Town Hall, White Paper Examine Telehealth as ‘New Normal’

AAFP Event Introduces Telehealth Toolkit, Offers CME Credit

September 9, 2020, 6:00 am News Staff -- SARS-CoV-2 and the COVID-19 pandemic pushed family physicians into the telehealth frontier, and now the challenge is building on those gains. Offering some direction: a Town Hall this week, viewable live on Sept. 9 and later as a recording, that spotlights the Academy's detailed new telehealth toolkit, and a recent white paper, published with the AAFP's participation.

The Town Hall event, "Sustaining Telehealth Through and After the Pandemic," focuses on the status of telehealth in primary care during the pandemic, how policy surrounding it could change after the public health emergency, and how AAFP members can take advantage of the toolkit. The Virtual Town Hall begins at 7 p.m. CT on Sept. 9 and will be available to view later. The activity is approved for one AAFP Prescribed credit.

"Even though telehealth at your practice may well have started out of necessity in an unprecedented emergency, the path from here is more likely to be evolutionary," reads the toolkit. "Developing and implementing a telehealth strategy requires an understanding of the regulatory environment and skills to make it work in your practice."

To guide members there, the toolkit includes a comprehensive review of telehealth services and payment, an outline of key considerations for family medicine practices seeking to make telehealth services sustainable and a series of family medicine telehealth "scenarios."

The 54-page document was prepared in collaboration with the consultancy Manatt Health.

Story Highlights

Leading the virtual event are Steven Waldren, M.D., M.S., the AAFP's chief medical informatics officer; Steve North, M.D., M.P.H., a family physician and the Rural Telehealth Research Fellow at the University of North Carolina’s Sheps Center for Health Services Research; AAFP President Gary LeRoy, M.D., of Dayton, Ohio; and Julie Wood, M.D., M.P.H., the Academy's senior vice president for Health of the Public, Science and Interprofessional Activities.

A recent complementary publication charts the swiftness of telehealth's evolutionary steps this year -- and examines how the broader statutory and regulatory care climate must also adapt as well as the ways in which program quality and integrity must be solidified.

The Health IT Leadership Roundtable's white paper, "The New Normal of Care Delivery: How COVID-19 Accelerated the Adoption and Use of Virtual Care and What’s Next," emerged from a July discussion -- conducted, naturally, online -- among health care and payment stakeholders, including the AAFP.

The 15-page paper places telehealth within a broader rubric, with virtual care also encompassing "remote monitoring, behavioral nudges, e-triage and data-informed clinical decision making," and provides a concise timeline of federal actions taken since March to broaden access to such care. Setting that scene, it rounds up several studies and surveys that quantify the startling surge of virtual care this year, including

a FAIR Health regional tracking report showing that telehealth utilization increased by more than 8,300% from April 2019 to April 2020, with a corresponding rise from 0.15% to 13% of commercial claims;
a McKinsey study indicating that patient adoption of telehealth went from 11% of Americans in 2019 to 46% in 2020; and
this June's widely reported claim by CMS Administrator Seema Verma, M.P.H., that Medicare virtual visits went from fewer than 12,000 a week in early March to about 1 million per week in mid-April.

Barriers remain, however, with age and income marking the places where patient outreach and education are needed, according to the paper. It cites a Black Book Research and Sage Growth Partners survey, which found that, despite broad patient satisfaction with telehealth, 81% of respondents ages 55 to 64, and 84% of respondents over age 65, said they had not made a virtual or telehealth visit. Meanwhile, 36% of people with annual income below $25,000 have access to telehealth, compared to 70% of those earning above $100,000, according to the same survey.

To push back against these and other obstacles, the paper includes a list of key steps. Taken together, the authors write, these measures "would collectively serve to improve access, efficiency and flexibility for virtual care while maintaining strong patient trust in the 'new normal' of care delivery." They include

additional investments in broadband services across the country, along with "funding for clinicians to invest in virtual care tools";
congressionally directed additional funding to the Federal Communications Commission and the Health Resources and Services Administration to expand the reach of and eligibility for the Rural Health Care Program, the Telehealth Network and Telehealth Resource Centers, and the Telehealth Network Grant Program;
permanent elimination of statutory barriers to the use of virtual care in the Medicare fee-for-service program, including site restrictions, modality restrictions and supervisory requirements;
targeted outreach and education campaigns, funded in part and promoted by HHS, to help patients understand virtual care;
research on how best to measure patient experience with virtual care; and
a data privacy structure, established by Congress, ensuring that health data are protected regardless of applicability of the Health Insurance Portability and Accountability Act.

The paper also calls for practices to gather new metrics. "Developing a comprehensive and integrated way to assess quality and performance of care delivered virtually will be a key in improving health outcomes and ensuring appropriate care," it notes.

"As a first step, in June 2020, the National Committee for Quality Assurance announced approval of a set of adjustments to 40 widely used Healthcare Effectiveness Data and Information Set measures to account for telehealth services." NCQA, the Alliance for Connected Care and the American Telemedicine Association, the report adds, also recently convened a workgroup and issued a request for information to develop strong recommendations for policymakers on expanding virtual care.

Besides the Academy, the roundtable included the Alliance for Connected Care, the American College of Physicians, the American Health Information Management Association, the American Heart Association, the American Hospital Association, the American Medical Informatics Association, the Blue Cross Blue Shield Association, the College of Healthcare Information Management Executives, the Consumer Technology Association, the Federation of American Hospitals, the National Partnership for Women & Families, and the Premier Healthcare Alliance.