TTA’s New Year Surprises: AliveCor wins ITC round v Apple, Amazon-One Medical Oregon OK, telehealth expansion done for 2 years, NHS advances effective stroke diagnosis, recovery by 48%, Allscripts now Veradigm, more!

 

 

Weekly Alert

Two surprises not under the Christmas tree or New Year’s hat. The ITC upheld AliveCor patents and damages versus Apple, pending their PTAB appeal, and Amazon got its first state approval for One Medical. As expected, telehealth’s national Medicare reimbursement was extended for two years, setting policy for health plans. And NHS advanced rapid stroke diagnosis with Brainomix trial in 22 hospital trust trial, tripling near-full recoveries to 48%.

Weekend news roundup: GE Healthcare spins off, adds CTO; Allscripts now Veradigm; NHS Brainomix AI stroke trial success; Withings home urine scanner; Careficient buys Net Health EMR; CommonSpirit’s class action suit on data breach
Amazon-One Medical gains conditional OK in Oregon–a preview of coming scrutiny?
(What happens at the big state and Fed level?)
Telehealth extensions signed into US law with Federal FY 2023 omnibus bill (Major breakthrough to widen nationally reimbursed telehealth)
Split decision! ITC rules that Apple violated AliveCor patents; enforcement held for PTAB appeal (David v Goliath continues!)

A potpourri of news wraps 2022, starting with confirming how telehealth can stand on its own even in specialty care visits and its continued strength in mental health. In the US, most telehealth expansion is confirmed for two years. But as predicted, DEA is going hard after ADHD misprescribing — a unicorn may lose its horn as a result. Oracle is erasing Cerner’s home town presence as Epic stomps a patent troll. And beware of DDoS–it may distract from more nefarious cybercrimes.

We wish our Readers all the happiness of the season, as we look forward to the start of the New Year. We’ll be back with new articles after 2 January. 

We wish our Readers a happy, healthy holiday season and New Year!
News roundup: DDoS attacks may be ‘smokescreen’, DEA slams Truepill with ‘show cause’, telehealth claims stabilize at 5.4%, Epic squashes patent troll, Cerner meeting exits KC, MedOrbis, Kahun partner on AI intake (From cybercrime to Cerner, c-c-c-changes roll)
Telehealth two-year extensions included in US Federal ‘omnibus’ budget bill (Tucked into a Moby Dick-sized whale of a bill)
Few specialty telehealth visits require in-person follow up within 90 days: Epic Research study 2020-2022 (Findings, though, may be pandemically skewed)

It’s a week of contrasts as the holiday season starts. There are ‘green shoots’ in startups and fundings, yet so many organizations have run into the red, with a high human cost. A literal bright spot–a lighting system that can detect and report falls. And the Holmes Defense Team files an appeal for a new trial that may delay her delivery to Club Fed for a long time. (Hoping the Feds will forget?)

Rounding up fundings and startups: Override(ing) pain; brainy Synchron and In-Med Prognostics; Click off migraine; Cardiosense and CHF detection (A touch of seasonal cheer)
Smart lighting that detects and reports falls in older adults–and more–debuts in UK and Ireland (Lighting up fall detection is a big step forward)
10 reasons for a new trial? Elizabeth Holmes’ legal team files appeal, delay in prison start (updated) (Foot dragging strategy continues as financial penalty to be decided)
Mid-week roundup: Wisconsin’s Marshfield Clinic zeros out telehealth staff; Komodo Health lays off 9%; epharmacy Medly’s Ch. 11, PharmEasy layoffs; OneStudyTeam releases 25% (Coal in too many stockings)

Windups as the holidays and year-end loom. AliveCor loses its David vs Goliath patent battle with Apple, with consequences to come. The Theranos drama nears its end with Balwani’s sentence. But in new developments, robotics for care support and care becomes part of…energy management? And can VIMPRO help NHS manage its patient population crush?

Theranos’ Balwani gets an unlucky 13 year sentence, restitution to come (No tears, no dramatic statements, little media scrum, and a lighter sentence than expected)
AliveCor loses Patent Office ruling with Apple; three patents invalidated (This one isn’t over–the stakes are high)
News (and robot) roundup: ElliQ companion robot upgrades, named to 2022 TIME list; Robin the Robot introduced for older adult care; Utilita acquires Canary Care (UK) (Robots advance, interesting integration of care with energy management)
Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand? (A smarter approach advocated in managing patient populations )
Optum Labs creates and funds digital health research hub at Cornell Tech NYC (Reviving NYC in digital health, or gathering ideas for Optum to develop elsewhere?)

Something a bit different this week with two maximum roundups. athenahealth may IPO–again. Amwell may bolster telemental health with Talkspace. Cerebral and former CEO dueling in court. Taking bets on where Theranos’ Elizabeth Holmes will spend her sentence–and when. Plus…year-end buys and fundings. 

Who’s buying, selling, funding wrapup: athenahealth IPO deux?, NextGen EHR buys reseller TSI for $68M, Cloudwave buys Sensato; fundings for Lumen, UpStream, Aide Health
“Big Story” update: where Elizabeth Holmes will spend 11 years, Cerebral sues former CEO Robertson, Amwell buying Talkspace? 

As usual in the rollup to (US) Thanksgiving, it was a light news week. Our two roundups include Babylon Health’s encouraging Q3 results, DOJ’s appealing to block the UHG-Change buy–already closed (!)–an senior exec move from Walmart Health to JPM, and digital health/health tech funding yellow flagged to 2025 by Very Important Investors.

Mid-week news briefs: House members’ ‘grave concerns’ on two deaths tied to Oracle Cerner VA rollout; care.ai’s $27M funding; Clear Arch’s new mobile RPM platform; digital health investment in rough times
News roundup: Babylon Health Q3 revenue up 3.9x; surprise–DOJ to appeal UHG-Change buy approval; Walmart loses senior health exec Pegus to JPM

Legal matters led this week, with Friday’s sentencing of Elizabeth Holmes to over 11 years in Federal prison and Cerebral’s ex-CEO fishing for evidence to use in legal actions. Amazon unveiled Clinic, a low-budget messaging platform for common condition diagnosis. Women’s health Maven rounded up $90M but Sema4 exited that testing field, losing 500. 

