Washington, D.C., September 18, 2023 – The American Telemedicine Association (ATA) announced this week that its CEO’s Advisory Group on Using Telehealth to Eliminate Disparities and Inequities is releasing three new tools this week, to inform ways in which telehealth can impact disparities and inequities.

“We launched the advisory group in 2021 to address the unique ways telehealth could be used to eliminate health disparities in the U.S. We are confident that the tools we are launching this week will support decision-making related to targeting and funding interventions that improve health in communities,” said Ann Mond Johnson, CEO of the ATA. “Our Advisory Group is comprised of national healthcare leaders uniquely focused on health disparities. Led by co-chairs Kristi Henderson, DNP, Yasmine Winkler and Ron Wyatt, MD, and facilitated by David Smith, CEO of Third Horizon Strategies, their groundbreaking work will further position our community to  leverage telehealth to eliminate healthcare disparities.”

All three tools were released today, to commemorate the third annual Telehealth Awareness Week. This year’s events will highlight the value telehealth brings to patients and helps to expand access to quality care, how virtual care is addressing many of the challenges faced by healthcare providers, and its role in building a modern, omnichannel care delivery system.

• The Digital Infrastructure Disparities Score and Map uses a newly created composite measure designed to score a community’s digital infrastructure on a scale of 1-100.
• The Economic and Social Value-Added Calculator tool is designed to scope the cost of telehealth-based clinical or social interventions, including estimates for the total value of an intervention created in favor of payers, providers, government, and business. The calculator analyzes the capital and operating costs for these interventions, including technology platforms (telehealth solutions) and funding needed to ensure community members have solid, reliable, and contiguous broadband connectivity.
• The third tool is a toolkit summarizing all resources the group has released to date, including a new roadmap to address inequalities in the delivery of healthcare information and services with a focus on both access and improving outcomes.

Access the above tools here: Disparities Advisory Group Toolkit.

“These new tools build on a framework and advance our efforts to ensure everyone is able to access needed care, recognizing that telehealth is a critical component and a modality for accessing care,” added Kristi Henderson, DNP, CEO of Confluent Health, chair of the ATA Board of Directors, and co-chair of the advisory group. “The work of our advisory group focuses on creating the infrastructures and tools to allow the industry – including healthcare providers, payers and policymakers – to appropriately assess the required components in eliminating disparities, and to understand where virtual care services can help to improve the health of our citizens and the requisite investment. These tools also look beyond the traditional return on investment framework to a broader notion of economic and social value-added. The advisory group believes the economic burden of inaction should be enough to galvanize all stakeholders towards leveraging the tools necessary to eliminate inequities in care.”

Webinar Alert: Digital Disparities and Re-thinking Economic and Social Value Creation

On September 19, the ATA will host a webinar featuring a discussion with the three co-chairs of the CEO’s Advisory Group on Using Telehealth to Eliminate Disparities and Inequities, who will share their thoughts on creating digitally-centric interventions that can deliver true economic and social value across communities.– Panelists:  Kristi Henderson, DNP, Confluent Health and ATA Board chair; Yasmine Winkler, managed care executive and secretary of the ATA Board; and Ron Wyatt, MD, Achieving Equity, LLC, with David Smith, Third Horizon Strategies. Register for the webinar, here.

About the ATA

As the only organization completely focused on advancing telehealth, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

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August 31, 2023 – Amid rising concerns about data privacy within the telehealth arena, the American Telemedicine Association (ATA) released a set of principles to ensure patient data is protected during telehealth utilization.  

The ATA’s Health Data Privacy Principles include six components: consistency, the definition of consumer health data, the Health Insurance Portability and Accountability Act (HIPAA), consumer rights, consumer consent, sale of data and opt-out, and enforcement.

The ATA states that a federal policy would offer much-needed consistency in data privacy practices for telehealth providers nationwide. But in lieu of such a policy, there need to be efforts to establish uniformity with existing federal and state privacy laws and standards to reduce compliance challenges and confusion.

Dig Deeper

• Using Data Analytics to Enhance Telehealth Services
• Mount Sinai Launches New mHealth App for Patient Data Access
• Providers Can Glean Useable Health Metrics from Wearable Tracker Data

In addition, state laws should define consumer health data and other common terms for protected health information using language similar to HIPAA and exempt HIPAA-covered entities and their business associates from state privacy laws that differ from HIPAA standards.

