The state is issuing $150,000 grants to community health providers around the state to purchase telehealth and remote monitoring technology to help underserved communities access care.
New York is investing $3 million in a program aimed at helping community health providers purchase new telehealth technology to expand access to care in underserved communities.
Governor Kathy Hochul said the program will spurt public-private support for technology platforms that enable more residents to access virtual care services, particularly in areas where access is difficult due to geographic or economic barriers.
“Every New Yorker should have access to high-quality health care no matter where they live,” she said in a press release. “Telehealth is an important tool that brings healthcare to underserved communities and saves New Yorkers both time and money. Through these investments, we are working to make sure that everyone has access to high-quality health care and can see their doctor.”
The grants are divided into $150,000 allotments and will be distributed to each of the state’s 10 regions in 2022. They’ll be used to help community health providers purchase technology – including audio-visual telemedicine platforms and remote monitoring devices – for use in telehealth stations located in public locations such as libraries, pharmacies and homeless shelters.
Telehealth use has skyrocketed during the pandemic, as healthcare organizations sought to reduce traffic at hospitals and clinics and shift more in-person services onto virtual platforms. The effort is being fueled by federal and state programs aimed at helping providers purchase the necessary technology and broadband connectivity.
New York is one of several states actively supporting telehealth expansion. Along with the grants for technology purchases, the state has updated its telehealth laws to, among other things, reduce barriers that prevent providers from either using telehealth or being reimbursed for it.
“Telehealth is a critical component to the future of healthcare in New York State,” Kristin Proud, Acting Deputy Commissioner for the state’s Department of Health, said in the press release. “By expanding access to telehealth, we are removing barriers that will help expand the care and treatment New Yorkers need and deserve in a timely manner. These investments will also provide high quality and reliable care to historically underserved communities, increasing equity and helping to close the gaps in healthcare.”
The re:Vive platform, developed by Miami-based Heru and the University of Miami's Bascom Palmer Eye Institute, enables care providers to use an AR/VR headset to screen and diagnose - and eventually be reimbursed for - several diagnostic and health and wellness eye issues.
A digital health platform that allows care providers to use virtual and augmented reality to diagnose visual defects has been named a CES 2022 Innovation Awards Honoree.
The re:Vive platform, developed by Miami-based Heru in a partnership with the University of Miami’s Bascom Palmer Eye Institute, will be showcased at the Consumer Technology Association’s CES 2022 conference next January in Las Vegas. The tool uses VR/AR software inside a specialized headset to guide patients and their providers through several diagnostic vision and health and wellness exams.
The technology is designed not only to improve and expand upon the basic eye exam, but enable care providers to conduct exams in remote locations, or even through a telehealth platform, opening up access to underserved populations in the US and elsewhere. It also builds on the rapidly developing VR/AR market, which got its start in gaming and has spread to other areas, including healthcare.
“Globally, approximately 450 million people are affected by visual defects caused by strokes, glaucoma, age-related macular degeneration, and other disorders,” Maurice R. Ferré, MD, chairman of Heru’s Board of Directors and CEO for Insightec, said in a press release. “Yet the decades-old standard of care is immobile, bulky, expensive, and requires a skilled technician or clinician to operate, limiting patients’ access to care. Limited access means that millions of individuals suffering from visual defects remain undiagnosed, causing irreversible damage to their eyesight. Heru’s technology brings us into an era in healthcare where improved access is no longer a goal, it is the new reality.”
“Screening for visual defects is only the beginning,” added Frederic H. Moll, MD, Chief Development Officer for Johnson & Johnson Robotics and a Heru advisor and investor. “In clinical development are therapeutic applications which include augmented vision correction. This new, cutting-edge technology will be the first of its kind and will transform the lives of patients with compromised vision around the world.”
Heru’s collaboration with one of the nation’s leading eye hospitals helps to give the platform traction in the clinical space – and standing with the payer market. To that extent, the company recently expanded the platform to include three new testing modalities, which will enable providers to perform six new tests that are supported by five reimbursable CPT codes.
Re:Vive was selected from among more than 1,800 innovative consumer technology products for the Innovation Award, which is judged by a panel of experts and handed out in 27 product categories.
Athenahealth, an established provider of electronic health records and digital healthcare platforms, has been acquired by a pair of private equity firms, the latest evidence of the rapid growth of cloud-based services in the wake of the pandemic.