Breaking–The Theranos denouement: Elizabeth Holmes sentenced to 11.25 years with an investor loss of ~$121 million (Loss to be finalized at later date, sentence to start 27 Apr 2023)
Ousted Cerebral CEO may sue company, accuses management of scapegoating on Schedule 2 prescribing (Set up for legal action–or more settlement to go away)
The Theranos denouement: ‘Humble, hardworking’ Elizabeth Holmes sentencing Friday; prosecution and defense paint different pictures (updated)
News briefs: ResMed-Verily’s Primasun sleep solution; Maven Clinic’s $90M Series E; Mount Sinai genomics spinoff Sema4 lays off additional 500, exits women’s health
Yes, Virginia, there is an Amazon Clinic, after all; non-face-to-face consults for common conditions (Amazon’s Chevrolet–or Yugo–entry?)

 

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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine, and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Telehealth extensions signed into US law with Federal FY 2023 omnibus bill

Jammed into the final moments of the now-ended 117th Congress before Christmas was the passage of the FY2023 ‘omnibus’ $1.7 trillion Federal budget bill. This bill did at least several good things for those of us concerned with US telehealth, as it extended provisions for Medicare reimbursement that become guidelines for commercial health plans and help to cement telehealth as a permanent part of health care delivery. There is also a tax provision that affects high-deductible health plans. 

Their passage is important as the Covid-19 Public Health Emergency (PHE) is set to expire on 11 January and no movement has been publicly discerned for its renewal. In the fall, the Department of Health and Human Services (HHS) notified US state governors that there would be at least a 60-day notice before the PHE ends. It is unknown whether this notice has been given.

To summarize the two-year extensions that go to the end of 2024:

  • Expanding originating and geographic site to include anywhere the patient is located, including the patient’s home
  • Expanding eligible practitioners qualified to furnish telehealth services, including occupational therapists, physical therapists, speech-language pathologists, and audiologists
  • Extending the ability for federally qualified health centers (FQHCs) and rural health clinics (RHCs) to furnish telehealth services
  • Delaying the in-person requirement for mental health services furnished through telehealth, including the in-person requirements for FQHCs and RHCs
  • Extending coverage and payment for audio-only telehealth services
  • Extending the Acute Hospital Care at Home (AHCAH) initiative, pioneered by Johns Hopkins two decades ago. It also requires the HHS Secretary to publish a report comparing AHCAH programs with traditional inpatient care delivery. 
  • Extending the ability to use telehealth services to meet the face-to-face recertification requirement for hospice care
  • Extending high deductible health plan (HDHP) safe harbor exceptions for telehealth services in high-deductible health plans.

The final bill did not extend the Ryan Haight in-person waiver for the remote prescription of controlled substances. As mentioned in our earlier article, this is a wise move in this Editor’s view given the abuse of this waiver by certain telehealth organizations. ATA/ATA ACTION release.

The HHS Secretary will be required to submit a report to Congress on the utilization of the above services. The interim report is due in October 2024 and the final report in April 2026, according to the American Hospital Association. Affecting hospitals and practices in the bill:

  • It delayed the statutory Pay-As-You-Go (PAYGO) Medicare 4% sequester for two years, preventing the $38 billion in Medicare cuts that otherwise would have taken effect in January.
  • Partial relief from a 4.5% reduction in physician reimbursement rates starting on 1 January. The legislation reduced the cut to 2% for 2023 and around 3% for 2024.

HealthcareFinance

Other features of this bill having an effect on healthcare and telehealth (from Infrastructure Report Card):

  • $455 million for the expansion of broadband service, including $348 million for the ReConnect program, a series of grants administered by the US Department of Agriculture for the construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas. This could help rural areas and hospitals in provider-patient and provider-to-provider consults.
  • $1.65 billion for the National Institute of Standards and Technology (NIST), an increase of $424 million, or 34%, above the FY 2022 enacted level. Specific funding is allocated for the measurement labs and research at $953 million, a $103 million or 12% increase above the FY 2022 enacted level. The goal is to spur research advances in cutting-edge fields like carbon dioxide removal, artificial intelligence, quantum information science, and cybersecurity.

The bill was signed into law by the president on vacation in St. Croix, USVI. Given the bumpy start of the 118th Congress today, these are at least not up for grabs.

Telehealth two-year extensions included in US Federal ‘omnibus’ budget bill

Expanded telehealth access extended for two years. The ‘omnibus’ fiscal 2023 spending bill before Congress Thursday contains extensions for four areas of improved national telehealth access developed during the COVID-19 Public Health Emergency (PHE) starting in January 2020. Because they apply to Medicare and high-deductible health plans (HDHP), they become guidelines for commercial health plans and help to cement telehealth as a permanent part of health care delivery.

The two-year extensions include:

  • Retained expanded reimbursable access to telehealth for Medicare beneficiaries put into place during the PHE
  • A two-year delay in implementing the Medicare telemental health in-person requirement
  • Extension of safe harbor provisions to offer telehealth as part of HDHPs with Health Savings Accounts (HSAs)
  • Extension of the Acute Hospital Care at Home Program. This waiver permits some emergency department and inpatient hospital patients to be treated from their homes. 

At this time, the PHE is set to expire on 11 January 2023. It has been extended every 90 days since January 2020 and may be extended again. The bill did not extend the Ryan Haight in-person waiver for the remote prescription of controlled substances, a wise move in this Editor’s view given the abuse of this waiver by certain telehealth organizations. It does request the Drug Enforcement Agency (DEA) to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued for controlled substances, and the procedure for obtaining the registration.

Another wise move on Congress’ part in this monster 4,000+ page, $1.7 trillion spending bill is to further prohibit the creation of a national patient ID for healthcare that supposedly would facilitate EHR interoperability. 

The bill is supposed to come before a lame-duck Congress at the eleventh hour before their Christmas leave on Thursday. Some opposition has coalesced due to wasteful earmarks covering pet projects that are included in the (unread by most representatives) bill and the fact that a new Congress with a change of party control in the House will be seated in January. However, for those of us in the US telehealth business, these inclusions are not controversial nor wasteful, and if the omnibus bill fails for some reason, will likely be included in any short-term extensions which are typical in keeping the government running. ATA release, POLITICO Future Pulse

Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand?

