Alliance News2021-05-05T14:08:38-04:00

Encore Healthcare: Encore Healthcare Announces Staggering Results in New Nexus TeleRespiratory Care Pilot

Encore Healthcare announced results from their new oxygen and nebulizer management Nexus TeleRespiratory Care model. Encore has used its over 20 million data points from chronic respiratory failure patients on home ventilation to build a predictive model that allows Home Medical Equipment (HME) providers to identify when patients need services before they end up in the hospital multiple times. In the initial pilot with a national HME provider Encore identified 12.5% of patients on oxygen/nebulizers needed additional services. The results are an example of how data can drive better patient outcomes and revenue to HME providers at the same time.

https://www.encorehc.com/post/encore-healthcare-announces-staggering-results-in-new-nexus-telerespiratory-care-pilot

June 11th, 2021|

Deloitte: 2021 Connectivity and Mobile Trends Survey

Deloitte: 2021 Connectivity and Mobile Trends Survey

Deloitte’s latest survey of more than 2,000 individuals found widespread satisfaction with telehealth — with some reservations. Eighty-two percent of respondents who went on a virtual visit said they were satisfied with the experience; respondents liked the ease of getting appointments and reduced risk of catching coronavirus. In contrast, 28 percent of respondents felt the experience lacked the human touch; 21 percent said doctors couldn’t collect vital statistics; and 17 percent cited connectivity issues.

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June 9th, 2021|

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey

COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic from a National Survey 

Summary: The purpose of this study was to describe the challenges and adaptations by HBPC practices made during the first surge of the COVID-19 pandemic. Seventy-nine practices across 29 states were included in the final analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices pivoted to new use of video visits (76.3%).

Discussion
In a large, geographically diverse sample of HBPC practices, we identified significant challenges faced due to COVID-19 and the rapid adaptation of processes, staffing, and workflow to accommodate these challenges irrespective of practice size. The pandemic led to more than 87% of practices reporting being under some level of strain. The majority of practices continued to see patients in the home.

The Challenges and Adaptations
Practices reported limited access to patients (self-imposed, access prevented by facilities, patients, or caregivers); workflow disruptions (work from home); adoption of new care modalities (telehealth); increased patient vulnerability (isolation, reluctance, heightened sensory issues); and emotional impact on staff (COVID-related fears, death of patients, understaffing, burden of new modalities of work). The most impactful practice challenges were technical difficulties reaching patients, managing both patient and clinician anxiety, and navigating supply chain shortages. Practices adapted quickly to the new challenges by reducing the number of in-person visits while increasing the use of telemedicine, adopting new infection control measures, and addressing the needs of both patients and staff with creative sharing of health system resources, tapping community-based services to support the nutritional and social needs of patients, and providing new training and support for staff. Findings from our study mirror many of the adaptations described by HBPC providers in New York City.9,12 The emotional toll of the pandemic on both practice staff and patients was high. Clinician anxiety was reported by more than 69% of practices, and perceptions of patient anxiety by clinicians was even higher. Home-based clinicians used to adapting to the unpredictable work environment of the home now faced new workflows, loss of staff and the pressure of patient visit prioritization amid personal concerns of getting or transmitting COVID-19. Practices observed increased social isolation, loneliness, and fear compounded by a reluctance to allow people into their homes. Sensory issues were exacerbated by the use of PPE and video communication. Clinicians reported increases in rates of decline and death at home and highlighted the additional challenges faced by patients and caregivers of those with dementia.

