Source : Medtech Insight
The Taskforce on Telehealth Policy released a final report on 15 September outlining findings and recommendations on safeguarding the future of telehealth beyond the COVID-19 pandemic.
Taskforce on Telehealth Policy webinar panelists American Telemedicine Association
The task force, which was convened by the National Committee for Quality Assurance (NCQA), the Alliance for Connected Care and the American Telemedicine Association (ATA), includes multiple stakeholders such as clinicians, health systems, insurers, state and federal health agencies and telehealth entities. The group spent the summer assessing early results from case studies of telehealth used to build consensus around the challenges and opportunities for telehealth. "Health Care Coalition Asks Congress For Permanent Telemedicine Incentives" "Medtech Insight"
“The historic increase in [telehealth usage since the start of the pandemic] offered a real-time case on the effects of virtually unfettered access to telehealth [amid the easing of regulatory restrictions] of telehealth,” Frank Micciche, vice president of public policy and external relations at the NCQA, said in a webinar discussing the findings and recommendations of the task force. He said the task force came together to make recommendations on how to “maximize opportunities” and “mitigate challenges” with a focus on three priority areas: patient safety and program integrity; data flow, care coordination and quality measures; and the impact on total cost of care. ("COVID-19 Telehealth-Use Explosion Gets US Senators Crossing Party Lines To Expand Its Practice" "Medtech Insight" )
Several task force members noted that there is often the assumption that telehealth is a substitute for in-person care or an add-on to care, and therefore, adds costs.
Krista Drobac, executive director for the Alliance for Connected Care, who oversaw the deliberations of the subgroup on the impact of total cost of care, however, said while there was little data to assess or project cost of widespread access to telehealth in a fee-for-service environment, particularly in Medicare, early data suggest that unfettered availability of telehealth has not resulted in excess cost or use increases – even as both supply and demand for in-person care has rebounded, except for behavioral health.
Data derived from 20 entities, including health systems, mid-level physician groups and accountable care organizations showed that overall use of telehealth remained steady during the early part of the pandemic when many clinics were closed and when patients started returning to clinics for care.
“The mix of whether patients use telehealth or in-person care changed, but the overall utilization of care stayed pretty steady,” Drobac said during the webinar. While more data is needed, she was pleased to see there wasn’t a spike in telehealth use “when you make it easy for people to access their physicians and other providers.”
She also pointed to anecdotal evidence suggesting that the expansion of telehealth helped reduce patient no-shows to appointments, which could potentially lead to better outcomes and lower costs, if people stick to their care plan, she said.
Kerry Palakanis, executive director of Connected Care Operations at Intermountain Healthcare, a not-for-profit system of 24 hospitals in Salt Lake City, UT, said, often policymakers look at telehealth as a “different type of care” versus what it is, a “different modality.”
“And therefore telehealth needs to be reimbursed based on value, just as we do with the cost of care and care delivery in person,” Palakanis said, adding, “What we often view as new costs associated with telehealth is probably baked in already into in-person visit costs.”
She said data showed no net increase in patient visits. After telehealth visits spiked during the pandemic, 70% of visits returned to in-patient visits with 30% remaining as telehealth visits.
“One of the most important things we are asking from the policymakers is to give us the opportunity to look at this in the post-pandemic new normal environment and let us see, if we can continue along the same data modalities to look at how we have utilized the services effectively,” Palakanis said. She added that telehealth has shown to add “incredible value” to Intermountain Healthcare and is now being evaluated for reducing hospital readmissions and reducing infections in skilled nursing facilities.
“That’s something that can be easily managed through telehealth and really can be managed at a lower cost than moving patients back and forth,” she said. Currently, there are many assumptions about telehealth when facts and more data is needed. “We won’t know the value of telehealth until it’s available to everyone.”
When it comes to patient safety, the task force found strong evidence that the use of remote management of chronic health conditions such as diabetes, heart failure, obesity and asthma and mental health improves outcomes, citing studies on telehealth and patient safety by the Agency for Healthcare Research and Quality.
The task force found strong – but not unanimous – support for permanently lifting all controlled substance prescribing restrictions on telehealth, especially for prescribing medications for behavioral health.
It recommended that policymakers, in partnerships with clinical-subject matter experts, identify and recommend minimum standards for assessing and ensuring patient safety via telehealth and integrate them into existing standards, but not layer new telehealth policies on top of existing in-person care regulations.
Congress should continue funding research efforts of telehealth initiatives and identify what works and what doesn’t work, the group concluded. It also pointed to opportunities for innovations.
Andrew Watson, vice president of Clinical Information Technology at the University of Pennsylvania Medical Center and a practicing surgeon, outlined how telemedicine evolved at the university in Philadelphia starting in the year 2000 with behavioral care, followed by an increase in live videos visits, and since 2018, the “tremendous boom in remote monitoring.”
“And now we see a lot of evolutionary pressure in the field of telemedicine,” Watson said during the webinar. “I’ve used surgical telementoring, remote monitoring, and live video visits in my practice.”
