The online, self-paced program examines innovative telehealth models and best practices and provides strategies to help providers overcome nagging hurdles.
The online, self-paced program examines innovative telehealth models and best practices and provides strategies to help providers overcome nagging hurdles such as reimbursement parity, set-up costs, regulatory red tape, and competition from retail clinics and urgent care centers.
"As a physician at one of Pennsylvania's first 100% virtual primary care practices, I can testify to the importance of education in telehealth – and teleprimary care in particular," said Salim Saiyed, MD, CMIO at UPMC in Central Pennsylvania and course director for ABT's teleprimary care program.
"Doctors and care teams need to understand how they can deliver teleprimary care more efficiently and effectively – from the start of the encounter to check out and arranging any follow-up care needed so that patients can access the right specialists, for the right test, or the right procedure," Saiyed said.
The Teleprimary Care Certificate program covers:
Barriers and opportunities of teleprimary care, along with the evolution of telehealth in the primary care setting, and progressive models now in the market;
Operations, workflow and productivity in the ambulatory setting, and how technology can optimize resources and maximize productivity while maintaining care standards;
Legal, regulatory and ethical considerations, with an emphasis on regulatory compliance challenges at the federal and state levels and mitigate risk guidance;
Providing care via a remote medium, examining best practices for hybrid care models, including tips for virtual patient encounters and strategies to promote quality and foster patient trust;
Health equity and social determinants of health, and how to enhance access for underserved populations.
"Teleprimary care is at the forefront of the telemedicine space, but it continues to evolve and expand with the development of new technologies, innovative care models and evolving reimbursement policies," said Whitney Flanagan, RN, director of education for the ABT. "Telehealth training – whether it's on the platform, regulations or webside manners – will be critical to long term success. Primary care teams need specialized skills to meet the growing demand for telemedicine services and ensure the highest quality care possible for patients."
California docs say the latest mandate is part of an ongoing and "common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it."
The California Medical Association is taking Aetna Inc. to task for what the physicians' association claims is cumbersome new red tape requiring prior authorization for cataract surgeries.
The CMA said the latest mandate, effective July 1, is part of an ongoing and "common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it."
"Aetna claims the practice will 'help members avoid unnecessary surgery,'" CMA said. "The reality is that this bureaucratic roadblock is not some kind of patient protection measure. It is an effort to deny care and pad the insurance company's bottom line."
The CMA noted that Aetna has seen record profits through the COVID-19 pandemic. Acquired by CVS Health in 2018, Aetna's operating income increase from $1 billion in 2019 to $3 billion in 2020.
A recent American Medical Association survey found that nearly 70% of 1,000 practicing physicians surveyed in Dec. 2020 reported that, amid the COVID-19 pandemic, health insurers had either reverted to past prior authorizations policies or never relaxed these policies in the first place.
More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care, and nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.
In a statement sent to California Health Facts, Aetna said it notified in March the ophthalmologists in their network and related professional associations about the "precertification policy" on cataracts, explained the rationale, and laid down the guidelines.
"Based on our decades of experience in reducing unnecessary surgeries, a multi-year, multi-state pilot on reducing unnecessary cataract surgeries, and national clinical guidelines and literature on surgeries, we believe up to 20% of all cataract surgeries may be unnecessary," Aetna said. "Our data from July shows that more than 99% of cataract precertification cases were compliant with turnaround time standards, which are based on regulatory and accreditation requirements."
In California, CMA is sponsoring SB 250 by Senator Richard Pan, MD, which would require state regulators to streamline the prior authorization system to ensure patients have access to critical care. That could include copying legislation in Texas that created an audit-based system where prospective prior authorization is waived for clinicians deemed high-performing.
CMA is also supporting federal legislation—HR 3173, the "Improving Seniors' Timely Access to Care Act" sponsored by U.S. Rep. Ami Bera, MD, D-CA. The bill would standardize and streamline prior authorizations for routinely approved services under Medicare Advantage programs.
Cricket claims its "StageSmart™" predictive analytics model can identify patients with chronic kidney disease stages 3b and beyond with 96% accuracy.
Blue Shield of California has partnered with Cigna Ventures and other investors to provide $83.5 million to expand Cricket Health, the San Francisco-based kidney care provider.
"In the year that we have been working with Cricket Health, our members with chronic kidney disease have received comprehensive care from the comfort of their homes, resulting in better health outcomes," said Blue Shield of California Interim CMO Susan Fleischman, MD. "Cricket Health's virtual platform has helped connect patients with clinical and peer support, making them feel more educated about their health and involved in their care plans, allowing them to live their best lives."
