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Ramona Midkiff

Carr Welcomes Launch of Round 2 of FCC’s COVID-19 Telehealth Program

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Media Contact:

Joseph Calascione, (202) 418-2085

[email protected]

For Immediate Release 

Carr Welcomes Launch of Round 2 of FCC’s COVID-19 Telehealth Program

FCC Seeking Comment on Additional $250 Million for Successful Telehealth Initiative

WASHINGTON, DC, January 6, 2021—Today, the FCC released a Public Notice seeking comment on how to allocate an additional $250 million that Congress recently appropriated for the FCC’s COVID-19 Telehealth Program.  This new funding will allow the FCC to launch a second round of this successful telehealth initiative, building on the $200 million that Congress provided and the FCC awarded through this telehealth program last year.

Commissioner Carr has been leading the FCC’s efforts to develop telehealth initiatives that enable Americans to access high-quality care from their homes or anywhere outside the confines of a health care facility.  The FCC’s COVID-19 Telehealth Program builds off of those efforts.

“Over two years ago, we identified a new trend in telehealth,” Commissioner Carr stated.  “The delivery of high-quality care is no longer limited to the confines of traditional brick-and-mortar facilities.  With smartphones and other connected devices, Americans can now access health care services right from their homes or anywhere they have an Internet connection.  FCC staff have worked tirelessly to support this new trend in care, and the agency’s work to stand up the FCC’s COVID-19 Telehealth Program has been part of those efforts.  Congress has recognized that delivering care at a distance is part of the bright future for telehealth.  And it has now authorized an additional $250 million for the FCC to allocate through a second round of this successful program.

“I have had the chance to meet with many of the health care heroes that received Round 1 funding, and the FCC’s Telehealth Program provided them with critical support as they saw demand for telehealth services skyrocket in the wake of COVID-19.  I look forward to working with my FCC colleagues as we launch a second round of this successful initiative.”

 

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Office of Commissioner Brendan Carr: (202) 418-2200

www.fcc.gov/about/leadership/brendan-carr

Palmetto Care Connections Names Telehealth Coordinator

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BAMBERG, SC—Palmetto Care Connections (PCC) Chief Executive Officer Kathy Schwarting announces that Breanna Parham, NRCMA, PCT has been named Telehealth Coordinator.

In her position, Parham assists with the implementation and ongoing management of telehealth care in conjunction with standards, protocols, guidelines, policies and procedures. She works with pharmacies, churches and schools and other telehealth providers to set up telehealth programs, assisting as a tele-presenter when needed, and providing education and training on the use of telehealth equipment and services.

Parham’s strong clinical experience includes positions as a medical assistant and patient care technician for a busy Urology practice, phlebotomist for a regional hospital, and certified nursing assistant for a full-service nursing home. She received certification as a Nationally Registered Certified Medical Assistant (NRCMA) and as a Patient Care Technician (PCT) from Orangeburg-Calhoun Technical College.

“Breanna brings a wealth of clinical experience to our team,” said Schwarting. “Originally from Cordova S.C., she knows what it’s like to grow up and live in a rural area. Her background, combined with her career experience in medical settings have already proven to be tremendous assets in PCC’s initiatives to implement innovative telehealth programs in rural S.C.”

A resident of Rowesville, in her spare time Parham enjoys creating art and crafts using Cricut vinyl applications, gardening and spending time with family and friends.

Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas in S.C. PCC leads South Carolina’s broadband consortium which facilitates broadband connections throughout the state. PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, partnering with health care organizations and providers to improve health care access and delivery for all South Carolinians.

Health Care After COVID: The Rise of Telemedicine

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By:  

 

TUESDAY, Jan. 5, 2021 (HealthDay News) — In late December, Dr. Ada Stewart asked her staff to check on a patient who had missed an appointment.

She soon learned that the patient had no transportation for the 45-minute drive, so Stewart offered to conduct the appointment by phone instead.

“It still accomplished so much. I was able to see how their diabetes was doing, how they were preparing for the holiday season, how they were really feeling mentally,” said Stewart, a family physician at Eau Claire Cooperative Health Centers in Columbia, S.C., and president of the American Academy of Family Physicians.

That’s just one example of how doctors are using telemedicine – having appointments by phone or video call – to check in with their patients.

