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

To white coat, or not to white coat? That is the telehealth doctor question.

A light but thoughtful take on the protocols of the white coat, and how the clinical dress translates to telehealth consults. Dr. Jayne, who writes the weekly ‘Curbside Consult’ column for HISTalk, discussed how wearing a white coat on a telehealth visit may very well be passé. Some companies require it, others don’t, but what’s in those pockets anyway? And in telehealth, does this garb turn off patients? 

Dr. Jayne’s practice, based on her columns, is a mix between office and telehealth, but she has previously worked in the ER/ED. Where the white coat comes from is hospital culture, where the differentiators were short white coats for the medical students and longer white coats for the degreed physicians–except in surgery where short coats were worn by interns (remember interns?) and first-year residents. Men wore ties, and the dress was uniformly professional under those white coats. The white coats descended from laboratory coats. As everyone changed into scrubs during the pandemic and ties were ditched (long ago in the UK, along with long sleeves), who is who in a hospital became even more confusing to outsiders, thus requiring even larger nametags.

Perhaps the precedent for telehealth is psychiatry, where most of the telehealth consults occur at the present time. In my brother’s clinical practice, and at the community hospital where he admitted patients, he and his colleagues didn’t wear white coats over their jackets and ties (or dresses/suits for the women). It was offputting to patients, even if they were already in the psych ward. One concession–short sleeves in summer. He did wear a white coat as a locum tenens in a much larger hospital’s psychiatric ER, mainly to protect his clothing from ER mayhem which was prevalent on the night shift. 

As Dr. Jayne put it, it’ll be interesting to see how the protocol evolves. Curbside Consult with Dr. Jayne 5/16/22

CMS telehealth pandemic waivers boosted usage among disadvantaged, urban patients

Broadening telehealth usage areas when in-person visits are restricted boosts–telehealth usage. Beyond the tautology, the surprising finding here is that it benefited two groups that telehealth hasn’t done well with prior to the pandemic: those living in the most disadvantaged neighborhoods and in metropolitan areas. It also increased usage among women and those of Asian and Hispanic heritage.

The Johns Hopkins study, published in Health Affairs (abstract only, restricted access), reviewed 30 million Medicare fee-for-service claims to quantify outpatient telemedicine use before and after the Medicare telemedicine coverage waiver that took effect on 6 March 2020. Prior to the waiver, Medicare beneficiaries were covered very narrowly for telehealth, in designated rural areas and specific designated facilities, using synchronous audio/video only–a total of 0.42% with one outpatient visit. After the waiver, this grew to 9.97% of patients with at least one outpatient telemedicine visit. Medicare had previously reported that Medicare beneficiary telehealth usage had grown to over 40% during the pandemic.

According to the study abstract, “After adjustment [for demographic variables], our data suggest that the coverage waiver increased access to telemedicine for all Medicare populations, including people residing in the most disadvantaged neighborhoods, although the odds of use were persistently lower with increasing age.” Other studies had found disparities based on demographics such as race, income, and residential location, with higher status pointing to greater telehealth usage, but this study indicates that the loosening of restrictions did not contribute further to these disparities. Thus the logic points to more availability (access) powering increased usage, or at least the odds of use, in this disadvantaged/minority population. 

It is certainly an argument for retaining most of the telehealth waivers–which will require Federal legislation for Medicare after the 90-day Public Health Emergency renewal expires in mid-July, if not renewed. Healthcare Finance, FierceHealthcare

ATA conference roundup: a new board chair, a digital app review pilot, and company announcements

The American Telemedicine Association (ATA) 2022 conference and expo is a wrap, after starting on Sunday through to Tuesday. While your Editor could not attend due to other commitments that precluded a trip to Boston, one industry insider who visited the expo–his first in-person event in two years–reported that after a slow start on Sunday, the floor busied up on Monday. Business was being done, finally and not virtually. What were the busy booths and what was ‘hot’? Companies in the areas of telemental health and remote patient monitoring (RPM). (Did you attend? What was your impression? Leave comments below.)

ATA had two major announcements of its own during the conference:

  • Kristi Henderson, DNP, NP-C, FAAN, FAEN, has been named as Chair of the ATA Board for a two-year term. Henderson is the CEO of Optum Everycare, where she leads a team building digital and virtual health solutions to improve quality outcomes and experiences for patients and providers. She has served on the board since December 2020. As Chair, she is succeeding Joseph Kvedar, MD and Professor at Harvard Medical School among other positions. Dr. Kvedar will become Immediate Past Chair and Senior Advisor to the ATA. Announcement
  • ATA, the American College of Physicians (ACP), and ORCHA, the Organization for the Review of Care and Health Applications,  announced a framework for the assessment of professional and consumer digital health technologies, including mobile apps and web-based tools. ACP and ORCHA, which has experience assessing compiling libraries of apps, will be piloting a test of the framework against a database of digital health tools. The goal of the pilot is to “determine how the library can be useful to physicians in recommending high-value digital health tools to their patients, and what other barriers to wider adoption of digital health tools may exist.” Announcement

