Patients and Practitioners Agree – Telehealth Is Important for Patient Access, Health Care Workforce
Patients and Practitioners Agree – Telehealth Is Important for Patient Access, Health Care Workforce
FOR IMMEDIATE RELEASE
April 6, 2022
WASHINGTON – Today, the Alliance for Connected Care released a major survey of both healthcare patients and practitioners conducted by Morning Consult on the Alliance’s behalf. The poll asked patients and practitioners about their telehealth usage, telehealth experiences, their use of care across state lines, and the workforce implications of these developments.
- A slide deck summarizing the findings can be found here.
- An Alliance infographic of key selected data points can be found here.
- A printable version of the infographic can be found here.
“This is the first time we have polled both patients and providers, and they are aligned on the merits of telehealth,” said Krista Drobac, Executive Director of the Alliance for Connected Care. “I am particularly excited to see practitioners reporting that telehealth is a tool to fight clinical burnout and to see such strong support from patients for access to care across state lines.”
“Effective access to telehealth is essential to improving America’s health care future. The findings of this research reinforce what we have experienced, which is telehealth makes health care easier for patients, and also provides flexibility and opportunities for balance for health care providers, said Brian Hasselfeld, MD, Medical Director, Digital Health and Telemedicine, Johns Hopkins Medicine. “Regulatory and policy changes that preserve these flexibilities, and address barriers such as restrictions on care across state lines, will be important for our patients and health care workforce going forward.”
“Clinicians at Stanford have experienced firsthand the benefits of telehealth for their patients, and we are not surprised to see these results – showing that the overwhelming majority of clinicians and patients support the option to engage in telehealth across state lines,” said Christopher (Topher) Sharp, MD, Chief Medical Information Officer for Stanford Health Care. “Telehealth has been a critical access point, particularly for specialty care which is in such short supply across the US.”
Notable findings of the poll:
The experience with telehealth is positive for both patients and providers
- Almost 3 in 4 of the general population “strongly agree” or “somewhat agree” that patients should have the option to receive telehealth, even after the pandemic. Among recent telehealth patients, this proportion increases to 84%.
- Three quarters of health care providers surveyed say they have provided care via telehealth at least once since the pandemic began. Of those surveyed, 91% of practitioners say telehealth has allowed for greater flexibility to meet the needs of both patients and health care practitioners.
- 91% of health care practitioners also agree that they should continue to have the option to deliver virtual care after the pandemic.
Patients and providers both believe telehealth is increasing access to health care when needed
Telehealth has been a crucial tool to expand the capabilities of the health care system during COVID-19, yet challenges remain. Telehealth may help to address soaring behavioral health needs, meet patients in their homes, and reduce health care wait times for patients. Accordingly –
- 96% of health care practitioners say that telehealth makes health care more accessible for patients.
- 89% of health care practitioners say telehealth is valuable for reaching vulnerable patients.
- 73% of practitioners believe telehealth improves the overall quality of care.
- 66% of adults believe that telehealth will make patients more likely to seek health care when they need it.
- 84% of recent telehealth patients say they have personally benefited from the option to receive care though telehealth.
Both patients and providers support telehealth across state lines
During the COVID-19 pandemic, all 50 states expanded the ability for practitioners to practice across state lines – expanding health care provider capacity and increasing access for patients. Strong support exists for policies to expand opportunities to give and receive care across state lines:
- One in five practitioners surveyed have provided health care services across state lines under a waiver since the pandemic began.
- 84% of health care practitioners support the option to provide telehealth across state lines.
- Over 8 in 10 telehealth patients also support the option to receive telehealth services from health care practitioners across state lines, suggesting that those who have received care via telehealth in the past view their experiences favorably.
- Health care providers expect that state actions to end broad access to care across state lines has had or will have a net negative impact on a variety of indicators:
- 64% say reducing cross-state care will reduce patient access to health care.
- 56% say reducing cross-state care will have a negative effect on health outcomes.
Telehealth is the key to supporting and retaining the health care workforce
Challenges with health care provider burnout are widely reported – and many health care institutions are struggling to recruit and retain the expertise needed to serve patients. Meanwhile – practitioners report that telehealth, and the ability to provide care from a range of locations when clinically appropriate, are a crucial tool to reduce these challenges. The polling found:
- 78% of health care practitioners agree that retaining the option to provide virtual care from a location convenient to the practitioner would “significantly reduce the challenges of stress, burnout, or fatigue” facing their profession.
