Ramona Midkiff

Lindsay Street· 08/21/2020 11:15 am·

By Lindsay Street, Statehouse correspondent | South Carolina’s legislators will begin a flurry of activity starting Aug. 24 with a meeting of the state budget’s revenue forecasters.

They are expected to answer the ultimate budget questions of how exactly the pandemic impacted the state’s biggest revenue year in history, how much of the projected surplus is still available, and what exactly could the next 22 months look like in this fiscal year.

Those questions are expected to have answers during a 1 p.m. Aug. 24 meeting of the S.C. Board of Economic Advisors, the state budget’s revenue forecasters.

The meeting will take place physically at South Carolina Educational Television’s Bank of America room at 1041 George Rogers Blvd. The public has been invited to join the meeting virtually here or via call-in at 571-317-3112, access code 849-535-589. For questions about the meeting, call 843-734-2265.

Meanwhile, Gov. Henry McMaster said Thursday state lawmakers should hold off on creating a new budget for now.

Other legislative meetings ahead:

House Equitable Justice committee to meet Aug. 25-26. A newly-formed House committee formed in light of racial justice and policing calls around the nation will convene three times next week:  10 a.m. Aug. 25 on sentencing reform, 1:30 p.m. Aug. 25 on law enforcement training and accountability, and 10 a.m. Aug. 26 on criminal laws. All meetings take place in room 110 of the Blatt building on Statehouse grounds in Columbia.

House Ways and Means panel meets on CARES Act funding.The House CARES Act Ad Hoc Committee will discuss updates to federal pandemic aid spending so far in the state and further expected expenses beginning next week. Meetings, to be held virtually, are at 2 p.m. on Aug. 26, Sept. 2 and Sept. 9. See the agenda here.

Senate reconvenes Sept. 2 on voting. South Carolina’s Senate will meet Sept. 2 to address early voting, according to an Aug. 17 statement from Senate President Harvey Peeler, R-Gaffney. He said while it is unclear “what the situation will be like in November,” the state should prepare now for “safe and secure voting.” Peeler’s announcement did not detail what measures the Senate will consider. Earlier this year, the legislature allowed the expansion of absentee voting in the state ahead of the June primaries amid the coronavirus pandemic, but did not expand that for any other elections. In recent weeks, more have pushed for the state to again expand absentee rules. Those who have joined the call to expand absentee voting have included Peeler, House Speaker Jay Lucas, R-Hartsville, and leaders of the S.C. Association of Registration and Election Officials. 

• Related: Lucas, Peeler trying to stop federal intervention into voting questions. Read more.

Senate Finance to meet in early September. A schedule has yet to be released to the public yet, but the Senate Finance Committee staff has confirmed the committee will begin meeting virtually via Zoom around the first of September and over six meetings to discuss the 2020-2021 budget. Check back here for meeting announcements.

In other news:

Keep an eye on the tropics over the weekend. Tropical Depression 13 appears unlucky, depending on all the things hurricanes depend on. A static cone image released the morning of Aug. 21 by the National Hurricane Center shows the storm strengthening to tropical storm-status by Saturday and potentially reaching hurricane-status by Tuesday along the west coast of the Florida peninsula. There is another storm vying for name-status, Tropical Depression 14 (which is expected to remain in the Gulf of Mexico), so it is unclear which storm will get the name Laura or Marco should they both continue to increase in intensity as expected.

Post Office frustrations aired in S.C. U.S. Rep. Jim Clyburn held a press conference Tuesday decrying changes to the U.S. Postal Service, which were seen as disproportionately impacting rural Americans and potentially causing mailed-in ballots for the Nov. 3 election to go uncounted. That same day, Postmaster General Louis DeJoy announced retail hours won’t change, no mail processing facilities will close, overtime for workers will be approved, and mail processing equipment and collection boxes will remain in place. But it was unclear whether moves ahead of that decision will remain in place — and some, like chicken producers in Maine, are reporting delays impacting businesses. DeJoy was to testify today at the Senate Committee on Homeland Security and Governmental Affairs.

