Teladoc said fourth-quarter revenue increased 15% year-over-year to $637.71 million, which beat average analyst estimates of $633.65 million, according to Benzinga Pro. The company reported quarterly earnings of $23.49 per share due to non-cash goodwill impairment charges of $23.26 per share.
Excluding the impairment charge, Teladoc’s net loss came in at 23 cents per share versus consensus estimates for a loss of 25 cents per share.
“Despite a challenging macro environment, we were able to expand our product offerings and enhance the level of care delivered across our integrated whole-person platform,” said Jason Gorevic, CEO of Teladoc Health.
All in all it was a bit of OMG kneejerk headline for basically pretty good news. Teladoc has been around 30 for stock share price (after hitting 34 in early Feb) and the loss knocked it down 10% to 25. It has recovered since back to 27.43 on 2/23
Teladoc Health reported a historic net loss in 2022 of $13.7 billion off revenue of $2.4 billion, mostly from an impairment charge related to the shrinking value of its Livongo acquisition. By comparison, the virtual care company reported a loss of $429 million in 2021.
The non-cash goodwill impairment charge of $13.4 billion reported over the past year reflects the waning market value of Teladoc’s $18.5 billion acquisition of chronic care company Livongo in late 2020. The impairment charge doesn’t impact the company’s financial position or its ability to invest in the business going forward, CFO Mala Murphy said on a call with investors Wednesday.
The New York-based telemedicine vendor beat Wall Street expectations for revenue but missed on earnings in fourth-quarter earnings released aftermarket Wednesday. Teladoc also issued 2023 guidance below analyst consensus, causing stock to slide in morning trading Thursday.
The Los Angeles County Office of Education (LACOE), in partnership with L.A. Care Health Plan, Health Net, their plan partners, and the Los Angeles County Department of Mental Health, will make mental telehealth services available to over one million K-12 public school students at no cost to families through Hazel Health. L.A. Care Health Plan and Health Net are allocating up to $24 million over two years to cover the new service.
LOS ANGELES, FEBRUARY 2—TheLos Angeles County Office of Education (LACOE), through a historic partnership withL.A. Care Health Plan,Health Net, and theL.A. County Department of Mental Health (LACDMH), is poised to offer access to mental health services for L.A. County’s 1.3 million K-12 public school students. The partnership with school-based telehealth companyHazel Health will use virtual care to deliver mental health support for all students, resulting in shorter wait times to connect with qualified therapists, and enabling earlier intervention.
To help make mental healthcare more accessible for students, all Local Education Agencies (LEAs) in the county may opt-in to participate in the Hazel Health virtual mental health program. LEAs, such as Los Angeles Unified School District (LAUSD) and Compton Unified School District, have already made the decision to leverage this service. L.A. Care Health Plan and Health Net are allocating up to $24 million to cover the services for all LEAs over two years. Funding is made possible by theDepartment of Health Care Services’ Student Behavioral Health Incentive Program (SBHIP), authorized by Governor Gavin Newsom.
“This historic partnership will bring much-needed mental health support to our students across the county,” Los Angeles County Superintendent of Schools Dr. Debra Duardo said. “We continue to see the devastating impact the pandemic has had on our children’s mental well-being. This crisis has called us to collective action. As a mental health professional, I am keenly aware that partnerships and collaboration across sectors are necessary to meet our children’s needs. We must remove barriers to access and continue our efforts to destigmatize help-seeking around mental health. We must also recognize that physical and mental health is crucial to teaching and learning. I look forward to continuing this critical work with our partners as we strive to improve educational and life outcomes for all children.”
“With unprecedented levels of trauma and stressors facing our students, the need for timely and effective mental health support has never been greater,” Los Angeles Unified Superintendent Alberto M. Carvalho said. “The groundbreaking solutions in virtual care made possible by our partnership with Los Angeles County will dramatically increase our support capacity, ensuring all students are ready for the world.”
“We are excited about this endeavor and honored to have such trusted partners join us in our efforts to ensure students receive every support possible on their education journey. Providing access to quality, responsive mental health services is not only important for their academic success, it is also our moral imperative,” said Compton Unified School District Superintendent Dr. Darin Brawley.
According to the 2022 California Health Care Almanac, 1 in 14 children has an emotional disturbance that limits functioning in family, school, or community activities. And according to the California Master Plan for Kids’ Public Health, over 284,000 youth cope with major depression, and 66 percent of youth with depression do not receive treatment. Alarmingly, suicide rates for kids age 10-18 increased 20 percent between 2019-2020.
