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

Elijah Labby

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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

Pandemic Creating Long-Term City Solutions to Technology Challenges: Route Fifty Town Hall

Derek Shumway

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Screenshot taken from Route Fifty town hall

March 24, 2021 – Partnerships between cities and tech companies have not only allowed municipalities to acquire technology to get online quickly during the pandemic, but it’s also helped city staff absorb technological training to address challenges in the future, a virtual town hall heard Tuesday.

“Government too, can be adaptable and flexible,” said Heidi Norman, acting director of innovation and performance for the City of Pittsburgh, Pennsylvania. Asked by Dell innovation officer Tony Encinias what allowed Norman to embrace remote working during the past year, she said having relationships with tech companies like Dell helped keep Pittsburgh connected with computers, hotspots, and Wi-Fi routers when in-person work was not an option.

The town hall, which heard about experiences during the first full year with Covid, was hosted by Route Fifty, a digital news publication from Government Executive Media Group, which also publishes Government Executive magazine, GovExec, Nextgov and Defense One.

Pittsburgh had to adapt and move fast and focus on getting eligible people to work remotely and, with that, more digital software was a priority. The city had to ensure its plans were executed and communicated clearly between its staff and city residents. And to accomplish that, proper videoconferencing technology was needed. 200 city employees were able to work from home in less than 2 weeks on new Dell laptops.

Pittsburgh’s government was able to prove it can do things in new and better ways, Norman said, as it had no other choice but to increase its remote working ability. As the pandemic was emerging, much of the city staff had not worked with many of the technologies needed to work remotely, she added. Staff needed to be trained on new videoconferencing technology and learn how to set up home offices as they began working from home.

Ed Zuercher, city manager of Phoenix, Arizona, said during the event that the pandemic should create long-term “systems” to address its effects rather than bring about temporary “responses.” The city has since been able to maintain its pandemic-driven response by partnering with Dell and turned it into a system that now has plans to keep its staff with the right skills to continue being able to serve its residents.

Pittsburgh also plans to stabilize its foundational IT structure into the cloud and to establish a new wide area fiber network called NetPGH, Norman said.

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Health

With Security And Cost Concerns, Telehealth Is A Double-Edged Sword: Harvard Professor

Samuel Triginelli

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Photo of Ateev Mehrotra from Harvard Medical School

March 4, 2021 – The benefits of telehealth, especially during the pandemic, is being offset by the enhanced security requirements and the increased costs to adapt, a professor of Harvard’s medical school said at a House hearing Tuesday.

Ateev Mehrotra said at the House Energy and Commerce Committee studying the future of telehealth that new technologies have allowed many Americans to get healthcare from home. But with its expansion, and its growing popularity, health care policies will also need to keep pace – and there may be significant adaptation costs and security enhancements that will need be made, he said.

One security concern is evident in existing telephone scams, which are increasing. If a prospective patient doesn’t have adequate internet at home to video chat with their physician and require a phone, they are opening themselves up to potentially being scammed or worse, being given bad medical advice.

Similarly, other witnesses present at the hearing addressed health care providers’ concerns about pricing, security, and lack of universal access to adequate broadband as the limiting factors of telehealth, especially to rural communities and underserved intercity areas.

The increasing popularity of seeing a doctor virtually on your device, compared to in person, has elevated these concerns. Now, private insurers and governments are concerned about the sustainability of the required increase in health care spending.

Mehrotra outlined that health plans would also need to be updated to reflect the technological differences, including having audio-only appointments, and align with existing plans that see patients go in person.

The long-term solution is for health care providers to invest in access to video visits to all Americans for good. Mehrotra said he advocates for telemedicine visits to be charged at a lower rate than in-person visits. In the longer-term, telemedicine visits have a lower overhead per visit, he said. The payment should reflect those lower costs, which may open up competition for customers and even lower costs.

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Expert Opinion

Debra Berlyn: Telehealth is Here Today and Here to Stay

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The author of this Expert Opinion is Debra Berlyn, president of Consumer Policy Solutions

The COVD-19 pandemic has been an extremely difficult time for everyone and has led to the implementation of major changes in our daily behaviors. In order to overcome this adversity and adapt to living in a new age, great innovations have been advanced.

New tech devices and programs have offered many solutions to help solve some of our struggles during this pandemic and raise our spirts.

The pandemic has also highlighted how technology supports consumers who are homebound or living distant from essential services.  In a post-pandemic environment, we can already predict that many consumers, particularly older adults, will continue to rely on many tech services they have adopted during COVID-19.  Services such as online shopping and telehealth have been particularly indispensable during this era of stay-at-home orders, social distancing and quarantine.

The benefits of telehealth options for all consumers have been demonstrated during this pandemic. Telehealth has replaced many routine doctor’s visits, has been used for setting-up COVID testing appointments, and conducting all too critical mental health sessions during periods of isolation. It has also served to keep medical workers safe during the pandemic.

According to a Center for Disease Control report, there was a “154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019….”

During the emergence of COVID-19, both a majority of doctor’s offices were closed, and their patients were staying in their homes.  Options for medical appointments were limited to a telehealth visit only, and while most medical offices reopened with safety protocols in place, many consumers opted to continue with telehealth medical appointments.

The reduction of red tape and the number of doctors who quickly adapted to virtual services was one of the greatest developments of 2020; however, only those who have adequate access to broadband internet are able to take advantage of this tool, leaving out the unconnected population.

As we contemplate permanent integration of virtual care into our medical health system, we must acknowledge that consumer demand for telehealth requires access to ubiquitous high-speed broadband. In 2021, policymakers need to take aggressive steps to deliver broadband to those who do not have access, or who are unable to afford the service.

The $900 billion-dollar COVID Relief package approved by Congress in the final days of 2020 provides $7 billion to increase access to broadband. In addition, Telehealth expansion is included within the broadband funding priorities. The package more broadly includes overall support for these initiatives, with funding for:

  • Expanding telehealth access to mental health services for Medicare patients
  • Closing rural telehealth gaps to provide increased funding to the Health and Human Services agency’s Health Resources and Service Administrations pilot project for Telehealth Centers of Excellence, to access broadband capacity available to rural health providers and patient communities
  • The Federal Communications Commission to support the efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

The FCC has made a broad commitment to telehealth programs, initially under the leadership of Chairman Ajit Pai, and now in the most capable hands of Acting Chairwoman Jessica Rosenworcel. The Chairwoman recently visited the Washington, D.C., Whitman-Walker Clinic, which provides community-based health and wellness services specializing in LGBTQ and HIV care.

Rosenworcel said: “Through expanded and affordable access to broadband for all, organizations like Whitman-Walker and clinics around the country can continue to grow their telehealth efforts to support their communities.”

The Acting Chair is committed to closing the digital divide and sees access to telehealth care services—especially for underserved and marginalized communities—as a top priority. The FCC has initiated a number of COVID-19 Telehealth Programs and the Connected Care Pilot Program to focus on implementing innovative telehealth initiatives.

Telehealth has met the demand of health care management during the pandemic and has become particularly essential for older adults unable to leave their homes for medical visits.  It is vital that programs and policies supporting this technology continue to be a significant priority. In addition, access and affordability of high-speed broadband must be ubiquitous and affordable for all.

Debra Berlyn is executive director of the Project to Get Older Adults onLine (Project GOAL), and president of Consumer Policy Solutions, a firm centered on developing public policies addressing the interests of consumers and the marketplace. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to [email protected]. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC. 

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