ORS approves $26.1M in broadband spending. As part of the broadband infrastructure component of the CARES Act, the S.C. Office of Regulatory Staff (ORS) has approved the funding of 81 applications submitted by 13 Broadband Service Providers. The move will spend $26.1 million of the $50 million appropriated for expanding internet access in the state. According to ORS, the infrastructure expansion will make high-speed broadband available to 27,994 homes, 771 businesses, and other entities like schools and health care facilities in unserved areas. Projects must be completed no later than Dec. 18.

S.C. Supreme Court to hear case over private school grant program. The S.C. Supreme Court agreed this week to hear arguments in the lawsuit over McMaster’s decision to spend $32 million in federal coronavirus aid on grants to help students afford private school tuition. Read more.

Brittain wins GOP nomination for Horry Co. House seat. Case Brittain of Myrtle Beach earned more than 70 percent of the vote in a special primary election for House District 107 Tuesday against his GOP foe to replace Republican Rep. Alan Clemmons, who unexpectedly resigned earlier this summer. Brittain faces Democratic candidate Tony Cahill and Libertarian candidate William Dettmering III in the Nov. 3 election.

S.C. top attorney seeks S.C. high court opinion on law. S.C. Attorney General Alan Wilson asked the state’s Supreme Court last week to determine whether the state’s monument protection law, the Heritage Act, is constitutional. He asked the court to weigh in on a lawsuit filed by the widow of state Sen. Clementa Pinckney, who is suing to overturn the law passed in 2000 that protects monuments, like those honoring Civil War-era generals or the Confederate battle flag, on public grounds from removal. Read more.

U.S. Senator Lindsey Graham met with medical professionals at the USC School of Medicine yesterday to discuss the benefits of improving access to broadband Internet and the expansion of telemedicine throughout South Carolina.

“I’ve learned that Telemedicine has unlimited potential to change our lives. It allows us to have doctor/patient interactions that are more convenient for the patient and more informative for the doctor. What is required to make all this happen? Broadband. There are places in South Carolina where you might as well be on the moon when it comes to getting cell phone service and high speed internet.”, Sen. Graham said.

The boardroom at Prisma Health’s Columbia office was brimming with state health advocates and politicians eager to find a solution to what has become a digital divide between urban and rural areas and along socioeconomic lines, making it difficult for some citizens to obtain quality healthcare. This divide has been an ongoing healthcare issue but has recently come to the forefront amid the COVID-19 pandemic.

“A wake-up call has descended upon the nation after the Coronavirus in a couple of areas, one of which is Telemedicine. A lot of people can’t get out of their homes for different reasons. A lot of seniors, people with mental health issues. The bottom line is: we can actually, through technology, reestablish a doctor/patient relationship that is incredibly personal. They tell me that about 20-30% of patient interactions today could be done just as well through a telemedicine platform as an actual office visit. And as technology improves, so can the interaction,” said Sen. Graham.

This week, Senator Graham and Senators Mark Warner (D-Virginia) and Tim Scott (R-South Carolina) will introduce legislation to allocate $10 billion to help governors across America speed up the deployment of broadband in areas where there is the greatest need. Senator Graham anticipates that South Carolina would receive roughly $170 million out of the overall fund.

Nationwide, there are 21 million Americans who do not have access to the FCC standard for high speed Internet with 650,000 of those living in South Carolina. According to Senator Graham, this grant is an emergency measure aimed at increasing access this fall to Americans who either live in a coverage dead-zone or are unable to afford service.

“This, to me, is an absolute medical essential requirement. Can you imagine living your life today without electricity? If you don’t have broadband, in many ways, you’re just as much in the dark in the 21st century as you would be if you had no electricity in your house. So here’s my goal: to get some money in the next stimulus package – and I believe we’ll have a breakthrough – that will expedite the delivery of broadband access to rural and urban areas that are basically dark,” said Sen. Graham.

