Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.
Claims Lines Steady as Waivers Extended
The Department of Health and Human Services (HHS) extended the COVID-19 public health emergency — including key waivers for telehealth — until April 2021, FierceHealthcare reported.
Under the emergency, HHS has allowed more types of providers to bill Medicare for telehealth services and has granted waivers for audio-only telemedicine to be reimbursed.
The extension comes as new FAIR Health data show that telehealth claim lines — the individual services or procedures listed on an insurance claim — continued to be relatively steady through October, though wildly outpacing 2019 levels.
Telehealth accounted for 5.61% of medical claims lines in October 2020, a giant leap from 0.18% in October 2019, the nonprofit’s Monthly Telehealth Regional Tracker showed.
The increase is a bump over September 2020’s numbers, when telehealth claims lines were 5.07%. In August, telehealth claims lines were 6.07%; in July, they were 6.00%. Peak numbers occurred in April 2020, when telehealth accounted for 13.00% of claims lines.
In October, exposure to communicable diseases was among the top five telehealth diagnoses nationally and in every region in the U.S., a departure from September. The rise in COVID-19 cases in October most likely explains this, FAIR Health said. As communicable disease exposure joined the top five list, other diagnoses fell off in different regions, such as substance use disorders in the Northeast and hypertension in the South.
FAIR Health data represent privately insured people, excluding Medicare and Medicaid patients.
Telehealth Triage Protocols
When should a patient use a virtual rather than in-person visit? And how can health systems help guide this decision?
These are questions telehealth triage protocols can help address, UCLA Health physicians said in a recent NEJM Catalyst commentary.
“The rapid transition to telehealth poses a few challenges,” the authors wrote. Primary care physicians (PCPs) at the University of California Los Angeles have “expressed concern about training and technology support, patient access to technology, data privacy and security, and clinical appropriateness — with the latter being at the top of the list.”
In April 2020, UCLA Health surveyed 228 of its PCPs and learned that 52% of the care they routinely provide could be conducted virtually without compromising quality. In July, UCLA surveyed PCPs again to investigate the appropriateness of telehealth in common patient scenarios, with the goal of identifying red-flag symptoms that could help direct patients to the appropriate type of visit. PCPs also said the following patient factors made it harder to provide effective care by telehealth: poor cognitive function, preferred language other than English, age over 70, first-time visit, and strong history of drug or alcohol abuse.
The survey findings and clinical data are helping to shape a pilot protocol at UCLA Health, including a telehealth appropriateness screener that patients must answer before setting an appointment. “Early challenges include achieving a consensus on the proper screener questions and modifying call-center workflows to support seamless integration of triage questions,” the authors noted. “These challenges emphasize that health systems will need to adjust the development and implementation of their triage protocols to their unique circumstances, patient populations, and technology.”
Remote Acute MI Care After Discharge
A post-discharge telehealth program for low-risk acute myocardial infarction (MI) patients had similar results as in-person care, the IMMACULATE randomized trial in Singapore showed.
Safety events, medication adjustment, and left ventricular reverse remodeling outcomes were no different in low-risk acute MI patients treated remotely in an intensive management program led by a centralized nurse practitioner for 6 months than in those who received usual care from a cardiologist, reported Mark Chan, MBBS, PhD, of the National University of Singapore, and co-authors in JAMA Cardiology.
“Other trials have tested telemedicine strategies to follow up and adjust medications in patients after hospitalization for heart failure,” Chan and colleagues wrote. “Instead, the IMMACULATE trial tested remote intensive follow-up and drug adjustment for patients in the early post-MI period. The limited window for ameliorating adverse post-MI remodeling presents itself as a unique opportunity for more cost-effective telemedicine deployment in contrast with chronic heart failure, which requires potentially perpetual deployment of telemedicine services to prevent recurrent hospitalization over a patient’s health span.”
One reason for IMMACULATE’s results may be lower-than-expected risk of participants enrolled with relatively young age, early revascularization, and preserved left ventricle ejection fraction (LVEF), the researchers noted.
“This feasibility study demonstrates the potential for remote intensive management to be tested on a higher-risk acute MI population with reduced LVEF or heart failure,” they added.