Telemedicine isn’t new, but the COVID-19 pandemic has really put the technology front and center, with clinics closing for certain services after state and local governments issued stay-at-home orders to help prevent the spread of the virus.

And even when doctors’ offices were open, some patients avoided in-person appointments due to COVID-19 fears.

Besides giving telemedicine a boost, the pandemic has also fostered the rise of innovative medical services, everything from getting prescriptions by mail to drive-through virus testing and pharmacy-based vaccinations.

Many of those innovative approaches to health care are likely to linger long after the pandemic ebbs, experts say.

“We saw the benefits that telehealth provided,” Stewart said. “People were able to receive access to health care. We were able to reach out to our patients who were afraid to come into the office to be seen. It really afforded that opportunity to still take care of our patients and do so in a safe way.”

Telemedicine also gave physicians the ability to keep their practices, which might otherwise have been shuttered as patients stayed home.

“We had to pivot,” Stewart explained. “We had always talked about telehealth and incorporating it into our practices,” but 2020 brought the technology to the fore.

The American Academy of Family Physicians distinguishes between telehealth and telemedicine. Telemedicine, the academy says, is using technology to deliver care from a distance, whereas telehealth is the technology and services to provide that distance care.

Prior to the pandemic, telemedicine was already growing in the United States, especially in mental health services. But it still only reached a small minority of patients, about 4% of the population, according to Lori Uscher-Pines, a senior policy researcher at the nonprofit RAND Corporation, which works to impact policy through research and analysis.

Restrictions on telemedicine delivery were a major barrier to growth. For example, many insurance providers would only reimburse telemedicine visits under specific circumstances.

However, “at the start of the public health emergency, payers across the board really relaxed restrictions on telemedicine, so patients could be served at home and that would support social distancing and help patients continue to get the care that they need,” Uscher-Pines said. “As a result, we’ve seen telemedicine use really skyrocket.”

Enhancing, not replacing, in-person care

A study recently published in JAMA Network Open evaluated how health services changed in March and April 2020, during the early part of the pandemic in the United States, among 6.8 million people covered by commercial insurance.

The study found that use of in-person medical services dropped by 23% in March and 52% in April, and that telemedicine services grew by more than 1000% in March and more than 4000% in April.

That doesn’t mean telemedicine completely replaced in-person care: The increase in telemedicine only offset about 40% of the decline in office visits.

Prior to the pandemic, Deidre Keeves and her team at UCLA Health in Los Angeles had been trying to get physicians to increase their use of video visits with modest success, averaging about 100 visits per day for several months. But from March through May of 2020 they jumped to 3,000 to 4,000 visits per day, Keeves said.

More recently, UCLA Health doctors were doing about 2,700 telemedicine visits a day. Keeves said she expects that pace to continue averaging that number, even once the pandemic is under control.

She sees telehealth as beneficial for patients, who save on time and travel, as well as for physicians, who can reach a geographically wider population.

“We think that telehealth is here to stay. Our patients are expecting it. Our doctors are very happy with it, and it’s a great avenue for care,” said Keeves, who is director of connected health applications at UCLA Health. “We’re expecting that about 20% of our volume is going to continue to be through telehealth.”

In-person visits continue to be necessary anytime a person needs a procedure, such as a biopsy, lab test or vaccine injection, Keeves said. Telehealth works for follow-up visits, medication instructions and talking with a mental health provider.

UCLA Health is located in Southern California, a current crisis area for COVID-19. Keeves said staff are also monitoring some coronavirus patients at home with the use of pulse oximetry (which measures blood oxygen levels) and regular check-ins with clinicians.

“We at UCLA Health don’t feel that video visits are a replacement for in-person care,” Keeves stressed. “We are not using technology to replace the doctor-patient relationship. We’re using technology to supplement and support that relationship.”

Direct-to-consumer safety valve

What’s known as “direct-to-consumer” telemedicine was also growing even before the pandemic, Uscher-Pines added. That involves scheduling a visit with a doctor who works for an online-only service provider. It’s typically used when someone has a minor acute illness, not a severe condition.

Uscher-Pines was an author on a study that appeared recently in the Journal of Medical Internet Research. The study focused on the experiences of one such telemedicine supplier, called Doctor On Demand, a national telehealth service provider.