Mark Sweatman, MUSC Director of Government Relations and Secretary to the Board of Trustees; Kathy Schwarting, Palmetto Care Connections CEO; Senator Graham; Meera Narasimhan, MD, DFAPA, Associate Provost Health Sciences USC, Professor and Chair Department of NeuroSciences and Behavioral Science, USC School of Medicine; Ken Rogers, MD, Director of SC Department of Mental Health; and Mark Wess, MD Chief Medical Information Officer at Prisma Health were in attendance.

For more information, follow @sctelehealth on Facebook and Twitter.

In an industry plagued by burnout, hospitals and health systems are using telehealth to give providers virtual access to mental health counselors – and to make their jobs less stressful.

August 14, 2020 – Like any profession that deals in life and death, healthcare has a stress and burnout problem – to which telehealth could be the answer.

Physicians have the highest suicide rate of any profession, losing 300 to 400 of their colleagues a year, and their struggles with stress and depression have an adverse effect on the healthcare industry’s economic health – a 2019 study posted in the Annals of Internal Medicine found that burnout adds roughly $4.6 billion in costs each year.

Writing in the American Journal of Medicine, Scott Yates, MD, MBA, MS, FACP, of the Plano, Texas-based Center for Executive Medicine, says burnout affects roughly half of all physicians in practice, manifesting itself in medical errors, lower quality of care and higher costs. Furthermore, it’s a systemic issue, rather than an individual one, and COVID-19 certainly isn’t helping.

At a time when the coronavirus pandemic is putting extra pressure on care providers to reduce in-person visits, hospitals and health systems are launching telehealth platforms to put doctors and nurses in front of mental health support at the time and place – and on the device – of their choice. And they’re looking to telehealth to reduce the burden on providers by automating many of the tasks that are causing stress in the first place.

“The appeal of telemedicine isn’t just that it makes things easier (though it certainly can),” Adrian Rawlinson, MD, a California-based sports medicine specialist, explained in a column on physician burnout for the online journal Medium. “Telemedicine is a unique and necessary new approach to healthcare that allows providers the freedom to administer the care that works best for both them and for their patients, and it gives patients greater flexibility in managing their health.”

Using Telehealth to Help Providers in Peril

Although the COVID-19 pandemic cast the spotlight on provider stress and burnout, the issue has been around long before the virus appeared. And networks like Providence Health have already taken steps to address it.

The Washington-based health system, with more than 50 hospitals in eight states, rolled out its Telebehavioral Health Concierge program in January 2020, offering virtual care visits with a counselor within two days. They’ve since renamed it the Behavioral Health Concierge program and expanded its reach to include caregivers and family members in Oregon, California and Montana.

“We wanted to build something dedicated to caregivers,” says Josh Cutler, a licensed clinical social worker who helped launched the service. “Before and especially during (COVID-19), we have been at the center of an epidemic of burnout and suicide in healthcare. We needed to give (providers) something that would address that on their terms.”

Arpan Waghray, MD, a psychiatrist and chair of the health system’s behavioral medicine clinical practice group who joined Cutler in developing the program, says the platform not only connects with people in crisis, but can be used to provide health and wellness resources that help providers before they reach that crisis stage.

“You automatically equate mental health with mental illness, as opposed to mental health and wellness,” he says. “With this program, our goal was to move upstream and meet people where they are.”

That points to one of the strengths of an online program: Giving users the resources they need and the freedom to access what they need at their own pace. For those who don’t feel comfortable talking to someone else about their problems, a self-serve platform might be more effective.

“It’s very consumer-centric to do this, but it’s not very provider-centric,” Waghray says. “In some ways we have to adjust our thinking.”

Cutler notes that doctors and nurses are trained to give care, but often aren’t sure how or when to seek it themselves. They’re either uncertain of how to access help or embarrassed about needing it.

A telehealth platform makes it easier to find help, he says, and gives them the opportunity to connect discretely at the time and place of their choice.

“I can talk to people who are sitting at home or in their parked car,” he says. “It’s all about giving them the space to talk, and establishing that connection.”

Technology as the Cause and Solution?

While health systems and hospitals are using connected health platforms to connect stressed out staff with counselors, they’re also touting the value of telehealth in reducing stress. And that benefit has been around since well before COVID-19.