“HIPAA is a proven, decades-old data privacy framework,” the ATA states. “Requiring HIPAA-covered entities to adhere to additional layers of state privacy laws would negatively impact their ability to deliver services, increase compliance costs, and stymie innovation.”

The ATA also emphasized the importance of consumer rights and consent. The association noted that consumers should have “a right to notice, a right to access, a right to correct, a right to portability, a right to delete” their data as long as the rights are consistent with other medical record retention laws and include legal exceptions.

Further, the ATA stated that consumers should be provided with clear disclosures on the patient data that is collected, how it will be used, and how to opt out of processing.

Finally, state attorneys general should be empowered to act when privacy laws are violated, the ATA stated. But, the association also noted that data privacy policies should not allow for private rights of action as they can result in frivolous lawsuits and out-of-court settlements.

“As states adopt privacy statutes and regulations, establishing uniformity with existing federal and other state standards would reduce both complexity of compliance and confusion for consumers and companies alike. Privacy laws should allow for innovation and the advancement of technology-assisted care,” said Kyle Zebley, senior vice president of public policy at the ATA, in the press release. “The ATA supports efforts to ensure telehealth practices meet standards for patient safety, data privacy, and information security, while advancing patient access and building awareness of telehealth practices.”

Concerns around data security on telehealth platforms have been steadily increasing.

In March, telehealth company Cerebral reported a healthcare data breach impacting more than 3.1 million individuals. The breach was related to the company’s use of tracking pixels.

This report came just one month after Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), Maria Cantwell (D-WA), and Cynthia Lummis (R-WY) sent letters to three telehealth companies, including Cerebral, detailing concerns over the companies’ health data privacy practices. In the letter to Cerebral, the senators noted that the company’s website claims that information entered on intake forms “is confidential and secure,” but “this information is reportedly sent to advertising platforms, along with the information needed to identify users.”

Amid the growing focus on data privacy in telehealth this year, the public health emergency (PHE) declaration ended, eliminating the Notifications of Enforcement Discretion issued under HIPAA and the Health Information Technology for Economic and Clinical Health (HITECH) Act during the pandemic.

The HHS Office for Civil Rights (OCR) issued four notifications that loosened HIPAA compliance obligations, including allowing telehealth providers to use non-public-facing communication technologies like Zoom and Skype.  

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Eight Essentials of Effective Telehealth Services, including:

• Making the Business Case & Activating an Executive Champion
• Making Telehealth Easy for Your Clinicians, Staff & Patients
• Understanding Essential Telehealth Policies & Regulations
• Moving as Fast as Your Organization’s Culture & Budget Will Allow

The Essentials Guide was made possible thanks to the generous support of the David M.C. Ju Foundation.

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WASHINGTON, DC, AUGUST 29, 2023 — The American Telemedicine Association (ATA) and ATA Action submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) CY2024 Physician Fee Schedule (PFS) proposed policy changes for Medicare payments under the PFS, and other Medicare Part B issues. The ATA and ATA Action commend CMS for extending most of the telehealth flexibilities implemented during the public health emergency (PHE) through calendar year 2024, in alignment with the 2023 Consolidated Appropriations Act passed into law last December.

“The proposed rule is, overall, positive for the telehealth community and patients, and looks beyond the now-expired COVID-19 public health emergency (PHE) to continue the expansion of telehealth services, providing much needed clarity for physicians and other stakeholders across the country,” said Kyle Zebley, senior vice president, public policy, the ATA, and executive director, ATA Action. “Our 11-page letter submitted to CMS includes detailed feedback intended to create a final PFS that allows everyone to have access to safe, affordable and appropriate care when and where they need it, especially our rural communities and underserved patient populations.

“However, while CMS tackled many of the critical telehealth policies implemented during the PHE, there was one important policy left out. During the PHE, CMS did not require providers to list their home address when most care was provided virtually. We urge CMS to permanently allow providers to bill their practice address in order to maintain the confidentiality and security of the provider’s home address, especially for those providing mental health services. It is imperative that this flexibility not be allowed to expire at the end of 2023.”

