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Monthly Archives

May 2021

HRMC opens new Tele ICU unit

By News

Michael M. DeWitt, Jr.

Augusta Chronicle

Small, rural hospital continues to break new ground with state-of-the-art technology and award-winning patient care.

In the Intensive Care Unit (ICU), every second counts, no matter the hour or the day. Now, thanks to technology and partnerships, life-saving critical care is only the push of a button away for patients in our local ICU.

On May 6, Hampton Regional Medical Center (HRMC) cut the ribbon on its new Tele-ICU Unit. Through a partnership with the Medical University of South Carolina (MUSC) Health and Hicuity Health, HRMC is now able to provide advanced intensive care around the clock through the use of telemedicine technology.

Faced with challenges that include remote locations and a shortage of specialists and intensive healthcare providers, many rural hospitals are turning more and more to virtual tele-health to provide quality care for their rural populations, and HRMC has fully embraced this concept.

“We can now keep patients closer to home, with their families near, and still provide the critical care they need,” said Cam Ulmer, a Registered Nurse who helps oversee the program. “It has been a blessing for this hospital, and for the whole community. Just having the support of an Intensivist is huge.”

Located inside the hospital’s five-bed Intensive Care Unit are two fully equipped Hicuity Health rooms, complete with high-resolution cameras and monitors to enable healthcare providers at the bedside to communicate directly with advanced specialists that may be on the other side of the continent. For small hospitals that can’t afford to keep an Intensivist on staff, this technology will make it possible to keep sicker patients locally for longer.

Source:  Augusta Chronicle

Rural Two New Broadband Bills, Including One Aimed at Rural America, Introduced in Congress

By News

The bipartisan Hassan-Capito bill would provide state and local governments with new financing options for broadband projects.

By: Ty Perkins

May 21, 2021 — Two new bills introduced into Congress this week both aim to accelerate the rate at which quality broadband access reaches unserved and underserved Americans living in rural communities.

The Expanding Opportunities for Broadband Deployment Act introduced Thursday by Rep. G. K. Butterfield, D-N.C., seeks to repeal unnecessary eligibility requirements that prevent otherwise qualified internet service providers from participation in federal universal support programs designed to close broadband access gaps nationwide. Universal support programs are federally funded and operate on the belief that all Americans should have access to communications services.

The bipartisan Rural Broadband Financing Flexibility Act introduced on Tuesday by Sens. Maggie Hassan, D-N.H., and Shelley Moore Capito, R-W.V., aims at helping states, cities and town spur investment in rural broadband projects. The bill would provide state and local governments with new financing options for broadband projects, giving states and localities access to additional tools to invest in rural broadband.

Butterfield’s legislation will retire the eligible telecommunications carrier designation requirements, which, according to the NCTA, “unfairly prevent qualified ISPs from participating in federal universal support programs.” By removing the requirements, more service providers with a history of competently operating broadband networks will participate in the federally funded programs.

Ideally, this will spur competition among more competing internet service providers, who will all seek to bring internet service to underserved areas for the best quality and lowest prices.

Hassan’s and Moore’s bill would allow states to issue tax-exempt bonds in order to finance rural broadband projects. These bonds would be backed by the federal government, which would ensure repayment on the bonds, thereby making the purchasing of such assets a riskless investment. Additionally, the legislation would create a federal tax credit that states and localities could direct toward rural broadband projects.

“I’ve been pursuing every angle to ensure rural areas get reliable, affordable connectivity,” Capito said. “This legislation will provide additional funding opportunities for communities looking to invest in rural broadband. I’m proud to team up with Sen. Hassan again to reintroduce this legislation that will help close the digital divide in West Virginia and across rural America by incentivizing buildout and expanding financing options.”

Source:  Broadband Breakfast

New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

By News

New bills introduced in the House and Senate signal Congress’ intent to make telehealth flexibilities in Medicare and Medicaid permanent after the pandemic ends.

By Robert King |

A pair of bills recently introduced in the House and Senate aim to ensure that a boom in telehealth use during the pandemic does not go away.

A House bill introduced Monday and a Senate bill introduced Tuesday both aim to make certain telehealth flexibilities permanent for Medicaid and Medicare beneficiaries.