Athenahealth, a longtime stalwart in the healthcare IT space, is being acquired by a pair of private equity firms.
Bain Capital Private Equity, Bain Capital Tech Opportunities, and Hellman & Friedman LLC are joining forces to purchase the Watertown, MA-based developer of enterprise-based cloud software solutions for physician practices for $17 billion.
“athenahealth is at the frontier of digital health in the United States, enhancing the clinical quality, operational efficiency, and delivery of preventive care to nearly 20 percent of the population today, unlocking the front door of the consumer healthcare journey and positioning the Company to support physicians in the continuing shift towards value-based care,” Devin O’Reilly, a managing director at Bain Capital Private Equity, said in a press release.
Launched in 1997 by Johnathan Bush and Todd Park as Athena Women’s Health, a women’s health and birthing center, the company took off two years later when Bush and Park pivoted to focus on digitizing medical data, beginning with claims data. The pair changed the company’s name to athenahealth and, in 2000, unveiled the athenaCollector platform.
The company debuted its first electronic medical records platform, athenaClinical, in 2006, then debuted the athenaCommunicator communications platform in 2008. In 2018, it was acquired by Elliott and Veritas Capital for $5.7 billion and taken private, then merged with Virence Health, a software company acquired by Veritas from General Electric.
Company officials say the athenaOne platform is used by more than 140,000 ambulatory care providers across more than 120 specialties. It includes modules for a wide array of services, including revenue cycle management, telehealth, patient engagement, population health management and value-based care management.
The acquisition points to the growing value of healthcare IT companies that specialize in cloud-based services, including telehealth. The healthcare industry saw a surge in online and virtual services during the pandemic, when health systems shifted from in-person to virtual care and consumers sought more healthcare services online. That trend is expected to continue as the nation shifts to a hybrid model that balances in-person and virtual care and gives consumers more options.
“Given our deep experience in software and healthcare, we are excited to work with Bob and the executive team to rapidly scale the business and continue to innovate and grow alongside our most disruptive and innovative ambulatory care clients to build the foundations of a multi-sided digital care network between patient, payer, and provider,” Allen Thorpe, a partner at Hellman & Friedman, added in the press release.
The Centers for Medicare & Medicaid Services has added new codes to its 2022 Physician Fee Schedule that will enable care providers to be reimbursed for more home-based services.
Health systems are looking at remote patient monitoring as an emerging piece of the care delivery puzzle, but they need help embracing the strategy. Recent moves by the Centers for Medicare & Medicaid Services to improve coverage are a step in the right direction, but experts say the effort is still very much a work in progress.
Remote patient monitoring, or RPM, is a relatively new concept, though its roots trace back a few decades to the concept of connecting with patients at home between visits to the clinic or doctor's office. The platform involves connecting with patients at home to track key health metrics, such as vital signs, to shape and modify care management. Providers often use mHealth devices to collect and transmit that data and telehealth platforms to analyze the results and communicate with the patient.
RPM was thrust into the spotlight during the pandemic, when providers sought to push more care services out of the hospital and into the home. Now they're looking to continue that momentum, and to develop use cases that work well for a variety of patients, including those who have been discharged from the hospital and those with chronic care management needs.
CMS first recognized remote patient monitoring in 2019, with a handful of CPT codes aimed at covering remote physiological monitoring, or the gathering of physiological data—such as heart rate, blood pressure and blood sugar—from patients at home. Those codes—also called RPM—have been tweaked each year to expand coverage incrementally, and with the recent release of the 2022 Physician Fee Schedule, CMS is adding new coverage for what it calls remote therapeutic monitoring (RTM), or the tracking of certain non-physiological data, such as medication or therapy response and adherence and pain level.
Healthcare providers and remote patient monitoring advocates hailed the RTM codes as a step in the right direction when they were proposed earlier this year, but many said the coverage was incomplete and confusing. With the final rule released this month, some of those concerns were addressed. But not all.
"It is definitely a step in the right direction," says Carrie Nixon, Esq., a co-founder and managing partner in the Nixon Gwilt law firm and an expert in healthcare innovation. "And there is absolutely more to be done."