“The ATA and ATA Action applaud CMS’ commitment to expanding access to care to all Medicare beneficiaries,” added Zebley. “We appreciate the opportunity to provide our detailed feedback on this year’s PFS proposed rule and look forward to continuing to work with CMS.”

Read the ATA and ATA Action Comment Letter to CMS here.

About ATA Action
ATA Action recognizes that telehealth and virtual care have the potential to transform the healthcare delivery system by improving patient outcomes, enhancing the safety and effectiveness of care, addressing health disparities, and reducing costs. ATA Action is a registered 501c6 company and an affiliated trade organization of the ATA.

— more –

About the ATA
As the only organization completely focused on advancing telehealth, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

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The American Telemedicine Association and affiliate ATA Action are voicing support for the Centers for Medicare & Medicaid Services’ proposed rule for the 2024 Physician Fee Schedule, which the advocates note extends into the new year the telehealth flexibilities put forward during the COVID-19 public health emergency.

“The proposed rule is, overall, positive for the telehealth community and patients, and looks beyond the now-expired COVID-19 public health emergency to continue the expansion of telehealth services, providing much needed clarity for physicians and other stakeholders across the country,” Kyle Zebley, ATA senior vice president, public policy, and executive director, ATA Action says in an 11-page letter sent this week to CMS Administrator Chiquita Brooks-LaSure.  

However, Zebley says the proposed rule raises privacy concerns for physicians.

“During the PHE, CMS did not require providers to list their home address when most care was provided virtually,” he says. “We urge CMS to permanently allow providers to bill their practice address in order to maintain the confidentiality and security of the provider’s home address, especially for those providing mental health services. It is imperative that this flexibility not be allowed to expire at the end of 2023.”

“THE PROPOSED RULE IS, OVERALL, POSITIVE FOR THE TELEHEALTH COMMUNITY AND PATIENTS, AND LOOKS BEYOND THE NOW-EXPIRED COVID-19 PUBLIC HEALTH EMERGENCY TO CONTINUE THE EXPANSION OF TELEHEALTH SERVICES, PROVIDING MUCH NEEDED CLARITY FOR PHYSICIANS AND OTHER STAKEHOLDERS ACROSS THE COUNTRY.”

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June 16, 2023 – In support of continued telehealth access, a bipartisan group of 60 United States senators reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act to expand Medicare coverage of telehealth, sustain virtual care flexibilities, enhance health outcomes, and ease healthcare communication.

The COVID-19 pandemic highlighted the efficacy of telehealth. Greater telehealth use was made possible during the pandemic due to numerous regulatory flexibilities. But these flexibilities were intended to be temporary.

Initially introduced in 2016, lawmakers have since enacted various provisions of the CONNECT for Health Act into law. In 2020, three provisions from the CONNECT for Health Act became law. This led patients to use telehealth more, highlighting virtual care’s capabilities in improving care access.

Dig Deeper

• Legislation Aims to Maintain Virtual Access to Physical Therapy
• Legislation Aims to Support Telehealth Access in Rural Areas
• Legislation Aims to Support Telemental Health Services for Medicare

In December, Sen. Brian Schatz (D-Hawai‘i), along with other lawmakers, further secured provisions from this legislation. The 2022 year-end spending bill for 2023 included provisions to extend pandemic-era telehealth and hospital-at-home waivers through Dec. 31, 2024. Given the projected expiration date, there is an urgent need to place permanence on telehealth flexibilities, a press release from Schatz’s office notes.

Alongside Sens. Roger Wicker (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), Mark Warner (D-Va.) and Cindy Hyde-Smith (R-Miss.), and many other senators, Schatz reintroduced the CONNECT for Health Act.

The reintroduced bill makes permanent various allowances surrounding virtual care. These include removing geographic restrictions on originating sites for telehealth, allowing health centers and rural health clinics to use telehealth, and increasing the list of professionals who can use telehealth. Other changes include waiving the need to initially participate in an in-person visit for mental healthcare, removing telehealth barriers during a public health emergency, and increasing published data requirements surrounding telehealth, its use, and its impact on care quality.

