Providers

Five Key Telehealth Takeaways from the Consolidated Appropriations Act of 2023  

On Thursday, December 29, President Biden signed into law H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. This legislation provides more than $1.7 trillion to fund various aspects of the federal government, including a 2-year extension of the major telehealth waivers that were initiated during the federal public health emergency (PHE). 

The full text of the legislation, which comes in at 4,155 pages, is available here. The most pertinent section of the new law that relates to telehealth is under:

The group chose to focus initially on video visits for those in need of mental health care.  We succeeded in step one: we surveyed 16 mental health provider organizations to find out what data they were collecting, and how success was being measured in 2020.  The organizations ranged from large university medical centers to private practices in nine states.  Not surprisingly, the data and metrics varied widely, even across large university-based systems.

In the early days of the Covid pandemic, Dianne Connery realized something needed to be done for people in her rural Texas community to help connect folks to their medical appointments.

Connery, director of the Pottsboro Area Library in Pottsboro, Texas, said it started when one woman with pulmonary disease came to the library for help, desperate to meet with her doctor but too high risk to come to his office—a two-hour drive south to Dallas.

It’s the start of Telehealth Awareness Week, and Ann Mond Johnson, American Telemedicine Association CEO, is beaming as she reflects on the growth of this second annual event.

“The number of endorsing partners for this second Telehealth Awareness Week has doubled (since the first),” Mond Johnson says, adding that the first had 25 endorsing partners, and this year’s has grown to 50, including organizations like Easter Seals, and the Association of American Medical Colleges. “To us, this means the messages that telehealth is important, needed, and accepted are being heard.”

For decades, the Centers for Medicare and Medicaid Services (CMS), only permitted telehealth in particular geographic settings with numerous restrictions surrounding originating sites, providers, services, modality, and access options. However, the COVID-19 pandemic led to a Public Health Emergency (PHE) that relaxed these restrictions and opened the doors to the use of telehealth in the home, among other measures, which have contributed to Medicare beneficiaries utilizing telehealth in droves with an increase from 840,000 in 2019 to 52.7 million in 2020.

In April 2017 Summit Healthcare started a multi-disciplinary program to treat patients with chronic and acute pain in the White Mountains of Arizona. Our patient service area is HRSA-designated as having a shortage of providers and medically underserved. The area is the size of Rhode Island and includes Native American reservations and other vulnerable populations. Many of our patients live in a high poverty area which makes access to care challenging.

We’ve all seen lots of reports from a variety of source documenting how telemedicine use has skyrocketed during the COVID public health emergency. There have also been many subsequent reports on the significant disparities in access to and use of telemedicine that were revealed and/or exacerbated by COVID. A simple search of Google Scholar brings up thousands of articles from around the world summarizing digital divide and related challenges that have been exposed, and many of them highlight some very creative strategies to help address and reduce barriers to telemedicine care. How can we offer a telemedicine option to someone who does not own a digital device? To someone who does but must choose between using their minutes to support their child’s remote school classes or see their doctor? Or someone who has access to the Internet but at limited bandwidth?

In hopes of sparking renewed commitment to applying improvement science to telehealth, we offer this Telehealth QI and QA Miniseries. Today is the fourth in the series.

Require expertise and excellence in telehealth service delivery. Expertise with telehealth requires deliberate practice which builds on or modifies existing skills, usually with the help and guidance of a coach or teacher with targeted feedback on what to improve and how to improve those skills.

How much do you love improvement science? I have been an improvement science evangelist and guru since 2007. That was the year I completed advanced training in health care improvement with Dr. Brent James at Intermountain Healthcare in Utah.

I was a practicing clinician, clinical manager, quality coordinator, practice transformation lead, IT support (and more) at a family medicine residency that was participating in the Safety Net Medical Home Initiative. Learning the power of data and the science of improvement was one of the biggest light bulb moments of my life. I often liken it to when Johnny 5 – the robot in “Short Circuit” – throws open the barn doors, seeing the outside for the first time and remarks, “Ahh – input!”. Suddenly I could ask and answer questions, using data and measurement.

Does it surprise you that some clinicians are NOT all that excited to continue to provide care without being in the same room with a patient? Virtual care includes care by video, telephone, email, text/chat, remote monitoring, social media, mobile apps, artificial intelligence and more! More than a decade ago, when I implemented video visits for one region of a large healthcare organization, one-to-one training was provided to approximately 1000 physicians, Advanced Practice Nurses and Physician Assistants who provided scheduled, outpatient care - primary care, medical and surgical specialties. Each of the trainees was given a webcam. One year after training was completed, only 70 of these trained clinicians had provided care by video at least once. Note that reimbursement was not an issue for these clinicians. They were and still are salaried, with incentives based on clinical outcomes and patient satisfaction.