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Adam Hunter, CCO at Phlo Connect, an API-driven pharmacy infrastructure platform to deliver enhanced patient and clinician experiences. Phlo Connect integrates with prescribing technologies and digital health platforms used by the NHS and by private healthcare providers, from the initial consult and prescribing, and processes the request through to patient delivery. This article discusses how Vertically Integrated Micro-Providers (VIMPRO) can work in partnership to streamline NHS services using technology and telehealth.

Interested in being a Perspectives contributor? Contact Editor Donna

The NHS is in crisis: with staff vacancies currently exceeding 130,000, elective care waiting lists are predicted to exceed 10 million by March 2024, and up to 22,000 appointments are cancelled every single day.

Speaking at a King’s Fund conference in London earlier this month, NHS Chief Executive Amanda Prichard told delegates that demand on national health and care providers is rising so quickly that patients are not always getting the level of care they deserve. Highlighting a projected £7bn NHS budget shortfall, she went on to emphasise that “We’ve got to shift the model of care from one that does late diagnosis and expensive treatment to one that does faster diagnosis, better treatment and better value for the taxpayer in the process.”

Such a model, where all patients can access timely, preventative care without exorbitant cost, is one that every developed national healthcare system aspires to adopt. Navigating the practicalities and finding the capacity for transformation has to date stalled the full realisation of this. However, gathering pace in the past decade has been the VIMPRO model of healthcare delivery, which is increasingly proving to be a successful way of meeting the needs of underserved patient groups and alleviating pressures. At this time of critical need, could this model save struggling public systems from drowning in demand?

The VIMPRO model explained

A Vertically Integrated Micro-Provider (VIMPRO) is a telehealth provider focused on delivering an end-to-end service to a specific patient group. VIMPROs are characterised by excellent user experience and personalised clinician-led care, and are increasingly entering into partnerships with national healthcare providers (including the NHS) to help bridge gaps in service delivery.

One example of a successful existing VIMPRO model operating in partnership with the NHS to meet a previously unmet patient need is Leva Clinic. They are UK leaders in chronic pain management and medical cannabis treatment. The majority of their users pay to use their digital platform, where they access psychology consultations, nurse appointments, physiotherapy advice, prescription and direct-to-door medication delivery.

This is a big step in the right direction towards meeting the needs of the UK’s underserved pain patients, many of whom have spent years with inappropriate support owing to a shortage of pain specialists and lack of personalised treatment options.

Patient and system benefits

From the perspective of NHS leaders, the benefits of the VIMPRO model are multiple. Firstly, they provide an alternative point of access to care for patients who’d otherwise need to be seen by GPs and referred on to NHS consultants. This frees up system capacity and cuts wait times and workloads. Secondly, VIMPROs provide the education and information that their specific patient group needs to manage their condition and improve their outcomes. This reduces the burden of ill health on the NHS further down the line. And thirdly, when VIMPROs are integrated properly with NHS systems, all the information about the patient’s care can be tracked in their electronic record without adding to practitioners’ admin burden. 

The VIMPRO model also offers multiple benefits to patients. Convenience and timeliness of access to healthcare are primary amongst these, as they remove the barriers of geography and waiting lists that obstruct care in the NHS. Patients can be quickly connected to leading specialists and prescribers anywhere in the county, and don’t even have to leave their homes to collect their medication. In addition, accessing remote care through a VIMPRO model means that patients who are reluctant to engage with local services for support – perhaps because of stigma around their condition – are offered an alternative source of care that’s entirely virtual and distinct from other NHS services. Finally, VIMPROs often take on the responsibility of creating education materials and championing the needs of their patient vertical. For example, men’s health VIMPRO Numan hosts a medically-reviewed blog delivering advice on weight management, erectile dysfunction, hair loss, mental health and other under-discussed men’s health issues.

The future of NHS care delivery?

There is no single solution that can fix the problems facing the NHS and other public health systems around the world. Replacing the core of NHS services with a network of VIMPROs is an unrealistic proposition that would be extremely difficult to achieve. However, carefully planned VIMPRO partnerships have already proven to be effective at redirecting patient demand to where it can be successfully dealt with.

If the right streamlined system integration and tailored digital infrastructure is put in place, patients and clinicians can enjoy seamless and convenient experiences. This means no clunky transition between platforms and service providers: from first consultation to the arrival of medication on the doorstep of the patient. 

Global health needs, and our expectations of healthcare, are constantly evolving. Only by constantly evolving the models of care delivery will we be able to keep up, and right now, that means embracing the opportunities of the VIMPRO model and making it work as well as we possibly can.

Telehealth-only follow up increased repeat ED visits by 2.8%, return admissions by 1.1%: JAMA Network study

Not good news for telehealth using the ‘lower healthcare utilization’ talking point, if this study is confirmed by others and not an outlier. A study published this week in JAMA Network Open could be dismaying for those advocating a ‘straight line’ view of telehealth as a complete substitute for the in-person visit. The researchers from University of California, UCLA, and the Wharton School – University of Pennsylvania (Leonard Davis Institute for Health Economics) found that telehealth follow-up was “associated with 28.3 more repeated ED encounters and 10.6 more return hospital admissions per 1000 patients compared with in-person follow-up.” In percentage terms, they are 2.8% and 1.15 respectively.

The retrospective study was based on 2 in-system EDs of a single integrated urban academic integrated health system in Los Angeles from 1 April 2020, to 30 September 2021. They sampled over 12,000 patients with close to 17,000 ED encounters who were discharged home, then obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days).

Based on postdischarge follow-up visits:

  • In-person: 1865 (16%) were followed by an ED return visit and 438 (4%) with a hospital admission within 30 days
  • Telehealth:  937 (18%) were followed by an ED return visit and 238 (5%) with a hospital admission within 30 days

The percentage is small in this study, but there, for which there is no substitute for in-person follow-up visits. The study conclusion addressed this with the following points:

  • “Patients with telehealth follow-up who return to the ED might have greater illness severity when they arrive or possibly other medical or social circumstances that prevent ED physicians from being able to discharge them home.”
  • Patients in the study who used telehealth follow-up lived farther from the ED than in-person patients
  • “A potential mechanism to explain increased health care utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms.” There is additional discussion of how the lack of a physical examination during telehealth may hamper clinicians in fully evaluating evolving illness or deterioration.
  • “Telehealth is not well suited to evaluate specific concerns, such as chest pain, abdominal pain, or shortness of breath, which represent a large proportion of post-ED follow-up visits” based on two other qualitative studies.
  • “The association of telehealth with increased health care utilization warrants further study to evaluate its appropriateness as modality for post-ED follow-up.”