“While telehealth use has skyrocketed these last few years, our laws have not kept up. Telehealth is helping people in every part of the country get the care they need, and it’s here to stay,” said Schatz in a press release. “Our comprehensive bill makes it easier for more people to see their doctors no matter where they live.”

This effort has gained the support of over 150 organizations, including AARP, the American Telemedicine Association (ATA), Kaiser Permanente, and the National Association of Rural Health Clinics.

“Since originally introduced in 2016, the CONNECT for Health Act has envisioned a world where Medicare beneficiaries have access to virtual care services where and when they need them. Today, our esteemed policy champions in Congress reintroduced an updated version of the CONNECT Act, including new and revised provisions that will help more people access telehealth services,” said Kyle Zebley, senior vice president of public policy at the ATA, and executive director, ATA Action, in a press release shared with mHealthIntelligence.

The College of Healthcare Information Management Executives (CHIME) also showed support for the CONNECT for Health Act.

“The CONNECT for Health Act will ensure patients continue to have ongoing access to their clinicians; removing many obstacles some patients face accessing needed services while putting protections in place to ensure federal resources are effectively used,” said CHIME President and CEO Russ Branzell in a press release shared with mHealthIntelligence. “CHIME is pleased to see the legislation expand originating sites to include the home and other sites, allow more healthcare professionals to deliver care virtually, and repeal the unnecessary in-person visit requirement for telemental health visits. 

Legislation supporting telehealth service growth and application has accelerated in the last year.

In February, six US House representatives introduced the Telehealth Benefit Expansion for Workers Act. This bipartisan legislation aims to provide American workers with standalone employer-sponsored telehealth benefits.

Through this legislation, telehealth benefits would work similarly to dental and vision benefits. US Rep. Tim Walberg (MI-07) noted that the pandemic emphasized the efficacy and usefulness of telehealth and that expansion would improve healthcare access.

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The CONNECT For Health Act has been filed again in both the Senate and House, and supporters say the groundswell for expanded telehealth coverage and services could finally give the bill the momentum it needs for passage.

KEY TAKEAWAYS

The CONNECT for Health Act, first introduced in 2016, aims to expand oportunities and coverage for telehealth through Medicare.

This is the fifth time the bill has appeared before Congress, and telehealth advocates say the lessons learned from the pandemic and broad support for telehealth expansion could compel the bill across the finish line this time.

The bill would eliminate geographic restrictions and in-person exam requirements, expand who can use telehealth, and require more studies on telehealth’s value.

A bill that aims to improve and expand Medicare coverage for telehealth is back for a fifth time before Congress.

The CONNECT for Health Act of 2023, filed this week by US Senators Roger Wicker (R-Mississippi), Cindy Hyde-Smith (R-Mississippi), and Brian Schatz (D-Hawaii), continues a lengthy campaign by telehealth advocates to address the Centers for Medicare & Medicaid Services’ restrictive rules around who can use telehealth and what services are reimbursable.

A companion bill has been introduced in the House by US Reps. Mike Thompson (D-California), Doris Matsui (D-California), David Schweikert (R-Arizona), and Bill Johnson (R-Ohio).

As proposed this year, the bill would:

• Eliminate geographic restrictions on telehealth use and expand the list of allowed “originating sites” to include the home and other sites;
• Allow federally qualified health centers and rural health clinics to provide telehealth services;
• Expand the list of eligible healthcare providers to use telehealth;
• Eliminate the in-person visit requirement for telemental health services;
• Allow for a waiver of telehealth restrictions during future public health emergencies; and
• Mandate studies on how telehealth is used, how it impacts quality of care, and how it can be improved to support patients and providers.

The bill, first introduced in 2016, has a long list of supporters—some 60 senators are supporting this latest version—but has been unable to cross the finish line. Several provisions of previous versions of the CONNECT for Health Act were signed into law through separate bills or adopted by CMS, including actions to improve telemental health and telestroke care and integrate telehealth in home dialysis programs.

Supporters say the rapid and successful use of telehealth during the pandemic should give this bill a better chance of success.