“The pandemic has created challenges for everyone, but it’s also shown us that technology can provide safe and dependable communication between patients and their doctors,” said Rep. Jason Smith, R-Missouri, one of the co-sponsors of the House bill alongside Rep. Josh Gottenheimer, D-New Jersey. “Innovations including telehealth and audio-only capabilities will improve efficiency, reduce costs and increase access to healthcare providers.”

At the onset of the pandemic, the Centers for Medicare & Medicaid Services waived key barriers to telehealth use, enabling providers to offer audio-only telehealth services and ensuring that originating site requirements were removed. The new flexibility helped greatly expand the use of telehealth as providers could get Medicare reimbursement and help patients scared of going to the doctor’s office or hospital for fear of contracting COVID-19.

But the telehealth flexibilities will only last through the extent of the COVID-19 public health emergency, which will eventually lapse as the pandemic gets under control.

CMS officials have said that they need Congress’ help to make the flexibilities permanent.

The House’s Permanency for Audio-Only Telehealth Act would enable audio-only telehealth services for Medicare enrollees.

The legislation would also remove geographic and originating site restrictions to ensure that Medicare beneficiaries’ homes can be telehealth originating sites for audio-only services.

The Medical Group Management Association applauded the legislation.

“During the COVID-19 pandemic, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits,” said Anders Gilberg, MGMA’s senior vice president of government affairs.

The bill builds on similar legislation introduced in the House in March that would enable audio-only telehealth services for Medicare Advantage plans. Currently, providers can offer telehealth services under MA plans but only if they involve a video component.

Congress is not just looking at how to expand access to telehealth for Medicare.

Sens. Tom Carper, D-Delaware, and John Cornyn, R-Texas, introduced legislation on Tuesday that seeks to increase telehealth access for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, according to a report in Politico.

The legislation would require the Department of Health and Human Services (HHS) to give guidance to states to increase telehealth access for CHIP and Medicaid. This would include outlining what services can be reimbursed by telehealth.

The bipartisan nature of both the House and Senate legislation underscores the likelihood they could get through Congress and signed into law.

HHS Secretary Xavier Becerra has repeatedly underscored the need for legislative help if the boom in telehealth wants to continue.

“COVID has taught us so much,” Becerra said during his confirmation hearing in February. If we don’t learn from COVID how telehealth can save lives then we are going to be in trouble.”

‘Let’s work together’: Vision Greenwood hosts broadband taskforce meeting

By News

As the Lakelands slowly creeps out of the novel coronavirus pandemic, a task force in Greenwood County is looking to solve an infrastructure problem that was highlighted during the pandemic.

“We failed you, in that we did not have what you needed,” Sen. Billy Garrett told superintendents of each of Greenwood County’s three school districts. “This hit us, we’re going to fix that.”

Garrett was addressing the need for rural broadband internet access, a challenge that was even more transparent last year as schools transitioned to e-learning to avoid the person-to-person contact that could spread COVID-19.

On Monday, leaders of Greenwood from city and county government, the Upper Savannah Council of Governments, state legislators, and school administrators met at the Greenwood Genetic Center’s Curry Conference Center to hear from the state Office of Regulatory Staff about the state of broadband in South Carolina.

“The focus has shifted,” said Nanette Edwards, executive director of the Office of Regulatory Staff. “I’ve had folks tell me that they see access to the internet the same way you would have access to water, sewer, same way you’d have access to electric utility electric service.”

She said broadband is an area where state law does not have a lot of regulation, which has provided opportunities to meet the needs in communities.

“The focus now shifting to broadband and giving consumers the access they need for telework, telehealth, and most significantly for our education,” Edwards said.

The Office of Regulatory Staff is the state’s office that is working with rural communities to develop paths to building rural broadband infrastructure in the most needed areas. While broadband does not have its own office, Regulatory Staff employs a broadband coordinator, Jim Stritzinger, who gave a presentation to the task force.

Stritzinger’s connection with Greenwood goes back to late 2014 when he worked with former Greenwood Partnership Alliance CEO Heather Simmons Jones to establish Greenwood County as one of the first certified connected communities, he said.

