Letter to MACs About RPM Meeting
The Alliance for Connected Care joined a letter, led by the Connected Health Initiative (CHI).
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Open in new tab Alliance Urges CMS to Preserve Beneficiary Access to Telehealth Services
Action Needed to Align Payment with Congressional Authority
On January 13, 2023, the Alliance for Connected Care sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the implementation of the telehealth provisions in the Consolidated Appropriations Act, 2023.
Some Medicare telehealth codes are currently scheduled to expire 151 days after the expiration of the COVID-19 public health emergency (PHE). While most telehealth codes can simply be extended in the annual calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) rulemaking, the timeline is too rapid to address the issue.
The Alliance requests that CMS issue an interim final rule to implement the date changes as per the Consolidated Appropriations Act, 2023.
To read the letter, see below or click here.
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The Alliance for Connected Care also joined a larger stakeholder letter to CMS to extend the availability of the codes that are temporarily on the Medicare Telehealth Services List to align with the Consolidated Appropriations Act of 2023.
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Background: The randomized INH (Interdisciplinary Network Heart Failure) trial (N = 715) reported that 6 months’ remote patient management (RPM) (HeartNetCare-HF) did not reduce the primary outcome (time to all-cause death/rehospitalization) vs usual care (UC) in patients discharged after admission for acute heart failure, but suggested lower mortality and better quality of life in the RPM group.
Objectives: The Extended (E)-INH trial investigated the effects of 18 months’ HeartNetCare-HF on the same primary outcome in an expanded population (N = 1,022) and followed survivors up to 60 months (primary outcome events) or up to 120 months (mortality) after RPM termination.
Methods: Eligible patients aged ≥18 years, hospitalized for acute heart failure, and with predischarge ejection fraction ≤40% were randomized to RPM (RPM+UC; n = 509) or control (UC; n = 513). Follow-up visits were every 6 months during RPM, and then at 36, 60, and 120 months.
Results: The primary outcome did not differ between groups at 18 months (60.7% [95% CI: 56.5%-65.0%] vs 61.2% [95% CI: 57.0%-65.4%]) or 60 months (78.1% [95% CI: 74.4%-81.6%] vs 82.8% [95% CI: 79.5%-86.0%]). At 60 and 120 months, all-cause mortality was lower in patients previously undergoing RPM (41.1% [95% CI: 37.0%-45.5%] vs 47.4% [95% CI: 43.2%-51.8%]; P = 0.040 and 64.0% [95% CI: 59.8%-68.2%] vs 69.6% [95% CI: 65.6%-73.5%]; P = 0.019). At all visits, health-related quality of life was better in patients exposed to HeartNetCare-HF vs UC.
Conclusions: Although 18 months’ HeartNetCare-HF did not significantly reduce the primary outcome of death or rehospitalization at 60 months, lower 120-month mortality in patients previously undergoing HeartNetCare-HF suggested beneficial longer-term effects, although the possibility of a chance finding remains.
Alliance for Connected Care Executive Director Featured in The Hill
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Krista Drobac, executive director of the Alliance for Connected Care, was featured in The Hill.
See below for an excerpt:
Clock is still ticking on virtual mental health prescribing
Congress acted last month to extend important telehealth flexibilities that will ensure millions of Americans and their providers will continue to have access to telehealth when the COVID-19 public health emergency is officially over. The importance of these policy extensions can’t be overstated. However, there is one remaining critical action item: prescribing for mental health and substance abuse treatment.
Read the full article here.
For more information about the Alliance’s advocacy in this area, see here.
Top Accomplishments 2022
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Building off of the transformation of telehealth access since 2020, the Alliance has continued to drive the advocacy steps needed for permanent telehealth expansion. We are excited to successfully hold on to important expansions and continue progress in 2023.
Alliance Top Accomplishments
1 A temporary two-year extension of all Medicare telehealth in the fiscal year (FY) 2023 Omnibus Appropriations bill was a major Alliance accomplishment. The Alliance has been calling for a two-year extension since 2021 – citing the need to create for predictability for patients and clinicians while we continue to work toward permanent telehealth authorization.
- The Alliance lobbied heavily for this expansion, led numerous advocacy letters with hundreds of signers, and most importantly – built the evidence base needed to support policy action.
- Notably, this expansion also includes a two-year delay of patient-harming in-person requirements on mental health in Medicare.
- On top of all this – it was the second legislative extension this year, expanding upon the short-term extension we secured in the spring of 2022.
2 A crucial two-year extension of commercial market telehealth flexibilities for individuals and families with high deductible health plans coupled with a health savings accounts (HDHP-HSA) allowing employers and health plans have to provide pre-deductible coverage of telehealth services. This policy is a game changer for the 32 million Americans who would otherwise have to think twice about out-of-pocket costs in accessing care.
- The Alliance led other groups on numerous comment letters, supported Congressional member advocacy letters, and continued to build the evidence base for how these important provisions impact individuals and families.
- Progress in this space is particularly notable because major wins in spring 2022 and December 2022 reversed a failure to extend this policy in December 2021.
3 Major progress in advancing cross-state licensure for telehealth and the need to reform outdated licensure laws that impose barriers in access to care for patients. The Alliance continues to be regularly consulted as an authority on these challenges and opportunities to advance them.
- The Alliance helped drive forward a new Model Telehealth Law with the Uniform Law Commission telehealth working group, which published its Uniform Telehealth Act in July 2022.
- The Alliance actively supported a number of state legislative initiatives and made headway on related areas, such as ensuring clinical trials are able to be managed across state lines – which is now recognized as an important access exception by the Federation of State Medical Boards. We are looking forward to significant new wins in 2023.