“The pandemic showed us just how valuable telehealth is to ensuring folks receive care, but telehealth’s use goes far beyond navigating public health emergencies,” Hyde-Smith said in a press release announcing the bill’s reintroduction this week. “Mississippians and Americans face many obstacles accessing healthcare, whether it’s living in rural areas, old age, or mobility issues. This legislation would be key to providing them with the quality, affordable care they need and deserve. It’s time to get this done.”

“While telehealth use has skyrocketed these last few years, our laws have not kept up,” added Schatz, a well-known telehealth advocate. “Telehealth is helping people in every part of the country get the care they need, and it’s here to stay. Our comprehensive bill makes it easier for more people to see their doctors no matter where they live.”

Many of the flexibilities sought in this bill are in place through the end of 2024, thanks to an omnibus spending bill passed by Congress in December. Supporters say these provisions need to be made permanent to that healthcare organizations can map out long-term telehealth strategies and programs and consumers can access them without fear that they would be eliminated in a few years.

Among the many organizations supporting the bill is the American Telemedicine Association.

“Since originally introduced in 2016, the CONNECT for Health Act has envisioned a world where Medicare beneficiaries have access to virtual care services where and when they need them,” Kyle Zebley, the ATA’s senior vice president of public policy and executive director of ATA Action, said in a press release. “Today, our esteemed policy champions in Congress reintroduced an updated version of the CONNECT Act, including new and revised provisions that will help more people access telehealth services.”

“The pandemic showed us that we need to use technology to deliver care when and where it is needed,” added Rene Quashie, vice president of digital health for the Consumer Technology Association, the driving force behind the annual CES show in Las Vegas, in an e-mail to HealthLeaders. “Extending telehealth access for Medicare beneficiaries will help bridge gaps in distance, accessibility, and availability of crucial health services in communities across the nation. The CONNECT for Health Act is a step in the right direction to modernize our health care system, and CTA is proud to endorse it.”

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March 09, 2023 – The COVID-19 pandemic spurred telehealth use to new heights, with policy changes and flexibilities enacted at the state and federal levels supporting the rapid integration of telehealth into routine care delivery. But now, with the public health emergency ending on May 11, lawmakers are evaluating how telehealth policy needs to evolve to continue supporting the new normal in healthcare.

Various pieces of legislation have been introduced at the federal level to solidify telehealth policy, but many have yet to be voted on. Telehealth proponents scored a win when telehealth flexibilities for Medicare beneficiaries were included in the 2022 year-end spending bill, with provisions extending pandemic-era telehealth and hospital-at-home waivers for two years.

At the state level, telehealth policies have evolved quickly, creating a patchwork of laws governing virtual care. But these telehealth policy changes were largely tied to states’ public health emergency declarations. As these expired, many states only temporarily extended telehealth flexibilities, leaving the future of state telehealth policy unclear.

“We’re beginning to watch some of those states that might have provided a one-to two-year temporary extension of some of their public health emergency waivers as they’re beginning to analyze costs and quality and utilization,” said Ben Steinhafel, director of policy and external affairs at the Center for Telehealth & e-Health Law (CTeL), in a phone interview. “There will be a lot of opportunity in the coming years at the state level, as some of those one-to two-year telehealth extension policies are beginning to sunset.”

Steinhafel, along with four telehealth policy experts, spoke with mHealthIntelligence about state telehealth policy, how it has evolved over the past three years, and what it could look like in the year ahead.

STATE TELEHEALTH POLICY DURING THE PANDEMIC

Telehealth policy at the state level has changed rapidly over the past few years as COVID-19 cases surged and fell.

“At the highest level, I think we’ve shifted from policy issues related to questions like, ‘Is telehealth covered?’ or ‘In which locations can telehealth be provided?’ to a kind of more advanced set of policy issues around what will coverage and reimbursement look like for non-video modalities? And how are we actually paying for really specific types of services and how do we enable providers to practice across state lines, but still maintain an ability for the state medical boards to play the role that they have,” said Jared Augenstein, managing director of Manatt Health Strategies, in a phone interview.

One of the most significant changes to state telehealth policy amid the pandemic has been growing payment parity, that is, reimbursing services equally whether they are provided via telehealth or in-person. According to Augenstein, 21 states now have payment parity policies compared to about 10 in the late 2010s.