- As a result, 8 in 10 practitioners say that retaining telehealth for health care practitioners would make them, personally, more likely to continue working in a role with such flexibility.
- 93% of health care practitioners agree they should have the opportunity to provide telehealth services from their home when clinically appropriate.
- 79% of health care practitioners and 84% of telehealth patients support allowing nurse practitioners to provide care to the full extent of their education and licensure, including through telehealth.
These findings have far-ranging implications for policymakers at both the state and federal levels. The Alliance for Connected Care looks forward to working with policymakers in these endeavors to improve the health and well being of all Americans.
Alliance submits comments in response to the White House Office of Science and Technology Policy on Strengthening Community Health Through Technology RFI
The Alliance for Connected Care submitted comments in response to the request for information from the White House Office of Science and Technology Policy (OSTP) on strengthening community health through technology.
The Alliance specifically commented on the burdensome licensure requirements which create a barrier in access to virtual health care. The Alliance recommends the federal government to:
- Develop and implement a national framework for interstate licensure; and
- Address state licensing limitations that impact clinical trial recruitment and diversity.
The Alliance believes telehealth and remote patient monitoring are important tools for bringing innovative services and treatments to those with the least access to it, however there continue to be barriers in place that impede such access. Provider shortages are associated with delayed health care usage, reduced continuity of care, higher health care costs, worse prognoses, less adherence to care plans, and increased travel. State lines create artificial barriers to the delivery of care – complicating access for patients and creating additional burden on clinicians.
To read the full letter, click here or see below:
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Open in new tab Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Frontiers in Endocrinology: Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background: Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes.
Purpose: To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids.
Data Sources: PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20th June 2021.
Study Selection: Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention.
Data Extraction: Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI).
Data Synthesis: Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias.
Limitations: Heterogeneity and potential publication bias may limit applicability of findings.
Conclusions: Remote management significantly improves control of modifiable risk factors.
Alliance submits comments in response to Healthy Future Task Force Treatments Subcommittee RFI
The Alliance for Connected Care submitted comments in response to the request for information from the Treatments Subcommittee of the Healthy Future Task Force regarding medical innovation to supercharge the availability and development of life-saving treatments, devices, and diagnostics, while addressing rising costs to patients.
The Alliance specifically commented on the question under “Goal 4: Increase access to medical innovation” about decentralizing clinical trials in order to expand access to innovative treatments to patients through remote monitoring.
The Alliance believes continuing to modernize and decentralize clinical trials is critical for creating opportunities for more diversity and patient engagement. Obviating the need for travel time, lost wages and childcare/eldercare through use of digital technologies will significantly increase the pool of potential participants in clinical trials across geographies. However, state licensing limitations continue to present a barrier to decentralizing clinical trials, and effectively prohibit clinicians working on clinical trials from recruiting patients from outside the state where the clinician is licensed.
To read the full letter, click here or see below:
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Alliance Applauds Inclusion of Major Telehealth Provisions in Consolidated Appropriations Act, 2022
This week, the House Appropriations Committee introduced the Consolidated Appropriations Act, 2022 (H.R. 2471), consisting of all 12 fiscal year 2022 appropriations bills and supplemental funding to support Ukraine. The House passed this bill on March 9, 2022 and the Senate passed this bill on March 10, 2022. The bill now goes to President Biden for signature.
The Alliance was thrilled to see the inclusion of several major telehealth provisions included in this package, which will continue several COVID-era telehealth policies for about five months after the public health emergency (PHE) ends. These provisions provide an opportunity for the telehealth community to continue advocating for permanent telehealth reform.
The only major legislative provision not included on a temporary basis were provisions allowing Critical Access Hospitals (CAHs) to serve as a distant site provider for telehealth and offer services the same way they do for in-person care. Without this flexibility, we are concerned that many CAHs will cease offering telehealth at the end of the PHE.
Below is a topline of the key telehealth provisions included in the appropriations bill and corresponding report language.
Division P – Health Provisions
Title III – Medicare, Subtitle A – Telehealth Flexibility Extensions. Unless otherwise noted, all provisions are active for the 151-day period beginning on the first day after the end of the public health emergency (bringing us through mid-December if the PHE ends in July).
- Sec. 301. Removing geographic requirements and expanding originating sites for telehealth services.