"While CMS in the Final Rule explicitly adopted important portions of this framework by expanding 1) the types of patient data captured and analyzed for remote monitoring, and 2) the types of practitioners who can order and bill for remote monitoring, it stopped short of fully aligning RPM and RTM, stating: 'In the interest of coding efficiency for these services, we hope to continue to engage in dialogue with stakeholders, including the AMA CPT, in the immediate future on how best to refine the coding for the RTM services to address some of the specific concerns raised by stakeholders,' " she said in a recent online analysis of the new codes. "This language leaves room for hope that remote patient monitoring stakeholders will not be forced to wait another full year for improvements to policy around RPM and RTM."
New Codes for Remote Therapeutic Monitoring
The RTM codes to be included in the 2022 PFS are as follows:
CPT code 98975, Initial Set-up and Patient Education: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment;
CPT code 98976, Supply of Device for Monitoring Respiratory System: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days;
CPT code 98977, Supply of Device for Monitoring Musculoskeletal System: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days;
CPT code 98980, Monitoring/Treatment Management Services, first 20 minutes: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes; and
CPT code 98981, Monitoring/Treatment Management Services, each additional 20 minutes: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure).
Some Good (And Not So Good) Reactions
One of the criticisms of the RTM codes is that they don't cover enough conditions. In a recent analysis, Nathaniel Lacktman, a partner with the Foley & Lardner law firm and chair of its Telemedicine & Digital Health Industry Team, and Thomas Ferrante, a partner and member of that team, point out that the RTM device supply codes (98976 and 98977) are limited to monitoring the musculoskeletal and respiratory systems and don't take into account, for example, neurological, vascular, endocrine, or digestive concerns.
"In the final rule, CMS acknowledged it received comments that a general device code should be created that would be system-agnostic and not restrict RTM reimbursement to monitoring patients' musculoskeletal and respiratory systems, (but the agency) did not include such a general device code in the final rule," the two wrote, adding that they're optimistic that CMS will expand that list in the future.
"That is craziness," Nixon says, noting there are many more opportunities for remote patient monitoring that extend beyond musculoskeletal or respiratory care management.
"In its final rule, CMS discusses RTM in the context of 'therapy adherence' and 'therapy response,' " she wrote in her analysis. "CMS further references monitoring of 'health conditions, including musculoskeletal system status, respiratory system status,' where 'non-physiologic data' is collected. While 'health conditions' can be interpreted broadly, the focus on 'musculoskeletal system status' and 'respiratory system status' comes into play with the two device codes, which may be interpreted as limiting reimbursement for 'device supply' to devices related solely to those two systems. CMS should rectify this with a system-agnostic device code as soon as possible to allow reimbursement for RTM services beyond monitoring patients' musculoskeletal and respiratory systems."
Nixon, Lacktman, and Ferrante also note that the RTM codes are classified as general medicine codes, rather than evaluation and management (E/M) codes, which is how the RPM codes are classified. This means they can't be used for care management services, or for services that are ordered by a physician and carried out by non-physician practitioners. So, while physicians can leverage their staff to manage RPM services, they must do the RTM monitoring themselves to qualify for Medicare reimbursement.
Nixon points out that the two sets of codes can be confusing. Healthcare providers are under a lot of pressure, and many would like to delegate or even outsource some remote patient monitoring services, thereby improving patient monitoring and care and avoiding workflow stress. They can't do that with RTM codes, which require their participation. And while many new providers can take advantage of the RTM codes, they'd like to use the RPM codes to collect data, but can't.
"There are cases where that's absolutely relevant," she says. "It would be very useful to allow these practitioners to be able to bill for RPM. … That's where we need alignment."
In any case, RTM codes do open the door to more care providers using the platform, including physical and occupational therapists, speech and language pathologists, physician assistants, nurse practitioners, and clinical social workers.
"In the final rule, CMS stated the primary billers of RTM codes are projected to be psychiatrists, nurse practitioners, and physical therapists," Lacktman and Ferrante note in their analysis. "The new RTM codes, classified as general medicine codes, should open up opportunities for therapists, psychologists, and other eligible practitioners who cannot currently bill for RPM."
In addition, CMS has amended the RTM codes in the final rule to allow self-reported data, or information either reported by the patient or uploaded by the patient into the monitoring device, as long as the device meets the U.S. Food and Drug Administration's definition of a medical device or a smartphone app or online platform defined as software-as-a-medical device (SaMD). This differs from the RPM codes, which require that data be collected and uploaded digitally, without any patient participation.