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department (JAMA Network Open–PDF, online link)

Pre-weekend short takes: Teladoc posts much smaller Q3 loss, 17% revenue boost; is telehealth threatening disability care quality; $2.8M for Australian wearables; more healthtech layoffs at Antidote, OrCam, Ada Health

Teladoc today (27 Oct) beat Wall Street consensus in reporting revenue of $611.4 million, a 17% increase versus prior year. It also reduced its per-share losses to 45 cents per share ($73.5 million) versus last year’s Q3 loss of 53 cents ($84.3 million) and Q2’s stunning $3.1 billion loss due to goodwill impairments from the Livongo acquisition [TTA 30 July]. Powering today’s stock bump (6.5% to $28.47) was primarily loss reduction from the prior quarter zeroing out the goodwill impairments and lower net interest expense. Motley Fool, Mobihealthnews

Disability groups are expressing concern that incentives to promote telehealth may be discriminatory. The concerns are primarily around the need for in-person care.  Groups such as the American Association of People with Disabilities admit that telehealth can benefit the disabled, but are wary of a swing towards telehealth as a cost-saving measure versus in person. Federal data confirms that Medicare beneficiaries due to disabilities use telehealth at about twice the rate of age-eligible Medicare beneficiaries. There’s also concern about how the disabled can access and use telehealth platforms, as well as the quality of assessment during the virtual visit. POLITICO.

The Australian government is funding three five-year projects using wearable sensors for activity and diagnostics. The US$2.8 million will go to Curtin University for monitoring activity in children with cerebral palsy who are unable to walk (US$950,000), University of New South Wales for a cuffless blood pressure for hypertension monitoring (US$1.2 million), and Bond University for a project combining data from wearable devices and medical records for Type 2 diabetes patients (US$700,000). Mobihealthnews

More healthcare tech layoffs confirm that VC Elvis has left the building. The tech downturn has hit Israel-based startups particularly hard, but Europe is also affected. This is despite fundings for two of them earlier this year.

  • Pinkslipping over a third (23) of its employees is telehealth platform Antidote Health. Based in Tel Aviv and New York, the layoffs hit primarily R&D staff in Israel. Antidote in March closed a $22 million Series A, bringing total funding to $36 million (Crunchbase). Antidote offers telehealth primary care, mental health, and hypertension chronic care as well as featuring sinus, tick bite, and UTI treatment on its website. The platform connects users to a network of about 100 doctors with a smart chatbot and through video calls. Their target audience is uninsured and underinsured people. Calcalist CTECH, Mobihealthnews   
  • Larger OrCam in Jerusalem is laying off about 16% (62) of staff, again primarily in Israel, as part of a reorganization. OrCam develops devices to help blind or visually impaired people read and navigate daily life more easily via AI. OrCam has over $86 million in funding through a Series A and three venture rounds (Crunchbase), the last in 2018. A planned 2020 IPO valuing the company at $3 billion never happened. The company also has offices and staff in New York, London, and Cologne. Calcalist CTECH, Jewish Business News

Berlin, Germany-based Ada Health also pinkslipped 50 people. According to a spreadsheet linked on Layoffs.fyi, most of the layoffs are in Europe and the UK in tech and product development, with others in marketing and medical. Ada has a medical assessment app that claims 10 million users and 25 million assessments. Employees are based in the US, London, and within Germany. Most recent funding was in March from a $30 million Series B, adding to a 2021 Series B of €74 million funded by Bayer (Crunchbase).

Week-end news roundup: Fitbit revives with 3 new watches, Sena Health hospital-at-home, SteadyMD surveys telehealth clinicians, 9.4% fewer adult dental visits in England, save the date for ATA 2023

Fitbit’s three new wearables–will they revive the brand? Fitbit, now owned by Google, announced the debut of two new smartwatches and one fitness tracker, available now for preorder and shipping in September. Will buyers find them more attractive than their predecessors? From left to right:

Fitbit Inspire 3 upgrades from the predecessor with a color display and similar $99.95 price. Monitors for irregular heartbeat, reminders to move, wakey-wakey alarm, apps, and more.

Fitbit Versa 4 is a thin, light fitness smartwatch with sleep, SpO2 monitoring, GPS, irregular heartbeat, stress, pay hands free, Amazon Alexa, and connects to your smartphone. Four colors, will set you back $229.95.

Fitbit Sense 2 is chunkier with more information and tracking on health and stress than Versa 4 for a higher price at $299.95.

Readers can weigh in on whether these will be attractive, as the Fitbit brand has, over the past two years, almost vanished from the fitness smartwatch consciousness. GearPatrol, Mobihealthnews

New entrant in the developing hospital-to-home service provision area Sena Health is partnering with southern New Jersey’s Salem Medical Center to deliver Salem’s hospital-to-home program. Sena’s capabilities with Salem include up to 23 hospital-level services at home and 24/7 care coordinators. To qualify, patients must have been seen in the ER and evaluated on certain criteria. When cared for at home, they receive two in-person nursing visits daily and can connect with a dedicated clinical team if needed. Hospital-to-home is being trialed all over the country and is considered to be ‘hot’, but at this point is not all that widespread. HealthcareITNews

SteadyMD conducted a survey among a group of potential workers for their telehealth care team, among 1,700 clinicians: doctors (35%), nurse practitioners (52%), and therapists (12%). Some interesting findings such as:

  • Experienced (10 years +) doctors and therapists are most interested in telehealth practice, with nurse-practitioners (NPs) less so
  • Flexible schedules and working from home are the main attractions
  • Night shifts are attractive to 86% of therapists. Doctors and therapists average about 60%. But the latter two are far more interested in weekend work–not the therapists.
  • Telehealth as a full time delivery of care goes between 50 and 69% for each. Clinicians want more hours if the arrangement is part-time.