“Even before COVID-19, the incidence of adolescent depression, suicidal ideation, and emergency room visits was on the rise, and mental health resources have not kept pace with rising levels of student distress, depression, and traumatic experiences,” said John Baackes, L.A. Care CEO. “L.A. Care saw an opportunity to support the mental health needs of members and students by leveraging telehealth to improve access to prompt evaluation and treatment. We believe this initiative will provide an accessible, expandable, and sustainable model to bring mental health treatment to students across L.A. County.”
“This significant expansion further demonstrates our commitment to the residents of Los Angeles County,” said Brian Ternan, President and CEO of Health Net. “Helping more children is why we partner with agencies like the Los Angeles County Office of Education, and local school districts, who dedicate every day to the health and wellbeing of California’s next generation of leaders. These efforts to bring mental health support to youth builds on our previous work with Hazel Health to increase their presence throughout California. This partnership is another large step in the journey to advancing health equity for the state’s most vulnerable residents.”
Timely care is essential for early intervention and prevention. Hazel’s virtual mental health platform allows California-licensed therapists across the U.S. to support students conveniently in school and at home. The partners are committed to connecting students to therapists who reflect and understand diverse populations. More than 60 percent of Hazel Health therapists identify as people of color, and more than 30 percent are bilingual. This commitment to culturally competent care is unique among service providers and reflects the LEAs’ commitment to equity and inclusion.
“Los Angeles County and its partners are rallying together to respond to the growing needs of our youth and the mental health crisis they face. Now, more than ever, the LACDMH believes that providing timely, comprehensive, and culturally responsive care to our community members requires a multi-pronged approach,” said Dr. Lisa H. Wong, Interim Director for LACDMH. “As such, L.A. County has led the efforts to expand services for youth through Hazel Health, providing access to virtual mental health services in partnership with schools. Hazel Health will provide students with less intensive mental health services, allowing LACDMH providers increased capacity to deliver intensive services to our most vulnerable youth.”
“Providing access to early intervention services, systematically, at this scale has the potential to change the trajectory for students struggling with mental health across L.A. County,” said Josh Golomb, Chief Executive Officer at Hazel Health. “This model provides more equitable access to care at an unprecedented rate for students from families who may otherwise not benefit from it and can truly change lives.”
The program will deploy in a phased approach for all L.A. County LEAs that choose to opt-in to the program. District leaders can learn about the implementation process and next steps through information sessions hosted by LACOE and Hazel Health in late January and February.
The program with Hazel puts forth a new model of what collaboration between public, private, and community stakeholders makes possible.
About The Los Angeles County Office of Education (LACOE)
The Los Angeles County Office of Education, based in Downey, is the nation’s largest regional education agency, providing a range of services and programs to support the region’s 80 school districts and some two million preschool and school-age children. To learn more about LACOE, visit www.lacoe.edu.
About Compton Unified School District
Compton Unified School District, whose Superintendent is Dr. Darin Brawley, is located in the south-central region of Los Angeles County. CUSD encompasses the city of Compton and portions of the cities of Carson and Los Angeles. The district currently serves over 18,000 students at 36 sites. CUSD is a district that is elevating, with a high school graduation rate nearing 90%, dramatic facilities improvements, increasing college acceptance rates and a focus on STEAM throughout all schools. The mission of the Compton Unified School District is to empower leaders to lead, teachers to teach and students to learn by fostering an environment that encourages leaders and teachers to be visionary, innovative and accountable for the achievement of all students. CUSD schools have received numerous awards, including Golden Bell Awards, Blue Ribbon School designations, and Top 10 LA Public Schools by Innovate LA. The District’s middle college, Compton Early College High School was recently ranked 32nd in California by U.S. News and World Report, and has had a 100% graduation and 100% college acceptance rate for every graduating senior class since its opening. CUSD is also a member of the League of Innovative Schools. For more information, visit http://www.compton.k12.ca.us.
About The Los Angeles County Department of Mental Health (LACDMH)
As the nation’s largest public mental health department, we ensure access to care and treatment for our most vulnerable residents in a region with more than 10 million people. With an annual budget approaching $3B and a committed staff of 6,000, LACDMH embodies a “heart-forward” approach to supporting hope, recovery and wellbeing across the County. For more information, visit dmh.lacounty.gov or follow @LACDMH on Facebook, Twitter, Instagram, and YouTube.
About L.A. Care Health Plan
L.A. Care Health Plan serves more than 2.7 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. As a public entity, L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on Twitter, Facebook, LinkedIn and Instagram.