Looking to the Future
The codes give healthcare providers some reimbursement for new RPM services, and they represent a subtle step forward. And they fall in line with CMS' line of thinking, which has always been that it wants to see proof that these technologies improve clinical outcomes and reduce wasteful expenses before they're embraced by federal regulators.
The challenge is that CMS is taking a piecemeal approach to RPM and providing two different sets of codes that don't mesh well together.
"On the one hand, it's great that there's acknowledgement that there are different types of data" to be gathered in remote patient monitoring programs, Nixon says. "On the other hand, this piecemeal approach is inhibiting" RPM adoption.
She says CMS has signaled more of an interest this past year in working with stakeholders, something the agency had been criticized for avoiding in the past. She's hoping for that discussion soon on how to better align RPM and RTM codes.
"I really don't want to wait another year for that to happen," she says.
Healthcare providers will soon be able to prescribe a virtual reality treatment that uses cognitive behavioral therapy to help patients manage their lower back pain.
Federal regulators have approved a prescription-based virtual reality platform designed to help people manage pain.
The US Food and Drug Administration this week authorized the marketing of AppliedVR’s EaseVRx product, which uses cognitive behavioral therapy (CBT) and an immersive VR platform to help patients manage chronic lower back pain. The treatment, designed as a prescription for at-home use, consists of a VR headset, controller, and “breathing amplifier” that attaches to the headset and guides the user through breathing exercises.
“Millions of adults in the United States are living with chronic lower back pain that can affect multiple aspects of their daily life,” Christopher Loftus, MD, acting director of the Office of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health, said in a press release issued by the FDA. “Pain reduction is a crucial component of living with chronic lower back pain. Today’s authorization offers a treatment option for pain reduction that does not include opioid pain medications when used alongside other treatment methods for chronic lower back pain.”
The agency’s action continues a slow and steady advance for digital therapeutics, or digital health tools and platforms designed to support clinical treatment, in many cases replacing in-person services or even medications. Advocates say these tools can improve access to care for patients at home and help reduce the nation’s ongoing opioid abuse epidemic.
The treatment consists of 56 VR sessions of between two and 16 minutes in length, part of an eight-week regimen that includes behavioral therapy and is designed to give the user skills to “achieve relief and reduction in the interference of pain in daily activities.”
The FDA’s approval is based on a study of roughly 180 people living with chronic lower back pain who were assigned either the EaseVRx program or a control 2-D program that didn’t include skills-based CBT treatment. After an almost nine-month period that included baseline assessment, eight weeks of therapy and follow-up assessments, two-thirds of the EaseVRx participants reported a reduction in pain greater than 30 percent, compared to 41 percent of the control group, and 46 percent of the EaseVRx participants reported a reduction in pain of more than 50 percent, compared to 26 percent of the control group.
AppliedVR executives say the platform also reduces sleep interference and stress, improves mood and offers a high level of patient engagement, with more than 90 percent of those in the study seeing the program through to its end.
FDA officials say there were no adverse events associated with using the technology, though about 20 percent reported discomfort with the headset and about 10 percent experienced motion sickness and nausea.
Driven by the popularity of AR and VR technology in gaming, health systems have been experimenting with the technology for years, particularly in treatments that involve behaviors. This includes Cedars-Sinai in Los Angeles, which hosts an annual symposium on VR in healthcare.
Los Angeles-based AppliedVR, meanwhile, is partnering with the University of California at San Francisco on a business accelerator aimed at finding ways to use VR to improved access to care for underserved populations. And one of its chief competitors, Israel-based XRHealth, launched a handful of VR clinics last year where patients could be referred for VR therapy.
An automated messaging platform helped Penn medicine save two lives per week during the early days of the pandemic by allowing care providers to monitor patients at home.
An automated messaging platform that helped Penn Medicine monitor patients with COVID-19 at home is being credited with saving two lives per week during the early days of the pandemic.
The platform, called COVID Watch, sent AI-enhanced text messages to patients twice a day, asking about their symptoms. If patients reported worsening symptoms, they were sent follow-up questions, then called by designated clinical staff at the hospital, who could recommend hospitalization.
According to a study supported by the National Institutes of Health and the Patient-Centered Outcomes Research Institute (PCORI) and recently published in the Annals of Internal Medicine, nearly 20,000 patients have been monitored at home since the platform was launched on March 23, 2020. In the eight months after the program’s launch, only three of the 3,448 patients died within 30 days of enrollment, compared to 12 patients in a similar-sized group who weren’t in the program, and five died within 60 days, compared to 16 outside the program.
