News from ATA 2023: debate over DEA in-person prescribing requirement, winners of Telehealth Innovators Challenge, 2024 board chair announced

March 15, 2023 | by

The American Telemedicine Association’s annual conference, ATA2023, which wrapped two weekends ago, had some major debates, awards, and some board changes.

Special ‘listening’ session on DEA’s proposed changes on telemedicine prescribing of controlled substances. This would resume the in-person visit requirement for Schedule III-V non-narcotic controlled medications. A 30-day limit on a prescription would be permitted for a telehealth remote visit and prescription, but an in-person visit would be required during that period or thereafter before any renewal. The DEA proposed rule issued 24 February (draft here) includes allowing care to be delivered uninterrupted for 180 days after the end of the public health emergency (PHE) ending 11 May, but then requires an in-person physician visit. ATA opposes this new requirement for patients who were prescribed these medications solely during telehealth during the PHE (release 25 Feb). Public comment on the proposed rule is open for 30 days (27 March). A representative of the DEA was in the audience for the Monday 6 March discussion moderated by Kyle Zebley, ATA’s senior vice president of public policy. Other telehealth measures were extended for two years in last year’s passage of the 2023 Federal budget bill [TTA 4 Jan]. Healthcare Finance

Winners were announced for ATA’s Telehealth Innovators Challenge. The four categories and winners were:

Femtech and Women’s Health Winner: SimpliFed. SimpliFed is a virtual breastfeeding and baby feeding provider network that improves access to professional lactation support.

In-patient Care Solutions Winner: Great Speech. Great Speech provides speech therapy through a network of 200+ therapists and adds artificial intelligence (AI) technology and proprietary algorithms.

The Patient Experience: Clearstep Health. Clearstep guides healthcare consumers to the best next steps for care based on their symptoms, insurance, location and preferences via a virtual triage system set up for providers. 

Tools That Deliver Care: Strados Labs. The Strados Cardiopulmonary Platform, using the RESP Biosensor, captures wheezing, coughing, and other lung sounds plus respiratory dynamics, then to a clinician portal supported by machine learning algorithms.

SimpliFed also won the overall Judges’ Choice Award. Oshi Health, a virtual-first gastrointestinal care clinic integrating evidence-based medical care and behavioral health support into a convenient, high-touch, data-driven care model, received the overall People’s Choice Award. Release

Sree Chaguturu, MD, has been named Chair-elect of ATA’s Board of Directors for a two-year term starting May 2024. Dr. Chaguturu is executive vice president and chief medical officer, CVS Health. He has served on the ATA Board of Directors since December 2020. He will follow Kristi Henderson, DNP, CEO, MedExpress and senior vice president of the Center for Digital Health and Innovation for Optum Health, who is now Immediate Past Chair. Release

Congress may extend emergency telehealth flexibilities for Medicare, high-deductible plans for five months in spending bill

March 10, 2022 | by

The quaintly titled 2,741 page $1.5 trillion omnibus bill to fund the US government for the remainder of fiscal 2022, rolled out in the wee hours of Wednesday, includes an extension of telehealth flexibilities established under the COVID-19 public health emergency (PHE). The flexibilities extend full geographic coverage (versus rural only), location (home and medical facilities), and full payment for beneficiaries and providers, including some audio-only visits. This will apply, however, only to Medicare beneficiaries and providers, members of high deductible health plans (HDHP), and patients of rural health clinics (RHCs), and Federally Qualified Health Clinics (FQHCs). This is a five-month stopgap into 14 September. (The Federal fiscal year 2023 starts 1 October.)

The telehealth rule extension includes:

  • Practitioners such as physical therapists, occupational therapists, special therapists, and audiologists 
  • Originating sites can be anywhere in the US including the home and medical facilities
  • 1,400 Federally Qualified Health Centers (FQHCs) and 4,300 Rural Health Clinics (RHCs) can continue providing telehealth services including mental health visits
  • Waiving in-person initial visit requirement for mental health as well as postponing the in-person visit six months after receiving a telehealth visit
  • Audio-only allowed for Medicare
  • HDHPs have a continued ‘safe harbor’ to offer members telehealth services pre-deductible for the remainder of the 2022 plan year 

The vote is scheduled for the House today (9 March–still not finalized as of this writing), and to the Senate 11 March, with a concurrent short-term funding extension to give the Senate the usual time through 15 March. As of this time of writing, the floor wrangling continues with COVID-19 funding dropped and $13.6 billion in emergency non-defense aid to Ukraine added. The inclusion was cheered by ATA and ATA Action in their release; also Becker’s Hospital Review and Roll Call.  Update: the House passed the domestic portion of the bill 260-171 late Wednesday 9 March evening, and it moves on to the Senate.

Congress calls to extend PHE telehealth flexibilities; FCC’s $48M telehealth funding boost, telehealth’s shortcomings in pediatric asthma treatment

February 2, 2022 | by

Permanent telehealth flexibility and expanded use still being debated, and still stuck in Congress. The expansion of telehealth that came with the US public health emergency (PHE) isn’t permanent, despite some expansion plugged into the Medicare Physician Fee Schedule. That can only come with legislation passed by Congress and signed into law–and it is still being debated. A fresh group of 45 Congresscritters (this Editor can’t restrain a certain sarcasm) is now plumping for a more permanent extension for a set–but undefined– time, as part of February funding legislation. This effort is being led in the Senate by Brian Schatz, D-Hawaii, and Roger Wicker, R-Mississippi. Oh yes, the power of a letter to the House and Senate majority and minority leaders (sigh!) Meanwhile, the CONNECT for Health Act and the Telehealth Modernization Act have languished for months in the Senate Finance committee and in House Ways and Means. Healthcare IT News

Over at the Federal Communications Commission (FCC), they’re doling out the sixth and final tranche of $47.89 million to 100 provider and community health organizations that applied to the COVID-19 Telehealth Program. The total FCC funding in this round 2 was $249.95 million that built on funding that was part of the CARES Act. The full list is in the FCC release (PDF). MHealthIntelligence

A combination of in-person care with telehealth as an adjunct may be the best protocol for treating pediatric asthma, a UC Davis Health study found. The first part of the study analyzed EHR records for asthma patients aged 2-24 treated at UC Davis Health in 2020. Of 502 patients, telemedicine usage was significantly lower among:

  • Patients with a primary language other than English (OR = 0.12, 95% CI: 0.025–0.54, p = 0.006)
  • School-aged children (OR = 0.43, 95% CI: 0.24–0.77, p = 0.005),
  • Those who received asthma care from a primary care provider instead of a specialist (OR = 0.55, 95% CI: 0.34–0.91, p = 0.020).

Focus groups are qualitative and should be used for direction and to surface issues, and they did with telehealth. The 12 parents and five young adult patients who were randomly selected and participated stated that:

  • The parents felt that in-person care built better rapport, was more effective in counseling the child and young adult patients on their medication and condition, and more actively engaged their children
  • Parents did not feel confident in correctly using diagnostic tools like peak flow meters and home spirometers on a telehealth visit
  • Scheduling follow-up telehealth appointments was more difficult than in-person 
  • Where telehealth stepped up was convenience–to see their specialist without travel time. The visit also ‘cut to the chase’ by seeing one physician only, not an entire care team. And it was protective of their children during the pandemic. 

Most of the focus group participants agreed that a combination of telemedicine and in-person visits would be preferred when asthma is well-controlled. Published in the Journal of Asthma. Also MHealthIntelligence, which read the study conclusions a bit different than this Editor.