This is a major shift from pre-pandemic telehealth policy. Before the pandemic hit, coverage parity among states was fairly common, said Mei Kwong, executive director of the Center for Connected Health Policy, in an email. Coverage parity refers to payers covering the same services, whether they are delivered via telehealth or in-person. But this does not guarantee the services will be covered at the same payment rate. 

Now, with states moving toward payment parity, many are changing private payer laws to require the same reimbursement for virtual and in-person care, she said.

Another significant change in state telehealth policy relates to physician licensure.

State governments decide both who is licensed to deliver care within state borders and the board of medical professionals to whom the healthcare professional will be accountable, noted Kyle Zebley, senior vice president of public policy at the American Telemedicine Association (ATA) and executive director of ATA Action, in a phone interview.

During the pandemic, many states adopted licensure compacts allowing medical professionals to practice virtually across state lines, he said. These compacts covered various types of providers, including physicians, nurses, physical therapists, and psychologists.

But even though there was an uptick in the adoption of licensure flexibilities, there were signs of a return to pre-COVID licensure rules last year.

“In 2022, most states had ended their state of public health emergency, which is, for the most part, what those flexibilities were tied to,” Augenstein said. “And I think now only seven states have any sort of ongoing telehealth licensure flexibility.”

Alongside licensure flexibilities, states revised Medicaid policies to expand the list of providers who could be reimbursed for providing services via telehealth. The provider lists were expanded to include physical therapists and occupational therapists, Kwong said.

Not only that, but Medicaid programs also started reimbursing for care provided in the home supported by virtual care technologies.

“While before some Medicaid programs did allow some narrow exceptions for telehealth in the home, we’re seeing more Medicaid programs expand or adopt home telehealth policies,” she said.

Audio-only telehealth also experienced a significant boost from state policy changes in the last few years. According to a report from the Center for Connected Health Policy (CCHP) released last October, the Medicaid programs of 34 states and the District of Columbia reimburse for audio-only telehealth services.

“Prior to COVID-19, the use of audio-only would not have even been a part of the conversation for telehealth reimbursement,” said Kwong. “That’s been one, if not the most, significant policy change so far.”

STATE TELEHEALTH POLICY IN 2023

The widespread changes to state policy undoubtedly spurred the adoption and use of telehealth across the country. But with many of these changes tied to states’ public health emergency declarations — several of which have ended — states must decide what telehealth policy will look like moving forward.   

As discussed above, policies around cross-state licensure have been allowed to expire in certain states, suggesting a pull-back from pandemic-era flexibilities. But other policies, like payment parity, will likely see continued support at the state level.

Audio-only telehealth also appears to be on solid ground, particularly with ongoing broadband and internet connectivity issues that prevent people, especially those living in rural areas, from accessing video-based care.

“In many cases, there are still 20 to 30 million Americans who don’t have access to broadband internet, and so really can’t participate in a video visit,” said Augenstein. “And in many cases from their home at least, audio-only is the only option… While the broadband access and affordability problem will hopefully get solved over the next few years, audio-only is a modality that more people are able to access. And so I expect to continue to see policy-making happening there.”

But one area where the future remains uncertain is the virtual prescribing of controlled substances.

At the federal level, the Drug Enforcement Administration has jurisdiction over these prescribing rules. The agency recently proposed regulations limiting the virtual prescription of certain controlled substances without an in-person evaluation including Adderall and Ritalin. But these proposed rules do not extend to Schedule III-V non-narcotic controlled medications or a 30-day supply of buprenorphine for treating opioid use disorder (OUD).

Christa Natoli, executive director of CTeL, believes states may align their policies with these proposed rules.

“With the onset of certain companies that have made the news recently in the mental health space that may not have been prescribing controlled substances in an appropriate way, we may see a trend by states to be more restrictive, to be protective of their patients, [and] not [give them] inappropriate access to stimulants,” she stated in a phone interview.

But telehealth proponents have decried the DEA’s proposed rules, with the American Telemedicine Association stating that they are “significantly more restrictive than is warranted.”  

“There’s concern a lot of patients will be abruptly cut off from needed medication because, for the last few years, they’ve been treated by telehealth providers utilizing this [public health emergency] exception,” Kwong said. “What happens to them is of great concern to many.”