The research team, from Penn Medicine’s Perelman School of Medicine, concluded that COVID Watch reduced a patient’s chances of dying by 68 percent, and that 1.8 lives per 1,000 patients were saved over the first 30 days and 2.5 patients per 1,000 were saved at 60 days.
“Automation isn’t something that will replace human clinical care, but it is something that can extend it,” David Asch, MD, a co-author of the study and executive director of the Center for Health Care Innovation, said in a press release. “Without an automated system to help us watch over the thousands of COVID patients in our community, our doctors and nurses would have been stretched even thinner than they were. This is a promising model for the future.”
Penn Medicine’s program fits neatly into the strategy behind remote patient monitoring, or expanding care management options for patients at home instead of admitting them to a hospital or waiting for them to visit their doctor’s office or a clinic. By creating a platform that uses automated and intuitive messaging to connect with them twice a day, the health system is able to monitor them daily and take action if they’re trending downward. The platform is designed to catch patients before they become serious and require hospitalization.
To manage the program, the health system created a small team of nurses focused on tracking those patients at home. Those nurses can very easily track 1,000 patients around the clock, as well as provide support, such as helping to arrange tests and discussing the results.
“At the beginning of the pandemic, we instinctually thought patients needed extra support at home, even if they weren’t sick enough or ill yet. And if they were to get very sick, we wanted to help them get to the emergency department earlier, so COVID Watch was our solution,” Krisda Chaiyachati, MD, medical director of Penn Medicine OnDemand, an assistant professor of m and co- primary investigator of the study, said in the press release. “Our evaluation found that a small team of five or six nurses staffing the program during some of the most hectic days of the pandemic directly saved a life every three to four days.”
Researchers also noted that the platform works well across all populations, including communities that traditionally face barriers to accessing care.
“We saw a higher proportion of higher-risk patients and also low-income and Black patients enrolled in COVID Watch, but the fact that we measured a significant benefit associated with enrollment in the program is a good indicator that there truly is a treatment benefit for everyone,” M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology, deputy director of the Penn Medicine Nudge Unit, and the study’s lead author and co-primary investigator, said in the press release. “It’s crucial that we found all major racial and ethnic groups benefited because non-white and low-income communities have had disproportionately higher infection rates, lower access to care, and higher death rates. This implies that this model of care could have reduced disparities in COVID outcomes if it was scaled up more broadly to these communities.”
Penn Medicine officials noted the platform was originally modeled to monitor at home patients living with chronic obstructive pulmonary disease (COPD), and was redesigned to handle COVID-19. Now they’ll look to see how the platform can be reconfigured to monitor other patient populations, such as those with chronic care needs.
Intermountain Healthcare and several other healthcare providers are using drones to deliver prescriptions, medical supplies, and telemedicine platforms.
Intermountain Healthcare will be using drones to deliver prescriptions and other medical supplies to homes in and around Salt Lake City.
The multi-state health system, based in Salt Lake City, has announced a partnership with Zipline, a San Francisco-based medical product delivery company. The deal will enable Intermountain to used drones to ship specialty pharmaceuticals and homecare products to homes within 50 miles of the health system’s distribution center.
“Making access to healthcare faster and more convenient will lead to better health outcomes for our patients,” Intermountain President and CEO Marc Harrison said in a press release.
“Patients can connect with providers from the home, and then receive the medications and supplies they need in a matter of minutes, directly to their doorsteps,” said Keller Rinaudo, co-founder and CEO of Zipline, which has facilitated more than 200,000 drone deliveries and is currently involved in programs in Ghana and Rwanda. “For example, a cancer patient could receive her medication without ever leaving her home. Or a single parent could get his child’s antibiotics without a trip to the pharmacy. Instant access to care is not just about convenience. It comes down to making healthcare more equitable, efficient, and reliable for people, regardless of where they live or their circumstances.”
Health systems have been experimenting with drones over the past few years to deliver medical supplies to remote locations and facilitate the transfer of time-sensitive lab tests and specimens from one healthcare site to another, particularly in congested areas such as Los Angeles or regions with rough terrain such as the Rockies or Appalachians.
WakeMed Health & Hospitals in North Carolina, University of Utah Health, and Kaiser Permanente are all working with UPS to use drones as healthcare delivery vehicles, while CVS Health has partnered with UPS Flight Forward to use drones to deliver prescriptions to residents of The Villages, a Florida retirement community of more than 135,000 residents.
