FTC staffs encourage telehealth regulations for Delaware speech pathologists, audiologists

Staffs of the FTC’s Office of Policy Planning, Bureau of Economics, and Bureau of Competition have applauded the Delaware Board of Speech/Language Pathologists, Audiologists and Hearing Aid Dispensers’ proposed revisions to its telecommunication and telehealth regulations, which would eliminate the current restriction on evaluation and treatment by telecommunication.

The Board’s new regulation would allow licensed speech/language pathologists, audiologists, and hearing aid dispensers to determine whether telepractice is an appropriate level of care for a patient. Before practitioners could provide telepractice services, however, the proposed regulation would require an in-person initial evaluation.

The proposed removal of existing restrictions on service by telecommunication is a significant and positive step, according to the FTC staffs’ comment. In particular, the changes could enhance consumer choice by providing an alternative to in-person care, potentially reducing travel expenditures, increasing access to care, and increasing competition.

Nevertheless, the FTC staffs are encouraging the Board to consider the potential effects on competition and access of the proposed prohibition on initial evaluations delivered by telepractice, as well as any potential health and safety consequences of the proposed regulation. The benefits of the telepractice provision could be enhanced by allowing practitioners to determine on a case-by-case basis whether telepractice is appropriate for an initial evaluation, according to the FTC staffs, instead of requiring that all initial evaluations be carried out in person.

AHA opens the door to hospital access strategies

The integration of rural hospitals with health clinics and the use of technology to provide 24/7 care are among the strategies developed by an American Hospital Association task force to assist hospital leaders with preserving access to health services in vulnerable rural and urban communities. The strategies set out in the task force’s report are designed to assist providers amidst growing pressures on the health care sector. The report recommends reforms for health care delivery and payment designed to identify and provide the essential health care services individuals need. The report also considers policies which may serve as a barrier to implementation of the strategies.

Status quo

The country has nearly 2,000 rural community hospitals and more than 2,000 urban community hospitals. Because of their location, the hospitals are what the AHA calls “the anchor for their area’s health-related services.” The report notes, however, that the hospitals face challenges in the form of: remote location, limited workforce, constrained resources, and financial instability. The survival of the hospitals is important because the hospitals serve as a critical health care access point in vulnerable communities.

Strategies

To assist the hospitals, the task force identified: characteristics and parameters for vulnerable communities, essential health care services, and emerging strategies to ensure the hospitals are able to provide those essential services. The nine strategies include:

  • addressing the social determinants of health (housing, utility needs, food insecurity, interpersonal violence, education, employment, low income);
  • implementing global budget payments, which provide greater financial certainty for vulnerable hospitals;
  • shifting inpatient resources to resources devoted to outpatient care;
  • the use of emergency medical centers to allow existing facilities to provide emergency medical services without having to maintain inpatient beds;
  • the use of urgent care centers as a viable outpatient alternative to emergency medical centers and inpatient hospitals;
  • implementing virtual care strategies like telehealth;
  • the creation of local, integrated health care organizations (called Frontier Health Systems) for very small, isolated frontier communities;
  • integration between rural hospitals and health clinics like Federally Qualified Health Centers (FQHCs); and
  • improved coordination between Indian Health Service (IHS) facilities and other providers.

Barriers

The task force acknowledged several barriers to the implementation of its strategies, including federal statutory and regulatory barriers. Additionally, the task force noted that certain facilities may have difficulty transitioning to new payment models or novel care delivery mechanisms like telehealth. The AHA acknowledged that the ability to attract and retain health care providers will continue to be a difficulty at the community level. To be successful, the AHA report notes that communities will need to expend time, effort, and finances, while hospitals will need to improve technology infrastructures and care planning.

The CONNECT for Health Act suggests the future isn’t too remote

A new piece of legislation would increase the use of telehealth and remote patient monitoring (RPM) in the Medicare program. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, a bipartisan piece of legislation, is aimed at cutting health care costs while improving care outcomes. The bill is premised on the belief that telehealth is the future of medicine and that the quality of care can be greatly improved, in a cost effective way, through better contact between patients and providers.

Provisions

The CONNECT for Health Act would loosen current restrictions on Medicare reimbursement for telehealth and RPM services. Specifically, the legislation would allow certain providers to use telehealth and RPM without many of the current 42 U.S.C. §1834(m) limitations, which include originating site restrictions, geographic limitations, restrictions on store and forward technologies, limitations on distant site providers, and limitations on covered codes. The act would also permit providers to use telehealth and RPM in alternative payment models without most of the Section 1834(m) restrictions. The act would allow RPM of certain patients with chronic conditions, permit more facilities to serve as originating sites, and enable telehealth and RPM to be considered basic benefits in Medicare Advantage, without most of the Section 1834(m) restrictions.

Response

According to an Avalere study, the bill could save as much as $1.8 billion over the next ten years. The American Medical Association (AMA) has expressed its support for the bill, noting that it stands to strengthen physician-patient relationships and improve care access while maintaining patient safety. The bill was introduced by Senators Brian Schatz (D-Hawaii), Roger Wicker (R-Miss), Thad Cochran (R-Miss), Ben Cardin (D-Md), John Thune (R-SD), and Mark Warner (D-Va). The Senators praised the advances of health information technology and the promise of telehealth, noting the importance of the opportunity to bring together improvements in technology with the prospect of better care quality.

AHRQ’s telehealth evidence map will lead the way to better policy

Advancing telehealth policy and practice was the goal of a draft technical brief released by the HHS Agency for Healthcare Research and Quality (AHRQ). Due to the rapid advancement and complexity of telehealth technology as well as an expansive quantity of research, AHRQ evaluated and synthesized literature and studies to arrive at an evidence map, which can be used to identify what is known about telehealth and what requires further investigation. The draft brief explains that the agency hopes that by identifying and describing available telehealth research, decision makers, and other stakeholders will be able to act on a straightforward and helpful body of information.

Telehealth

In the process of constructing the evidence map, AHRQ relied on the Health Resources and Services Administration (HRSA) definition of telehealth: “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.” In part due to the expansive nature of telehealth and the complex association it shares with related terms like ehealth, telemedicine, and telecare, multiple stakeholders—including Senators, medical, patient advocacy, and industry groups—supported a call for a comprehensive literature review. Because of the volume and variability of literature on telehealth, stakeholders realized that is not possible to quickly assess telehealth literature to determine if there is support for a particular policy decision.

Method

In order to meet stakeholder needs, AHRQ surveyed telehealth research and produced an evidence map. AHRQ describes the evidence map as “a form of rapid or abbreviated review.” Although the map is not intended to be exhaustive, the goal is to arrive at a practical and more useful body of information to direct stakeholders. To obtain information for the map, AHRQ conducted interviews, searches of databases, and reviewed literature. After identifying a subset of reviews, AHRQ extracted relevant telehealth data and synthesized it into an evidence map combining graphics, tables, and text.

Findings

Out of over 1,300 articles, AHRQ selected 562 for full-text review. Of those, AHRQ chose 44 that met the agency’s inclusion criteria for the evidence map. The agency only chose reviews with “content that was organized, analyzed, and presented in a way that could support policy and practice decisions about telehealth.” The most-often included reviews focused on more than one technology, mixed chronic conditions, and communication and counseling. As a result, it was those types of reviews that AHRQ identified as having the highest relative benefit from a literature review standpoint. The agency also examined gaps in the literature that still need to be closed. For example, AHRQ identified urgent/primary care as an area that has not been adequately reviewed.