Cricket claims its "StageSmart™" predictive analytics model can identify patients with chronic kidney disease stages 3b and beyond with 96% accuracy, which allows the provider to risk stratify patient populations and deliver stage-specific care.
Cricket's "MyCricket™" patient support platform provides access to a multidisciplinary care team, peer support, and educational resources online, by telephone, or in person. Cricket patients in end-stage kidney disease are more likely to be referred for transplants and have access to home dialysis to reduce unnecessary hospitalizations.
The Series B funding round, led by the healthcare private equity firm Valtruis, a portfolio of Welsh, Carson, Anderson & Stowe, also includes existing investors Oak HC/FT, and K2 HealthVentures. With the new funding, Cricket has raised more than $120 million in equity and debt financing.
"Changing the way kidney disease is identified and managed is how we are able to deliver better clinical results," Cricket Health CEO Robert Sepucha said. "By identifying patients earlier and delivering the care they need, we are helping more Americans than ever stay healthy, at home, and out of the hospital. With new partners Welsh Carson and Blue Shield of California and existing partners Oak HC/FT, Cigna, and K2 Health Ventures, we will be able to continue to expand our innovative model of kidney care across the country."
Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said the payer's partnership with Cricket has made kidney disease management more affordable, predictable and simple for beneficiaries.
"Since May 2020, we've seen more than a 50% reduction in hospitalizations and an increase in patient autonomy in a customer's transition to dialysis," he said, "and we look forward to continuing our partnership to help improve our customers’ experience and their health."
The settlement stems from violations of the Mental Health Parity and Addiction Equity Act of 2008.
United Behavioral Health and parent United Healthcare Insurance Co. will pay $15.6 million to settle allegations that the payer unlawfully denied mental health and addiction treatment services to thousands of people.
"United's action violated the Mental Health Parity and Addiction Equity Act of 2008, which prohibits Employee Retirement Income Security Act-covered health plans from imposing treatment limitations on mental health and substance use disorder benefits that are more restrictive than the treatment limitations they impose on medical and surgical benefits," DOL said.
As a result of United's violations, beneficiaries did not get mental health and substance use benefits mandated by their ERISA-covered plans. More than $13 million of the settlement will be paid to those beneficiaries, with the remainder collected as penalties, DOL said.
United also failed to disclose adequate information about these practices to plans and their beneficiaries, and has agreed to stop the violations, improve its disclosures to plan participants and commit to compliance.
"In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before," New York Attorney General Letitia James said.
"United's denial of these vital services was both unlawful and dangerous – putting millions in harm's way during the darkest of times. There must be no barrier for New Yorkers seeking healthcare of any kind, and I will always fight to protect and expand it."
UnitedHealth Group issued a statement saying it is "committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member's health plan and state and federal rules."
"We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need."
The new feature is designed for infrequent users of telehealth or people who may not be tech savvy, according to a post on Zoom's website.
Online video conferencing provider Zoom announced this week that it is launching a mobile browser that will allow users to join secure telehealth appointments without downloading the app.
The new feature is designed for infrequent users of telehealth or people who may not be tech savvy, according to a post on Zoom's website.
"Everyone needs healthcare, but not everyone uses technology all the time," Zoom said. "Some patients unfamiliar with how to download an app may have to spend time on the phone with their doctor's office to get assistance — which isn't very convenient if you're sick and trying to access care. Others may only use Zoom to connect with their doctor once or twice a year and may not want to download an app for that."
The mobile browser allows patients to receive a Zoom meeting link from their provider via text or email. When the appointment begins, patients simply clink the link and follow the prompts to launch the meeting on their mobile device.
Patients seeking telehealth access on their desktop or laptop computer can join Zoom meetings directly from a web browser, where they click the link and follow the prompts.
Zoom says the mobile browser will also make life easier for providers by streamlining the process, eliminating the need to download an app, and reducing time spent with tech support.
While patients using the browser will have a simplified user interface that is easy to use, providers will get all the benefits of a Zoom app call, including meeting host controls and virtual background. The browser also allows patients more flexibility to schedule appointments from anywhere, as opposed to being chained to a desktop.
In addition, providers can schedule appointments with a feature that simulates a traditional clinical workflow.
The mobile browser client is available in beta for providers and patients to start using for iOS, with later plans to roll out to additional operating systems.
Zoom is also planning additional features for the browser that will allow providers to send a Zoom meeting link to patients by email or text without exposing the email address or phone number of the web scheduler.