Researchers compared data from February to June in 2019 and February to June 2020. They found that total visit volume increased from March through April 7, 2020, by 59% above the baseline, before declining to 15% above the baseline through the week of June 2, 2020. The growth wasn’t typically fueled by COVID-19 concerns, but rather by visits for issues of behavioral health and chronic illness.

In this way, “telehealth services may play a role as a ‘safety valve’ for patients who have difficulty accessing care during a public health emergency,” the study concluded.

Pharmacies also fill gaps

Other innovations that have expanded during the pandemic range from drive-through COVID-19 testing to pharmacy-based vaccinations for younger children.

In August, the U.S. Department of Health and Human Services (HHS) authorized state-licensed pharmacists to vaccinate children age 3 and up. That followed a U.S. Centers for Disease Control and Prevention report, issued in May 2020, that found a “troubling drop” in routine immunizations for children.

“What I love about pharmacy is we’ve really stepped up to be a very essential access point for people when a lot of other things might have been closed,” said Sandra Leal, president-elect of the American Pharmacists Association and executive vice president of SinfoniaRx, which works with health plans to do comprehensive medication reviews with patients via telehealth.

Another change Leal noted is that pharmacists can now conduct COVID-19 testing within their communities. In April, HHS allowed licensed pharmacists to test patients for COVID-19.

As the pandemic forced office closures, SinfoniaRx’s team worked with patients to do not only the usual work of ensuring they had no medication questions, but also talking about COVID-19.

“We’re finding that so many people have so many questions around COVID and the pandemic, and vaccines and when they’re going to be available to them,” Leal said. “We’re really trying to address those concerns.”

Ordering prescriptions by mail is a service that’s been around for a long time, Leal said. In May, the Wall Street Journal reported that mail-order prescriptions had risen 21% over the previous year during the last week in March. Yet, Leal said patients are concerned about postal delays, which can be a big problem for people with certain conditions, such as people with type 1 diabetes who need insulin.

Future depends on policy

The COVID-19 pandemic has highlighted health inequities, and the shift to a broader acceptance of telemedicine is an opportunity to improve health care in the United States, Stewart said. She would like to see telemedicine continue, along with the technology infrastructure to ensure that health care is equitable.

Uscher-Pines said that it may be difficult to return to the pre-pandemic status quo, with its focus on office visits, because providers and patients are now familiar with and appreciate the convenience of telemedicine.

“I think that what ultimately happens with telemedicine really depends on how the policy environment evolves,” she said. “There is a lot of action going on at both the state and federal level right now on telemedicine policy, and a lot of strategizing on what should stay permanent and what should go back.”

More information

The U.S. Centers for Disease Control and Prevention has more on telemedicine during COVID-19.

SOURCES: Ada Stewart, MD, family physician, Eau Claire Cooperative Health Centers, Columbia, S.C., and president, American Academy of Family Physicians; Lori Uscher-Pines, PhD, senior policy researcher and research quality assurance manager, RAND Corporation; Deidre Keeves, PT, director of connected health applications, UCLA Health, Los Angeles; Sandra Leal, PharmD, executive vice president, SinfoniaRx and president-elect, American Pharmacists Association; JAMA Network Open, Nov. 5, 2020, online; Journal of Medical Internet Research, Dec. 15, 2020, online; U.S. Department of Health and Human Services, Aug. 19, 2020; American Pharmacists Association, Nov. 4, 2020; Wall Street Journal, May 12, 2020

How telehealth can boost care for heart attack patients

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What Patients Like — and Dislike — About Telemedicine

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CMS Rule Expands States’ Flexibilities for Network Adequacy and Telehealth

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In November the Centers for Medicare and Medicaid Services (CMS) released its 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule. CMS states that its goal with the rule was to reduce federal regulatory barriers, support flexibility and promote transparency and innovation when states develop and implement managed care programs for Medicaid and CHIP.   The rule addresses telehealth specifically in relation to how telehealth visits should be counted towards meeting a managed care plan’s network adequacy requirement.  CMS states in the rule the following:

 

We defer to each state to determine the criteria to be applied to telehealth providers and how such providers would be taken into account when evaluating network adequacy of the state’s Medicaid managed care plans. Section 438.68(b) does not set criteria of this nature that states must use. Under § 438.68(c)(1)(ix), states must consider the availability and use of telemedicine when developing their network adequacy standards. If states elect to include telehealth providers in their network adequacy analysis, we believe that the states will establish criteria that appropriately reflect the unique nature of telehealth, as well as the availability and practical usage of telehealth in their state.

