Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care

430 telehealth and remote care companies, along with major health providers and associations, have organized to petition Congress to make permanent the changes instituted by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for the duration of the COVID-19 public health emergency (PHE). These changes will expire this year unless the pandemic emergency extends into 2022.

Like the Senate Telemental Health Care Access Act of 2021 that would extend telemental health Medicare coverage to patients without a prior in-person visit [TTA 16 June], the extension of CARES Act coverage would require Congressional action to amend the Social Security Act: for telemental health, Title XVIII; for telehealth, Section 1834(m). While the Telemental bill is actually in the Senate, the permanent expansion of telehealth and remote care would require its own and far more complicated bill and corresponding regulations.

Based on the letter (PDF link), these changes would include:

  1. Remove Obsolete Restrictions on the Location of the Patient and Provider. This is the rural geographic restriction.
  2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and
    Modalities for Telehealth. This would expand the list of practitioners, services, and also expand telehealth in some cases to audio-only consults.
  3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics
    Can Furnish Telehealth Services After the PHE. These are the ‘safety net’ providers for underserved and rural areas.
  4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services
    Offered Through Telehealth. This covers much the same ground as the Telemental bill.

What is unclear, of course, it being Washington, is how quickly Congress will bestir itself to enact these changes to existing law before the end of 2021 and the expiration of the CARES Act window with, presumably, the end of the PHE. American Telemedicine Association (ATA) releaseHealthcareITNews, FierceHealthcare

Funding update, 4 March: big Series Ds for new unicorn Dispatch Health and Tyto Care; USDA’s $42M for rural telehealth; UK’s Perfect Ward hospital inspection app secures £4m

Once upon a time for health tech companies, Series D funding and unicorn status were rare, especially when the tech relates to the under-the-radar, formerly unsexy area of home health. 

  • DispatchHealth, an in-home mobile care provider based in Denver, just closed a $200 million Series D led by Tiger Global with additional participation from Alta Partners, Echo Health Ventures, Humana, Oak HC/FT, and Questa Capital. This comes less than a year after a $135.8 million Series C led by Optum Ventures, The new total of $417 million in funding brings its valuation to a unicorn level of $1.7 bn. DispatchHealth is in the desirable, high potential cost-saving areas of care that replaces ER visits or hospital stays. The platform integrates in-home care services booked through a call, their app, or online by patients, care providers, payers, EMS, senior living, and health systems. The objectives of care are to substitute for ER visits, hospital stays, and to coordinate ancillary services. Currently serving 19 markets across 12 states with care to more than 170,000 patients in 2020, the new funding will be used for expansion to 100 national markets. DispatchHealth recently announced partnering with Humana for advanced hospital-level care for their Medicare Advantage members in several cities. Release, FierceHealthcare
  • More on the health tech side is Tyto Care’s remote diagnostic exam platform. Today they are announcing an additional raise of $50 million, doubling the earlier Series D and now totaling $100 million. Leading the extension is Insight Partners, with participation by Tiger Global (see DispatchHealth), Qumra Capital, Qualcomm Ventures LLC, Olive Tree Ventures, and Shenzhen Capital Group Company. Tyto’s funding is now $155 million and claims a doubling of its valuation. Release.

The US Department of Agriculture (USDA) is surprisingly now an investor in rural telehealth, in part courtesy of the CARES Act from March 2020. (Yes, there were considerable funds left over from that $2.2 trillion pandemic relief bill and now some of them are being used.) USDA is funding projects with a total of $42.3 million, including $24 million from the CARES Act, to improve infrastructure for telemedicine and distance learning infrastructure. Approved to go are 86 projects through the Distance Learning and Telemedicine grant program, to help rural education and healthcare organizations remotely reach students, patients, and outside expertise. USDA’s study found that due to population health, lack of insurance, and lower access to health facilities, there are higher rates of COVID-19 related deaths in rural areas. Healthcare IT News