Stritzinger said when looking at broadband an evaluation has to be made of three areas: access, adoption and use. He presented a number of maps to the task force showing broadband access and capabilities in the state using the 2015 minimum criteria of 25 Mbps download speed and 3 Mbps upload speed, the speed that it takes to stream a video without buffering.

Using that information, he identified 10 target areas representing about 36 square miles in Greenwood County where people live that do not have access to internet service.

“It’s not affordability, it doesn’t exist,” Stritzinger said.

Stritzinger said 556 similar target areas exist across the state.

He said the state has 35 internet service providers and praised one that was represented in the room. Stritzinger said WCTEL – whose CEO Jeff Wilson was in attendance — made a visionary move in 2008 to rebuild infrastructure in Abbeville County to make broadband fiber internet service available throughout the county.

Much of the southern parts of Greenwood County outside of Greenwood city limits are areas where there is no internet available.

“That means the people that live there have no choice for an ISP, candidly, there’s nothing there,” Stritzinger said.

Stritzinger said a lot of the data he obtains on internet speeds come from the Ookla Speed Test, a service available by website and mobile app that tests the speed of an internet connection.

He said the state will also see some federal money — $122 million — help with broadband initiatives. Charter Spectrum has been awarded a grant to expand broadband in the state as well as Elon Musk’s SpaceX Starlink program, a satellite-based internet provider.

Edwards said coordination is the biggest issue. The task force hopes to help with that.

“Our task force was formed in order to assess areas of Greenwood, McCormick, in portions of adjacent counties which needed broadband coverage,” Garrett said.

Garrett said Upper Savannah COG will help with writing grants the group may want to seek.

“I’m really heartened by what Vision Greenwood has done,” Stritzinger said.

Vision Greenwood, formerly GPA’s Foundation for a Greater Greenwood, has been coordinating broadband taskforce meetings even before the organization is ready to fully introduce itself.

“Vision Greenwood is all about community development, providing leadership to enhance the quality of life in Greenwood through long-term vision and strategic community development initiatives,” Kay Self, executive director of Vision Greenwood, said. “It’s a continuation of some of the efforts that we’ve started for the past 10 years. Bringing in new fresh ideas, taking on some of the gaps and shortfalls in our community.”

Collaboration is the key to success for Vision Greenwood and its broadband efforts.

“Let’s work together,” Self said. “We are going to need your help to collaborate and make this happen for our community.”

Contact staff writer James Hicks at [email protected] or on Twitter @jameshicks3.

More telehealth therapy means fewer skipped sessions

By News

When the COVID-19 pandemic forced behavioral health providers to stop seeing patients in person and instead hold therapy sessions remotely, the switch produced an unintended, positive consequence: Fewer patients skipped appointments.

That had long been a problem in mental health care. Some outpatient programs previously had no-show rates as high as 60%, according to several studies.

Only 9% of psychiatrists reported that all patients kept their appointments before the pandemic, according to an American Psychiatric Association report. Once providers switched to telepsychiatry, that number increased to 32%.

Not only that, but providers and patients say teletherapy has largely been an effective lifeline for people struggling with anxiety, depression and other psychological issues during an extraordinarily difficult time, even though it created a new set of challenges.

Many providers say they plan to continue offering teletherapy after the pandemic. Some states are making permanent the temporary pandemic rules that allow providers to be reimbursed at the same rates as for in-person visits, which is welcome news to practitioners who take patients’ insurance.

“We are in a mental health crisis right now, so more people are struggling and may be more open to accessing services,” said psychologist Allison Dempsey, associate professor at University of Colorado School of Medicine in Aurora. “It’s much easier to connect from your living room.”

The problem for patients who didn’t show up was often as simple as a canceled ride, said Jody Long, a clinical social worker who studied the 60% rate of no-shows or late cancellations at the University of Tennessee Health Science Center psychiatric clinic.

But sometimes it was the health problem itself. Long remembers seeing a first-time patient drive around the parking lot and then exit. The patient later called and told Long, “I just could not get out of the car; please forgive me and reschedule me.”

Long, now an assistant professor at Jacksonville State University in Alabama, said that incident changed his perspective. “I realized when you’re having panic attacks or anxiety attacks or suffering from major depressive disorder, it’s hard,” he said. “It’s like you have built up these walls for protection and then all of a sudden you’re having to let these walls down.”

