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America’s Race for Universal Telehealth May Rely on Making Medicare Payments Permanent

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Photo of Kimberly Sanders by Stephanie Daniel courtesy KUNC

August 31, 2020 – Kimberly Sanders was recovering from a heroin addiction when the coronavirus struck.

She had been homeless before and struggled to commute long distances for treatments. But because of her failure to attend several appointments, her previous doctors stopped seeing her.

Years later, in a bid to get clean, she moved to Estes Park, Colorado, and began attending a treatment program at Salud Family Health Center.

“It’s beautiful. It gets me away from the hustle and bustle of everything,” Sanders told KUNC, a radio station in Greeley, Colorado. “Estes Park is like a little bubble – a little protective bubble, and I like it.”

Then, because of the coronavirus, Salud began limiting in-person treatments.

“I didn’t know what we were going to do. I had no clue,” she said.

Sanders’ story is illustrative of the experiences of millions of Americans. And while America is racing to provide increasingly vital telehealth services universally during the coronavirus, there are still significant challenges with conducting telemedicine.

Fixes for permitting telemedicine during the coronavirus

In early March, Congress passed legislation that would temporarily allow patients in need to access telehealth services across state lines, as well as other key expansions.

The law, including as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6074, allows psychologists to treat patients from their homes, permits telehealth for Medicare recipients across the country and not just in underserved rural areas, and also allows nursing home patients to receive services via telehealth.

In August, President Donald Trump signed an executive order would allow individuals to pay for telehealth with Medicare in certain circumstances. It also directs task forces from the Departments of Agriculture and Health and Human Services to be created, and it calls for one of the FCC’s existing task forces to focus on telehealth.

The executive order was widely praised. At the Republican National Convention, Registered Nurse Amy Ford went so far as to say that Trump’s Executive Order would save lives.

“As a healthcare professional, I can tell you without hesitation, Donald Trump’s quick action and leadership saved thousands of lives during COVID-19,” she said. “And the benefits of that response extend far beyond coronavirus.”

The American Telehealth Association also praised the move, saying that it was a necessary step “to ensure individuals receive the care they need during this national health emergency.”

However, some worry that these expansions could leave millions unconnected when the virus is over.

“There is more work that needs to be done, on both the federal and state levels, to cement these gains and make permanent the waivers put in place in response to COVID-19,” said ATA CEO Ann Mond Johnson.

She said that while Trump’s Executive Order was a step in the right direction, continued work is needed to combat the coronavirus’s potential to harm vulnerable populations.

“The stresses on our healthcare system were well-documented prior to the pandemic – including crippling provider shortages, escalating costs, and an aging population – and will only be exacerbated as our nation begins to recover from this health crisis,” she said.

But Frank Micciche, vice president of public policy and external relations at the National Committee for Quality Assurance, thinks that telehealth legislation will continue to advance out of necessity.

“I think the Administration and even the private sector would have a really hard time going back to pre-COVID, Just because people on all ends of the system, providers, patients, you name it, have appreciated a lot of the benefits,” he said.

The future of telehealth after the pandemic ends

Companies like Teladoc, which partners with medical practitioners across a variety of disciplines, have become essential arbiters for providers historically unable to offer services across state lines.

A representative for Orlando Health Network said that they have advanced their remote services substantially during the coronavirus thanks to Teladoc.

“We deployed a dedicated COVID-19 screening and questions service on our Virtual Visit platform,” they said. “This was available to the community, as well as offered in partnership with several Central Florida employers to give patients 24/7 access to an Orlando Health physician for their questions about COVID-19.  We have done over 60,000 virtual visits during COVID-19.”

The representative said Orlando Health is positive about the future of telehealth.

“We believe that consumer demand will drive the legislative environment and we are optimistic that coverage for telehealth services is here to stay,” they said.

However, while federal funding and legislative proposals are plenty, the future of telehealth is uncertain. It is unclear which, if any, broadband and telehealth stimulus bills will pass, and a unified national telehealth expansion effort down to the local level is unlikely.

Sanders said that the ease of access that remote health has afforded her will make it difficult to return to in-person appointments if inter-state telehealth provisions are not agreed upon.

“I just step to the back at work for about 15-20 minutes and then I’m back right at work,” she said. “I don’t want to have to go back to having to go in person.”

Health

Providers Call for More FCC Telehealth Funding as Demand Grows

‘I think obtaining funding from the Universal Service Fund would go a long way.’

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Photo of FCC Chairwoman Jessica Rosenworcel

WASHINGTON, July 26, 2022 – Health care providers in parts of America say they are struggling to deliver telehealth due to a lack of broadband connectivity in underserved communities, and recommended there be more funding from the Federal Communications Commission.

While the FCC has a $200-million COVID-19 Telehealth program, which emerged from the Coronavirus Aid, Relief and Economic Security (CARES) Act, some providers say more money is needed as demand for telehealth services increases.