SteadyMD is a telehealth infrastructure provider that works with healthcare organizations, labs and diagnostics companies in 50 US states.

Something that can’t be delivered by telehealth except for diagnosis is your annual dental visit and treatments, and it’s down 9.5% in England, based on a report published by NHS Digital. The tracking of NHS adult dental visits covers the 24 months prior to June 2022 compared to the 24 months prior to June 2021. When compared to the 24 months up to June 2019, the reduction is 25.3%. Since dental practices closed except for emergency care due to Covid in March of 2020, there is an overlap in the numbers. They do indicate that dental treatments have not recovered in volume from before the pandemic. One good sign is that child dental treatment has strongly rebounded, up 42.1% in the 12 months prior to June 2022 versus up to June 2021, but still down over 20% compared to the 12 months prior to June 2019. Regional data is included in the NHS Digital report (link above).

The American Telemedicine Association announced its 2023 ATA annual conference will be in San Antonio, 5-7 March 2023. More information on “From Now What? to How To! The Vision and Realities of Telehealth Adoption” already is up on their website here.

More Oracle-Cerner VA/DOD EHR misery with 4 hour+ outage; 51% of VA iPads unused for video appointments

Oracle-Cerner’s VA and DOD systems were down for 4+ hours on 4 August. The culprit was a corrupted patient database that needed to be fixed and reprogrammed. The problem was likely not minor. An insider source claimed to FedScoop that it could be an indexing problem that could mean that “one patients files could point to a different patients data” (sic) which could be disastrous. The VA statement is verbatim from FedScoop.

VA spokesperson Terrence Hayes said: ““VA experienced a system outage of its electronic health Record system on August 4, 2022, which also affected VA, Department of Defense and U.S. Coast Guard sites using the Oracle-Cerner EHR. At 12:07 p.m. EDT, Oracle-Cerner received monitoring alerts indicating an issue with one of its databases. The system was taken offline to execute recovery of the database, during which time the sites switched to standard downtime procedures.

He added: “During downtime of the EHR, medical personnel could still care for patients, but documentation occurred on paper. The system was fully restored for all end-users at 4:23 p.m. EDT, for a total downtime of 4 hours and 16 minutes. No data corruption or data loss occurred.”

The VA’s Office of the Inspector General has been busy indeed, in this case tracking down usage of Veterans Health Administration-distributed iPads. These, along with internet service, were distributed to 41,000 qualifying patients during FY 2021 for the VA Video Connect program–to connect Veterans to care during the pandemic when facilities were fully or partially closed. The OIG audit issued 4 August indicates is that less than half were used in the way intended. 

  • Consults were created for over 56,000 patients. Devices were sent to 41,000 patients.
  • 49% of patients–20,300 patients–completed a video appointment
  • Over 10,000 patients had a video appointment scheduled, but did not complete the visit for various reasons, such as technical issues or canceled. They did not schedule another virtual appointment.
  • If unused in 90 days after issue, the devices were supposed to be taken back. This did not happen with 11,000 devices.
  • Going back to November 2021, VHA’s tablet dashboard showed patients did not use nearly 8,300 of those 11,000 devices.

The value of the 8,300 unused devices was $6.3 million with cellular fees of about $78,000. Even more interesting, VHA’s data showed 3,119 patients had multiple devices. In August 2021, VHA ordered 9,720 additional new devices at a cost of $8.1 million, but as of January this year, there was a backlog of 14,800 returned devices that needed refurbishment–not at all atypical given this Editor’s experience years back with the VA and RPM devices.

Recommendations for the program include clarifying the number of days from consult initiation to device order, adding procedures to prevent and retrieve duplicate devices, tracking device packages, creating detailed refurbishment reporting, and using that information to guide new device purchases. Federal News Network

Short takes for Thursday: Diagnostic Robotics $45M raise; Sage’s $9M seed; VA names EHR ‘functional champion’; Aussie telehealth startup Coviu arrives in US

Tel Aviv-based Diagnostic Robotics gained a $45 million Series B. The company has developed AI predictive analytics for health plans, providers, government, and employers for clinical assessment and decision support. The Series B was led by StageOne investors, with participation from Mayo Clinic, thus becoming a Mayo Clinic Platform portfolio company, plus Technion – Israel Institute of Technology, as well as other existing investors. Total funding since 2019 is $69 million (Crunchbase) Release, Mobihealthnews

NYC-based Sage received $9 million in seed funding to further develop and market its app that rethinks the nurse call system in use in senior living. The platform provides caregivers with data to coordinate incident responses and triage quickly and effectively, plus provide care managers with tools to better understand resident needs, provide proactive care, and view staff performance. The round was led by Goldcrest Capital, with existing investors ANIMO Ventures, Distributed Ventures, and Merus Capital. Release

VA names ‘functional champion’ for their VistA to Oracle Cerner transition. Dr. David Massaro will work as the clinical executive representing the Veterans Health Administration (VHA). He will lead functional initiatives to support the department’s medical personnel during the transition. Dr. Massaro is a long-time VA-er, previously acting chief health informatics officer for the Office of Community Care and before then director of integrated health practice within the Office of Health Informatics, as well as a practicing physician who joined VA in 2006. FedScoop

Coviu, an Australian telehealth startup, is launching its platform in the jammed US market. It’s marketing as an ‘all-in-one virtual engagement platform’ and is clearly appealing to primary care practices that need a less expensive solution. Its difference is apparently with modular apps that can extend a provider’s clinical work: behavioral health, speech pathology, and audiology. Base pricing starts at $25 monthly with the highest level package $65/month. Integrated apps are the Wechsler Individual Achievement Test, pulse oximeter remote monitoring, and a checklist for PTSD. They are also developing a new digital wound care toolkit in collaboration with the Commonwealth Scientific and Industrial Research Organisation and the Western NSW Primary Health Network, for release in 2026 (!!). Coviu claims use by 90,000 clinicians worldwide who deliver a daily average of over 14,000 telehealth consultations. Their US base is in Dover, Delaware and is HQd in Brisbane and Sydney. Release, Mobihealthnews

Telehealth waivers take critical step in extending to 2024 in House bill now passed

In a 406-12 vote last week, the US House of Representatives passed HR 4040, the Advancing Telehealth Beyond COVID–19 Act of 2021. The bill, which now goes to the Senate after the August recess, extends key Medicare telehealth waiver provisions to the end of 2024.