Absences strain providers whose bosses set billing and productivity expectations and those in private practice who lose billable hours, said Dempsey, who directs a program to provide mental health care for families of babies with serious medical complications. Psychotherapists often overbooked patients with the expectation that some would not show up, she said.

Now Dempsey and her colleagues no longer need to overbook. When patients don’t show up, staffers can sometimes contact a patient right away and hold the session. Other times, they can reschedule them for later that day or a different day.

And telepsychiatry performs as well as, if not better than, face-to-face delivery of mental health services, according to a World Journal of Psychiatry review of 452 studies.

Virtual visits can also save patients money, because they might not need to travel, take time off work or pay for child care, said Dr. Jay Shore, chairperson of the American Psychiatric Association’s telepsychiatry committee and a psychiatrist at the University of Colorado medical school.

Shore started examining the potential of video conferencing to reach rural patients in the late ’90s and concluded that patients and providers can virtually build rapport, which he said is fundamental for effective therapy and medicine management.

But before the pandemic, almost 64% of psychiatrists had never used telehealth, according to the psychiatric association. Amid widespread skepticism, providers then had to do “10 years of implementations in 10 days,” said Shore, who has consulted with Dempsey and other providers.

Dempsey and her colleagues faced a steep learning curve. She said she recently held a video therapy session with a mother who “seemed very out of it” before disappearing from the screen while her baby was crying.

She wondered if the patient’s exit was related to the stress of new motherhood or “something more concerning,” like addiction, she said. She thinks she might have better understood the woman’s condition had they been in the same room. The patient called Dempsey’s team that night and told them she had relapsed into drug use and been taken to the emergency room. The mental health providers directed her to a treatment program, Dempsey said.

“We spent a lot of time reviewing what happened with that case and thinking about what we need to do differently,” Dempsey said.

Providers now routinely ask for the name of someone to call if they lose a connection and can no longer reach the patient.

In another session, Dempsey noticed that a patient seemed guarded and saw her partner hovering in the background. She said she worried about the possibility of domestic violence or “some other form of controlling behavior.”

In such cases, Dempsey called after the appointments or sent the patients secure messages to their online health portal. She asked if they felt safe and suggested they talk in person.

Such inability to maintain privacy remains a concern.

In a Walmart parking lot recently, Western Illinois University psychologist Kristy Keefe heard a patient talking with her therapist from her car. Keefe said she wondered if the patient “had no other safe place to go to.”

To avoid that scenario, Keefe does 30-minute consultations with patients before their first telehealth appointment. She asks if they have space to talk where no one can overhear them and makes sure they have sufficient internet access and know how to use video conferencing.

To ensure that she, too, was prepared, Keefe upgraded her Wi-Fi router, purchased two white noise machines to drown out her conversations and placed a stop sign on her door during appointments so her 5-year-old son knew she was seeing patients.

Keefe concluded that audio alone sometimes works better than video, which often lags. Over the phone, she and her psychology students “got really sensitive to tone fluctuations” in a patient’s voice and were better able to “pick up the emotion” than with video conferencing, she said.

With those telehealth visits, her 20% no-show rate evaporated.

Kate Barnes, a 29-year-old middle school teacher in Fayetteville, Arkansas, who struggles with anxiety and depression, also has found visits easier by phone than by Zoom, because she doesn’t feel like a spotlight is on her.

“I can focus more on what I want to say,” she said.

In one of Keefe’s video sessions, though, a patient reached out, touched the camera and started to cry as she said how appreciative she was that someone was there, Keefe recalled.

“I am so very thankful that they had something in this terrible time of loss and trauma and isolation,” said Keefe.

Demand for mental health services will likely continue even after the lifting of all covid restrictions. About 41% of adults were suffering from anxiety or depression in January, compared with about 11% two years before, according to data from the U.S. Census Bureau and the National Health Interview Survey.

“That is not going to go away with snapping our fingers,” Dempsey said.

After the pandemic, Shore said, providers should review data from the past year and determine when virtual care or in-person care is more effective. He also said the health care industry needs to work to bridge the digital divide that exists because of lack of access to devices and broadband internet.

Even though Barnes, the teacher, said she did not see teletherapy as less effective than in-person therapy, she would like to return to seeing her therapist in person.

