Digital Health Groups Call on Congress to Extend Telehealth Access
The Alliance for Connected Care, American Telemedicine Association, College of Healthcare Information Management Executives, Connected Health Initiative, eHealth Initiative, Health Innovation Alliance, HIMSS and the PCHAlliance called on Congressional leaders to act to preserve access to telehealth as part of an end of year package.
“While we seek permanent reforms to enable Medicare beneficiaries to continue to access services via telehealth once the COVID-19 public health emergency (PHE) ends, we write today to express our support for provisions, proposed by a bipartisan group of Senators, that would extend temporary telehealth flexibilities until the end of 2021 in an end-of-year package to fund the federal government. We believe this extension is a reasonable policy that will help provide certainty for patients and providers as we work together on permanent reform in 2021.”
“Since many of these needed policies are contingent upon the PHE, millions of Americans risk losing access to vital health care services unless you and your colleagues takes specific actions. Additionally, the continued risk of telehealth flexibilities ending with each subsequent 90-day renewal of the PHE adds additional uncertainty to an already strained health care delivery system. Patients and their health care professionals should not have to worry if they will be able to continue to receive or deliver necessary care.”
Read the Letter to Congressional Leaders on Extending Telehealth Flexbilities 12-11-2020
Milken Institute 2020 Future of Health Summit
Milken Institute 2020 Future of Health Summit, “Realizing the Promise of Telehealth During the Pandemic and Beyond.”
Alliance Executive Director Krista Drobac joined the Milken Institute in a telehealth panel to discuss the rapid shift to telehealth during the COVID-19 pandemic and whether telehealth will allow us to spread access to health services and help foster health equity and narrow the disparities in health outcomes across underserved communities.
Remote Optimization of Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction
Remote Optimization of Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction
Importance: Optimal treatment of heart failure with reduced ejection fraction (HFrEF) is scripted by treatment guidelines, but many eligible patients do not receive guideline-directed medical therapy (GDMT) in clinical practice.
Objective: To determine whether a remote, algorithm-driven, navigator-administered medication optimization program could enhance implementation of GDMT in HFrEF.
Design, setting, and participants: In this case-control study, a population-based sample of patients with HFrEF was offered participation in a quality improvement program directed at GDMT optimization. Treating clinicians in a tertiary academic medical center who were caring for patients with heart failure and an ejection fraction of 40% or less (identified through an electronic health record-based search) were approached for permission to adjust medical therapy according to a sequential titration algorithm modeled on the current American College of Cardiology/American Heart Association heart failure guidelines. Navigators contacted participants by telephone to direct medication adjustment and conduct longitudinal surveillance of laboratory tests, blood pressure, and symptoms under supervision of a pharmacist, nurse practitioner, and heart failure cardiologist. Patients and clinicians declining to participate served as a control group.
Exposures: Navigator-led remote optimization of GDMT compared with usual care.
Main outcomes and measures: Proportion of patients receiving GDMT in the intervention and control groups at 3 months.
Results: Of 1028 eligible patients (mean [SD] values: age, 68 [14] years; ejection fraction, 32% [8%]; and systolic blood pressure, 122 [18] mm Hg; 305 women (30.0%); 892 individuals [86.8%] in New York Heart Association class I and II), 197 (19.2%) participated in the medication optimization program, and 831 (80.8%) continued with usual care as directed by their treating clinicians (585 [56.9%] general cardiologists; 443 [43.1%] heart failure specialists). At 3 months, patients participating in the remote intervention experienced significant increases from baseline in use of renin-angiotensin system antagonists (138 [70.1%] to 170 [86.3%]; P < .001) and β-blockers (152 [77.2%] to 181 [91.9%]; P < .001) but not mineralocorticoid receptor antagonists (51 [25.9%] to 60 [30.5%]; P = .14). Doses for each category of GDMT also increased from baseline in the intervention group. Among the usual-care group, there were no changes from baseline in the proportion of patients receiving GDMT or the dose of GDMT in any category.
Conclusions and relevance: Remote titration of GDMT by navigators using encoded algorithms may represent an efficient, population-level strategy for rapidly closing the gap between guidelines and clinical practice in patients with HFrEF.