Silver-Linings
Despite the clear negative impact of the pandemic, many COVID-19 “silver linings” emerged. Although not a comparison between home- and office-based care, HBPC may have been better positioned than traditional office-based care to pivot and adapt to COVID-19 because of an established access-path to patients, strong pre-existing interactions with the community, and connections with community-based service providers. Some practices reported a new recognition by health system leadership of the critical role HBPC care plays in caring for vulnerable older adults and keeping them out of the ED or hospital. Indeed, recent literature advocates for a more integrated role for home-based medical care.13,14 The expansion of telemedicine may allow some HBPC clinicians to increase patient panels by reducing travel time to and between visits. Collaborations with health systems and health departments increased, fostering better access to supplies and workforce and targeted outreach to at-risk groups. Partnerships with health departments and health systems have the potential to foster ongoing benefit to patients if they result in increased access to vaccines and a natural delivery channel for vaccine distribution.15 Increased partnerships with community organizations facilitated identification of those at risk of food insecurity, caregiver burnout, and medication shortages and resulted in shared efforts to better support homebound patients. Although health system affiliation could have contributed to less agility to COVID-19 response, we did not see these differences among those who responded to the survey.

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June 8th, 2021|

Maturing Virtual Care In Tribal Communities

Maturing Virtual Care In Tribal Communities 

Philips Healthcare and the eHealth Initiative and Foundation (eHI) released a report which addresses the digital health challenges faced by tribal communities, including existing data gaps, funding sources, and the digital divide. Although some 60-70 percent of health care services in tribal communities are telehealth visits, significant connectivity challenges exist in rural areas due to poor infrastructure for cell and internet services, in addition to lack of electricity and running water in many residences.

Read the full report here and below

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June 8th, 2021|

How leaders are leveraging telehealth to achieve their strategic plan

More than convenience: How leaders are leveraging telehealth to achieve their strategic plan

In early 2021, AvaSure partnered with Modern Healthcare Custom Media to survey healthcare leaders about their organizations’ use of telehealth technology in acute care and inpatient facilities. The survey contained several questions asked in a similar study in 2018. Responses from 173 executives paint a picture of how telehealth is currently being utilized at health systems, how that compares to the past, and how executives expect to utilize the technology in the years ahead.

Telehealth is being used to supplement care and support hard-to-recruit specialties

When asked how telehealth is being currently used at their organization, more leaders cited telepsychiatry than any other specialty. Fifty percent of leaders said their organization has a telepsychiatry program—a significant increase from 35 percent in our 2018 survey.

Other top telehealth uses cited in our 2021 survey include teleradiology (45 percent), telestroke (40 percent), tele-ICU (26 percent) and TeleSitting (26 percent).

Access, safety and workforce are key reasons for telehealth investment

When leaders were asked what telehealth services they plan to add in the next year, more leaders mentioned TeleSitting than any other service, with 19 percent of respondents noting that they are planning to implement the technology. The other top responses for future investment matched the top four uses cited by respondents for current use: telepsychiatry (17 percent), telestroke (16 percent), teleradiology (14 percent) and tele-ICU (14 percent). When asked about the top drivers of their telehealth purchasing decisions in 2021, leaders’ top responses were improving provider-to-patient access (52 percent), patient safety (43 percent), access to specialists (43 percent), workforce efficiencies (30 percent) and the caregiver shortage (26 percent). A majority of respondents said they plan to make some type of telehealth purchase in 2021.

Telehealth’s emerging role in health system enterprise strategy

When asked whether they agree that they are “pleased with the level of analytics and data [they] have regarding telehealth visits,” only 15 percent of respondents strongly agreed, compared to 32 percent who agreed. A notable 37 percent said they neither agree nor disagree with the statement, and 15 percent disagreed or strongly disagreed.

While our 2018 survey found that the majority of telehealth purchases were decided by the CNO (60 percent) and CMO (51 percent), the variety of leaders involved in these decisions has since shifted. The CEO and CFO went from being telehealth decisionmakers at only two to three percent of health systems in 2018 to over 40 percent of health systems in 2021. The top five decisionmakers cited in the 2021 survey included the CMO (55 percent), CNO (53 percent), CEO (45 percent), CFO (43 percent) and CIO (42 percent). The inclusion of more c-level executives in these decisions—especially the CEO and CFO—points to the newfound significance of telehealth to health systems’ long-term goals and overall strategies.