“When you are in person with someone, you can pick up on their body language better,” she said. “It’s a lot harder over a video call to do that.”

Thousands in the Upstate could see faster Internet with $150 million rural broadband effort

By News

Mike Ellis

Greenville News

Thousands of people in the Upstate could get faster Internet access by the end of the year from a new broadband company, Upcountry Fiber, launched by two utility cooperatives.

The company’s $150 million expansion is a large investment, and the state of South Carolina has set aside $30 million for broadband expansion programs in the most recent budget.

The program is a great trend and has a lot of promise for the Upstate, said Jim Stritzinger, South Carolina’s state broadband coordinator.

He said that both companies partnering, Blue Ridge Electric Co-Op and Western Carolina Telecommunications Cooperative, have well-earned reputations.

The electric cooperative brings a larger base of people and geography as well as easements while the telecommunications cooperative has been a pioneer in broadband in the state, building a network in Abbeville a dozen years ago, Stritzinger said.

About a half million people in South Carolina can’t get the Internet speeds that make digital learning, remote work and telehealth possible.

It will go into Pickens, Oconee, Anderson, Greenville and Spartanburg counties.

Rural areas will be a challenge to reach for broadband, going out to rural homes is often not profitable, said Ann Eisenberg, an associate law professor at the University of South Carolina whose work includes rural economic opportunities.

That’s the challenge that the new company, Upcountry Fiber, believes it has cracked.

Jim Lovinggood, president and CEO of Blue Ridge Electric Co-Op, said the economic model is working and has worked in a pilot program.

The program was in the Stillwood neighborhood in Oconee County, and 85 of 130 homes participated in the pilot, which was finished in February.

The next expansions would be in parts of Seneca and Central and would continue outward this year.

The new broadband offers speeds up to 1 gigabyte of both upload and download speed, lower speed packages start at $40 a month.

There is a federal program that can give students up to $50 a month to pay for broadband in many cases and that would cover the cost to get the new service into a large number of homes in the Upstate, company officials said.

People do not have to be serviced by the cooperatives to qualify.

The $150 million is coming from federal and regular loans, said Jeff Wilson, CEO of Western Carolina Rural Telecommunications Cooperative.

The only other all-fiber network is in Abbeville County and was built by Western Carolina Rural Telecommunications Cooperative, which is partnering with Blue Ridge Electric Cooperative in launching the standalone broadband company.


Source:  Greenville News

Patients, doctors like telehealth. Here’s what should come next.

By News

By:  Tanya Albert Henry

Contributing News Writer

Patients and physicians like telehealth and want it to continue after the pandemic comes to an end, according to one of the largest studies to examine the mode of practice during COVID-19. But there’s work to be done to make the most of the technology going forward.

Digital health playbook series

Access key steps, best practices and resources for the adoption and scale of digital health solutions.

The AMA collaborated with the COVID-19 Healthcare Coalition—comprised of more than 1,000 health care organizations, including the AMA, technology firms and nonprofits—and others to perform the “COVID-19 Telehealth Impact Study.”

Researchers analyzed deidentified claims data that represented more than 50% of private insurance claims from 2019 and 2020, surveyed nearly 1,600 physicians and queried more than 2,000 patients. The AMA, though not a formal part of the COVID-19 Healthcare Coalition, took part in its telehealth workgroup.

The AMA recently hosted a webinar to highlight what the data showed and explore what needs to happen to make telehealth a permanent, equitable part of the health care landscape.

“Patients really are not only pleased with their telehealth, but they are anticipating—pretty much expecting —to be able to use it in the future. So, for policy makers and for health care providers … we need to figure out how do we do this for the benefit of our patients,” Francis X. Campion, MD, the principal lead for digital health at the nonprofit Mitre Corp., told webinar viewers.

Congress should act to ensure that telehealth services are covered and remain available permanently at the end of the COVID-19 public health emergency. Learn how the AMA is advancing telemedicine during the COVID-19 pandemic.

The AMA Physicians Grassroots Network is calling on physicians and others to contact their congressional representatives to support recently introduced legislation in both the House and Senate that, if passed, would make the expanded access to telehealth services permanent.

