{"id":31445,"date":"2020-11-19T19:00:28","date_gmt":"2020-11-19T19:00:28","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=31445"},"modified":"2020-11-19T19:00:28","modified_gmt":"2020-11-19T19:00:28","slug":"ama-adopts-policy-to-expand-access-to-telehealth","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/ama-adopts-policy-to-expand-access-to-telehealth\/","title":{"rendered":"AMA Adopts Policy to Expand Access to Telehealth"},"content":{"rendered":"\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p>Most physicians at the&nbsp;<a href=\"https:\/\/www.medpagetoday.com\/meetingcoverage\/ama\" target=\"_blank\" rel=\"noreferrer noopener\">American Medical Association<\/a>&#8216;s virtual special meeting of its House of Delegates agreed that expanding access to telemedicine during the pandemic benefited patients and practices alike &#8212; saving at least one from bankruptcy.<\/p>\n\n\n\n<p>In a recent&nbsp;<a href=\"https:\/\/c19hcc.org\/telehealth\/physician-survey-analysis\/\" target=\"_blank\" rel=\"noreferrer noopener\">AMA poll<\/a>, 60% said that telehealth has improved the health of their patients.<\/p>\n\n\n\n<p>Yet delegates struggled to craft policy recommendations that could preserve newfound telehealth flexibilities while side-stepping unintended consequences, such as payers diverting patients to other non-physicians for care and the perennial issue of caring for patients across state lines.<\/p>\n\n\n\n<p>What started as a set of far-reaching policy proposals &#8212; touching on everything from copayments to in-state licensing &#8212; was whittled down to a set of core principles, first by a designated council&nbsp;<a href=\"https:\/\/www.medpagetoday.com\/meetingcoverage\/ama\/89707\" target=\"_blank\" rel=\"noreferrer noopener\">following a committee discussion on Saturday<\/a>, and then by the full House of Delegates in votes on the virtual House floor Monday evening and Tuesday morning.<\/p>\n\n\n\n<p>The agreed-upon policy resolution, included in&nbsp;<a href=\"https:\/\/www.ama-assn.org\/system\/files\/2020-11\/nov20-ref-com-b-annotated.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">the AMA&#8217;s preliminary report<\/a>&nbsp;released Wednesday, charged the AMA with continuing to advocate &#8220;for the widespread adoption of telehealth services in the practice of medicine for physicians and physician-led teams post SARS-COV-2.&#8221;<\/p>\n\n\n\n<p>The resolution also tasks the AMA with the following steps:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Urging the federal government, the Centers for Medicare and Medicaid Services (CMS), states, and insurers to &#8220;adopt clear and uniform laws, rules, regulations, and policies relating to telehealth services that provide equitable coverage that allows patients to access telehealth services wherever they are located&#8221;<\/li><li>Providing &#8220;the use of accessible devices and technologies, with appropriate privacy and security protections, for connecting physicians and patients&#8221;<\/li><li>Advocating for &#8220;equitable access to telehealth services&#8221; for vulnerable and low-income patients<\/li><li>Pushing for greater funding and planning related to telehealth infrastructure, for both practices and patients, including for broadband<\/li><li>Supporting telehealth as a means &#8220;to reduce health disparities and promote access to health care&#8221;<\/li><\/ul>\n\n\n\n<p>Use of telehealth has surged during the pandemic, aided by Trump administration orders that increased the number of services available and reimbursements for them.<\/p>\n\n\n\n<p>Some of these flexibilities are slated to expire when the pandemic ends, however, and others may end sooner.<\/p>\n\n\n\n<p>In AMA committee discussions,&nbsp;<a href=\"https:\/\/www.medpagetoday.com\/meetingcoverage\/ama\/89707\" target=\"_blank\" rel=\"noreferrer noopener\">delegates raised concerns over &#8220;scope creep&#8221;<\/a>&nbsp;in telehealth by non-physicians such as nurse practitioners and physician assistants, as well as the limitations in accessing the full array of services for older patients.<\/p>\n\n\n\n<p>The full House then discussed an alternate policy resolution put forward by AMA&#8217;s Council on Legislation, after listening to and reviewing comments from delegates.<\/p>\n\n\n\n<p>The proposed alternate policy included many of the provisions that were ultimately adopted in the AMA&#8217;s preliminary report, however the council&#8217;s proposal &#8212; which combined resolutions on the subject of telehealth from multiple delegations &#8212; called on the AMA to encourage CMS, other agencies, and industry to adopt &#8220;clear and uniform&#8221; laws, regulations, and policies that would permanently achieve certain goals. Two of those recommendations were adopted in the preliminary report, though the word &#8220;permanently&#8221; was stricken, and the following provisions were not adopted and instead referred to the Board for further study:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>&#8220;Promote continuity of care by preventing payors from using cost- sharing or other policies to prevent or disincentivize patients from receiving care via telehealth from their physician&#8221;<\/li><li>&#8220;Provide equitable payment for telehealth services that are comparable to in-person services&#8221;<\/li><li>&#8220;Ensure qualifications of physicians duly licensed in the state where the patient is located to provide such services in a secure environment&#8221;<\/li><\/ul>\n\n\n\n<p>During the full House&#8217;s discussion on Monday, members debated whether the timing was right for these reforms.