See here or below for the Alliance’s top accomplishments in 2022.
The Alliance’s expertise was quoted on average of
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Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF)
Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF)
Background: Guidelines recommend early initiation of multiple guideline-directed medical therapies (GDMTs) to reduce mortality/rehospitalization in patients with heart failure and reduced ejection fraction. Understanding GDMT use is critical to improving clinical practice.
Objectives: This study sought to describe GDMT use in Japan, Sweden, and the United States in contemporary real-world settings.
Methods: EVOLUTION HF (Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients: A Multinational Observational Study Based on Secondary Data) is an observational cohort study using routine-care databases. Patients initiating any GDMT within 12 months of a hospitalization for heart failure (hHF) discharge were included. Dapagliflozin (the only sodium-glucose cotransporter-2 inhibitor approved at study onset), sacubitril/valsartan, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were considered separately. Doses and discontinuation were assessed in the 12 months following initiation. Target dose was defined as ≥100% of the guideline-recommended dose.
Results: Overall, 266,589 patients were included. Mean times from hHF to GDMT initiation were longer for novel GDMTs (dapagliflozin or sacubitril/valsartan) than for other GDMTs: 39 and 44 vs 12 to 13 days (Japan), 44 and 33 vs 22 to 31 days (Sweden), and 33 and 19 vs 18 to 24 days (United States). Pooled across countries, proportions of patients who discontinued therapy (not including switches from ACE inhibitor or ARB to sacubitril/valsartan) within 12 months were 23.5% (dapagliflozin), 26.4% (sacubitril/valsartan), 38.4% (ACE inhibitors), 33.4% (ARBs), 25.2% (beta-blockers), and 42.2% (MRAs). Corresponding target dose achievements were 75.7%, 28.2%, 20.1%, 6.7%, 7.2%, and 5.1%, respectively.
Conclusions: Initiation of novel GDMTs is delayed compared with other GDMTs. Few patients received target doses of GDMTs requiring uptitration. Persistence was higher for dapagliflozin than other GDMTs.
Alliance Applauds Inclusion of Major Telehealth Provisions in FY2023 Omnibus Appropriations Bill
The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans. The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both.
The package includes a two-year extension of widely supported Medicare telehealth services that Congress enacted at the start of the pandemic. This extension will provide certainty to beneficiaries and health care providers, along with continued access to these critical virtual care services, while ensuring sufficient time is taken to analyze the impact of telehealth on patient care throughout the pandemic and beyond. With the data currently pouring in, we are confident Congress will have the evidence needed to make telehealth permanent in Medicare two years from now.
The package also includes a two-year extension of the flexibility employers and health plans have to provide pre-deductible coverage of telehealth services for individuals and families with high deductible health plans coupled with a health savings accounts (HDHP-HSA). This policy is a game changer for the 32 million Americans who would otherwise have to think twice about out of pocket costs in accessing care.
Overall, a big win for America’s patients and caregivers. Bravo Congress.
Summary of Key Telehealth Provisions:
See here for bill text, press release, and Labor-HHS summary and explanatory statement. Below is a quick analysis of what was included in this package:
- Sec. 4113: Advancing Telehealth Beyond COVID-19 (pg. 3714) – This section provides a two-year extension of the following Medicare telehealth flexibilities through December 31, 2024:
- Removing Geographic Requirements and Expanding Originating Sites for Telehealth Services
- Expanding Practitioners Eligible to Furnish Telehealth Services
- Expanding Telehealth Services for Federally Qualified Health Centers and Rural Health Clinics
- Delaying the In-Person Requirements Under Medicare for Mental Health Services Furnished Through Telehealth and Telecommunications Technology
- Allowing for the Furnishing of Audio-Only Telehealth Services
- Use of Telehealth to Conduct Face-to-Face Encounter Prior to Recertification of Eligibility for Hospice Care During Emergency Period
- Study on Telehealth and Medicare Program Integrity
- Sec. 4151: Extension of Safe Harbor for Absence of Deductible For Telehealth (pg. 3805) – This section provides a two-year extension of the flexibility allowing employers/plans to provide coverage for telehealth services pre-deductible for individuals with a high-deductible health plan coupled with a health savings account (HDHP-HSA) through December 31, 2024.
For a full summary of telehealth and related provisions in the FY2023 Omnibus package, click here or see below:
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Alliance Supports Members of Congress in Letter Pushing for Extension of HDHP Telehealth
On December 12, 2022, Reps. Schneider (D-IL), Steel (R-CA) and Lee (D-NV) led a bipartisan group of 30 House Members in a letter asking House leadership to extend critical commercial market telehealth flexibilities in the year-end appropriations package. The Alliance for Connected Care worked closely with the Congressional offices on this advocacy effort.
The letter called on Congress to include the extension of the flexibility that allowed health plans and employers to provide pre-deductible coverage of telehealth services for individuals with a high deductible health plan coupled with a health savings account (HDHP-HSA). This provision was included in both the Primary and Virtual Care Affordability Act (H.R. 5541) and the Telehealth Expansion Act (H.R. 5981).
The Alliance has been a leading voice in advocating for the continued extension of this flexibility over the past several years. This policy has meaningfully expanded access to virtual care for a range of critical health services for the 32 million individuals with these plans. Without action by Congress, this flexibility will expire on December 31, 2022.
To read the letter, see below or click here.
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Diabetes Technology: Standards of Care in Diabetes—2023
Diabetes Technology: Standards of Care in Diabetes—2023
The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted.