Telehealth

During the COVID-19 pandemic, Telehealth is a valuable tool in expanding access to testing and care in the home. This will help limit new infections while ensuring sick people receive the care they need. It will also help capacity issued by triaging patients who may have symptoms of the virus, but who do not require hospitalization. Finally, Telehealth can help protect the health and safety of health workers by limiting needless exposure to infected patients.

On March 6, Congress enacted into law a provision to allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by Telehealth during the current coronavirus public health emergency.

The legislation:

Allows telehealth services to be provided to Medicare beneficiaries by phone, but only if the phone allows
for audio-video interaction between the qualified provider and the beneficiary.
Is limited to qualified providers who have furnished Medicare services to the individual in the three years prior to the telehealth service (or another qualified provider under the same tax identification number that has provided services within three years).
Requires the patient to initiate the service and give consent to be treated virtually, and the consent must be documented in the medical record before initiation of the service.

On March 17, the President and HHS announced an expansion of telehealth coverage and reimbursement, mostly achieved by waiving (or by authorizing states to waive) the statutory restrictions put in place by Congress.

Congress should:

Make In-Home Testing an Option. Fund a program to provide for in-home testing as an alternative to facility, office or drive through testing. This would minimize increased risks of infection. The program should provide patients guidance on collecting specimens via a reimbursed telehealth visit. Test result reporting should be done real-time to patient, provider and public health authority. A reimbursed telehealth visit to discuss test results, including any additional requirement to seek in-person care should be required coverage.
Eliminate Patient Barriers to Care. While the administration has waived many of the statutory barriers to care, Congress can make a telehealth response to a future pandemic easier by repealing the requirement for both audio and video phone capabilities and the prior relationship requirements. Why legislate such barriers if HHS and the states will then waive them to get care to people in need?
- Evidence of meeting a pandemic’s symptoms (fever, cough, shortness of breath) should be sufficient to
  trigger coverage and reimbursement of a telehealth visit during an emergency.
- Many people have phones that only assist audio capabilities. It makes little sense to bar this population from accessing care if infected.
- Medicare Advantage members have access to telehealth without meeting a requirement that they have an
  existing physician-patient relationship with that physician within the past three years. This flexibility should be expanded to allow Medicare enrollees the same access as Medicare Advantage members.
- Allow providers with a valid license in one state to provide care in other states without obtaining a second, duplicate license. This would automatically take effect after a public health declaration is made and is similar to the current rules for Veterans care.

HHS Should:

Urge all governors to request a Section 1135 waiver so that Medicare, Medicaid and CHIP programs may take advantage of a wider range of flexibilities, including “[r]equirements that physicians and other health care professionals be licensed in the State in which they are providing services, so long as they have equivalent licensing in another State.”[1] HHS should also urge states to clarify whether a “non-Federal” provider is authorized to provide services in the state during the COVID-19 crisis without a state license.
Approve in-home diagnostic tests to identify patients before they enter hospitals or physician offices where the risk of infection is more likely.

[1] See https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers, which also notes “this waiver is for purposes of Medicare, Medicaid, and CHIP reimbursement only – state law governs whether a non-Federal provider is authorized to provide services in the state without state licensure.”

Artificial Intelligence (AI)

Congress should provide $20 million to HHS to contract with AI experts to predict the progression and spread of the coronavirus. The program should also provide for predictive modeling to inform capacity issues at health systems and in local communities for the following issues:

Hospital staffing predictions (how many nurses)
Predicting operational efficiency and resilience during a pandemic
Hospital supply chain predictions
Predicting responses by city, hospitals
ICU transfers and triage
Population risk segmentation
Sepsis predictions

Information resulting from the program should be provided real time to health systems and local community health departments to assist on the ground efforts to halt the spread of coronavirus and to better treat those with COVID-19. Data should also be used to produce reports to congress about actual and predicted capacity and resource use to help inform current and future hospital funding needs.

Real-Time Benefit Tools

Providers need access to real-time, patient-specific prescription information to safely prescribe medications to
patients at all times, but especially during a public health emergency. Likewise, patients need access to medications to control and mitigate acute and chronic conditions especially during a public health emergency.
Providers need access to real-time, patient-specific prescription information to safely prescribe medications to
patients at all times, but especially during a public health emergency. Likewise, patients need access to medications to control and mitigate acute and chronic conditions especially during a public health emergency.

Unique Patient Identifier (UPI)

We need to learn from past mistakes. HHS should have the flexibility to engage in UPI solutions so that when a
vaccine or treatment for COVID-19 is available, those vaccines and/or treatments are able to be administered efficiently, and with a high degree of certainty to the right patient at the right time. As a first step, Congress
needs to remove the appropriations rider that prohibits such HHS action.

The use of a UPI is critical to preventing patient misidentification and ensuring patients are getting the correct tests, results, diagnoses and treatment in future pandemics.

Modernize Public health data infrastructure

October 19, 2020 - Letter to President Trump urging decisive action on modernizing our nation’s public health data infrastructure. Letter and list of co-signers can be found HERE.