About Health Net
At Health Net, we believe every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Founded in California more than 40 years ago, we’re dedicated to
transforming the health of our community, one person at a time. Today, Health Net’s 2,600 employees and 90,000 network providers serve 3 million members. That’s nearly 1 in 12 Californians. We provide health plans for individuals, families, businesses of every size and people who qualify for Medi-Cal or Medicare — Coverage for Every Stage of Life™. Health Net also offers access to substance abuse programs, behavioral health services, employee assistance programs and managed health care products related to prescription drugs. We offer these health plans and services through Health Net, LLC and its subsidiaries: Health Net of California, Inc., Health Net Life Insurance Company and Health Net Community Solutions, Inc. These entities are wholly owned subsidiaries of Centene Corporation (NYSE: CNC), a Fortune 25 company that offers affordable and high-quality products to nearly 1 in 15 individuals across the nation. For more information, visit www.HealthNet.com.
About Hazel Health
Hazel Health is the national leader in school-based telehealth, contracted to provide services to nearly three million students in over a hundred school districts across fourteen states, consistently delivering successful outcomes for access and quality of care. Hazel partners with school districts and more than fifty health plans to provide mental and physical health care services to K-12 students where they are–at school or home. Hazel’s diverse, culturally competent providers work with parents and school staff to make the best care decisions for students. Hazel Health’s mission is to transform children’s access to health care, intervening earlier to help fuel better learning and health outcomes to create thriving communities. www.Hazel.co.
Electronics giant Samsung has been expanding its reach in healthcare with mobile devices and hardware for hospitals, home health and remote patient monitoring. (Samsung and HealthTap) — Noted on FierceHealthcare 10/20/2022 —
In Brief Summary
Uses built-in camera on Smart TV
Consumers can review doctor bios, credentials and video interviews to select a doctor and easily schedule an appointment, often within the same week.
The electronics company also has been eyeing big business opportunities to leverage its technologies to help aging seniors live healthy at home.
“We’re in the home with mobile devices, TVs and appliances, and we see the collision of healthcare happening in the home,” Hon Pak, M.D., chief medical officer at Samsung Electronics, said at the SXSW 2022 conference this year.
grants VA health care providers the ability to provide telehealth services within their scope of practice, functional statement, and/or in accordance with privileges granted to them by VA, in any location, within any State, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located.
VA-contracted health care professionals remain excluded from the definition of health care professional.
Verbal consent – propose to add a new rule, which would provide another example of a situation where a State license, registration, certification, or other State requirement may be inconsistent or conflict with VA policy. One example would be where a beneficiary has not provided VA with a signed written consent in order to receive health care via telehealth. This example is added because some States do not allow a health care professional to provide telehealth services to a beneficiary unless the beneficiary has signed a written consent form. VA regulations only require verbal consent for the provision of telehealth. Requiring signature consent would disadvantage beneficiaries who do not possess the technology or digital skills to complete a remote signature consent prior to their telehealth visits. This provision would allow for the provision of health care services via telehealth.
An unpublished Proposed Rule by the Veterans Affairs Departmenton 08/23/2022. This document is unpublished. It is scheduled to be published on 08/23/2022. Once it is published it will be available on this page in an official form. Until then, you can download the unpublished PDF version.
SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its medical regulations that govern the VA health care professionals who practice health care via telehealth. This proposed rule would implement the authorities of the VA MISSION Act of 2018 and the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021.
DATES: Comments must be received on or before [INSERT DATE 60 DAYS AFTER THE DATE OF PUBLICATION IN THE FEDERAL REGISTER].
ADDRESSES: Comments may be submitted through www.Regulations.gov. Comments should indicate that they are submitted in response to [“RIN 2900-AQ59 – Health Care Professionals Practicing Via Telehealth.”] Comments received will be
available at regulations.gov for public viewing, inspection or copies.
FOR FURTHER INFORMATION CONTACT: Kevin Galpin, MD, Executive Director Telehealth Services, Veterans Health Administration Office of Connected Care, 810 Vermont Avenue, N.W., Washington, D.C. 20420. (404) 771-8794. (This is not a tollfree number.) [email protected]
As we commemorate the 32nd anniversary of the Americans with Disabilities Act (ADA), the Justice Department and the Department of Health and Human Services (HHS) are partnering to publish guidance on the protections in federal nondiscrimination laws, including the ADA, Section 504 of the Rehabilitation Act of 1973, Title VI of the Civil Rights Act of 1964 and Section 1557 of the Patient Protection and Affordable Care Act, requiring that telehealth be accessible to people with disabilities and limited English proficient persons. These laws work in tandem to prohibit discrimination and protect access to health care. The guidance is available here on the Justice Department website. The guidance is also available here on the HHS website.