Group Letter on DEA Special Telemedicine Registration
The Alliance worked to convene over 80 organizations in a letter to the Drug Enforcement Administration (DEA) calling on the DEA to finalize the special registration for telemedicine. The anticipated registration would enable a practitioner to deliver, distribute, dispense, or prescribe via telemedicine a controlled substance to a patient who has not been medically examined in-person by the prescribing practitioner.
Special registration to prescribe controlled substances through telemedicine was originally called for in the Ryan Haight Act of 2008.
View the letter.
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Open in new tab CMS Survey of Medicare Beneficiaries During COVID-19
CMS released a survey of Medicare beneficiaries during COVID-19
According to the survey, the most common type of forgone care because of the pandemic was dental care (43%), followed by regular check-up (36%), treatment for ongoing condition (36%), and diagnostic or medical screening test (32%). The most common reason cited for forgoing care was not wanting to risk being at a medical facility (45%).
In addition to forgone care and preventative health behaviors, the survey asked about the impact of the pandemic on daily life and well-being, availability of telemedicine appointments, access to technology, and sources of information about the pandemic.
Of beneficiaries who have a usual health care provider:
- 60% reported that this provider currently offers telephone or video appointments.
- 58% reported that their provider offers both telephone and video appointments
- 22% reported that their provider offered telemedicine appointments before the pandemic
- 57% reported that their provider offered a telemedicine appointment to replace an appointment during the pandemic
An infographic with a snapshot of the survey results is here. A link to the public use file detailing the survey results is here.
Cardiovascular Events and Costs With Home Blood Pressure Telemonitoring and Pharmacist Management for Uncontrolled Hypertension
Cardiovascular Events and Costs With Home Blood Pressure Telemonitoring and Pharmacist Management for Uncontrolled Hypertension
Abstract
Uncontrolled hypertension is a leading contributor to cardiovascular disease. A cluster-randomized trial in 16 primary care clinics showed that 12 months of home blood pressure telemonitoring and pharmacist management lowered blood pressure more than usual care (UC) for 24 months. We report cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, hospitalized heart failure, coronary revascularization, and cardiovascular death) and costs over 5 years of follow-up. In the telemonitoring intervention (TI group, n=228), there were 15 cardiovascular events (5 myocardial infarction, 4 stroke, 5 heart failure, 1 cardiovascular death) among 10 patients. In UC group (n=222), there were 26 events (11 myocardial infarction, 12 stroke, 3 heart failure) among 19 patients. The cardiovascular composite end point incidence was 4.4% in the TI group versus 8.6% in the UC group (odds ratio, 0.49 [95% CI, 0.21-1.13], P=0.09). Including 2 coronary revascularizations in the TI group and 10 in the UC group, the secondary cardiovascular composite end point incidence was 5.3% in the TI group versus 10.4% in the UC group (odds ratio, 0.48 [95% CI, 0.22-1.08], P=0.08). Microsimulation modeling showed the difference in events far exceeded predictions based on observed blood pressure. Intervention costs (in 2017 US dollars) were $1511 per patient. Over 5 years, estimated event costs were $758 000 in the TI group and $1 538 000 in the UC group for a return on investment of 126% and a net cost savings of about $1900 per patient. Telemonitoring with pharmacist management lowered blood pressure and may have reduced costs by avoiding cardiovascular events over 5 years. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00781365.
Help Protect Telehealth Access for Our Seniors – Urge your Representatives to Cosponsor H.R. 7663
Ask your Member of Congress to support and cosponsor commonsense legislation that would ensure Medicare beneficiaries may continue to access care through telehealth after the current health crisis has passed. The Protecting Access to Post-COVID-19 Telehealth Act of 2020 (H.R. 7663) would do just that.
For too long, outdated and overly burdensome restrictions in Medicare have severely limited access to telehealth services for our seniors and vulnerable populations. When the COVID-19 pandemic hit and in-person care was not an option for many patients, particularly the most vulnerable populations, Congress permitted providers to deliver care via telehealth on a temporary basis – providing a lifeline to patients and providers. Throughout the pandemic, health care systems, providers, and the federal government have invested time and resources in telehealth to ensure patients can continue to receive necessary care in a safe and effective manner.
There is no longer doubt that clinicians and patients benefit from telehealth – for many it has been the only safe means to access vital care. However, our seniors will again lose access to this important service unless Congress takes decisive action and makes these changes permanent.
Back in June, AdvaMed, the Alliance for Connected Care, American Telemedicine Association, eHealth Initiative, Health Innovation Alliance, HIMSS, and PCHAlliance led 340 healthcare organizations in a letter urging Congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. This legislation is our best chance to achieve these goals.
Now we need your help to protect the critical gains. We must continue to ensure access to quality care. Tell Congress we can’t go back and ask your Member of Congress to cosponsor bipartisan legislation that makes these important changes permanent.
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Taskforce on Telehealth Policy Issues Final Report
Taskforce on Telehealth Policy Issues Final Report
View the report here.
Twenty-three of the nation’s leading healthcare experts released their much-anticipated final report on Tuesday, September 15, identifying challenges and opportunities for telehealth in the wake of the COVID-19 pandemic. The Taskforce on Telehealth Policy, convened by the National Committee for Quality Assurance, the Alliance for Connected Care, and the American Telemedicine Association, spent the summer building consensus among its members on a comprehensive set of findings and recommendations.
Taskforce members – representing a broad spectrum of health plans, providers, consumer advocates and health quality experts from the public, private and non-profit sectors – see the report as a blueprint for how policymakers can harness the rapid expansion of telehealth and create lasting healthcare improvements that prioritize patient safety, quality, and equitable access to care.
“This report sets the stage for the clear, decisive action from policymakers,” said Krista Drobac, Executive Director of the Alliance for Connected Care. While there is a need for continued data collection and thoughtful regulation, this report demonstrates that both patients and clinicians agree that remote care options should remain available after the public health emergency comes to an end.”
The Alliance for Connected Care is proud to be partnering with NCQA and the American Telemedicine Association to launch the Taskforce on Telehealth Policy to develop recommendations to Congress on permanent telehealth policy. View background on the initiative.
CY 2021 Proposed Physician Fee Schedule and White House Executive Order on Improving Rural Health and Telehealth Access
HHS released the Calendar Year 2021 Physician Fee Schedule (PFS), which makes payment and policy changes under Medicare Part B for physicians, with significant telehealth provisions included. Also, the White House Issued an Executive Order on Improving Rural Health and Telehealth Access.
Physician Fee Schedule
Please find our summary of the PFS here.
Please find some topline elements and links below.
- Press release
- Fact sheet
- Quality Payment Program Fact sheet
- Medicare Diabetes Prevention Program (MDPP) Fact sheet
- Proposed rule
Telehealth Codes
For CY 2021, CMS is proposing to add the following list of services to the Medicare telehealth list on a Category 1 basis. Services added to the Medicare telehealth list on a Category 1 basis are similar to services already on the telehealth list:
| Service Type | HCPCS Code |
|---|---|
| Visit complexity inherent to evaluation and management associated with primary medical care services that serve as the continuing focal point for all needed health care services | GPC1X |
| Group psychotherapy (other than of a multiple-family group) | 90853 |
| Neurobehavioral status exam | 96121 |
| Prolonged office or other outpatient evaluation and management service(s) | 99XXX |
| Assessment of and care planning for a patient with cognitive impairment | 99483 |
| Domiciliary or rest home visit for the evaluation and management of an established patient. Typically, 15 minutes are spent with the patient and/or family or caregiver | 99334 |
| Domiciliary or rest home visit for the evaluation and management of an established patient. Typically, 25 minutes are spent with the patient and/or family or caregiver | 99335 |
| Home visit for the evaluation and management of an established patient. Typically, 15 minutes are spent face-to-face with the patient and/or family. | 99347 |
| Home visit for the evaluation and management of an established patient. Typically, 25 minutes are spent face-to-face with the patient and/or family. | 99348 |
Additionally, CMS is creating a third temporary category of criteria for adding services to the list of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the public health emergency (PHE) for the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends.
RPM Services
- CMS is clarifying that following the PHE for the COVID-19 pandemic, we will again require that an established patient-physician relationship exist for RPM services to be furnished.
