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In this interview, Dr. Neufeld, director of gpTRAC, discusses the ubiquity of telehealth during COVID-19, contextualizes telehealth “success stories,” and offers guidance about how to best leverage telehealth for rural America. Dr. Neufeld also talks about several points that will be important for telehealth providers, including choosing technology, quality measures, and billing & coding.

Iowa-based grocery store Hy-Vee debuted RedBox Rx, a subsidiary that provides telehealth and online pharmacy services and ships prescribed treatments directly to patients throughout the United States. The service allows patients “quick, easy and discreet access to a provider who can prescribe prescription medication that is then shipped for free directly to the patient.”

Researchers analyzed claims from 32,417 Medicare beneficiaries at an ACO in southern Wisconsin, both before and during COVID-19. During the pandemic, more primary care visits for high-risk beneficiaries were conducted via telehealth compared to primary care visits for low-risk beneficiaries. Within both the high- and low-risk groups, beneficiaries who used telehealth were more likely to live in urban rather than rural areas. Further, beneficiaries who were 86 years or older in both groups were less likely to have used telehealth during the pandemic.

Of 159,301 visits at a cancer center in Minnesota in 2020, 33,242 were telehealth visits. About two-third of telehealth visits were among those aged 18-49, and telehealth visits were less common among rural compared with urban residents (43% vs. 53%). Patients that were aged older than 70, rural residents, and most patient groups of color used video for only between 33% to 43% of their telehealth visits.

In 2019, before COVID-19, Connected Nation Michigan conducted a study to identify telehealth barriers in five rural Michigan counties. In 2021, CN Michigan conducted another survey in the same five counties to understand how telehealth utilization and perceptions had changed since 2019. More than half of the adults surveyed in 2021 (54%) reported that they used the internet to communicate with a healthcare provider, compared to 34% in 2019. Younger adults and adults with children were more likely than older and single-dwelling adults to use telehealth. According to the report, using telehealth instead of in-person care for routine 15-minute visits to general practitioners across the five counties generated nearly $13.6 million in savings in one year.

The FDA announced that they are removing the in-person dispensing requirement for mifepristone, the first of two pills in a medication abortion regimen. Currently, 19 states require the provider to be physically present when the patient takes the pill, and the FDA’s choice to remove restrictions will not override these kinds of state or local laws restricting medication abortion.

U.S. Senators Dick Durbin (D-IL) and Tammy Duckworth (D-IL) today announced $4.3 million in federal funding to several Illinois health care providers for the COVID-19 Telehealth Program, building on an initiative established as part of the CARES Act.

In Ohio, Governor DeWine signed the Telemedicine Expansion Act, which will widen access to telehealth services in several ways, including allowing a wider variety of providers to conduct telehealth visits, prohibiting health plans from imposing higher out-of-pocket prices for telehealth services than those for comparable in-person services, and requiring payers to provide coverage for asynchronous communication. In New Jersey, Governor Murphy signed a bill that requires payers to reimburse providers for all forms of healthcare, including behavioral health, delivered through telehealth at the same rate as in-person care, and it bans payers from placing restrictions on locations from where services are provided, and the technological platforms used.

A bipartisan group of lawmakers in Congress recently introduced the Telehealth Extension Act. Some of the bill’s major provisions include eliminating the requirement that patients live in a rural area in order to have telehealth services covered by Medicare and continuing the expanded list of eligible providers after the COVID-19 PHE ends.

CMS's response to a request for clarification concerning the billing of a telehealth transaction on the professional fee bill known as the CMS- 1500. For telehealth services, the practitioner should enter on the claim the address where they typically practice. If they furnish some or all of these services from their home or another location that is not their typical practice location, they should use the address of the office location where they usually practice. For a practitioner who works from home 100 percent of the time with no other office site, the home address is the address they should enter on the claim.

CCHP’s fall webinar series included the following topics:
Telehealth & Medicaid: Medicaid & Audio Only – September 17
Telehealth & Medicaid – Medicaid Telehealth Policy & Data, Evaluations, & Stakeholders – September 24
Telehealth & Medicaid – Telehealth & Patients with Disabilities – October 1
Telehealth & Medicaid – Medicaid Telehealth Permanent Policies – October 8

This report found that, even in states with good overall health, racial and ethnic health disparities endure. "By pursuing new policies that center [on] racial and ethnic equity, expand access to high-quality, affordable care, and bolster the primary care workforce, we as a nation can ensure that the health care system fulfills its mission to serve all Americans," wrote the Commonwealth Fund report authors.