Quite a few company announcements were made during ATA–a selection:

  • Johns Hopkins Bloomberg School of Public Health highlighted the publication of a major scientific study (full text) documenting telehealth outcomes in JAMA Network Open. This Johns Hopkins-based research was partially supported by the ATA. The study followed a national cohort of 40.7 million commercially insured persons from July to December 2021 and included 21 chronic and non-chronic conditions. Fourteen-day follow-ups for persons with an initial telehealth visit were compared to persons receiving in-person care. On average, patients participating in an initial telehealth consult for a new health condition did not require more unplanned hospitalizations or follow-up ED visits within 14 days of their initial consult compared with patients making an initial in-person visit. The exception was respiratory conditions. Release
  • BioIntelliSense, which last year scored $45 million in funding for its on-body sensors, announced two major collaborations for remote patient monitoring (RPM) with UC Davis Health and Houston Methodist.
  • CDW Healthcare and Caregility announced a strategic partnership to expand their virtual care capabilities, including Caregility’s new Inpatient Virtual Engagement solution (IVE), also launched during ATA. 
  • Connect America, which snapped up Lifeline last year, launched Connect America Home, a single health and safety platform connecting (PERS) and remote patient monitoring (RPM) with supporting services, including AI-enabled virtual health assistance and Social Determinants of Health (SDoH) support, along with analytics. Release.
  • AliveCor announced the launch of KardiaComplete, a comprehensive heart health enterprise solution designed to drive improved health outcomes and reduce the cost of cardiac care. The service will be available through self-insured employers, health insurance plans, and health systems to those diagnosed with hypertension and arrhythmias, like atrial fibrillation.
  • Withings launched Withings RPM, the company’s most advanced remote patient monitoring solution designed to enhance the patient experience. It is a single platform that enables clinicians to order and send Withings RPM devices, manage data from multiple patients with automated alerts and reminders, communicate via SMS, phone, and in-app video calls, billing, sleep tracking, and more. 

TTA was a media partner of ATA 2022.

Some thoughts on Teladoc and the Week That Was in telehealth

Yes, your Editor has, for the past few weeks, felt like Pepper the Robot, moving at two speeds–crazed and off. (‘Off ‘ to the left. Now cart me off.) Home renovations, with strangers tramping through your abode, noise, dust, and the corresponding moving of furniture, packing and unpacking, pre- and post-cleaning, then trying to put things right and get your life back will do that. Add to that an unexpected gushy kitchen sink that took three ‘fixes’ to get actually fixed. Then there were technical problems with our email sender that Editor and Administrator Emeritus Steve had to work through. One becomes more appreciative of order, routine, and Peace and Quiet.

Speaking of Peace and Quiet, there is little to be found in telehealth. Instead, there is a lot of Feeling Off. The Big News of late last week, of course, was Teladoc’s troubles. In the words of Seeking Alpha, they had one horrific quarter. The horror show started with writing off the Livongo acquisition– a noncash goodwill impairment charge of $6.6 billion, for a massive loss of $41.11 per share for a total of $41.58 per share. To compare, last year’s Q1 loss was $1.31 per share. While revenues were up almost to projection (25%), it was still a $3 million miss and in context, it was the cherry on a very nasty sundae. After rosy projections last year, Teladoc lowered their 2022 revenue guidance from $2.6 billion to $2.45 billion.  

Moving forward from the questionable Livongo acquisition at the absolute peak of the market, CEO Jason Gorevic admitted some hard truths to investors that deepened the hole: much more competition, particularly in telemental health; the rising cost of paid search advertising and the keywords driving towards direct-to-consumer telehealth driving up the cost of acquisition; and difficulty closing B2B deals. This creates, in the terms of analyst SVB Leerink’s Stephanie Davis quoted in FierceHealthIT, “a direct-to-consumer air pocket that business-to-business sales (and their inherently longer cycles) are too slow to fill” at least, in her view, until the end of the year.

Teladoc’s difficulties, as this Editor has noted, started after a peak in early 2021 as the pandemic started its protracted wind-down and telehealth volumes plunged to well below 5% of claims as practices reopened. The stock value is down over 90% from last February, not helped by a volatile market triggered by war and inflation. Similar difficulties are plaguing Amwell (down 92% since February 2021), Talkspace (down to a paltry 16 cents and in court for misleading investors), SOC Telemed (taken private at a 70% drop in value, TTA 8 Feb), and other health tech companies. For our Readers, this is no surprise: the telehealth bender is ovah.