“Telehealth has become an evolving and common pathway for accessing healthcare, particularly as our society becomes increasingly digitized,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “It is critical to ensure that telehealth care is accessible to all, including patients with disabilities, those with limited English proficiency and people of all races and national origins. Federal civil rights laws protect patients from discrimination regardless of whether they are receiving health care online or at the doctor’s office. The Department of Justice will vigorously enforce the ADA and other civil rights laws to ensure that health care providers offering telehealth services are doing so free from discrimination.”
“We have seen important expansions in health care technologies, such as telehealth, that provide great convenience and help for people seeking care,” said Acting Director Melanie Fontes Rainer of HHS’s Office for Civil Rights. “This guidance makes clear that there is a legal obligation to ensure that all people receive full access to needed health care and can connect to telehealth services, free of discriminatory barriers. While we celebrate the progress of the ADA, we know how important it remains to uphold the rights of people with disabilities and other protected individuals to make our country accessible and inclusive for all. That work has been a priority of this Administration from day one, and President Biden’s Executive Order on advancing equity explicitly includes people with disabilities in its call for comprehensive action.”
Technological developments and the COVID-19 public health emergency have increased the importance of providing telehealth and greatly expanded its use. Telehealth can take many forms, including communication between a patient and a health care provider via video, phone or other electronic means. While telehealth has many benefits, including making health care more available and convenient, certain populations may face discrimination or other barriers in accessing care provided via telehealth. For example:
A person who is blind or has limited vision may find that the web-based platform their doctor uses for telehealth appointments does not support screen reader software.
A person who is deaf and communicates with a sign language interpreter may find that the video conferencing program their provider uses does not allow an interpreter to join the appointment from a separate location.
A limited English proficient person may need instructions in a language other than English about how to set up a telehealth appointment.
The HHS Office for Civil Rights and Justice Department’s Civil Rights Division have collaborated to provide this new guidance to help health care providers better understand their nondiscrimination obligations and patients better understand their rights under federal law in this area. The guidance provides examples of actions that may be discriminatory and describes steps that providers may need to take to ensure that health care offered via telehealth is accessible. The guidance also provides a list of resources that providers and patients may wish to consult for additional information about telehealth and civil rights protections.
If you believe that you or someone else has been discriminated against because of your race, color, national origin, disability, age, sex or religion in programs or activities that HHS directly operates or to which HHS provides federal financial assistance, you may file a complaint with the HHS Office for Civil Rights at: https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.
Ways that telehealth providers are reacting to the SCOTUS ruling. Full Article from FierceHealthcare
deploying fleet of mobile clinics at borders of states
consultation and secure delivery of medications
eventually mobile clinic-based procedural abortion
Will serve those over 11 weeks (not eligible for medication)
Medication abortions account for more than 50% of abortions
FDA approved in first 10 weeks
Expect legal challenge by red states to FDA
Moving forward, states trying to crack down on access to abortion services will focus on pharmaceutical companies and groups providing virtual abortions, Sue Swayze Liebel, state policy director for anti-abortion rights group Susan B. Anthony List, told Politico.
But states will face significant enforcement challenges in attempts to restrict patients’ access to medication abortions, experts say. And it’s an issue that will likely be litigated in court.
With the rise of telehealth and self-managed abortions, enforcement of state abortion laws may shift away from providers to focus on patients who seek abortions and people who aid them, some experts say.
Telehealth services filled crucial medical care gaps during the COVID-19 pandemic and will appropriately remain an important part of the health care system going forward. Telehealth services can increase access to timely and effective care, and, in some cases, improve the efficiency and quality of the health care system.
However, it is important that telehealth policy be designed and implemented carefully to avoid increases in utilization, misaligned provider payment incentives, fraud, and abuse.
For the first time in India, a telemedicine centre based entirely on Teladoc technology was inaugurated by Minister for Health and Family Welfare Ma. Subramaniam at the Meenakshi Mission Hospital and Research Centre (MMRCH) here on Sunday. [Kiosk by Olea Kiosks]
During the pandemic telehealth largely acted as a substitute for traditional care.1Yet, the pandemic experience is not representative of a future where telehealth is more fully integrated into patient practice and provider business models. The United States has a uniquely poor track record when it comes to effective health care at low cost and new technologies often burden our system with rising costs.