The American Telemedicine Association made physician well-being and stress reduction a cornerstone of its 2019 conference and exhibition in New Orleans. The effort was spearheaded by Peter Yellowlees, MD, a professor of psychiatry at the University of California at Davis and Chief Wellness Officer at UC Davis Health.

The kicker? At that time, the industry was looking at stress as a by-product of dealing with new technology, particularly electronic medical records platforms.

“We have not worked well with technology in the past,” Yellowlees said. “We’re actually causing poor care with the way we use technology,” he says. “We have to understand how to use it better.”

“The main issue is documentation,” he said, pointing out that American doctors spend three times as much time documenting as do their counterparts in Australia and Europe.

But while older technology platforms – including telemedicine – may have been cumbersome, newer versions are smaller and more portable. Whereas providers once had to go to the technology, such as a nurse’s station or a computer in the office, they can now bring the technology with them as they make their rounds.

“The beauty nowadays is we’re freed up to do more of what we want to do,” he said.

The same applies to seeing patients. Providers who once had to jump through several different hoops to set up a telehealth visit can now connect with a patient on a laptop or smartphone from the comfort of their own homes. They can set schedules that fit better into their daily lives, setting aside time for family and for seeing patients.

“It actually is a much more egalitarian relationship,” says Yellowlees, who uses a telemedicine platform to see patients at home “Patients feel like this is a much more normal interaction.”

A connected care platform can also foster collaboration and teamwork, a cornerstone of the industry’s move toward value-based care and the patient-centered medical home. Through telemedicine, doctors and nurses can collaborate with each other, and with specialists, reducing stress on one provider and enabling different providers to handle the tasks more suited to them.

“Healthcare is increasingly a team game,” says Yellowlees. “The future (of the industry) lies in virtual care, and virtual care teams.”

How Telehealth Improves the Work-Life Balance

Aside from improving patient care and reducing costs, a selling point for the adoption of telemedicine technology has always been that it can help improve clinician workflows by reducing administrative tasks and giving them access to clinical decision support. This, in turn, allows the clinician to practice at the top of his or her license and focus on the patient.

One such example can be found in teleneurology.

Keith J. McAvoy, MD, the medical director of teleneurology for New Hampshire’s Dartmouth-Hitchcock Medical Center in Manchester, says a telemedicine platform that links neurologists at a central site, like Dartmouth-Hitchcock, to smaller hospitals across the region can reduce stress on doctors and nurses in those rural hospitals who have to transfer critically injured patients to a larger facility because they don’t have the skills or resources to treat on-site.

“Healthcare is increasingly a team game. The future (of the industry) lies in virtual care, and virtual care teams.”

“There are many of our spoke hospitals that have no neurology coverage at all, so we provide that neurology coverage,” he said of a network that provides on-demand services to close to a dozen locations in New Hampshire, Vermont and Maine, to a tune of roughly 800 consults a year.

McAvoy, speaking at a recent virtual conference coordinated by the Northeast Telehealth Resource Center and the Mid-Atlantic Telehealth Resource Center, said a telehealth platform gives providers in those spoke hospitals the resources and support they need to treat more patients, and it helps to reduce self-doubt and feelings of isolation.

The platform also gives neurologists more of an opportunity to expand their horizons and treat more patients – not only by administering emergency care to those suffering a stroke, but in offering specialist consults and follow-up services to any number of rural and remote locations.

That’s an often-overlooked benefit for a specialty that ranks in the top 5 in burnouts.

They “address many conditions without a known cure,” he said, which is often stressful. “Telling a patient that they don’t have a neurologic condition,” he added, is often the best part of being a neurologist.

Telehealth “has the potential for providing more dedicated and consistent care,” McAvoy says, which in turn improves outcomes for patients and perks up the providers.

“A happy neurologist means better care for the patients,” he added.

Another example can be found in eConsults.

With the COVID-19 crisis expanding the ranks of the unemployed and pushing more and more people off their insurance plans, community health clinics, federally qualified health centers and rural health clinics all expect to see a surge in business. This puts pressure on clinic staff who already have a lot on their plates.