One industry leader in a post-ATA conversation with this Editor cited a less obvious factor–that hospitals and other health providers are now putting together their own telehealth/triage packages tied into population health and case management software, with and without ‘white label’ providers such as Bluestream Health and Zipnosis (acquired by insurtech/payvider Bright Health a year ago). Teladoc is a late entry to this provider/payer market with Primary360, where they also compete with Babylon Health [TTA 7 Oct 22]. And health retailers have joined the primary care telehealth game. Walmart last week announced a virtual health diabetes care program for employers through their recently acquired MeMD.

Big Telehealth’s troubles may depress investment in related earlier stage companies–or help those in niches such as telemental and population health, or remote patient monitoring (RPM) systems that have telehealth features (e.g. TytoCare), as VC investment seeks a brighter home. Right now, this Editor’s Magic 8 Ball is saying ‘outlook, cloudy”. 

Wisconsin’s $5M for child psychiatry, community telehealth; FQHC patients prefer audio-only telehealth–Rand

The state of Wisconsin is granting $5 million to telehealth vendors, equally split between child telemental health and community telehealth delivery. Governor Tony Evers announced the grant series which was funded by the American Rescue Plan, the third COVID stimulus round of 2021 as part of the State and Local Fiscal Recovery Fund to bolster rural telehealth plus mental health. With COVID fading, the funds are being redeployed by states for related health initiatives.

Applications are due 6 May for:

  • Up to five one-year grants of approximately $500,000 will be provided to Wisconsin hospitals and health systems to expand and improve child psychiatry telehealth services
  • Between 25 and 50 providers to partner with community organizations to establish neighborhood telehealth access points at food pantries, homeless shelters, libraries, long-term care facilities, community centers, and schools. These are targeted to reach people with limited access to technology and reliable internet service. These are also one-year grants of up to $100,000 each.

While big telehealth funding for mental health grabs the headlines, at the local level, it is these state initiatives that often keep both providers and smaller telehealth companies going. State of Wisconsin release, mHealth Intelligence

RAND Corporation’s study of telehealth in Federally Qualified Health Centers (FQHCs) found that audio-only telehealth was used more frequently during the pandemic, and continued to be used by patients for behavioral health even when primary care shifted back to in-person visits. The study group was the California Health Care Foundation (CHCF)’s 45-center Connected Care Accelerator (CCA) program started in July 2020. These centers serve rural, low-income, and underserved populations, common in places like Wisconsin (this Editor worked with a successful FQHC ACO there) and in California.

Audio and video telehealth was problematic for both the patient population and the clinics. Those with limited English proficiency participated in a significantly lower percentage of video visits. Behavioral health centers also had difficulties. Centers that coordinated efforts to replace audio-only with video visits had specific promising practices.

According to the RAND study, “key facilitators of telehealth implementation were leadership support, patient willingness to use the technology, platforms that were easy to use and access, a sense of urgency within clinics, changes in reimbursement policy, and training opportunities for staff.” Another recommendation was to retain centers to serve as distant telehealth sites (and to be reimbursed). Also mHealth Intelligence

What do physicians really think about telehealth, now that they’ve used it? Lower use, substantial frustrations remain.

Optum finds a part-rosy, part-jaundiced picture. Not much notice was taken of a survey on behalf of UnitedHealth Group’s Optum survey of 240 physicians, 75% of whom were in primary care with the remainder in specialty or urgent care. Most (65%) hadn’t used telehealth prior to the pandemic, yet shifted to 74% heavy to moderate use during it. Good times for telehealth providers of all types, secure and non-secured platforms. The problem, despite Optum’s optimistic headline in the release? Telehealth use predictably rolled back; doctors aren’t sticking with it–86% project now rare (<10%) to moderate (10-49%) usage in future. 

Telehealth in use was primarily synchronous (real-time), and almost equally audio/video (88%) and phone only (80%). 30% used secure messaging. Patients also preferred phone to online, 86% to 51%, for scheduling. Most providers saw telehealth as convenient (69%), efficient (35%), and timely (29%). For patients, the convenience factor soared to 90%, with 47% happy they could have telehealth from home.

But provider frustrations were found to be substantial, with dissatisfaction over 50% in three key areas. 58% felt that they could not provide the level of care they want (58%), meet patient expectations (55%), or were frustrated with telehealth audio/video technology (50%). As to the last, 40% wanted better technology and 35% wanted EMR integration. Only 23% wanted a mobile app. 47% wanted training–for their patients. Only one in four said that job satisfaction and patient health improved.

A picture that needs some improvement for telehealth to succeed. Optum release, Provider Telehealth Use and Satisfaction Survey. Hat tip to EPTalk by Dr. Jayne on HISTalk.