“The need for broadband connectivity in underserved communities exceeds current availability,” said Jennifer Stoll from the Oregon Community Health Information Network.

The OCHIN was one of the largest recipients of the FCC’s Rural Health Care Pilot program in 2009. Stoll advocated for the need for more funding with the non-profit SHLB Coalition during the event last week. Panelists didn’t specify how much more funding is needed.

Stoll noted that moving forward, states need sustainable funding in this sector. “I am hoping Congress will be mindful of telehealth,” said Stoll.

“The need for telehealth and other virtual modalities will continue to grow in rural and underserved communities,” she added.

Brian Scarpelli, senior global policy counsel at ACT, the App Association, echoed the call for FCC funding from the Universal Service Fund, which subsidizes basic telecommunications services to rural areas and low-income Americans. “I think obtaining funding from the Universal Service Fund would go a long way.”

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Artificial Intelligence in Healthcare Has Benefits, But Also Challenges That Must Be Rectified: Experts

The technology needs to be examined to ensure it doesn’t create inequities in healthcare, panel hears.

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Screenshot of the Atlantic event in late June

WASHINGTON, July 11, 2022 – While the use of artificial intelligence in healthcare has been lauded by some, experts said at an Atlantic event late last month they are concerned that inaccurate data can also hamper progress in the field.

Artificial intelligence has been used widely across the medical field to analyze relationships between medical providers and patients to improve equality of care, including providing patient risk identification, diagnostics, drug discovery and development, transcribing medical documents, and remotely treating patients.

Carol Horowitz, founder of the Mt. Sinai Institute of Health and Equity Research, argued that while AI plays a substantial role in diagnosing health problems at earlier stages, diagnosing patients more quickly, providing second opinions in diagnoses, enhancing scheduling abilities, stimulating hospital workflow, and finding drug availability for a patient as in dermatology, therapeutics, or population health, it’s not a golden ticket.

She reasoned that it “can reflect and really exaggerate inequities in our system,” negatively affecting healthcare equity among patients.

She stated that AI tools have led to inaccurate measurements in data that have proved harmful to individuals’ health. Horowitz shared the example of faulty AI technology during March 2020 meant to allow individuals to self-monitor their own oxygen levels as a precautionary method to the COVID-19 pandemic but led to inaccurate pulse readings for those with darker skin, and inaccurate data gathering, resulting in delayed treatment for many in need.

Michael Crawford, associate dean for strategy of outreach and innovation at Howard University, added that if these certain mismeasurements and flaws in the technology are not addressed, “AI could increase disparities in health care.”

Alondra Nelson, head of the White House Office of Science and Technology Policy, said when it comes to assessing AI technology innovation for the future, there are both cost and benefits, but we must find “where can we move forward in ways that don’t harm human society but that maximize human benefits.”

As we grapple with how to implement this technology, “we must do science and technology policy that always has equity at the center” for future innovation, said Nelson.

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States Lagging on Bills to Implement 988 Suicide Hotline Mandate as Deadline Approaches

As of June 7, 20 states have passed legislation to implement the 988 suicide hotline mandate, according to FCC data.

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Screenshot from the FCBA event on June 8

WASHINGTON, June 15, 2022 – Only 20 out of the 35 states that have introduced legislation for a new suicide hotline have made the legislation law as of June 7, according to information from the Federal Communications Commission, as the July 16 implementation deadline nears.

States are required to implement the infrastructure and the funding for a 988 number that will go to the National Suicide Hotline, but only four states have passed bills to finance it, Emily Caditz, attorney advisor of the Wireline Competition Bureau under the FCC, said at a Federal Communication Bar Association event last week. Those states – Colorado, Nevada, Virginia, and Washington – fund the implementation from fees on cellphone lines.

James Wright, chief of crisis center operations at the federal Substance Abuse and Mental Health Services Administration, suggested that “key partnerships between state and local governments” will be necessary to help states meet this deadline.

Laura Evans, director of national and state policy at Vibrant Emotional Health, said this funding will “make sure we have robust capacity for the anticipated 9-12 million contacts we expect to come in that first year.”

The commission ordered the adoption of the nationwide line nearly two years ago, on July 16, 2020.

According to the National Suicide Hotline Designation Act of 2020, “988 is designated as the universal telephone number within the United States for the purpose of the national suicide prevention and mental health crisis hotline system operated through the National Suicide Prevention Lifeline.”

“America’s suicide rate is at its highest since World War II,” said former FCC Chairman Ajit Pai at an FCC event in December of 2019. “A simple three-digit code for a suicide hotline can reduce the mental stigma surrounding mental health and ultimately save lives.

Caditz said the implementation of text messaging “is especially popular with groups that are at heightened risk of suicide or mental health crises, including teenagers and young adults and individuals who are deaf, hard of hearing, deafblind, or speech disabled.”

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