The key provisions extended are:

  • Permitting Federally Qualified Health Centers (FQHCs) and rural health clinics to serve as the distant site (i.e., the location of the health care practitioner)
  • Medicare beneficiaries to receive telehealth services at any site, regardless of type or location
  • Any type of practitioner to furnish telehealth services, subject to approval by the Centers for Medicare & Medicaid Services
  • Audio-only evaluation and management and behavioral health services
  • Delay of in-person requirements for behavioral health telehealth
  • Use of telehealth to satisfy Medicare face-to-face telehealth requirements for hospice care

The current emergency telehealth extension expires five months after the end of the Covid-19 public health emergency (PHE). As of today, that ends in October 2022. For any further extensions or permanent changes, the Centers for Medicare and Medicaid Services (CMS) is required to seek them from Congressional legislation. FierceHealthcare, ATA releases 25 July, 27 July 

Weekend reading roundup: Amwell’s Schoenberg opines to Politico; Teladoc’s new CMO also opines, SPACs are done, done, done

If Teladoc’s Jason Gorevic [TTA 1 July] and new CMO Vidya Raman-Tangella (below) are suddenly available to the health press, can a Schoenberg brother be far behind? This brief Q&A with Politico is with Roy Schoenberg of Amwell and covers the state of telehealth, obstacles, abortion, consolidation, and automation. He stays pretty much on message with no surprises as the questions are short and, as is the practice, pre-submitted:

  • Telehealth is a distribution arm of healthcare, not just videoconferencing
  • The biggest war in telehealth remains state licensure–as it was pre-pandemic, past the ‘jumping in’ stage
  • Telehealth will not be a ‘pill mill’ for abortion pills (abortifacients) or controlled substances–it will be based on clinician professional judgment. (In the Editor’s opinion, this ‘hot potato’ was pre-written by the legal department.)
  • Consolidation as a question is not answered. We will see telehealth delivered by large healthcare organizations and telehealth that works with multiple brands. (What is not addressed is what telehealth services large healthcare organizations will go forward in using–the ‘high-priced spread’ of all-inclusives or the white-labels)
  • His opinion around automation is that it will be split between the camps of replacing clinicians, or augmenting them plus giving patients the opportunity to manage their health reality. (One wonders for what reality Amwell is preparing)

Teladoc’s new chief medical officer Raman-Tangella is also on the healthcare charm offensive with a Healthcare Dive interview on strategy and new products. She discusses enterprise clinical strategy and whole-person care, which echoes the Gorevic interview. There’s a diversion to ‘health equity’ which is first defined as a continuum [Editor’s term] of gathering data, taking solutions to customers, and seeking outcomes that validate the first two. She then moves on to closing care gaps through this information, especially in musculoskeletal and physical therapy, and returning to health equity, disparities and then (what we used to define as) proactive care based on all this patient information.

Forget the fork. SPACs as an IPO method are burnt and heading to the trash bin. Again [TTA 9 June] we have PrivCo’s Daily Stack addressing their demise, this time quantifying the crack of the full SPAC market (in and outside healthcare):

  • From one in 2009 to 248 in 2020
  • 2021: an estimated 50% of the total US IPO market in Q1 with 299 listings valued at $98.3 billion
  • 2022: 18 registrations this entire 2022 year and still in the process of raising $2 billion. (This Editor noted that the only healthcare SPAC apparently in progress is VSee and iDoc Telehealth with Digital Health Acquisition Corporation to close in Q3.)

As we’ve previously noted, SPACs are under attack by the SEC and by perpetual hair-on-fire for the press Senators such as  Elizabeth Warren. According to Bloomberg (sign-in needed), 30 SPACs have been called off this year. And as we’ve noted, there are healthcare SPACs like SOC Telemed which went private at a fire sale discount. Others like Owlet, Headspace, and Talkspace are struggling. Watchful eyes are on late SPACs such as Pear Therapeutics and Babylon Health. It’s a less-than-grand finale to what was touted as a low-muss way to IPO.

Weekend news roundup: Teladoc adds to Primary360; Novartis, Medtronic support UK digital cardiac startups; Bluestream adds PrimaryOne Health; NoKo ransomware threatens healthcare; more Fed scrutiny on telehealth Rx, billed time may be coming

Teladoc had some positive news this week with additions to Primary360, its new primary care service for the provider/payer market. It added in-network referrals and care coordination capabilities, free, same-day prescription delivery from Capsule, and in-home, on-demand phlebotomy from Scarlet Health. The release notes that about half of patients fail to pick up their prescriptions. In addition, Priority Health, a nonprofit health benefits company serving Michigan, has added Primary360 to its fully insured virtual first plan design for employers. FierceHealthcare

Some good news from the UK in a time of government upheaval. Novartis is supporting cardiac digital health startups through the Novartis Biome UK Heart Health Catalyst 2022. This investor partnership is to identify and scale innovations for non-invasive lipid testing and at-home blood pressure testing using software as a medical device. Partners in support are Medtronic, RYSE Asset Management and Chelsea and Westminster Hospital NHS Foundation Trust and its official charity CW+. Successful applicants will receive support from partners during the competition process, the opportunity of investment up to £3 million provided by RYSE Asset Management, subject to due diligence at RYSE`s discretion, access to the Novartis Biome UK eco-system located in White City, and opportunities to work with our NHS partners to set up and deliver a pilot evaluation of the winning innovation. Applications must be in by 31 August–form is here. FierceBiotech

Bluestream Health adds PrimaryOne Health. Bluestream provides a white-labeled customized virtual care service that will be integrated into PrimaryOne’s services. This medical group of 11 community healthcare facilities across central Ohio serves 48,000 patients with primary care, OB-GYN, pediatric, vision, dental, behavioral health, nutrition, pharmacy, physical therapy, and specialty care.  Release

North Korea’s Maui Ransomware is no Hawaiian vacation. The threat has built enough since May 2021 for the Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and the Department of the Treasury (Treasury) to release a joint Cybersecurity Advisory (CSA) on Thursday warning healthcare and public sector health organizations. It is state-sponsored North Korean malicious cyber activity. The CSA provides a sample of how it executes, what it targets, how it encrypts files, and how to respond. Hackermania, NoKo Style, is Running Wild with breaches piling up [TTA 7 July], and not only in healthcare. Healthcare Dive, Healthcare IT News