Not only that, but the prescription of abortion drugs via telehealth is also in flux. Providers offering abortion care increasingly turned to telehealth to ensure access following the overturning of Roe v Wade last year. And while some states supported this move, others sought to block access, attempting to ban telehealth use in abortion care or limit the use of the drugs themselves.

Augenstein believes that states will continue to change policies surrounding medication abortions via telehealth. This issue may also be further complicated by a potential nationwide ban on one of the drugs routinely used for abortions, mifepristone.

In addition, Augenstein expects to see policy focused on the extent to which telehealth can be used to meet network adequacy requirements.

Network adequacy requirements aim to ensure that health plans “maintain a network of appropriate providers that is sufficient to provide adequate access to covered services to meet the needs of the population served,” according to the Centers for Medicare and Medicaid Services.

“I think we’ll see more activity this year…around the intersection between telehealth and network adequacy, with some states wanting to allow for plans to use telehealth in meeting their network adequacy requirements, and other states kind of banning the practice of allowing telehealth to be used to meet network adequacy requirements,” Augenstein said.

As healthcare stakeholders glean more insights into telehealth use and its impact on patient care, states have some critical decisions to make. Though there are many factors to consider, telehealth proponents are urging state governments to ensure that the benefits provided by expanded access to telehealth are not wiped out by a move back to pre-pandemic restrictions on virtual care.

“At the end of the day, healthcare and telehealth are the same,” Zebley said. “They’re not separate and apart. Telehealth is health. We should make sure that telehealth is not being held to, certainly not lower standards, and not to higher standards either. But instead, the same standard that in-person care is held to.”

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By Anuja Vaidya

February 24, 2023 – The American Telemedicine Association and Alliance for Connected Care have expressed concerns regarding a Contractor Advisory Committee (CAC) Meeting on remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices slated to take place on Feb. 28.

The meeting, hosted by multiple Medicare Administrative Contractors (MACs), will seek advice on the strength of published evidence related to RPM and RTM for non-implantable devices and other relevant data to determine “meaningful and measurable patient outcomes (e.g., decreases in emergency room visit and hospitalizations) for our Medicare beneficiaries,” a press release notes.

MACs are private health insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. MACs make Local Coverage Determinations (LCDs) on whether to cover a particular item or service in its jurisdiction or region. These determinations are based on whether that item or service is deemed reasonable and necessary.

In a Feb. 21 letter to Novitas Solutions and First Coast Service Options — the MACs hosting the meeting — the telehealth advocacy groups raised several concerns. These include the absence of noteworthy studies from the bibliography, the short time allotted for discussion, combining discussions on RPM and RTM into one meeting, and certain clinical conditions and disease states being omitted from consideration.

“We are concerned that advice rendered by the CAC in this instance will not be the result of a full scientific inquiry, nor will it help ensure unbiased or contemporary consideration of state of the art technology and science,” the groups wrote in the letter.

They noted that at least 45 credible studies were missing from the bibliography, including some from well-known physicians using RPM, and urged a more comprehensive literature review.

Further, they emphasized that RPM and RTM are very different services, but the meeting leaders have allotted only 75 minutes on the agenda for discussion, “which is not enough time for meaningful evidentiary presentation and deliberation.”

In addition, the groups requested that meeting leaders widen the evidence being considered to include more conditions RPM/RTM can help treat.

“There is a broad range of chronic conditions for which utilizing RPM and RTM are appropriate, and limiting the evidentiary review indicates you are considering limiting an LCD to only the conditions considered,” the groups wrote. “This would leave clinicians currently using RPM outside of cardiology with no feasible way to continue.”

The concerns regarding the meeting come as healthcare providers increasingly adopt RPM.

Last September, the American Medical Association released survey results showing that the proportion of physicians using tools that support remote monitoring for efficiency — defined in this analysis as smart versions of common devices such as thermometers and blood pressure cuffs — jumped from 12 percent in 2016 to 30 percent in 2022.

Further, the percentage of physicians using remote monitoring and management tools to improve care, including applications and devices for vital sign monitoring of chronic care patients, increased from 13 percent to 34 percent between 2016 and 2022.

Not only that, but 75 percent of physicians polled in 2022 said being able to offer remote care was an important reason to use digital health tools.

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