In San Diego, the Rady Children’s Institute for Genomic Medicine has been working with Deloitte to study how drones might improve care for seriously ill children. And researchers at the University of Cincinnati launched a program aimed at using drones to make telehealth house calls. The program, still in pilot phase, would send drones equipped with an audio-visual telemedicine platform and a waterproof compartment for carrying supplies or test samples into homes.
“When the COVID-19 pandemic began, we saw a need for telehealth care delivery drones to provide healthcare in the home and in locations where access to care is not readily available,” Debi Sampsel, telehealth director for UC’s College of Nursing, said in a new release supplied by the university.
Intermountain officials expect to develop the program in early 2022 and launch it by mid-year.
Gov. Phil Murphy says payers should be able to negotiate payment for telehealth services with healthcare providers.
New Jersey Gov. Phil Murphy has tapped the brakes on payment parity for telehealth, telling supporters he’s hesitant to make permanent a tactic that has been an emergency measure during the pandemic.
Murphy, a cautious supporter of telehealth in the past, has conditionally vetoed SB 2559, which would have mandated that payers – including the state Medicaid program – reimburse healthcare providers for telehealth services at no less than the rate they pay for in-person services.
“Approving this bill would amount to a very heavy thumb on the scale in favor of providers vis-à-vis carriers, in an area traditionally left to private negotiations,” he said in a lengthy notice attached to the veto. “Moreover, the cost to carriers – which would be felt both by those paying 3 premiums and taxpayers alike – could be substantial. And, while the cost of providing telehealth may be the same as or higher than the cost of providing in-person care in the short term, providers could realize significant cost savings over the long term, as expanding telehealth options might bring reductions in clinical space, support staff, and other expenses.”
Long a controversial strategy, payment parity has become popular during the pandemic as means of convincing hesitant care providers to try out telehealth, with the promise that they’ll be paid at the same rate as for in-person care. But opponents, including many in the insurance industry, say payers should be able to negotiate their own reimbursement rates, and that telehealth over the long run will actually reduce costs and save money.
Murphy’s action keeps the state’s current payment parity mandate in place through the end of 2023 to give the state Department of Health time to study the issue and make a policy recommendation, and to give lawmakers the time to decide whether they want to revise the legislation. Murphy also said that he would be recommending amendments to the Legislature “to remove some of the restrictions placed on carriers in order to ensure that carriers continue to have the flexibility they need to adapt to changing circumstances.”
Murphy’s veto isn’t unique. While most states and the federal government enacted a flurry of emergency rules to expand telehealth coverage and access during the height of the pandemic, many of those measures are ending. Some states have made those rules permanent, particularly for mental health and substance abuse services, while others are waiting on the federal government to enact long-term telehealth policy.
Telehealth advocates worry that an abrupt end to these emergency measures will force health systems to discontinue telehealth programs and patients to lose access to needed services. Opponents say the measures may have worked well during the pandemic but won’t be successful in the long run.
Murphy took a similar tack with proposals to allow medical marijuana providers to prescribe via telehealth. The governor initially vetoed the proposed legislation earlier this year, saying it created too many legislative hoops to jump through. He approved an amended bill in July.
Murphy argues that the concept of payment parity is good, in that it forces payers, providers and patients to think of telehealth on the same level as in-person care. But the concept hasn’t been fully thought out, and it might do more harm than good in the long run, he says.
“We do not yet have a full understanding of whether or how pay parity could negatively affect patients,” he said. “Notably, the federal Centers for Medicare & Medicaid Services has not yet taken a permanent position on pay parity. And, although providers must meet the same standard of care for telehealth as for in-person care, the quality of care could be impacted. In the short term, the flexibility afforded by expanded access to telehealth has greatly benefited New Jersey residents who may not have the time or resources to receive in-person care when local in-network options are limited. But I am concerned that in the long term, pay parity could over-incentivize telehealth, further limiting in-person options. This could be especially detrimental for those in underserved communities.”
The Federal Communications Commission is issuing awards to 75 healthcare organizations through the COVID-19 Telehealth Program, which helps providers in launching or expanding telehealth platforms to address healthcare access issues cauded by the pandemic.
The Federal Communications Commission has announced 75 more awards to help healthcare providers use telehealth technology to address healthcare needs during the pandemic.