And in Dog Bites Man News, a former US assistant district attorney for Massachusetts predicts that Federal entities such as the Department of Justice (DOJ) may not stop with telemental prescribing. They will not only be ramping up their scrutiny of telemental health companies–but also telehealth billing. For Cerebral and Done Health that facilitate the prescribing of Schedule 2 drugs, this assumption of scrutiny has become a no-brainer. What it also is: a caution for mainstream telehealth providers such as Teladoc and Amwell charging into psychiatric telehealth.  But the former ADA, Miranda Hooker, now a health sciences area partner with Troutman Pepper in Boston, makes a broader prediction. Prosecuted telehealth fraud, as this Editor has noted, has grown in other areas, such as prescriptions for durable medical equipment (DME) billed to Medicare [TTA 6 May] and cardiologists moonlighting as Dr. Mabuse, Master Cybercriminal [TTA 19 May]. But the next frontier may be time-specified telehealth consults billed to Medicare under various CPT codes (e.g. 994XX). A 15-minute consult billed as a more lucrative 30-minute consult can be considered fraud. The Cerebral investigation, according to Hooker, marks a shift by the DOJ into investigating the actual provision of telehealth services and whether they are being billed properly. FierceHealthcare

Weekend news, deal roundup: Teladoc CEO’s tapdance interview, VA EHR cost reporting now law, Tunstall-Doncaster Deaf Alliance partner, Cleveland Clinic’s $33M medtech spinoff

Teladoc CEO Jason Gorevic’s curious tapdance of an interview. Teladoc has had a rough 2022 to date. Their 2022 Q1 financials [TTA 4 May] were disastrous, their share price has not recovered since it cracked in late April with a 62% year-to-date plunge, the Livongo acquisition is shaping up to be the healthcare equivalent of Eastern Airlines’ takeover by Texas Air Corporation circa 1986, and shareholders are filing class action lawsuits. Now this Editor doesn’t mean to pile on. As a professional in two fields, she does understand the value of the press and leadership being available. But FierceHealthcare’s Heather Landi cleverly got Mr. Gorevic to stake his ground for growth yet again on “holistic, integrated solutions” that combine multiple care services from primary to complex care as the ‘longitudinal’ way to go. Yet Ms. Landi does have the nerve to bring up recent history and their long-time competitors like Amwell and Doctor on Demand (now Included Health) in the same space. Then there are the slices taken by players in the direct-to-consumer and niche target players (she cites troubled Cerebral and Talkspace–I’d offer DTCs like Babylon Health and the ‘white-labels’ like Bluestream Health and Zipnosis, now owned by BrightHealth, which are directly and cost-effectively working with providers). Think of this: in an economic downturn, will providers buy the ‘premium spread’ that requires a big implementation lift, or get by a less comprehensive solution that’s easier to implement and costs less?  Surprisingly, given the ‘everyone wants everything’ strategy, he again blames the cost of paid search advertising and brushes off Microsoft and Amazon. I’m not so sure that so soon after their Q1 bad news in May, with lawsuits centering on statements to investors, and nothing new in good news, this interview was particularly good timing.

VA corralled by Congress on Cerner EHR. The Department of Veterans Affairs now, by Federal law enacted late last week, has to prepare quarterly reports on its transition to the Cerner Millenium EHR to both House and Senate Veterans committees on performance and cost, including a breakdown of program funding sources. The new bipartisan law’s title is the VA Electronic Health Record Transparency Act.  Healthcare Dive

Tunstall Healthcare is now working with a local trust, the Doncaster (UK) Deaf Trust, to provide support for deaf and hearing-impaired children and adults. With Whitley Parish Council, Tunstall is working with the specialist gardening team at Communication Specialist College, part of Doncaster Deaf Trust, to secure over 100 plants for the planters which have been grown at the Trust’s gardens. Tunstall volunteers planted them in the planters across the village. Doncaster Free Press

Cleveland Clinic’s successful spinoff, Centerline Biomedical, closed a $33 million Series B equity financing. Leading it was Cleveland Clinic with participation by GE Healthcare, RIK Enterprises, JobsOhio, Jumpstart Ventures, and G2 Group Ventures. Centerline’s technologies improve visualization and guidance of stents, catheters, and guidewires in endovascular procedures, reducing dependence on radiation and contrast agents with the goal of improving patient outcomes. These include sensors and electromagnetic tracking that create 3-D color visualization and navigation of the human vascular system. Release, Becker’s

Catching up with ISfTeH (International Society for Telehealth and eHealth): three courses and a report

It’s been awhile since this Editor has heard some news from the ISfTeH but suddenly there’s quite a bit!

Upcoming ISfTeH webinars and courses
Over the course of the next week, the ISfTeH presents several online events. Here’s just a short reminder of those events and a link to the free registration pages (agenda can be found on the registration page):

ISfTeH Student Contest and Award
Friday, June 24th
https://us02web.zoom.us/webinar/register/WN_1mbkNqXOSRGXlGhTya0Tsg

Standards and accreditations for telemedicine and telehealth services in the international space
Monday, June 27th
https://us02web.zoom.us/webinar/register/WN_m6hoQvkuSe2Ui2XsWJigdw

Digital health education: why and what professionals need to know
Thursday, June 30th
https://us02web.zoom.us/webinar/register/WN_FJo8rtedR7CqIgc-lpYICA

The Future of Virtual Health and Care–report
 
The report delivers a roadmap that describes which policies have enabled a rapid uptake of virtual health and care during the pandemic, to serve as recommendations to help governments and other stakeholders ensure that virtual health and care drives access and equity, rather than entrenching or exacerbating existing divides. Thee is also an analysis of virtual health and care policies in 23 countries. The Working Group is chaired by the Novartis Foundation and the World Health Organization.
76% of patients want virtual care visits to be a standard part of their care regimen
83% of health and care providers intend to continue using virtual delivery post the COVID-19 pandemic
 
The ISfTeH also contributed to the report as part of a panel of external experts. A downloadable full copy, executive summary, and more are available here.
 