Though telehealth has the potential to reduce some health care expenditures, both the Congressional Budget Office (CBO) and the Government Accountability Office (GAO) project that increased use of telehealth will add to overall health care costs.2
Based on a recent CBO score of a five-month extension of pandemic authorities, permanent expansion could cost Medicare alone $25 billion over ten years, even without expanded use.3As telehealth use grows, there is the potential for even greater costs in both federal health care programs and the private sector.
With policymakers rapidly approaching a decision point on the direction of telehealth policy, it is important that they take time to fully understand the health and fiscal implications of adding telehealth services to our menu of care. Rather than make permanent decisions in the coming months, any extension of telehealth authorities should have proper guardrails, checkpoints to allow for data analysis and learning, and a way to align incentives for better and less expensive care.
Much has been written on the merits and promises of telehealth.4The purpose of this paper is to outline key health care costs and federal budget challenges that should be considered when developing long-term regulations surrounding telehealth.
The State of Play for Telehealth Coverage
Prior to the COVID-19 pandemic, Medicare coverage of telehealth was very limited. Reimbursement for telehealth services was only covered for those living in rural areas with more limited access to nearby providers, and beneficiaries wishing to utilize those services were required to travel to a designated medical facility.5Private health insurance and Medicaid coverage was also limited, following Medicare’s lead, and often varied from state to state. In January 2020, less than 1 percent of medical services in the United States were provided through telehealth.6
In response to the pandemic, Congress gave the Department of Health and Human Services (HHS) the authority to waive restrictions on Medicare telehealth coverage for the duration of the officially declared Public Health Emergency (PHE). This new authority allowed anyone to receive services in their home, using a wide variety of audio-video technology with the option for audio-only care. It also allowed patients to see new providers rather than being required to have a preexisting relationship before permitting telehealth visits. The private sector followed Medicare’s telehealth expansion, increasing patient access and helping providers stay in business.7
In response, overall telehealth claims rose from less than 1 percent of all claims before the pandemic to a peak of 13 percent in April 2020, settling at below 5 percent after that.8Medicare telehealth usage followed a similar trajectory to overall claims.9
Telehealth waivers have been repeatedly extended along with extensions of the PHE, which can be renewed every 90 days by the HHS secretary. The most recent extension from April 16, 2022, will be in effect until July 15, 2022. Additionally, the Fiscal Year (FY) 2022 omnibus appropriations bill (signed on March 15) allows for the telehealth waivers to extend 151 daysafter the PHE ends.
The omnibus also requires the Medicare Payment Advisory Commission (MedPAC) and the HHS Office of the Inspector General to provide an analysis and recommendations on telehealth by the middle of 2023 covering the implications of expanded Medicare coverage; utilization of services; Medicare expenditures; Medicare payment policies; program integrity risks; recommendations on preventing waste, fraud, and abuse; and other relevant topics.10
Congress will ultimately need to determine the parameters for telehealth coverage in Medicare and Medicaid. This decision will also indirectly influence private insurance coverage decisions, although lawmakers might decide to legislate those directly. Some legislation will need to pass within five months of the end of the PHE in order to avoid a dramatic disruption in ongoing care, but there is no reason for that legislation to include permanent and blanket changes in policy. That is especially important because of the above-mentioned essential information from the mandated HHS and MedPAC reports.
The Cost Challenges of Telehealth
The promise of telehealth is that it can increase access to care. It can bring doctors to places they wouldn’t necessarily be, and it cuts out the requirement for patients to physically travel to an appointment. One study estimated that the time commitment inherent in these visits, along with the need to take off work, costs patients $89 billion a year in total lost time and wages.11 In some scenarios, expanded telehealth may also reduce direct health care costs: for example, allowing a patient to avoid a more costly trip to a doctor’s office.
However, telehealth is likely to increase health care costs overall, especially if policymakers don’t pay special attention and care to its design. With federal and overall health care costs continuing to grow faster than the economy, these cost increases should be of particular concern.
When thinking about the long-term direction for telehealth authorities, we suggest attention to the following challenges related to the federal budget, and to national health expenditures.
Utilization – telehealth services should ideally help reduce over-utilization of care, but could end up substantially increasing patient utilization of health care services.
Provider incentives – telehealth services should ideally help providers reduce the cost of care, but payment incentives might lead to more costly care – especially if telehealth services continue to be reimbursed at parity with in-person care.
Fraud and abuse – telehealth services are at particular risk for fraudulent billing.
Below, we discuss each of these challenges and the opportunities for policymakers to address them through caution and guardrails.
The Risk of Increases in Utilization
The easier it is to access a given health intervention, the higher utilization is likely to be. Conversely, increased friction through high deductibles or increased cost-sharing reduces utilization.12 Depending on the quality of care, higher utilization may improve, worsen, or have little effect on health outcomes; but it will nearly always result in higher costs.