<\/p>\n\n\n\n<p>Joshua Rosenow, MD, a delegate from the American Association of Neurological Surgeons, said many aspects of reimbursement and care provision in telehealth &#8220;are up in the air&#8221; currently.<\/p>\n\n\n\n<p>&#8220;We don&#8217;t know what the Biden administration is going to do,&#8221; he said, with respect to leadership at CMS and other agencies.<\/p>\n\n\n\n<p>&#8220;We don&#8217;t know what the Supreme Court is going to&nbsp;<a href=\"https:\/\/www.medpagetoday.com\/washington-watch\/repeal-and-replace\/89596\" target=\"_blank\" rel=\"noreferrer noopener\">rule on in the [Affordable Care Act] ruling<\/a>. There&#8217;s also the new implementation of the&nbsp;<a href=\"https:\/\/www.medpagetoday.com\/practicemanagement\/reimbursement\/88438\" target=\"_blank\" rel=\"noreferrer noopener\">[Evaluation &amp; Management] codes<\/a>&nbsp;in January,&#8221; Rosenow said.<\/p>\n\n\n\n<p>The resolution encompasses so many important issues and &#8220;[w]e have one chance to get this right.&#8221;<\/p>\n\n\n\n<p>For those reasons, Rosenow recommended the proposed policy be referred to the Board for study and report back to the House.<\/p>\n\n\n\n<p>Others opposed referral, calling for at least some of the policy provisions to be adopted.<\/p>\n\n\n\n<p>&#8220;As a family doctor, without telehealth, we would have gone bankrupt and closed the office,&#8221; said Chris Bush, MD, an alternate delegate from Michigan, speaking on his own behalf. &#8220;Now with another surge upon us, this item is of utmost urgency, and I speak against referral.&#8221;<\/p>\n\n\n\n<p>Michael Miller, MD, a delegate from Wisconsin, speaking for himself, agreed with Bush.<\/p>\n\n\n\n<p>&#8220;If there&#8217;s going to be a change of presidential administration or a Supreme Court ruling, why wouldn&#8217;t we want to have really good policy in place?&#8221; Miller asked. Any necessary modifications to policy could be made later, he added.<\/p>\n\n\n\n<p>The motion to refer was rejected in a vote of 323-158.<\/p>\n\n\n\n<p>The virtual House then attempted to amend and vote on individual provisions, requesting very specific amendments such as stating that &#8220;equitable coverage&#8221; be granted for patients&#8217; from the &#8220;originating site&#8221; to a physician&#8217;s &#8220;distant site.&#8221;<\/p>\n\n\n\n<p>Russell Libby, MD, author of that amendment, explained that some patients may travel &#8212; for leisure, for college, or because of a move &#8212; to states where a physician doesn&#8217;t hold a license and may still want care from their original physician.<\/p>\n\n\n\n<p>&#8220;The current situation &#8230; requires that we be licensed in the state where the patient is located when they receive your care, but as we see telemedicine grow, it&#8217;s going to need to be addressed,&#8221; Libby said.<\/p>\n\n\n\n<p>That change was voted down by the House.<\/p>\n\n\n\n<p>A handful of other amendments looked to either limit where a physician or patient could receive telehealth or to blow up those restrictions entirely.<\/p>\n\n\n\n<p>Sandra Swantek, MD, a delegate for the American Association of Geriatric Psychiatrists, opposed requiring that physicians be licensed in states where telehealth patients reside &#8212; acknowledging a personal interest, in that she treats &#8220;snowbirds&#8221; from Chicago who spend winters in Florida.<\/p>\n\n\n\n<p>&#8220;Physicians may treat patients temporarily out of state due to school vacation or temporary migration during the winter,&#8221; Swantek said.<\/p>\n\n\n\n<p>While a local physician would be best for any long-term treatment, Swantek suggested that the relationship between a patient and his or her physician &#8220;back home&#8221; should be encouraged as it preserves continuity of care.<\/p>\n\n\n\n<p>The proposed policy could potentially &#8220;disqualify&#8221; physicians from responding to patients who are temporarily out of state, she said, calling for the policy to be referred and clarified.<\/p>\n\n\n\n<p>It was not adopted.<\/p>\n\n\n\n<p>A provision declaring the opposite, that the AMA should advocate for allowing physicians to provide telehealth &#8220;regardless of current location,&#8221; was also not adopted.<\/p>\n\n\n\n<p>Douglas Murphy, MD, a member representing the Florida delegation, put forward an amendment urging the AMA to advocate that payers allow patients to see &#8220;the physician of the patient&#8217;s choice&#8221; via telehealth.<\/p>\n\n\n\n<p>The House initially voted to approve that amendment but a handful of delegates panned the idea.<\/p>\n\n\n\n<p>&#8220;We&#8217;re way down a rabbit hole that we shouldn&#8217;t be down,&#8221; said Jim Milam, MD, a delegate from Illinois.<\/p>\n\n\n\n<p>The proposed policy aims to prevent payers from cost-sharing with the physician of a patient&#8217;s choice, but, said Milam, &#8220;if you&#8217;re in the network you already had that.&#8221;<\/p>\n\n\n\n<p>Lindsay Ackerman, MD, a delegate for the Dermatology Section Council, argued that allowing patients to choose their healthcare provider could lead them to someone with a lower co-pay, for example, &#8220;a cadre of NPs providing care all over the place without any historical reference on the patients,&#8221; which Ackerman said would be &#8220;dangerous.&#8221;<\/p>\n\n\n\n<p>Neither the policy idea around preventing payers from cost-sharing, nor the proposed amendment calling for patients to have their choice of physicians, were included in the preliminary report released Wednesday.<\/p>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Most physicians at the&nbsp;American Medical Association&#8216;s virtual special meeting of its House of Delegates agreed 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