There is also a video of Dr. Michele Griffith, ISfTeH President, addressing the 75th World Health Assembly (#WHA75) in May 2022.

Thursday news roundup: bet on Oracle-Cerner closing next week, VA EHR progress reports mandated, Homeward-RiteAid rural care, Medtronic-DaVita kidney JV, Withings reenters RPM, Lightbeam buys Jvion AI

The Oracle acquisition of Cerner will close as early as Monday next week, no later than mid-June. Mid-June is the prediction of Seeking Alpha. They based it on Oracle-Cerner already passing Australia’s Foreign Investment Review Board, no questions posed by the UK antitrust authority, and the US waiting period expiring in February. As rumored [TTA 25 May], European Commission regulators approved it today (Barrons, paywalled) which predicts the close will be next Monday. Hat tip to HISTalk for their alert yesterday.

Scrutiny of Cerner’s $16 billion EHR implementation with the Department of Veterans Affairs by Congress ramps up. New legislation due to be signed by the president shortly will require the VA Secretary to submit regular reports 30 days after the last day of each fiscal quarter on the VA’s Electronic Health Record Modernization (EHRM) program. Content will include spending, performance metrics, outcomes, safety, transitioning from VistA to Cerner Millenium, interoperability, and progress or issues with all. Text of Senate bill, FierceHealthcare  TTA’s previous article on Cerner EHR interoperability problems with DOD and VA

Bringing healthcare to rural America is Homeward with a freshly inked deal with RiteAid. Founded by former Livongo president Jennifer Schneider, MD, Homeward will set up distinctive purple mobile van clinics at up to 700 Rite Aid location parking lots in rural communities starting Q3 this year. Michigan will be the first market. Homeward will accept regional Medicare Advantage plans and Medicare.

The company is targeting the 60 million Americans who live in rural areas and have been losing access to basic medical care as local practices and clinics close. Their technology enablement will be for appointments, checkins, telehealth, remote patient monitoring, and scheduling home visits. Homeward announced its launch at the recent ViVE2022 in March including $20 million in funding from General Catalyst. Other Livongo alumni with the new company are Brian Vandenberg, former general counsel, Amar Kendale, former chief product officer, and Bimal Shah, MD, former chief medical officer at Livongo. Nice to know that they have moved to another healthcare chapter of real need, versus cruising the Caribbean in very large yachts. FierceHealthcare, Homeward release

Medical device giant Medtronic and DaVita are establishing a joint venture by next year to advance kidney care therapies and technologies, including new products to be used in clinics and in the home. The intent of the JV is to increase the availability of kidney care including dialysis. 10% of adults worldwide–700 million people–have chronic kidney disease. 2.6 million have kidney failure. The JV is expected to be formed in early 2023 with each company owning an equal share. Initial investment is not disclosed. According to the release:

  • Medtronic will contribute its Renal Care Solutions (RCS) business including the current product portfolio (renal access, acute therapies, and chronic therapies), product pipeline, and global manufacturing R&D teams and facilities.
  • Both companies will provide an initial investment to fund the new company (NewCo) and future certain operating capital.

FierceBiotech, Medtronic release

Withings reenters remote patient monitoring with Withings RPM. Their initial entry was with MedProCare back in 2019 but apparently in the repositioning of the company since the buyback from Nokia in 2018, it was back-burnered. The new RPM will be based on an app that will:

  • track time for CMS-compliant billing reports and uploadable to the provider EHR
  • support billing for CMS codes 99453, 99454, 99457, 99458
  • a digital patient-facing assistant
  • full connectivity to Withings devices such as scales, blood pressure monitors, and sleep monitors
  • implementation support by their Health Solutions teams

Withings RPM page, Outsourcing-Pharma

Looking hard for an M&A that relates to us in this very quiet market, Lightbeam Health Solutions, a population health software company, is acquiring Jvion Inc. Jvion has AI-enabled prescriptive analytics and social determinants of health (SDoH) solutions which will be combined with Lightbeam’s health analytics and outcomes for payers and providers. Terms of the acquisition and leadership transitions were not disclosed. Lightbeam release

CVS, Walmart refuse Cerebral, Done Health controlled substance prescriptions via telehealth; Cerebral CEO replaced

More hot water dumped by CVS Health and Walmart on Cerebral, Done Health. The two retail giants announced last week that they would refuse to fill prescriptions of all controlled substances by telemental health providers Cerebral and Done Health. Cerebral was already under investigation by DOJ on over-prescribing of controlled substances by its provider network as a business practice, including advertising [TTA 10 May]. It turns out that seed-stage Done Health, a telemental provider specializing in ADHD diagnosis and support, is also facing the same scrutiny and treatment. 

Cerebral had already restricted prescribing controlled substance prescriptions for new ADHD patients as of 9 May. They initially continued to prescribe controlled substances for new patients diagnosed with other mental health conditions, according to a memo from their chief medical officer to their clinician network, but stopped that on 20 May with an exception for opioid use disorder. Truepill, Cerebral’s recommended mail order pharmacy, had stopped filling all Cerebral Schedule 2 prescriptions prior to that date. The CVS and Walmart refusals close off two more pharmacies for patients. FierceHealthcare

Earlier in the month, Cerebral CEO and co-founder Kyle Robertson was forced out by the Cerebral board. His replacement by medical officer and president Dave Mou, MD is effective immediately. According to reports, Robertson is fighting their action, calling it illegal and accusing the board of making him the scapegoat for the company’s problems. FierceHealthcare

Companies like Cerebral and Done grew quickly in 2020-21 due to the pandemic-driven loosening of psychiatric patient evaluations, eliminating the usual initial in-person initial visit and permitting online treatment. Restrictions were also loosened for diagnoses permitting the prescription of Schedule 2 drugs (those judged to have potential for abuse) with solely a video visit and follow up. With fast growth came more need to maintain that growth, according to current and former employees.  

Upon taking the CEO position, in an email to the prescriber team, Dr. Mou announced that patients on controlled substances would be transitioned as follows: a visit prior to 1 August to establish a treatment plan to transition to a non-controlled medication, titrating off of their controlled substance, or transferring their care to a local provider by 15 October. With the pandemic policies around telehealth ending soon, this is called playing defense, though it well may stop growth. Wall Street Journal, The Verge