Expanded telehealth coverage for FQHCs and RHCs is one of the cornerstones of a legislative plan to continue telehealth’s momentum beyond the coronavirus. This would allow these providers to, among other things, use telehealth channels to seek specialist consults and support.

That’s what the MAVEN Project does. Launched in 2014, this Massachusetts-based group provides mentoring and consults to health clinics in high-stress, low-resource environments. Their services are free of charge, and their support group is comprised of retired and semi-retired physicians who want to give back to their profession.

“What we have are a group of physicians who are truly best in class, and want to share their skills with others.”

“They offer a wealth of knowledge and expertise and decades and decades of clinical experience,” Lisa Bard Levine, MD, MBA, the organization’s CEO, told mHealthIntelligence in 2018. “What we have are a group of physicians who are truly best in class, and want to share their skills with others.”

One of the guiding principles of the MAVEN Project is to help harried providers who need some advice or support.

“We’re here to give these providers support that’s really needed,” Levine says. “A lot of these primary care providers are newly trained, or working for clinics that struggle to provide necessary support for their physicians. A lot of them are realizing that this is a gray area in healthcare.”

Making Telehealth the Rule, Rather Than the Exception

While health systems like Providence Health create virtual care programs to care for the caregivers, telehealth advocates say the advances in telehealth coverage brought on by the COVID-19 crisis will, in the long run, reduce provider stress.

While the Centers for Medicare & Medicaid Services has released a proposed 2021 Physician Pay Schedule that increases coverage for certain services, Congress is dealing with dozens of bills – and pressure from a large lobbying group – that aim to make permanent many of the telehealth freedoms enacted during the ongoing public health emergency.

The hope among many is that using telehealth and mHealth tools will become second nature for care providers, resulting in improved workloads, reduced stress and a better work-life balance. And while using those tools to help their patients, they’ll also make us of them to help themselves when and where necessary.

“When it’s going right, all the technology disappears, and we have this connection,” says Cutler, at Providence Health, whose work has helped dozens – if not hundreds – of care providers address their health struggles. “This has been some of the most meaningful clinical work that I have done.”

Online Learning Initiative (Mobile Hotspots and Monthly Internet Service)

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By Eric Wicklund on August 10, 2020

A new bill before Congress aims to increase funding for telehealth expansion programs that target improved broadband connectivity.

The Accelerating Connected Care and Education Support Services on the Internet (ACCESS the Internet) Act, introduced this past week by Senators Joe Manchin (D-WV) and John Cornyn (R-TX), proposes to add $400 million to Federal Communications Commission’s COVID-19 Telehealth Program, which was shut down last month after exhausting its $200 million allocation through the CARES Act. It would also set aside another $100 million for the Department of Veterans Affairs to expand connected health access for veterans in rural and underserved areas.

The bill targets a significant barrier to telehealth expansion in rural and remote areas of the country. Healthcare providers can’t extend programs and services into these areas – and residents can’t use them – unless they have access to reliable and uninterrupted broadband.

“The current COVID-19 pandemic has shone a new light on the broadband issues in West Virginia and across rural America,” Manchin said in a press release. “Americans and West Virginians have had to adjust to a new way of working, learning, and living from home due to the COVID-19 pandemic and for most people, this change relies on accessible, reliable broadband which many rural Americans do not have.”

“This commonsense bill could help our children, Veterans and families access reliable broadband to pay their bills, complete their homework, and keep up with doctor’s appointments,” he added.

The bill would also add $1.3 billion to the Department of Education to boost distance learning service and give $200 million to the Institute for Museum & Library Services, with at least $1.6 million set aside per state, to improve Internet connectivity in libraries in low-income and rural areas.

The FCC’s COVID-19 Telehealth Program has been a hot topic on Capitol Hill in recent months. Created out of the CARES Act in March, the program provided funding for 539 programs in 47 states, Washington DC and Guam before running out of funding in July. At the time, FCC Chairman Ajit Pai said the agency would follow up with a study on how well the program accomplished its goals.