What is needed to evolve telehealth into a strategic asset

  1. Involve the C-suite and make telehealth an enterprise-level priority: As mentioned, an increasing variety of executives are involved in the telehealth purchasing process, and for good reason. If telehealth is the future of care, then it must have the buy-in and consideration of the highest leaders at hospitals and health systems. Health systems and hospitals should create a high-level executive position that is responsible for virtual care and ensure it reports to the C-suite, if not the CEO.
  2. Leverage telehealth to tackle the biggest challenges and the most promising opportunities: Telehealth has significant promise in its ability to both ease the burden on existing providers and support expansion of services that would otherwise be difficult to staff in person. As leaders look to implement telehealth in more acute-care settings, they should consider where clinical staff are most strained, where outcomes can be improved and where opportunity exists for additional revenue. For example, telepsychiatry is a high-demand specialty where hospitals may be able to provide billable services that they otherwise wouldn’t be able to offer. TeleSitting, teleradiology and tele-ICU similarly offer significant opportunity in their ability to improve the quality and productivity of patient care, while allowing bedside clinicians to focus on the most complex cases.
  3. Don’t cut corners in the purchasing process—buy the best-in-class products that fully serve organizational needs: It can be tempting to seek out an “all-in-one” solution, but bundled systems won’t always offer the level of sophistication or support needed. Leaders should seek out products that are customizable and directly solve for their most pressing challenges. There are sophisticated technology and services on the market that can help integrate disparate devices and ensure that they are reliable and fully addressing the needs of patients and clinicians.
  4. Harness the power of data to improve care efficiency and quality: Leaders should ensure that their telehealth platforms are collecting and analyzing data regarding clinical care and operations. Data on indicators such as utilization, productivity and staff responsiveness can support key business decisions that can shape the future of an organization.

 

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June 4th, 2021|

Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era

The Milbank Quarterly: Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era

This study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene’s Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020. While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. The report concludes that to ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.

Policy Points:

  • Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode.
  • Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic.
  • Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities.
  • To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
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June 2nd, 2021|

American Psychiatric Association: 2021 Public Opinion Poll: Access to Care

American Psychiatric Association: 2021 Public Opinion Poll: Access to Care

A new national public opinion poll of U.S. adults by the American Psychiatric Association (APA), finds that expansion of telehealth is welcomed by most Americans. A large portion of the population have used telehealth services; more than half say they would use telehealth for mental health services; and more than one in three say they prefer telehealth.

  • Nearly four in ten Americans (38%) have used telehealth services to meet with a medical or mental health professional, up from 31% in the fall of 2020. Among those using telehealth services, the vast majority have used the services since the start of the pandemic (82%). Most survey respondents are using telehealth through a video format (69%), while 38% have used phone calls only.
  • Though telehealth services have become widely used during the pandemic, according to the survey, difficulties scheduling mental health appointments has been a problem for many Americans. One in three survey respondents who have sought to make an appointment for mental health services say they had difficulty scheduling an appointment in the past several years. African Americans and Hispanics were more likely than whites to have had difficulty, and younger adults were more likely than older adults to have had trouble scheduling an appointment.

“The quick pivot to providing telehealth services at the start of the pandemic was vital to providing continued access to care, and this poll shows the important potential role for telehealth going forward,” said APA President Vivian Pender, M.D. “Telepsychiatry especially helps those facing barriers such as lack of transportation, the inability to take time off work for appointments, or family responsibilities.”

“Continued access to telehealth during and after the pandemic is vital, and the poll indicates increasing public support for it,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “As we continue to face the long tail of the pandemic, we have an opportunity to innovate and continue to improve access through telehealth.”

Other findings:

APA-Poll-May-26----nearly-6-in-10.png

  • Perception of the quality of telehealth services has improved over the last year. Survey respondents are slightly more likely this year than last to say that telehealth services can offer the same quality care as in-person services (45% up from 40%).
  • The percentage of Americans saying they would use telehealth services for mental healthcare increased from 49% in 2020 to 59% in 2021. Younger adults were more likely to say they would use telehealth for mental health services (66% of 18-29-year-olds) compared to older adults (36% of those 65 and older). Similar percentages of Blacks, Hispanics and whites said they would use telehealth services for mental healthcare (between 58% and 61% each).