The browser will also soon offer patients an enhanced virtual Waiting Room that will allow providers in a Zoom session to send chat messages to patients in the Waiting Room, greeting them, offering instructions, and letting them know they're in the right place, and presenting a pre-recorded video welcoming patients and familiarizing them with the virtual office.
While 80% of respondents said their primary care health issues were resolved using telehealth, accessing virtual care remains a challenge for the elderly and rural patients.
About 14% of respondents to a new the survey reported that access to telehealth kept them out of the emergency department.
The new national survey of 1776 people, conducted by telephone in June and July by the Bipartisan Policy Center and Social Sciences Research Solutions, also found that 80% of respondents had a primary care health issue resolved using telehealth.
"New telehealth flexibilities have allowed millions of Americans to access healthcare from home, and as our survey shows, telehealth has the potential to take non-emergency cases out of the emergency department," said Marilyn Serafini, BPC health project director.
"BPC encourages Congress to act swiftly to extend telehealth flexibilities beyond the public health emergency to study their impact on consumers, providers, and payers in a post-pandemic world," she said.
One-third of adults surveyed reported having a telehealth visit for themselves or a dependent in 2020, with Medicare beneficiaries (44%) having the most visits.
And while 80% of respondents said they were likely to use telehealth to access routine and preventive healthcare during the ongoing pandemic, access challenges remain for the elderly and rural residents.
"Telehealth has helped transform the way healthcare has been delivered during COVID-19; however, broadband remains an obstacle that must be addressed, especially in rural areas," said Walter Panzirer, trustee, Leona M. and Harry B. Helmsley Charitable Trust, who funded the survey.
"To accelerate care delivery, policymakers must provide and expand high-quality virtual care across the country. The technology is popular, effective, and addresses care disparities," he said.
The most common telehealth visit was for preventive services, prescription refills, or routine visit for a chronic illness (63%). Rural residents said they were more likely to use telehealth for surgical consults than people living in non-rural areas.
More than nine in 10 respondents said they were satisfied with the audio and video quality of their telehealth, while older adults were more likely to use audio-only, telephone services
More than half (55%) of Black respondents said they would likely use telehealth for a routine visit for a chronic illness compared to 45% of white respondents.
The survey also found that seniors had higher rates of telehealth use over the past year but faced significant challenges. Nearly half (45%) of adults reported technology related problems when accessing telehealth, including digital literacy, access to high-speed internet, and securing devices.
More than one-third (35%) of rural residents and 42% of older adults said access to high-speed broadband was an obstacle, compared to 24% of non-rural residents and 21% of younger adults.
Before May, telehealth as a percentage of medical claims had steadily fallen from February through April.
Telehealth as a percentage of all medical claims rose 2% nationally from April to May after dropping for the three previous months, according to nonprofit FAIR Health's Monthly Telehealth Regional Tracker.
Overall, telehealth represented 5% of all medical claims in May, up from 4.9% in April, according to tracker data, which examines privately insured plans, including Medicare Advantage, and excluding Medicare fee-for-service and Medicaid.
Before May, telehealth as a percentage of medical claims had steadily fallen from February through April.
Regionally, the South (5.6%) and the West (4.8%) saw the largest increases in telehealth claims, while the Northeast and the Midwest saw declines of 5.4% and 1.7%, respectively.
Substance use disorders were among the top five telehealth diagnoses nationally for the first time, coming in fifth place. The pattern was consistent with reports of increased misuse of opioids and stimulants during the COVID-19 pandemic, FAIR said.
The percentage of telehealth claim lines accounted for by mental health conditions rose nationally and in every region in May 2021. Mental health conditions remained the number one telehealth claim nationally and in every region.
Acute respiratory diseases and infections climbed in the national rankings of telehealth diagnoses from number four to number three, joining the top five diagnoses in the Northeast and West. The diagnosis had already been in the top five in the Midwest and South in April and continued there in May.
FAIR said the rise in respiratory claims suggested a return to non-COVID respiratory conditions, such as colds and bronchitis, as cases of COVID-19 fell.
In May 2021, the top five telehealth procedure codes by utilization remained the same as in April nationally and in every region but the Midwest. There, CPT®2 99213, an established patient outpatient visit with a total time of 20-29 minutes, fell from second to fourth place.
CMA claims that Aetna's actions violated the state's Unfair Competition Law.
The California Supreme Court has granted a California Medical Association request to review a decade-long lawsuit against Aetna challenging the health insurer's denials of out-of-network benefits.
The story begins in July 2012, when CMA, the Los Angeles County Medical Association, and other providers sued Aetna for what the plaintiffs alleged was "a systematic practice by Aetna of harassing and terminating contracted physicians from the Aetna network when they refer patients to out-of-network ambulatory surgery centers."
Fast-forward to November 2019, and after seven years of mind-numbing litigation, the Los Angeles Superior Court ruled that CMA did not have legal standing to pursue claims against Aetna on behalf of its physician members.
However, CMA has argued that the Los Angeles appellate court wrongly concluded that CMA's use of its own money didn't count as injury to the organization because CMA "was founded to advocate on behalf of its physician members" and that CMA staff time spent fighting these abuses "was typical of the support CMA provides its members in furtherance of CMA's mission."
CMA claims that Aetna's actions violated the state's Unfair Competition Law, which grants standing to any person or organization that "has suffered injury in fact and has lost money or property as a result of the unfair competition."
"Aetna's practices at issue in this case both harmed CMA and its members and frustrated the other more expansive purposes of the organization, as CMA was forced to expend resources and money in order to protect its members from Aetna's unfair practices," CMA said in a media release. "That is all that is required to establish standing under the UCL."
"If the appellate court's decision is allowed to stand, it would effectively preclude any membership organization from ever seeking relief under the UCL and undercut a central plank of private enforcement of one of the state's most important consumer-protection laws," CMA said.
CMA is calling the decision to hear the petition "a major victory" because the state's highest court reviews only about 3% of the more than 1,000 civil petitions for review it gets each year.
Four Michigan hospitals were named in the suit, which stems from the questionable practices of one gynecologic oncologist.
Ascension Michigan will pay $2.8 million to settle whistleblower False Claims Act allegations that four of its hospitals filed claims for medically unnecessary procedures performed over more than six years by a gynecologic oncologist, the Department of Justice said.
According to federal prosecutors, from Feb. 1, 2011, through June 30, 2017, Ascension Michigan knowingly falsely billed Medicare and other federal government healthcare programs and improperly kept payments for professional and facility fees related to medically unnecessary radical hysterectomies that "the Doctor" – not named by DOJ -- performed, including chemotherapies that the doctor administered, and evaluations and management services by the doctor that were not performed or misrepresented.
The federal complaint notes that the doctor's higher-than-average rates of pulmonary embolisms and surgical infections, and patients' complaints, aroused the suspicions of Ascension Michigan managers. They hired an independent doctor to conduct a peer review that found that, for most of the radical hysterectomies and chemotherapy performed by the doctor, a less aggressive surgery or medical intervention would have been the care standard.
In June 2018, Ascension self-disclosed the fees it billed to federal healthcare programs for services provided by the doctor. Though the health system at first improperly kept the money, it cooperated in the DOJ investigation and "took active steps" to address concerns raised about the doctor, including the peer review, placing the doctor on a performance improvement plan, and canceling its contract with the doctor.
"When hospitals receive payment from federal healthcare programs for medically unnecessary surgical procedures, they cannot simply retain those payments; they have an obligation to return them," DOJ's Civil Division Acting Assistant Attorney General Brian M. Boynton said. "We will continue to ensure that taxpayer funds are used appropriately for the important programs that they support."
The four Michigan hospitals named in the settlement are: Providence Park Hospital; St. John Hospital and Medical Center; St. John Macomb Oakland Hospital; and Ascension Crittenton Hospital.
Ascension Michigan did not respond to HealthLeaders' request for comment on the settlement.
Overall, the healthcare sector created 37,000 new jobs in July, with the gains by hospitals and 32,000 new jobs in ambulatory services offsetting the loss of 13,000 jobs in nursing and residential homes, the Bureau of Labor Statistics reports.
The BLS report accounts for employment in mid-July and can be subject to considerable revision.
The healthcare sector has shed 502,000 jobs since the start of the pandemic in February 2020, with hospitals accounting for 86,000 job losses, and nursing homes accounting for 378,000 job losses. Ambulatory services sector lost 37,000 jobs in that span.
There were 15.9 million people attached to the healthcare sector workforce in July, BLS said.
For the second straight month, the larger economy saw solid job growth in July, with 943,000 new jobs created, as the unemployment rate ticked down to 5.4% from 5.9% in June, and the number of unemployed people fell by 782,000 to 8.7 million.
Nonfarm payroll employment is up by 16.7 million since April 2020 but down by 5.7 million, or 2.7%, from its pre-pandemic level in February 2020.