The data showed that patients overall had positive experiences with telehealth and don’t want to see it go away. Among those surveyed:

  • 79% were very satisfied with the care received during their last telehealth visit.
  • 81% said the provider was thorough.
  • 84% were confident their personal information was secure and private during the visit.
  • 83% believed the quality of the patient-physician communication was good.
  • 73% will continue to use telehealth services in the future.
  • 41% would have chosen telehealth over an in-person appointment for their last visit, even if both required a copay.

On the other side of the video chat, 68% of physicians told researchers they were personally motived to increase the use of telehealth in their practice and 71% said their organization’s leadership was motivated.

Here are the top five services physicians surveyed say they want to offer after the COVID-19 pandemic has ended, along with the percentage who said they wanted to continue each service:

  • Chronic disease management—73%.
  • Medical management—64%.
  • Care coordination—60%.
  • Preventative care—53%.
  • Hospital or emergency department follow-up—48%.

Physicians also identified what they anticipate to be the barriers to maintaining telehealth after the public health emergency. No. 1 on that list? About 73% of physicians worry there will be low—or no—payment.

Among the other areas physicians have concerns about:

  • 64%—technology challenges for patients.
  • 33%—medical liability exposure.
  • 30%—integration with the EHR.
  • 23%—clinician dissatisfaction.
  • 18%—licensure.

The AMA’s Telehealth Implementation Playbook walks physicians through a 12-step process to implement real-time audio and visual visits between a clinician and a patient. It is a powerful resource for practices now and as they continue to implement telehealth beyond the pandemic.

While there have been many positives with telehealth, there’s work to be done to optimize visits in the future—“especially to ensure equitable access and outcomes for all,” said Meg Barron, the AMA’s vice president of digital health.

She outlined four key areas that need attention: device access, connectivity, digital literacy and design relevance. Expanding broadband access and creating ways for those with audio, visual and motor impairment to better access telehealth are among the specific needs that must be addressed.

Dr. Campion and the AMA’s Barron also said there is a great opportunity to increase remote patient monitoring. Not all physicians taking advantage of telehealth are using remote patient monitoring. Workflow issues for physicians and patients will need to be addressed to improve use, they said.

American Academy of Neurology Lobbies for Telehealth Coverage

By News

By Eric Wicklund on

The American Academy of Neurology is joining the effort to compel Congress to extend telehealth coverage past the pandemic, saying connected health will continue to be a valuable tool to help people with neurologic conditions.

The AAN issued a 22-page telehealth position statement this week in advance of next week’s annual “Neurology on the Hill” conference in Washington DC. At that event, the organization will meet with lawmakers to press for permanent telehealth policy.

“People with neurologic conditions like Alzheimer’s disease, migraine, multiple sclerosis, Parkinson’s disease, ALS or epilepsy often must visit their neurologist many times a year to monitor the progression of disease and to have medications adjusted,” AAN President Orly Avitzur, MD, MBA, FAAN, said in a press release. “However, this can be challenging due to mobility issues, lack of reliable transportation and cost. The COVID-19 pandemic has led to neurology practices dramatically reshaping the delivery of care for their patients. The American Academy of Neurology is asking members of Congress for a permanent expansion of telehealth services to improve safety and access to care and to reduce health care costs for people with neurologic disease.”

The position statement updates a 2014 document that also called for more telehealth coverage, but adds in a considerable amount of evidence accrued over the last few years – and particularly during the pandemic – that telehealth is benefitting both providers and their patients.

“Prior to the pandemic, telehealth programs were restricted, mostly available only to people in rural areas or a limited number of specified locations who did not otherwise have access to specialized care, or in small pockets of contracted services, often outside of Medicare or other insurance coverage,” Bruce Cohen, MD, FAAN, who chairs the AAN’s Advocacy Committee, said in the release. “Neurologists have been asking for an expansion of telehealth for many years. Now it is clear, telehealth is an essential and effective method of delivering care. This has only been possible due to the policy flexibilities enacted by the federal government, along with the broad interpretation of these provisions by the Centers for Medicare & Medicaid Services, and with cooperation from the states and commercial payers. It is important to neurologists and their patients that after the pandemic, telehealth continues to play an essential role in medical care.”