A UK company that’s in an unusual area of health tech is Perfect Ward, which is designed to put on a laptop and mobile app the complicated process of health inspections of hospitals, care homes, and other health and social care organizations in the UK and internationally. Their £4 million round comes from Octopus Investments (Octopus Group). Current clients include King’s College, Barts Health, The Royal Free and London Ambulance Service. Release (Business Cloud)

FCC opens application window for $200 million telehealth cost reimbursement program

In more COVID related news, the Federal Communications Commission (FCC) will be administering the $200 million allocated by the CARES Act to fund telehealth related expenses for providers to furnish connected care for patients. The program will fully fund practices and health systems in telecommunications services, information services, and devices necessary to provide critical connected care services. Funding will continue through the national health emergency or until the program funds have been fully spent out.

The application period opened on Monday 13 April. Applicants can download a fillable PDF form linked to the FCC’s program web page, but before they do that, there’s several pre-requirements typical of any Federal program:

  • Obtain an FCC Registration Number (FRN) from the Commission Registration System (CORES), as well as a CORES username and password at that link. An FRN is a 10-digit number that is assigned to a business or individual registering with the FCC and is used to identify the registrant’s business dealings with the FCC.
  • Obtain an eligibility determination from the Universal Service Administrative Company (USAC) by filing FCC Form 460 through My Portal on USAC’s webpage. (Filers do not need to be rural health care providers in order to file Form 460 for this program.)
  • Register with the federal System for Award Management (SAM)

When approved, the program operates as a reimbursement program where approved providers will have to submit invoices and supporting documentation which are also subject to audit.

FAQs are linked here. Also HISTalk.

After the COVID Deluge: a Topol-esque view of what (tele)medicine will look like

A typically cheery view by Eric Topol, MD of what medical practice will look like after COVID is over. With the full court press to go remote in hospitals and practices worldwide, telehealth and telemedicine has gone fast forward in a matter of under two months. But what will it look like after it’s over? Most of what the good doctor is prognosticating will be familiar to our Readers who’ve followed him for years–certainly he was right on mobile health overall and especially AliveCor/Kardia Mobile— but not so on point with mobile body scanners (anyone remember VScan?)

When the high tide recedes, what will the beach look like?

  • “Telemedicine will play the role of the first consultation, akin to the house-call of yore.” (Terminology note–interesting that Dr. T still uses ‘telemedicine’ versus ‘telehealth’–Ed.)
  • Chatbots will serve as screeners–once they are proven to be effective (a ways to go here, as the Babylon debate rages on)
  • Smartphones will be the hub, connecting with all sorts of monitoring devices (the ‘connected health’ Tyto Care and Vivify Health model–which makes the Editor’s former company, the late Viterion Digital Health, even more of a pioneer that died crossing the Donner Pass of 2016)
  • Smartwatches are also part of this hub (this Editor remains a skeptic) 
  • Now is the time to harness technology by both health systems and individual practices, but multiple barriers remain. (This Editor can speak to the difficulties for both primary care and specialty practices in not only practice but also reimbursement–and acceptance by patients.) Device expense is also a problem for the non-affluent.

As to the rest, it is pretty much what we’ve heard from Dr. T before.  The Economist

Your Editor will add:

  • Easy to use, secure platforms that don’t put users through multiple security steps remain a concern for users. This Editor’s concern is that easy to use = insecure. Skype and Zoom are inherently insecure–Skype’s user unfriendliness and insecurity outside enterprise platforms and Zoom’s major security problems on its platform and user flaws are well-known (ZDNet).
  • Reimbursement, again! CMS has done a creditable job in broadening reimbursement for telehealth a/v and telephonic services, but coding remains a nightmare for practices struggling to remain open and with some lights on. After COVID, will CMS and HHS get religion, or put it right back in its rural bottle? Covered in the CARES Act passed at the close of March, $200 million sounds like a lot from the FCC to bankroll telecom equipment for providers, but these funds will go quickly. At least they are not delayed in endless rule making, as the Connected Care Pilot Program has been for two years. Mobihealthnews