- This section would amend the current originating site definition and expand it to mean any site in the United States at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system (without geographic restriction). Additionally, there is no facility fee.
- Sec. 302. Expanding practitioners eligible to furnish telehealth services.
- This section temporarily adds qualified physical therapist, qualified speech-language pathologist, and qualified audiologist as eligible providers to provide telehealth services.
- Sec. 303. Extending telehealth services for federally qualified health centers and rural health clinics.
- This section would extend the CARES Act telehealth payment structure for federally qualified health centers and rural health clinics.
- Sec. 304. Delaying the in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology.
- This section delays in-person requirements for mental health services until the day that is the 152 day after the end of the emergency period. In-person requirements for rural health clinics and federally qualified health centers shall not apply prior to the day that is the 152 day after the end of the PHE.
- Sec. 305. Allowing for the furnishing of audio only telehealth services.
- This section requires the HHS Secretary to continue providing coverage and payment for audio-only telehealth services as of the date of engagement during the 151 day following the end of the PHE.
- Sec. 306. Use of telehealth to conduct face-to-face encounter prior to recertification of eligibility for hospice care during emergency period.
- This section continues the CARES Act provision which allows virtual recertification of hospice care.
- Sec. 307. Extension of exemption for telehealth services.
- This section renews flexibility for employers or plans using high-deductible health plans coupled with a health savings account (HDHP-HSAs) to provide first-dollar coverage for telehealth services from March 31, 2022 – January 1, 2023. Any care provided between January 1, 2022 and March 31, 2022 is not covered.
- Sec. 308. Reports on telehealth utilization.
- This section requires a MedPAC report on utilization of telehealth services, expenditures on telehealth services, Medicare payment policy for FQHCs and RHCs, and other areas as determined appropriate by the Commission.
Title I – Public Health, Subtitle D – Maternal Health Quality Improvement
Under Chapter 2 – Rural Maternal and Obstetric Modernization of Services section, the following provision is included:
- Sec. 143. Telehealth Network and Telehealth Resource Centers Grant Program.
- This section amends Section 330I of the Public Health Service Act (42 U.S.C. 245c-14) to add providers of prenatal, labor care, birthing, and postpartum care services, including hospitals that operate obstetric care units, to the list of eligible entities to receive a grant to provide services through a telehealth network. It will also help develop plans for, or to establish, telehealth networks that provide prenatal care, labor care, birthing care, or postpartum care.
Highlights from the Joint Explanatory Statement Report Language and House Report Language for Labor-HHS-Education
CMS –
- Telehealth and the Homeless Population — The agreement directs CMS to identify and share with States best practices regarding ways in which telehealth and remote patient monitoring can be leveraged through the Medicaid and Medicare programs for the homeless. This should include identification of barriers to mental health services via telehealth coverage, as well as ways to address those barriers.
- Audio-Only Evaluation and Management Services — The agreement requests CMS, in coordination with the Assistant Secretary for Planning and Evaluation, conduct a review of audio-only services delivered during the COVID-19 public health emergency, and provide an update on the provision of such services in the fiscal year 2023 Congressional Justification.
- Blue Button — The Committee believes that the Blue Button program can play an important patient safety and care coordination role for Medicare beneficiaries and their health care providers, particularly in relation to COVID–19 vaccination efforts and the increasing use of telehealth. Unfortunately, Blue Button has had a low participation rate. The Committee urges the Secretary to examine barriers to participation, including health and technology related inequities, and widely educate beneficiaries about Blue Button.
- Telehealth for Pediatric ESRD.—The Committee understands that due to the scarcity of pediatric nephrologists and precautions following the COVID–19 pandemic, more children are successfully receiving care for end stage renal disease at home through telehealth technology. However, persistent inequalities in access to broadband and information technology prevent many children from accessing this technology. The Committee requests that, within 120 days of enactment of this Act, the Secretary provide a report on the usage of telehealth technology for pediatric end stage renal disease patients covered by Medicare and Medicaid during the COVID–19 pandemic, including an analysis of use in HRSA-designated rural counties and designated eligible census tracts in metropolitan counties and HRSA-designated medically underserved areas.