- CMS is proposing to clarify that RPM services are considered to be evaluation and management (E/M) services.
- CMS is clarifying that only physicians and NPPs who are eligible to furnish E/M services may bill RPM services.
- CMS is clarifying that practitioners may furnish RPM services to patients with acute conditions as well as patients with chronic conditions.
Direct Supervision by Interactive Telecommunications Technology
- In the CY 2021 PFS proposed rule, CMS is proposing to allow direct supervision to be provided using real-time, interactive audio and video technology (excluding telephone that does not also include video) through December 31, 2021.
Executive Order on Improving Rural Health and Telehealth Access
Key Provisions Include:
- Launching an Innovative Payment Model to Enable Rural Healthcare Transformation. Within 30 days of the date of this order, the Secretary of HHS (Secretary) will announce a new model, pursuant to section 1115A of the Social Security Act (42 U.S.C. 1315a), to test innovative payment mechanisms in order to ensure that rural healthcare providers are able to provide the necessary level and quality of care. This model should give rural providers flexibilities from existing Medicare rules, establish predictable financial payments, and encourage the movement into high-quality, value-based care. (CMMI MODEL)
- Investments in Physical and Communications Infrastructure. Within 30 days of the date of this order, the Secretary and the Secretary of Agriculture shall, consistent with applicable law and subject to the availability of appropriations, and in coordination with the Federal Communications Commission and other executive departments and agencies, as appropriate, develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.
- Improving the Health of Rural Americans. Within 30 days of the date of this order, the Secretary shall submit a report to the President, through the Assistant to the President for Domestic Policy and the Assistant to the President for Economic Policy, regarding existing and upcoming policy initiatives to: (a) increase rural access to healthcare by eliminating regulatory burdens that limit the availability of clinical professionals; (b) prevent disease and mortality by developing rural specific efforts to drive improved health outcomes; (c) reduce maternal mortality and morbidity; and (d) improve mental health in rural communities.
- Expanding Flexibilities Beyond the Public Health Emergency. Within 60 days of the date of this order, the Secretary shall review the following temporary measures put in place during the PHE, and shall propose a regulation to extend these measures, as appropriate, beyond the duration of the PHE:
- (a) the additional telehealth services offered to Medicare beneficiaries; and
- (b) the services, reporting, staffing, and supervision flexibilities offered to Medicare providers in rural areas.
Telehealth Guidance Documents for Commercial Health Plans
Commercial Plan Guidance from the Centers for Medicare and Medicaid Services
Commercial health plans have also taken broad actions to increase access to telehealth services during the COVID-19 public health emergency. View AHIP’s list of ways health insurance providers are taking action to respond to COVID-19.
CMS has issued sets of FAQs encouraging states and private health insurance issuers to increase access to telehealth services. For example, CMS is not taking action against any health insurance issuer that modifies its product to provide greater coverage for telehealth services or reduces or eliminates cost-sharing requirements for telehealth, even if those services are not related to COVID-19. Issuers in the individual and group markets are generally not permitted to modify a health insurance product mid-year.
- April 27 – FAQs on Telehealth and HHS-Operated Risk Adjustment for Individual and Small Group Health Insurance Health Plans – Updated August 3
- March 24 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease
- March 12 FAQs on Essential Health Benefit Coverage and the Coronavirus
Guidance for Expanded Telehealth Flexibility for those using HSA-Eligible High-Deductible Health Plans
Section 3701 of the CARES Act provides a temporary safe harbor for providing coverage for telehealth and other remote care services. As added by the CARES Act, it allows HSA-eligible HDHPs to cover telehealth and other remote care services without a deductible or with a deductible below the minimum annual deductible. Section 3701 of the CARES Act also amends the Code to include telehealth and other remote care services as categories of coverage that are disregarded for purposes of determining whether an individual who has other health plan coverage in addition to an HDHP is an eligible individual who may make tax-favored contributions to his or her HSA. Thus, an otherwise eligible individual with coverage under an HDHP may also receive coverage for telehealth and other remote care services outside the HDHP and before satisfying the deductible of the HDHP and still contribute to an HSA.