Senators Steve Daines (R-Mont.), Tina Smith (D-Minn.), Jerry Moran (R-Kan.) and Jacky Rosen (D-Nev.) introduced the Expanded Telehealth Access Act, which would extend CMS reimbursement for telehealth services to physical therapists, audiologists, occupational therapists and speech language pathologists. Under the bill, the secretary of Health and Human Services can also make more providers eligible.

A recent study found that several populations who already face negative health disparities were also more likely to use audio-only telehealth as opposed to audio-visual. Of all telehealth users, 45.4% received care via the telephone, while 54.6% completed at least one video visit. Older and Black patients were more likely to use audio-only telehealth. Further, need for an interpreter and rural zip code were characteristics of audio-only telehealth usage. Finally, those whose primary insurer was Medicaid were 12.1% more likely than those covered by other insurers to use audio-only telehealth.

Several health IT leaders were interviewed for this article, including Matt Hocks, COO at Sanford Health (based in Sioux Falls, South Dakota), a large health system with a mostly rural patient population. In 2020, Sanford Health provided approximately 300,000 telehealth visits. They are looking to continue investing in virtual care through a partnership with TytoCare and a new virtual care center that “will focus on innovation, education and research initiatives to advance digital health solutions for the future.”

In a recent study, 91% of surveyed providers from around the world reported using telehealth. However, 52% of telehealth providers reported having patients who refused a virtual visit citing mistrust in technology or concerns about privacy and data safety. Clinicians also expressed concern about the security of patient data and personal penalties that may arise if data is leaked.

Regions Hospital and HealthPartners were granted money from the Federal Communications Commission to buy technology that will allow them to begin the work of correcting health disparities in the community. New software will make connecting to telehealth simpler for patients, and can allow providers to monitor rural and vulnerable populations remotely.

Zoom is now accepting beta customers for its Cerner EHR integration to support telehealth services. Using Cerner EHR, Healthcare organizations will be able to integrate virtual visits better within their workflow. For instance, providers will be able to share test results and complete documentation while in a Zoom appointment.

New York State is investing $3 million in a program aimed at helping community health providers purchase new telehealth technology to expand access to care in underserved communities. In $150,000 allotments, the grants will be distributed to each of the state’s 10 regions in 2022. They will allow community health providers purchase technology–including audio-visual telemedicine platforms and remote monitoring devices–for use in telehealth stations located in public locations such as libraries, pharmacies and homeless shelters.

Washington state’s Office of the Insurance Commissioner finalized regulations to implement the audio-only telehealth law that was passed in May of this year. The law requires payers to reimburse providers for audio-only telemedicine services at the same rate as in-person care. Beginning Jan. 1, 2023, payment parity is only required if the provider and patient have established a relationship through an in-person exam within the past year. Finally, the law prohibits hospitals from charging payers a facility fee if the hospital serves as the originating site for audio-only telemedicine.

A survey of 2080 adults found that about a third of patients who had had a virtual visit since March 2020 preferred a video visit to an in-person visit. Furthermore, patients who preferred virtual visits were more sensitive to out-of-pocket costs than patients who preferred in-person visits.

Founded in 2020, Nurse Disrupted provides telehealth solutions designed to help provide remote care at homeless shelters, rural health clinics and community organizations that don't have on-site health staff. The program began in Wisconsin with the aim to bridge the digital divide in health care.

A new report from the U.S. Department of Health and Human Services showed the dramatic increase in telehealth usage during COVID-19, which was in part due to CMS’s use of emergency waiver authorizations and waiving of certain limitations concerning geographic restrictions of patients/providers. Medicare telehealth visits increased from approximately 840,000 in 2019 to 52.7 million in 2020. However, the report also highlights that telehealth services were accessed more in urban areas than rural communities, and Black Medicare beneficiaries were less likely than White beneficiaries to utilize telehealth.

gpTRAC Conference Scheduled for May 23-25, 2022 at the Radisson Blu — MOA
gpTRAC Conference Scheduled for May 23-25, 2022 at the Radisson Blu — MOA

Mark your calendars so you don’t miss the next regional conference hosted by gpTRAC. We are excited to be planning our in-person gathering for the end of May 2022. We will again be meeting at the Radisson Blu at the Mall of America in the Minneapolis area. More information will be coming very soon.

In this webinar hosted by RAND Australia and the University of Sydney, experts from Australia and the United States discussed their respective countries' recent experiences with telehealth. Although the uptake of telehealth has been similar in both countries during the COVID-19 pandemic, there have been variations in how it has been deployed, funded, and adopted by populations with differing characteristics. The experts also discussed best practices, key requirements for telehealth sustainability, and how telehealth can be incorporated into an integrated care model that reduces the rate of hospitalization.

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