Just two years ago, the AAN released an analysis of roughly 100 studies that indicated telehealth treatments address some of the barriers to access to patients, including availability of specialists and travel issues, and are considered just as good as in-person care by those patients. But that document also pointed out the lack of studies on the ability of telehealth to make an accurate diagnosis, and urged more research on clinical outcomes.

“We need to conduct further studies to better understand when virtual appointments are a good option for a patient,” senior author Raghav Govindarajan, MD, of the University of Missouri, who served as a chair on the American Academy of Neurology’s Telemedicine Work Group and is a Fellow of the American Academy of Neurology, said at that time. “Keep in mind that telemedicine may not eliminate the need for people to meet with a neurologist in person. Rather, it is another tool that can help increase people’s access to care and also help lessen the burden of travel and costs for patients, providers and caregivers.”

Now, with COVID-19 providing more evidence and Congress facing pressure from many interested parties to permanently extend telehealth freedoms, the AAN is ramping up its lobbying efforts.

“Telehealth won’t replace all in-person neurologic care, but for people with neurologic conditions, it has been shown to complement it,” Jaime Hatcher-Martin, MD, PhD, of SOC, one of the authors of the position statement, sad in the release. “It is also important that people have options. In addition to video visits, telehealth visits by phone are essential to ensure access to care for people who either cannot afford or who do not have access to high-speed broadband internet.”

“The AAN predicts that telehealth will continue to play an essential role in the care of patients with neurologic conditions,” the document concludes. “We will best serve our patients and our members by advocating for increased access; broader insurance coverage; fair reimbursement; reduced regulatory and legislative barriers; and expanding the telehealth evidence base by promoting research on its proper roles and value in neurologic care and on the costs associated with providing telehealth services.”

Telehealth can be an effective alternative for seniors, study shows

By News

Researchers examined more than 300,000 virtual visits for patients older than 60 over the course of three years.

By Kat Jercich

A wide-ranging study published in the Journal of Telemedicine and Telecare this past month found that telehealth can be an effective modality of care for patients over 60, particularly when deployed in the confines of their existing primary care provider.

When researchers, including a team from the West Health Institute, which focuses on addressing the care needs of seniors, analyzed 313,516 telehealth visits across three healthcare organizations, they found that virtual encounters successfully resolved urgent and non-emergent needs in the vast majority of cases.

“While the median rate of visit resolution for telehealth visits was lower than clinically comparable in-person visits, telehealth was effective in resolving urgent, non-emergent conditions a high percentage of the time,” read the study.


The COVID-19 pandemic has shone a new spotlight on the potential for telehealth to complement in-person care – especially for people who may face mobility challenges in going to a brick-and-mortar office.

For this study, researchers sought to examine telemedicine’s effectiveness and impact on downstream utilization for people over 60.

They examined more than 300,000 telehealth visits that had taken place at Kaiser Permanente Southern California, Spectrum Health and Jefferson Health from November 2015 through March 2019.

The study found that telehealth index visits were successful at resolving urgent, non-emergent needs between 84.0% and 86.7% of the time across the three organizations. Researchers noted that telemedicine is most commonly used by seniors for upper respiratory infections, UTIs and skin conditions, all of which were resolved at least 80% of the time with one visit.

When follow-up visits were warranted, the number of visits was largely similar to an in-person cohort – suggesting downstream utilization is similar.

Researchers pointed out that the study relied on the premise that if a patient did not see a provider within 30 days of initial visit, the condition was resolved – which may not have been true in all cases.

“Episodes of care or number of visits is only a single marker as to whether clinical quality of care was delivered, as a routine follow-up compared to follow-up for re-examination serve two different purposes,” they wrote.


Downstream utilization is a point of interest for many researchers around telehealth, given potential concerns about spending.

A recent study found, for example, that on-demand virtual care (as opposed to telemedicine visits by the patients’ primary care providers) may not lead to cost savings down the line.

Some stakeholders have said that coverage parity is required to ensure equity, while others say payment for virtual care should be lower.


“While in-person visits have traditionally been the gold standard, our results suggest that when deployed within the confines of a senior’s existing primary care and health system provider, telehealth is an effective alternative to in-person care to address acute unplanned needs without increasing downstream utilization,” wrote researchers.