HHS Office of the Secretary –
- Telehealth Report – The agreement directs HHS to submit a report no later than 180 days after enactment of this Act detailing the impact of the actions taken by the Secretary during the COVID- 19 public health emergency (PHE) to increase telehealth services under the Medicare, Medicaid, and Children’s Health Insurance Programs, as well as other HHS entities engaged in policy or programmatic telehealth changes during the PHE.
- Telehealth Standards.—The Committee believes that the flexibility afforded to telehealth providers has played an essential role in ensuring that Americans receive timely and quality care throughout the COVID–19 pandemic; however, quality standards remain important no matter the health care delivery method to ensure quality and safety. The Committee urges the Secretary to establish an advisory group to study issues relating to the provision of telehealth and associated quality of care. Such a study should generate recommendations regarding the applicability of telehealth modalities for various clinical scenarios. The Secretary shall assemble a technical advisory group that includes experts in the delivery of telehealth services. The advisory group shall also evaluate whether equity exists in access to appropriate telehealth modalities throughout the country, including broadband, computers, smartphones, landline telephones, and cell phones that only allow for audio-only communications. The Committee requests the Secretary deliver a report from the advisory group, no later than one year after enactment of this Act, with recommendations as to whether quality of care criteria should be applied to the specific use of any telehealth modality in different clinical scenarios.
Health Resources & Services Administration –
- Telehealth Centers of Excellence – The agreement includes $7,500,000 for the Telehealth Centers of Excellence (COE) awarded sites, an increase of $1,000,000 above the fiscal year 2021 enacted level. Grantees examine the efficacy of telehealth services in rural and urban areas and serve as a national clearinghouse for telehealth research and resources. The Centers of Excellence serve to promote the adoption of telehealth programs across the country by validating technology, establishing training protocols, and by providing a comprehensive template for States to integrate telehealth into their State health provider network. Additional funding for the Centers of Excellence will support the development of models of care and best practices for the expansion of telemental health.
- Telehealth — The Committee includes $39,000,000 for Telehealth, an increase of $5,000,000 above the fiscal year 2021 enacted level and $2,500,000 above the fiscal year 2022 budget request. Funds support the Office for the Advancement of Telehealth, which promotes the effective use of technologies to improve access to health services for people who are isolated from health care and to provide distance education for health professionals.
- Urban Focused Telehealth Network Grant Program — The Committee believes that a fundamental element to ensuring our health care system is prepared for pandemic events is the development of robust telehealth services and integrated systems that can provide a continuum of care across State and regional lines. This is especially true in the nation’s urban areas, where a pandemic event has the potential to disproportionately impact and overwhelm the health care and delivery system. The Committee believes increased investments in urban telehealth services could have a tremendous impact on the health and well-being of the nation’s most vulnerable citizens and medically underserved populations, especially during times of national public health emergencies. The Committee encourages HRSA to establish a pilot program to expand academic health system telehealth programs aimed at addressing the health inequities of urban populations.
Substance Abuse and Mental Health Services Administration (SAMHSA) –
- Opioid Abuse in Rural Communities —The agreement encourages SAMHSA to support initiatives to advance opioid abuse prevention, treatment, and recovery objectives, including by improving access through telehealth. SAMHSA is encouraged to focus on addressing the needs of individuals with substance use disorders in rural and medically underserved areas. In addition, the agreement encourages SAMHSA to consider early interventions, such as co-prescription of overdose medications with opioids, as a way to reduce overdose deaths in rural areas.
- Substance Use Disorder Response in Rural America —The Committee is aware that response to the SUD crisis continues to pose unique challenges for rural America, which suffers from problems related to limited access to both appropriate care and health professionals critical to diagnosing and treating patients along with supporting recovery. Rural America’s unique challenges require a comprehensive approach, including training to provide care in a culturally responsive manner with an understanding of diverse populations; the use of technologies to ensure improved access to medically underserved areas through the use of telehealth; and workforce and skills development to advance data capture and analytics. The Committee encourages SAMHSA to support initiatives to advance SUD objectives in rural areas, specifically focusing on addressing the needs of individuals with SUD in rural and medically-underserved areas, and programs that stress a comprehensive community-based approach involving academic institutions, health care providers, and local criminal justice systems.