APA-Poll-May-26----43--telehealth.png

  • 43% of adults surveyed say they want to continue using telehealth services when the pandemic is over. More than one in three adults (34%) say they would prefer telehealth service to an in-person doctor’s office visit, up from 31% in 2020. Among younger adults, ages 18 to 44, 45% would prefer telehealth service to in-person visits.
  • A majority of Americans surveyed say they are receptive to using a support line or an online chat during a time of personal difficulty and mental anxiety. This refers to use of a confidential, free service offering conversation, emotional support and information before a crisis develops. Fifty-seven percent would consider using a support line or online chat––in addition to the 7% who have already used one. Only 21% say they would not consider using one.

More on the poll:

See the full results of the poll. The new findings come from an APA-sponsored online survey conducted March 26 – April 5, 2021, among a sample of 1,000 adults 18 years of age and older. The equivalent margin of error is +/-3.1 percentage points. Additional polling information available: more from the 2021 polling and information from polls in October 2020 and prior years.

May 27th, 2021|

Federal Government Continues to Push False Narrative Regarding Telehealth Fraud

PUBLIC STATEMENT
May 26, 2021

 Today, the Department of Justice (DOJ) issued a statement consistent with the federal government’s record of falsely creating the impression that telehealth is uniquely vulnerable to criminal behavior. No federal regulator or oversight body has yet issued a comprehensive study of telehealth claims during the pandemic, yet the agencies continue to send out charged statements with misleading headlines.

The reality is that the majority of instances of fraud highlighted by DOJ today in its “2021 National COVID-19 Health Care Fraud Takedown” have nothing to do with telehealth. The one case of alleged fraud billed as telehealth-related by the DOJ represents behavior that just as easily occurs in in-person settings.  The HHS OIG has previously clarified that tele-fraud does not constitute telehealth fraud, and that their work to examine telehealth continues.

Over the first eight months of the pandemic, utilization of telehealth services in Medicare FFS sharply increased from about 325,000 services in mid-March to a peak of nearly 1.9 million services in late-April. As people began going back to in-person appointments, utilization of telehealth dropped. In early June there were 1.3 million billed telehealth services and the number of visits declined through mid-October.

These visits represent billions of Medicare dollars appropriately spent on telehealth visits. In today’s notice, DOJ indicates that it has uncovered $550,000 associated with false telehealth claims during the COVID-19 pandemic, which were associated with a broader scheme related to unnecessary genetic screenings. That represents an impossibly small fraction of a fraction of a percent of the total dollars appropriately spent on care for Medicare beneficiaries – providing treatments necessary during the pandemic, ensuring continued access to primary care, behavioral health, chronic disease management Imagine the secondary health catastrophe we would be facing right now if all Medicare beneficiaries had forgone chronic disease management services for an entire year.

To put these findings into further context, during the 2019 fiscal year, the Federal Government won or negotiated over $2.6 billion in judgments and settlements in health care fraud cases and proceedings. The level of telehealth fraud identified today does not seem to rise to the level of the “National Rapid Response Strike Force.”

Finally, contrary to the popular perception that there are many unscrupulous telehealth providers setting up shop to bilk Medicare, in a large survey conducted by the COVID-19 Taskforce, 83% of seniors saw their own doctor by telehealth. Eight percent saw a doctor in their provider’s practice, and 1.4% saw a provider recommended by their insurer. A mere 1% saw a doctor through an app or online service that they identified themselves. This hardly constitutes telehealth “mills” turning out false claims.

The Alliance for Connected Care continues to support efforts to root out health care fraud across all modalities, including telehealth and virtual care. To date, neither DOJ nor HHS OIG nor any other oversight body has identified a pattern of fraudulent behavior unique to telehealth as a modality of care.

