in rural communities? What challenges lie ahead in this sweeping move to #telehealth?
Telehealth is allowing SNFs to provide timely and effective care during the COVID-19 pandemic, but its impact is likely to extend well into the future.
Sponsored by Sound Physicians
– Skilled nursing facilities across the country are using telehealth to reduce costly and unsettling hospitalizations — an essential goal during the coronavirus pandemic. SNFs are also laying the groundwork for improved care management and coordination well after the emergency is over.
Falls Village Skilled Nursing & Rehabilitation in Cuyahoga Falls, Ohio, went live with Tacoma, WA-based Sound Telemedicine in October 2019. Their goal was to reduce a rehospitalization rate of 23.7 percent that was “higher than you’d (our organization) like it to be,” according to Administrator Nick Gulich. Currently– Falls Village has a 21.9% readmission rate for that same patient cohort which is now better than the national rate of 22.3% for Short-term Medicare patients.
“The whole idea with telehealth originally was to reduce readmissions to the hospital,” he says. “The ability to connect with a dedicated physician on off-hours that could assess decompensating patients has proven to be overwhelmingly valuable and has definitely kept many patients from ending up back in the hospitals unnecessarily.”
“With the emergence of the COVID-19 epidemic, it has taken on a whole new level of importance,” Gulich adds. “The ability to reduce exposure from the community while still having the ability to assess the patients virtually has been crucial. I believe this has become a mutually beneficial tool for both the staff at the facility as well as the providers as it makes them more accessible than they ever would have been previously.”
Before using telehealth, the 103-bed, 130-staff facility used the same protocols for patient care that most other SNFs used. When a patient began showing signs of decline, nurses would call for a doctor — literally, during off-hours and weekends.
“We were relying solely on the nurse caring for the patient to call the physician and give as detailed of an update as they could on what was going on,” Gulich explains. “But it’s hard for those attending physicians, especially in the middle of the night, to get the full picture on patients. And many times, they would have been called in too late. Without the doctor being able to lay eyes on the patient or get the full story, plenty of folks would end up going back to the hospital.”
With telehealth, nurses can access a tele-hospitalist, either immediately or by scheduling an online consult for within the hour. A telemedicine cart, equipped with real-time audio-visual capabilities and an mHealth-enabled stethoscope, is wheeled into the patient’s room.
“It has been quite beneficial, even just the access to a dedicated physician so that they (attendings/medical directors) are not being woken up in the middle of the night and caught off guard by this,” Gulich says. “It has certainly prevented numerous residents from going back out to the hospital.”
The telehealth service also ensures that patients who do return to the hospital are there for a good reason. They’ve been seen — virtually — by a tele-hospitalist who has approved transport and is in touch with the Emergency Department to coordinate care. The platform eliminates unnecessary transfers (which are often flagged by CMS for penalties) because the tele-hospitalist can diagnose and treat more patients right at the facility.
According to Gulich, the telehealth service also instills confidence in nurses.
“Nurses very much appreciate the fact that they have dedicated access to a physician on those off-hours,” he says. And “it boosts their assessment skills. They know what to look for a bit better. It has boosted their confidence.”
And that confidence translates into better care management and better clinical outcomes. With the experience of collaborating with a tele-hospitalist, nurses learn how to be better care providers, knowing what to look for and anticipating when a patient might be having problems.
While the primary goal of the telehealth platform is to reduce off-hours hospitalizations, nurses are beginning to use the service for daily care management as well.
“When we first rolled it out, I strictly saw it as an emergency management type of thing, so I have been a little bit surprised to see that more and more,” Gulich says. “Ultimately, most of the encounters are routine management kind of things. If you’re getting more of those addressed promptly, that adds up. With telehealth, they’re able to reach out for more routine types of things that aren’t necessarily emergent. It’s a resource.”
SNF staff can use the technology to get timely answers to questions and better manage day-to-day care. That daily care will be important as Falls Village gets used to telehealth. In the six months since the facility launched a telehealth service, hospitalization rates have decreased and the skilled patient census has inched upwards. More stability translates to better care and better outcomes.
What’s more, hospitals are likelier to do business with facilities such as Falls Village because of that success with telehealth; as a result, SNF administrators can use that as a marketing tool for filling staff openings and becoming a provider of choice for their local hospitals.
“I think the fact that we utilize telemedicine makes us more marketable and appealing to hospitals,” says Gulich.
Among the positive statistics is the SNF’s rehospitalization rate. In the six months that they’ve been using telehealth, the facility has been able to push that rate down to 21.9 percent.
As staff become more accustomed to telehealth, particularly in daily care management, the facility intends to find more ways to use the platform, including access to specialty care services (e.g., mental health, social services, chronic care management). “Utilizing the platform to the fullest extent increases its longevity,” Gulich stresses.
This extended lifespan will be particularly important when the current coronavirus pandemic ends and SNFs run the risk of losing out on Medicare coverage currently included in emergency orders. By proving the value of telehealth, they might be able to persuade lawmakers to extend those benefits or even make them permanent.
“Personally, this is going to be the wave of the future for nursing homes,” Gulich concludes. “It’s going to become the norm that every facility would ultimately have telehealth.”
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.
(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)
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 Federal Communications Commission released a list of healthcare providers that were approved for funding through its COVID-19 Telehealth Program authorized by the CARES Act. Conway Medical Center, formally known as Conway Hospital, is the first hospital in South Carolina to received funding through this program. Click the link below for more details.
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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