There have been a few attempts to keep that program going. In April, the American Telemedicine Association petitioned Congressional leaders to add $300 million to the program, and in July US Reps. Abigail Spanberger (D-VA) and Dusty Johnson (R-SD) introduced a bill to add $200 million to the program through an FY 2020 supplemental appropriation, following up on a letter to Pai that was signed by more than 40 members of Congress.

The VA’s telehealth and mHealth programs haven’t gone without notice, either. Earlier this month, US Reps. Susie Lee (D-NV) and Jim Banks (R-IN) introduced the VA Telehealth Expansion Act, which aims to give the VA Secretary more authority to enter into new partnerships and expand existing deals that support connected health access for veterans. It would create a grant program to facilitate those partnerships, and would give special emphasis to programs that help veterans in rural or underserved parts of the country.

In June, the VA announced that the coronavirus pandemic had created a surge in business for the agency’s three-year-old connected health platform, including a 1,000 percent increase over the usual traffic recorded on the VA Video Connect mHealth app.

A bill introduced this week would allow healthcare providers in good standing to use telehealth to treat patients in any state during the coronavirus pandemic.

August 05, 2020 – A new bill before Congress takes aim at one of the bigger barriers to telehealth expansion: interstate licensure.

Senators Chris Murphy (D-CT) and Roy Blunt (R-MO) this week unveiled the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, which would enable healthcare providers in good standing to use connected health to treat patients in any state during the coronavirus pandemic.

“The COVID-19 pandemic has created unique challenges for our health care system, like reaching patients who are advised to avoid clinics and hospitals, allowing students to continue care when they’re away from campuses, or speeding reinforcements to areas with a high number of cases,” Blunt said in a press release. “The TREAT Act responds to those challenges by increasing flexibility for providers to care for patients wherever they are. The bill maintains all the safeguards patients should expect, while eliminating bureaucratic hurdles that impede access to care. It’s the right approach to make sure we keep people connected with their providers and allow frontline workers to lend support in areas where they’re needed most.”

Current guidelines require providers to have licenses in each state in which they practice, a costly and time-consuming issue for health systems that span several states and telehealth services that reach patients regardless of where they’re located. It’s a hotly debated issue, with some supporting the current practice, some supporting licensure compacts that span several states or regions, and some even suggesting one license for the entire country.

Some states have relaxed their guidelines during the ongoing COVID-19 crisis, but telehealth advocates note the process is still very confusing, with each state having its own rules. And those emergency measures will end with the emergency.

Providers sanctioned by the Department of Veterans Affairs already have the ability to use telehealth to treat veterans in any state. That freedom was included in the Veterans E-Health & Telemedicine Support (VETS) Act, which was passed in 2017.

The bill would give Health and Human Services Secretary the authority to phase out the service over a six-month period after the coronavirus ends and launch it again in future emergencies. It would also require the provider to obtain oral or written permission from the patient before using telemedicine or mHealth technology, and give each state the authority to pursue investigations or disciplinary actions on any provider who has practiced in that state under the reciprocity measure.

“COVID-19 has hammered our already fragile health care system, and the last thing our frontline workers need is more bureaucratic red tape. We should be doing everything in our power to make sure any health care provider, in good standing and with a valid license to practice medicine, can provide services in any location throughout the pandemic,” Murphy said in the press release. “That’s why we are introducing the TREAT Act, which provides a temporary uniform licensing standard so health care workers can help those in need, including through telehealth, regardless of the patient’s physical location. With over 150,000 Americans dead and millions more infected, we must be all hands on deck to contain COVID-19.”

The bill is quite similar to the Equal Access to Care Act, introduced in June by Senators Marsha Blackburn (R-TN) and Ted Cruz (R-TX), which would allow a provider in any state to use telehealth to treat a patient in any location for up to 180 days after the national emergency.

And it’s one of dozens introduced to Congress over the past few months that address expanding telehealth access and coverage – including the TREATS (Telehealth Response for E-prescribing Addiction Therapy Services) Act, introduced in July, which aims to expand the telehealth platform for substance abuse treatment.

The bill has a considerable list of supporters, including the American Hospital Association, American College of Physicians, American Medical Group Association and dozens of high-profile hospitals and health systems.