CMS also states in its press release on the rule that the adjustments it made to the minimum standards states must use in developing network adequacy requirements will support state facilitation for telehealth options.  Specifically, the rule removes the requirement for states to set time and distance standards and adds a more flexible requirement that states set a quantitative network adequacy standard for network adequacy.  It also broadens its definition of provider types, and allows states to have authority to define a ‘specialist’.  They do note however that they expect states to apply network adequacy standards to all providers types and specialties necessary to ensure that all services covered under the contract are available and accessible to all enrollees in a timely manner.  For more information on the final rule, see CMS’ factsheet or read the rule in its entirety.

 

CCHP Animated Video on Telehealth Reimbursement Basics
CCHP knows that telehealth policy is complicated, especially when it comes to the way that reimbursement works in the United States.  To help, we’ve developed an animated video to help those new to telehealth policy understand how telehealth policy works in the US, and the role of telehealth COVID-19 waiver and exceptions during the public health emergency.  If you want a crash course in telehealth reimbursement policy in just 13 minutes, this is the place to start!  See the video HERE.

Permanent Expansion of Telehealth Services – A Silver Lining?

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Nexsen Pruet Continues to Build Corporate Experience
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ATA, HIMSS Lobby Congress to Extend Telehealth Freedoms Through ‘21

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By Eric Wicklund

In a letter to Congressional leaders, several telehealth groups have asked that emergency measures enacted during the coronavirus pandemic be kept in place through 2021 as Congress continues to work on long-term coverage.

– Telehealth advocates are lobbying Congress to get something done before the end of the year to ensure continued access to and coverage of telehealth services during the coronavirus pandemic.

In a letter last week to Congressional leaders, the group called for the extension of connected health flexibilities during the public health emergency through the end of 2021. This would keep in place emergency provisions that remove geographic restrictions to telehealth, allow the patient’s home to be an originating site for telehealth services, give the Health and Human Services department the authority to approve telehealth services and providers and enable federally qualified health centers (FQHCs), rural health clinics (RHCs) and critical access hospitals (CAHs) to be reimbursed for telehealth.

“Since many of these needed policies are contingent upon the PHE, millions of Americans risk losing access to vital health care services unless you and your colleagues takes specific actions,” the letter states. “Additionally, the continued risk of telehealth flexibilities ending with each subsequent 90-day renewal of the PHE adds additional uncertainty to an already strained health care delivery system. Patients and their health care professionals should not have to worry if they will be able to continue to receive or deliver necessary care.”

The letter is the latest salvo in the ongoing battle to make these emergency measures permanent, so that healthcare providers can continue the momentum seen in telehealth use past the COVID-19 emergency and plan long-term telehealth strategies.

Some states and even a few payers have taken that action, while many others are waiting on the federal government to take action.

Congress has been flooded with dozens of bills seeking permanent expansion of telehealth access and coverage, and has in the past included some measures in pandemic relief and stimulus packages, but there’s no guarantee that another bill will be passed or that any telehealth legislation would be included in it.

The Centers for Medicare & Medicaid Services, meanwhile, has advanced telehealth, mHealth and remote patient monitoring coverage in its 2021 Physician Fee Schedule, though critics have said the new guidelines don’t go far enough, and that Congress needs to take the lead.

The letter is signed by the American Telemedicine Association, Healthcare Information and Management Systems Society (HIMSS), Alliance for Connected Care, eHealth Initiative, College of Healthcare Information Management Executives (CHIME), Connected Health Initiative, Health Innovation Alliance and Personal Connected Health Alliance (PCHA).

“There is no time like the present for passing needed common sense permanent reform to ensure telehealth services remain a lifeline for millions of Americans in rural and underserved communities after the public health emergency is rescinded,” ATA CEO Ann Mond Johnson said in a press release accompanying the letter. “Absent the timely enactment of permanent policies, we urge Congress to extend these temporary flexibilities for as long as possible, to at least provide one year of certainty and enable patients to continue to receive care when and where they need it.”