Thus, it is very likely the case that an expansion of telehealth, by removing some of the friction from provider-patient interaction, will lead to increased utilization. This will be the case in the aggregate, despite there being some circumstances where a telehealth appointment might allow a patient to avoid a longer or more intensive interaction with the health care system.13
To be sure, there is evidence that telehealth during the pandemic primarily substituted for in-person care.14However, the circumstances were obviously unique, and that evidence is hardly generalizable to a future health care system where telehealth is more integrated into care and patients are used to relying on the easy access technology provides. One survey suggests three-quarters of patients anticipate continuing the use of telehealth for at least some of their care.15
Policymakers will need to manage the transition to telehealth to avoid excessive increases in utilization. Unfortunately, policymakers are often unwilling to follow through on restrictions.
An example from the pandemic is illustrative. The CARES Act allowed those in high-deductible plans tied to Health Savings Accounts to receive telehealth services without having to meet their deductibles – even though these deductibles are core to the benefit design of such plans (which are meant to control cost growth).16 Rather than allow this emergency measure to expire as intended at the end of 2021, Congress revived the waivers in the recent omnibus bill, extending them through the end of 2022.
Not only does this choice drive up overall utilization of care but adds unjustified incentives to specifically increase utilization of telehealth services, which are given a financial advantage over in-person care. Policymakers should avoid creating these perverse incentives when designing a new telehealth regime.
The Problem of Payment Incentives and Payment Parity
The decisions providers make as telehealth expands have important implications for growing health care costs. In the United States’ health care system, doctors and hospitals have substantial influence on the volume, intensity, and price of care – more so than patients do in most cases.17
Avoiding dramatic increases in provider-led utilization will be especially important in government programs like Medicare, which have few mechanisms for managing care. Already, utilization in fee-for-service Medicare is slated to grow nearly 4 percent per year through 2030 when adjusted for demographics.18
To avoid further driving up health care costs, an expansion of telehealth would ideally occur only within the context of a shift away from fee-for-service payment to alternative payment models like Accountable Care Organizations. Such value-based payment (VBP) approaches could be an opportunity to maximize the opportunities of telehealth without substantially increasing spending.19 VBP could also create guardrails for providers to promote quality care through telehealth in a manner that is good for patients’ health while protecting Medicare from a payment system that promotes volume in the maximization of profits.
The goal is to avoid falling into the trap of misaligned provider payment incentives that increase provider revenue and increase national health expenditures, on top of the system-wide problems inherent in fee-for-service payment20 and provider pricing power.21
Examples explored by our Health Savers Initiative, like site-of-service-based payment, Part B drug ad-on fees that promote higher-priced drugs, and insurance plan gaming of risk adjustment in Medicare Advantage all demonstrate the same design flaw. Payment policies legislated to achieve worthwhile goals created misaligned incentives, yet the ability of the executive branch to re-align incentives was limited by that legislation, and Congress became hesitant to revisit the policies because the interest groups profiting from the incentives lobby them to avoid changes.
Thus, getting incentives right for telehealth, and, perhaps, more importantly creating the means or action-forcing ability to review them regularly, will be crucial to limiting any negative fiscal impact. As providers have the time to create new telehealth business models and build technological capacity, provider payment incentives should bend providers towards value, substitution, and quality.
It is especially important that policymakers resist calls for mandating permanent payment parity, where telehealth visits are paid at the same rate as in-office visits. Doing so would drive up overall health care costs, undermine any potential telehealth might have to reduce costs in select circumstances, and be highly problematic for the goal of appropriately aligning incentives.
Parity is problematic because just like on the patient side, telehealth is a form of care that should have less friction for the provider. Theoretically, the time spent by a provider interacting with a patient during a telehealth appointment might be similar to an in-person visit. However, there are numerous other ways in which telehealth can be less burdensome on a provider’s time and resources.22And, as groups of providers utilize telehealth more, there will be opportunities to get paid for shorter, follow-up interactions – some of which might be happening in the current system without payments attached.
The physician fee schedule in Medicare already accounts for the overhead costs to providers. So, separating payments as telehealth expands can still consider the costs of maintaining telehealth technology while incorporating any overhead savings.
The Special Case Of Mental Health Coverage
There are unique advantages to using telehealth as part of mental health care due to the general ability for such care to be provided virtually, along with the regular and frequent cadence of care being integral to a patient’s care plan. However, there are important considerations for when a care plan might require in-person patient-physician interactions.