Office of the National Coordinator for Health IT (ONC) –
- Accessibility of Online Telehealth Platforms.—The Committee recognizes that the COVID–19 pandemic led to the increased use of online portals and web services for patients seeking information, scheduling, and accessing remote services. However, the Committee is concerned that many online platforms are not user-friendly, especially for less digitally literate communities, including seniors. The Committee urges the Secretary, working through ONC, to coordinate with the Agency for Healthcare Research & Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), and Office for Civil Rights (OCR) on any Federal efforts that can be made to evaluate the accessibility of digital health platforms for Federally-supported providers, including any assessments of how seniors and persons with disabilities are included in the design and testing of the platforms. Further, the Committee directs the Secretary, working through ONC, AHRQ, CMS, and OCR, to establish best practices for healthcare providers to improve their online telehealth platforms for seniors, individuals with disabilities, and individuals with limited English proficiency.
Other Notable Provisions –
- Federal Communications Commission – $382 million for the FCC, an increase of $8 million above the FY 2021 enacted level, to support efforts to expand broadband access, improve the security of U.S. telecommunications networks, and administer billions in COVID relief programs.
- Agriculture, Rural Development, Food and Drug Administration – $550 million in the expansion of broadband service to provide economic development opportunities and improved education and health care services, including an additional $450 million for the ReConnect program.
- Office of the Assistant Secretary for Preparedness and Response (ASPR) – The agreement includes funding for the National Emergency Tele-Critical Care Network (NETCCN), which enables skilled telehealth providers to support health systems undergoing a COVID-19 surge or experiencing staff shortages to operate remotely during the COVID-19 public health emergency. This funding could be used to expand the NETCCN to meet additional COVID-19 needs or used in future public health emergencies and disaster response efforts.
Alliance submits comments in response to Healthy Future Task Force Modernization Subcommittee RFI
The Alliance for Connected Care provided comments in response to the Healthy Future Task Force Modernization Subcommittee request for information regarding the utilization of wearable technologies, the expansion of telemedicine, and digital modernization efforts in the United States health care system. The goal of the Healthy Future Task Force is to build on Republican health policy goals and craft patient-focused agendas for the future. The Modernization Subcommittee aims to harness technological innovations to deliver affordable, quality care to all Americans.
The Alliance believes telehealth has the potential to broaden access to care and improve patient engagement and outcomes, and we should catalyze on the progress made throughout the COVID-19 pandemic to ensure the telehealth flexibilities that have been utilized and enjoyed over the past two years can be maintained or expanded. As such, we provided recommendations that we believe the Modernization Subcommittee should consider when developing legislative solutions to expanding telehealth and addressing barriers to interstate licensure.
In response to the Subcommittee’s question on which flexibilities created under the COVID-19 public health emergency should be made permanent, the Alliance provided comments on each of the following recommendations:
- Reinstate telehealth safe harbor for individuals with HDHP-HSAs
- Permanently remove obstructive in-person requirements for telemental health services
- Remove outdated geographic and originating-site restrictions on telehealth
- Ensure FQHCs, CAHs, and RHCs can furnish telehealth in Medicare
- Remove distant site provider list restrictions
- Allow employers to offer telehealth benefits for seasonal and part-time workers
- Enable CMS to investigate and retain some “Hospital Without Walls” authorities
- Allow CMS to cover audio-only telehealth services where necessary to bridge gaps in access to care
- Facilitate the removal of remaining telehealth restrictions on alternative payment models
- Expand virtual chronic disease interventions with the potential to prevent downstream costs to the Medicare program.
The Alliance also provided comments on what Congress can do to remove barriers to providing care across state lines, including a proposal that would instruct HHS to convene experts and support the development of a voluntary, national framework for interstate licensure using a policy of mutual recognition.
To read the full letter, click here or see below:
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Optimizing Foundational Therapies in Patients With HFrEF: How Do We Translate These Findings Into Clinical Care?
Optimizing Foundational Therapies in Patients With HFrEF: How Do We Translate These Findings Into Clinical Care?
Given the high risk of adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF), there is an urgent need for the initiation and titration of guideline-directed medical therapy (GDMT) that can reduce the risk of morbidity and mortality. Clinical practice guidelines are now emphasizing the need for early and rapid initiation of therapies that have cardiovascular benefit. Recognizing that there are many barriers to GDMT initiation and optimization, health care providers should aim to introduce the 4 pillars of quadruple therapy now recommended by most clinical practice guidelines: angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors. A large proportion of patients with HFrEF do not have clinical contraindications to GDMT but are not treated with these therapies. Early initiation of low-dose combination therapy should be tolerated by most patients. However, patient-related factors such as hemodynamics, frailty, and laboratory values will need consideration for maximum tolerated GDMT. GDMT initiation in acute heart failure hospitalization represents another important avenue to improve use of GDMT. Finally, removal of therapies that do not have clear cardiovascular benefit should be considered to lower polypharmacy and reduce the risk of adverse side effects. Future prospective studies aimed at guiding optimal implementation of quadruple therapy are warranted to reduce morbidity and mortality in patients with HFrEF.