We urge policymakers to read the fine print on these cases and develop interventions that are an appropriate level of response to the fraud challenges identified.

May 26th, 2021|

FAIR Health – Monthly Telehealth Regional Tracker

The Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving on a monthly basis. Selecting a month and clicking on one of the four US census regions in the map below will display an infographic on telehealth in that month in that region. Clicking on national statistics will display an infographic for the nation as a whole. Each infographic includes a 2019 vs. 2020 comparison for that month of telehealth’s:

  • Volume of claim lines;
  • Urban vs. rural usage;
  • Top five procedure codes; and
  • Top five diagnoses.

One month can be compared to another month, and regional statistics for each month can be compared to national statistics for that month.

View the data here: https://www.fairhealth.org/states-by-the-numbers/telehealth?national-month=apr-2020

May 26th, 2021|

Patient experience of telemedicine for headache care during the COVID-19 pandemic: An American Migraine Foundation survey study

Patient experience of telemedicine for headache care during the COVID-19 pandemic: An American Migraine Foundation survey study

The American Migraine Foundation (AMF) designed a standardized electronic questionnaire to assess the patient experience of telemedicine for headache care between March and September 2020 to help inform future quality improvement as part of its patient advocacy initiative. The study demonstrated that telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates, and a desire to continue to use telemedicine for future headache care among those who completed the online survey.

Objective: We sought to investigate the patient experience of telemedicine for headache care during the coronavirus disease 2019 (COVID-19) pandemic.

Background: The use of telemedicine has rapidly expanded and evolved since the beginning of the COVID-19 pandemic. Telemedicine eliminates the physical and geographic barriers to health care, preserves personal protective equipment, and prevents the spread of COVID-19 by allowing encounters to happen in a socially distanced way. However, few studies have assessed the patient perspective of telemedicine for headache care.

Methods: The American Migraine Foundation (AMF) designed a standardized electronic questionnaire to assess the patient experience of telemedicine for headache care between March and September 2020 to help inform future quality improvement as part of its patient advocacy initiative. The date parameters were identified as the emergence of severe acute respiratory syndrome coronavirus 2 disease and the declaration of a national emergency in the United States. The questionnaire was distributed electronically to more than 100,000 members of the AMF community through social media platforms and the AMF email database.

Results: A total of 1172 patients responded to our electronic questionnaire, with 1098 complete responses. The majority, 1081/1153 (93.8%) patients, had a previous headache diagnosis prior to the telemedicine encounter. A total of 648/1127 (57.5%) patients reported that they had used telemedicine for headache care during the study period. Among those who participated in telehealth visits, 553/647 (85.5%) patients used it for follow-up visits; 94/647 (14.5%) patients used it for new patient visits. During the telemedicine encounters, 282/645 (43.7%) patients were evaluated by headache specialists, 222/645 (34.4%) patients by general neurologists, 198/645 (30.7%) patients by primary care providers, 73/645 (11.3%) patients by headache nurse practitioners, and 21/645 (3.2%) patients by headache nurses. Only 47/633 (7.4%) patients received a new headache diagnosis from telemedicine evaluation, whereas the other 586/633 (92.6%) patients did not have a change in their diagnoses. During these visits, a new treatment was prescribed for 358/636 (52.3%) patients, whereas 278/636 (43.7%) patients did not have changes made to their treatment plan. The number (%) of patients who rated the telemedicine headache care experience as “very good,” “good,” “fair,” “poor,” and “other” were 396/638 (62.1%), 132/638 (20.7%), 67/638 (10.5%), 23/638 (3.6%), and 20/638 (3.1%), respectively. Detailed reasons for “other” are listed in the manuscript. Most patients, 573/638 (89.8%), indicated that they would prefer to continue to use telemedicine for their headache care, 45/638 (7.1%) patients would not, and 20/638 (3.1%) patients were unsure.

Conclusions: Our study evaluating the patient perspective demonstrated that telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates, and a desire to continue to use telemedicine for future headache care among those who completed the online survey.

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May 21st, 2021|
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