For instance, some conditions related to mental health care can best or only be diagnosed through in-person contact.23Also, the pandemic experience has shown that those with the most serious mental health issues tend to use telehealth visits at a lower rate than in-person care.24
The specific opportunities and challenges for tele-mental health, along with the increases in mental health demands due to the pandemic, have already led policymakers to create a slightly different set of rules. In 2021, lawmakers permanently authorized tele-mental health services to be provided in the home, though only after prior in-person interaction, and then in conjunction with in-person visits.25These requirements, supported by MedPAC, are meant to provide safeguards against inappropriate use and prevent solicitation of unneeded mental health care.26
The President’s FY 2023 budget supports extending Medicare coverage of tele-mental health beyond the pandemic, along with numerous other mental health initiatives and investments. Some of these priorities include reducing barriers to care, ensuring coverage by private plans, and delivery across state lines.27The Senate Finance Committee also intends to propose mental health legislation over the summer.28 In March, the committee released a report on mental health care that dives into the impacts of the pandemic, what was done with respect to telehealth, the urban-rural divide, and disparities in access. It signaled support for both eliminating in-person visit requirements for mental health services and coverage of audio-only services.29
Lawmakers should follow CMS’s lead on guardrails and not rush to make permanent rules on issues still being studied. The renewed attention on the need for better mental health care and increasing access to care is an important development, with the caveat that the longer-term problem of practitioner scarcity is not solved by such increases in access.
Having as much data for policymakers as possible will be essential before they rush to change the current rules and guardrails. They need to understand who uses tele-mental health care and when in-person visits are crucial for quality care, along with the results from studying new audio-only service-level modifiers to determine how audio-only mental health impacts quality, access, and utilization. As with other types of care, it is also important to consider utilization, provider incentives, and risks of fraud and abuse – which can drive up costs without improving quality.
New Opportunities for Fraud and Abuse
With new avenues for care come more opportunities for fraud and abuse.30 Since telehealth’s entrance into the health care market, overall recoveries in health care fraud have doubled from $2.6 billion in FY 2019 to over $5 billion in FY 2021.31
According to the American Bar Association, potential problems include up-coding time and complexity; misrepresenting the virtual services being provide; billing for services not rendered; and kickback schemes that spread profit from unnecessary tests, medications, and equipment.32
While there are existing statutes making these acts unlawful, there must be guardrails in place to make misuse more difficult and easier to discover. MedPAC has already suggested some ways to accomplish this, such as additional scrutiny to outlier clinicians who bill many more telehealth services per beneficiary than other clinicians and prohibiting “incident-to” billing for telehealth services provided by any clinician who can bill Medicare directly.33
MedPAC holds additional concerns with the Centers for Medicare and Medicaid Services (CMS) allowing clinicians to provide direct supervision through audio-only telehealth, which was originally put into place to limit COVID-19 exposure. The concerns are not only that it could limit quality and increase spending, but also that it may impose a safety risk because with one clinician supervising many individuals in different locations, there is an increased difficulty in addressing urgent needs.34This rule remains in effect until the end of the year that the PHE ends.35
Permanent coverage for audio-only communication needs to also have limitations to ensure that it can serve as a benefit for those without access to video or in-person care, without allowing provider preference or skimping to perpetuate inequities or gaming.36
Another concern with audio-only telehealth is its use in determining Medicare Advantage diagnostic risk scores. Those scores are already subject to gaming and have led to vast plan overpayment.37 The HHS Office of the Inspector General has found that in-home Health Risk Assessments are problematic as a locus for coding intensity and MedPAC has suggested that diagnosis from these visits be excluded from risk scores.38 Permitting diagnoses from audio-only interactions would clearly amplify the gaming problem.
That is why a study of these communications, their evolution, and differences in care quality will be essential. One key step taken by CMS in its 2022 Payment Policies rule was to create an audio-only claims identifier to identify mental health services delivered through telehealth.39
There is also precedent for in-person requirements as a condition for reimbursement to reduce fraud. Such current requirements for home health services and durable medical equipment have resulted in $2 billion in savings to Medicare between 2010 to 2019.40
Health care, even beneficial care, is not free. Increases in costs are passed along to employees and Medicare beneficiaries in the form of higher premiums and to taxpayers through additional Medicare and Medicaid spending, higher insurance subsidies through the tax code, or more borrowing through the national debt.