President Biden Announced Strategy to Address the National Mental Health Crisis
On March 1, 2022, President Biden announced his strategy to address the national mental health crisis during his first State of the Union. This strategy will strengthen system capacity, connect more Americans to care, and create a continuum of support to transform our health and social services infrastructure to address mental health holistically and equitably.
As part of this strategy, President Biden included a goal to expand access to tele- and virtual mental health care options. More specifically:
- The Administration will work with Congress to ensure coverage of tele-behavioral health across health plans, and support appropriate delivery of telemedicine across state lines, to maintain continuity of access;
- The Department of Health and Human Services (HHS) will create a learning collaborative with state insurance departments to identify and address state-based barriers, like telehealth limitations, to behavioral health access; and
- The United States Office of Personnel Management will facilitate widespread, confidential, and easy access to telehealth services, in part by strongly encouraging Federal Employees Health Benefits Program carriers to sufficiently reimburse providers for telehealth services, and to eliminate or reduce co-payments for consumers seeking tele-mental service.
To read the full press release on this initiative, click here.
Remote Patient Monitoring During COVID-19
JAMA Network: Remote Patient Monitoring During COVID-19
COVID-19 has advanced patient safety in an unexpected way. Before the COVID-19 pandemic, patient monitoring for harm and many approaches to prevent harm were linked to where the patient was treated in the hospital.
A report based on data prior to the COVID-19 pandemic suggested that routinely monitoring hospitalized patients with continuous pulse oximetry and heart rate devices was associated with reduced mortality. In that study, arly recognition of hypoxemia and respiratory depression were largely responsible for the observed decrease in mortality, from 0 deaths among 111 ,487 patients in monitored units vs 3 deaths among 15 ,209 patients in unmonitored units. COVID-19 created a need to monitor patients treated in standard medical units, in emergency departments (EDs), and to also monitor some patients at home for clinical deterioration (eg, hypoxemia) to help increase hospital capacity. With the increased volume of patients coupled with high staffing ratios for all types of clinician workload, hospitalized patients are at increased risk for unrecognized clinical deterioration.
A recent cost-utility analysis estimated that daily assessment and 3-week follow-up of at-home pulse oximetry monitoring was projected to be potentially associated with a mortality rate of 6 per 1,000 patients with COVID-19, compared with 26 per 1,000 without at-home monitoring. Based on a hypothetical cohort of 3,100 patients, the study projected that remote monitoring could potentially be associated with 87 percent fewer hospitalizations, 77 percent fewer deaths, reduced per-patient costs of $11, 472 over standard care, and gains of 0.013 quality-adjusted life-years.
Patients can now be monitored based on risks and needs rather than location in the hospital. While enhanced monitoring at home could potentially improve safety and value, empirical evidence of the benefits of this approach are limited. Home monitoring and hospital at-home models offer the potential to transform care and potentially allow a substantial proportion of hospitalized patients to receive care from home. Yet, health systems will need to collaborate with technology companies to accelerate learning and produce greater value for patients, clinicians, and health care organizations.
Alliance Support Letter for Kansas SB 454
The Alliance submitted a letter of support to Sen. Richard Hilderbrand, Senate Majority Whip and Chair, Senate Committee on Public Health and Welfare, for Senate Bill 454.
Senate Bill 454 would amend the Advanced Practice Registered Nurse (APRN) authorized scope of practice to permit the prescribing of controlled substances without a supervising physician. This bill would help to eliminate barriers such as collaborative practice agreements with a supervising physician and grant full practice authority to improve access to care for Kansas patients.
Allowing APRNs to practice at the top of their licenses means allowing them to use all of their education and training to care for patients. Removing these restrictions on APRNs would increase consumer access to health care, address persisting barriers to care for vulnerable populations and/or patients living in provider shortage areas, and reduce unnecessary health care costs.
Read the full letter here and below:
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