The FCC announced the fourth round of awards from the COVID-19 Telehealth Program, which was originally launched in 2020 to help providers acquire telecommunications services, information services, and connected devices to improve access to care. The agency had been given $200 million in 2020, ran out of money in the middle of the year, and was given roughly $250 million from the Consolidated Appropriations Act at the end of 2020 to continue the program this year.
With this week's announcement, roughly $166 million has been awarded to 280 programs, with at least one program in every state and territory and the District of Columbia receiving funding. The FCC's Wireline Competition Bureau will now give the remaining applicants time to revise their applications before choosing more awards.
"Advances in telehealth continue to help bridge the gap in health care for our most vulnerable populations and keep Americans connected with their doctors, nurses, and health care providers in the face of the pandemic," Acting FCC Chairwoman Jessica Rosenworcel said in a press release accompanying the third round of awards announced last month. "With today's announcement, the FCC has approved more than $123 million in applications for Round 2 of its COVID-19 Telehealth Program—nearly half of the amount allotted in the 2021 Consolidated Appropriations Act. We remain committed to helping facilitate even more innovative health care efforts in every corner of our country."
The program is designed to reimburse healthcare providers for certain expenses tied to expanding connected health platforms during the ongoing COVID-19 pandemic, and to help underserved populations access care through technology. Providers are required to submit detailed invoices to qualify for reimbursement.
The program runs alongside the FCC's Connected Care Pilot Program, a separate, $100 million effort to use technology to improve access to care for underserved populations, especially veterans and those in rural regions. The FCC had announced a third round of awards in late October.
The Centers for Medicare & Medicaid Services is making it easier for healthcare providers to use telehealth – including the telephone – to deliver mental health and substance abuse care to patients in their homes.
The Centers for Medicare & Medicaid Services is expanding coverage for the use of telehealth technology in underserved areas and for the delivery of mental health services.
In its final rule for the 2022 Physician Fee Schedule, released this week, the agency has amended its rules to allow beneficiaries to receive care in their homes "for the purposes of diagnosis, evaluation, or treatment of a mental health disorder." This ends the long-debated practice of excluding a patient's home from the list of originating sites for telehealth services, and gives providers the opportunity to craft telehealth programs that reach patient where they live.
As part of that service, CMS is mandating that the provider and patient must meet in person at least six months prior to adopting virtual visits, and that an in-person exam be conducted at least once every 12 months thereafter, with some exception allowed due to "beneficiary circumstances."
The agency is also changing its definition of telehealth to include audio-only platforms, the most common of which is the telephone, for these home-based telehealth visit for mental health services. The move reflects a surge in telephone use during the pandemic, when providers were replacing in-person care with telehealth visits and patients were looking for easier ways to access care—especially in dealing with stress, depression, anxiety and substance abuse.
"The COVID-19 pandemic has highlighted the gaps in our current healthcare system and the need for new solutions to bring treatments to patients, wherever they are," CMS Administrator Chiquita Brooks-LaSure said in a press release. "This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options."
CMS officials emphasized that coverage for audio-only telehealth services is limited to mental healthcare services furnished by providers who use two-way audio-visual telehealth platforms (often called video visits), but whose patients either can't or don't want to use that platform. The agency is also clarifying that mental health services can include treatment for substance use disorders (SUD).
The agency is making permanent several measures enacted during the ongoing public health emergency (PHE) caused by the pandemic to expand telehealth access and coverage. And the moves come as both federal and state lawmakers look to establish long-term policies that combine in-person care with technology platforms that improve access to care, including telehealth and remote patient monitoring.
The efforts address a surge in mental health and substance abuse issues tied to the pandemic, and the reluctance of many healthcare providers to embrace telehealth without reimbursement, especially in treating underserved populations who rely on Medicare and Medicaid.
In this vein, CMS is also establishing permanent coverage for mental health services delivered via telehealth through federally qualified health centers (FQHC) and rural health clinics (RHC), two types of care providers that have traditionally targeted underserved populations, but which haven't been reimbursed for telehealth services.
On a related note, the agency is extending dozens of telehealth services allowed during the PHE through the end of 2023. Coverage for those services would have expired at the end of 2021, but CMS has said it wants more time to study how these services have impacted care delivery and clinical outcomes. The move gives providers more time to gather data on the effectiveness of their telehealth services, which could be used to convince CMS to make coverage permanent.