He pointed to the convergence in health tech including consumer electronics, apps, and wearables, such as the announcement this week of the new Apple Watch Series 6 with an integrated sensor to measure blood oxygen levels. ("Apple Adds Blood Oxygen Sensor To Apple Watch" "Medtech Insight" )
“This comprehensive suite of technologies and telemedicine will have a significant impact on how we coordinate interoperability, how we look at data sharing, and the new governance rules, how we’re looking at quality, electronic health records, payer care management systems, claims systems, what patient-generated health data means in the future,” Watson said. He said all of this offers an opportunity for the multi-dimensional aspect of telemedicine to bring value to the health care system as a whole.
When it comes to quality standards, the task force said that telehealth should be held to the same standards and quality measures as in-person care, wherever possible. Rules and protocols for data sharing and care coordination between telehealth and other care sites should be aligned and implemented in with telehealth platform certification requirements. The work should build on existing standards and 21st Century Cures Act data-sharing and anti-data-blocking legislation and regulations, the report said.
Fraud detection and abuse also remains a key challenge.
The taskforce recommended that Congress should direct and fund enforcement agencies to harness both available and new technologies, such as artificial intelligence, to prevent and detect fraud, waste and abuse in telehealth, noting that this would not require new programs.
Under the Health Care Fraud and Abuse Control program, the HHS inspector General and Centers for Medicare and Medicaid Services, have extensive programs in place that address fraud, waste and abuse and improper payments, which could be integrated into telehealth.
Peggy O’Kane, president of the NCQA, told listeners that despite all the cost spent on digitalizing health care, data blockage and the free flow of information to optimize care remains a challenge.
“Integration where telehealth permits greater integration of all care team members and a much more deliberate and strategic care management process, that is exactly the potential that we think should be maximized,” O’Kane said. The team also proposed that the Centers for Medicare and Medicaid Services should pilot a patient experience survey to learn “what’s working and what isn’t working” from virtual care, given that patients as well as providers have different requirements.
The task force also recommended that policymakers should reinstate enforcement of the Health Insurance Portability and Accountability protections that were suspended at the start of the public health emergency.
In addition, the task force asked lawmakers to “promptly expand efforts to address deficiencies in broadband access and technology infrastructure, as well as trust and digital literacy to increase health disparities and limit the dispersion of telehealth’s benefits.
Regina Benjamin, former US Surgeon General and CEO of the Bayou Clinic/Gulf States Health Policy Center, talked about the challenges around access to care for patients, including those living in rural communities.
“Many of the patients I talked to in the rural communities particularly – they may only have a landline … so I can’t do all that I can do in an audio call. So, we have to make sure we understand that everybody doesn’t have the same access to technology,” Benjamin said. She also said it is important to recommend policies that address access to care for various groups, such as the hearing-impaired or people with vision problems, and people at different income levels.
“I’m particularly interested in those who work for a living, but don’t have enough money to afford insurance, but they make too much for Medicaid and they’re what I call the self-insured and some people call the uninsured,” she said. She also noted that many telehealth restrictions that were lifted during the COVID-19 pandemic were good but wants to make sure that patients and their privacy are protected.
The task force asked policymakers to make the following COVID-19 policy changes permanent:
Lifting geographic restrictions and limitations on originating sites
Allowing telehealth for various types of clinicians and conditions
Acknowledging, as many states now do, that telehealth visits can meet requirements for establishing a clinician/patient relationship if the encounter meets appropriate care standards or unless careful analysis demonstrates that, in specific situations, a previous in-person relationship is necessary
Eliminating unnecessary restrictions on telehealth across state lines
Regarding next steps, the American Telemedicine Association, the NCQA and the Alliance are currently planning for a September briefing on the Hill, according to Gina Cella, a spokeswoman for the ATA.
The discussion on the expansion of telehealth is already underway.
In August, President Trump signed an executive order on “Improving Rural Health and Telehealth Access,” directing the Administration to extend telehealth services offered to Medicare beneficiaries beyond the public health emergency. CMS also proposed changes to expand telehealth permanently. "Telehealth Trump EO Would Extend Payments While CMS Proposes Permanent Rule" "Medtech Insight"
In a virtual meeting, members of the Medicare Payment Advisory Commission discussed how and whether to permanently expand telehealth in Medicare.
Several federal policymakers have enacted changes that enable greater access to telehealth. For instance, the Veterans Access to Online Treatment Act, introduced in August by US Reps Jared Golden (D-ME) and Jim Banks (R-IN), would allow the VA to launch a two-year pilot program using telehealth to help veterans living with cognitive behavioral health issues.
A recent study released by Royal Philips focusing on the future of health care showed that 61% of younger doctors ranked telehealth as the digital health technology that would have most improved their experiences during COVID-19. ("COVID-19 Impact Young Doctors Rank Telehealth Above AI As Role Support Tool" "Medtech Insight" )
By Marion Webb