How much telehealth expansion will cost the federal government must be taken seriously. In addition to waiting for the data and research to decide what permanent decisions to make on telehealth authorities, having circuit breakers in the process for re-evaluating will be important from both a regulatory standpoint and a fiscal one. A large and bipartisan group of lawmakers have advocated for a two-year extension of telehealth waivers.41 MedPAC has also suggested this time frame. This should be the maximum extension Congress considers, ideally including mental health in the more limited extensions.
Because telehealth as a mode of care is here to stay, the argument that authorities need to be made permanent in order to convince providers to invest in technology is not convincing.42 Instead, the occasional expiration of authorities will provide policymakers the opportunity to review research into telehealth’s impact on health care costs. That way, it will be possible to pair extensions with other health care cost reductions. There are numerous ways to control health care costs and using the opportunity of expanding benefits is a natural opportunity to enact cost controls.
Telehealth has become an essential tool for the delivery of health care services for millions of Americans. Congress should take the time to develop comprehensive and sound legislation that would improve accessibility, but provide proper safeguards that protect patients and federal spending levels. It is ideal for short-term legislation to include components to ensure fraud protection, include studies to gather the impact telehealth has made on health care access and delivery, and give Congress time to further debate the issues.
You can now use Amazon Echo to ask to speak to a Doctor
Connects you to Teladoc Call Center
Teladoc doctor calls
Latest features of Amazon Care include elder care coordination and medication management
First “on-demand” medical care
“Teladoc Health’s collaboration with Amazon is yet another step in breaking down barriers to healthcare access,” said Donna Boyer, chief product officer at Teladoc, in a statement. “By introducing and integrating our virtual-first care experience with Echo devices, we are providing an innovative and convenient way for users to connect with a doctor. We are meeting consumers where they are to continue to deliver value and high-quality care to members.”
Amazon expanded its Alexa-related healthcare efforts last year with additions both for hospitals and individual consumers.
Hospitals like Boston Children’s, Cedars-Sinai, BayCare and Houston Methodist signed on last fall to add Alexa to some facilities to allow patients easy access to care team members and to their families.
Let’s Talk Interactive, a leading provider of customizable telehealth solutions, has provided more than 160 schools, colleges and education organizations across Florida and throughout the U.S. with technology that connects students with physicians, counselors and other healthcare providers.
As School-Based Health Care Awareness Month continues, Let’s Talk Interactive has developed systems that proactively identify at-risk students and link them to support services that address their needs. In some regions, a custom case management portal helps track students throughout their treatment and ensures the necessary roles–from parents, to providers and administrators–are notified throughout the program.
These support services are needed more than ever. Studies by the U.S. Department of Health and Human Services show that the COVID-19 pandemic greatly increased rates of mental health issues in children and teenagers and amplified the need for counseling and support services.
Children diagnosed with the illness were nearly 30% more likely to develop a mental health condition, increasing the need for schools to provide counseling assistance, the agency found. Another federal study found emergency room visits in 2020 for mental health rose 24 percent among children and more than 30 percent for teenagers.
“At a time when we are more focused on than ever physical and mental needs of children, Let’s Talk Interactive is building on its track record of helping schools give students the healthcare access they need,” said Arthur Cooksey, founder and CEO of Let’s Talk Interactive.
In the wake of Hurricane Michael in 2020, Let’s Talk Interactive deployed telehealth kiosks and portals in schools in six counties in Florida’s Panhandle region. Working with regional health care organizations, Let’s Talk Interactive’s technology facilitated thousands of sessions for students who needed mental, acute and emergency care.
In 2021, Let’s Talk Interactive expanded that service with four more Panhandle counties, and Orange and Broward counties, two of Florida’s largest jurisdictions and expanded their school based services to other regions of the United States.
Let’s Talk Interactive’s telehealth platform fully complies with FERPA and HIPAA and provides licensed backup support network for school counselors and nurses, including speech and occupational therapists, licensed counselors and psychiatrists. To learn more about Let’s Talk Interactive, Inc., visit https://letstalkinteractive.com/.
WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA) and Tammy Baldwin (D-WI) today introduced the Health Data Use and Privacy Commission Act to begin the process of modernizing our outdated health privacy laws and regulations. The presence of technology companies is increasing in health care, and health information is expanding beyond the reach of The Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an over 25-year-old law that protects all interactions between patients and their doctors, but does not protect health data recorded on emerging technologies (cell phones, smart watches, etc.) which puts this data at significant potential risk.
This legislation forms a health and privacy commission to research and give official recommendation to Congress on how to modernize the use of health data and privacy laws to ensure patient privacy and trust while balancing the need of doctors to have information at their fingertips to provide care.
“As a doctor, the potential of new technology to improve patient care seems limitless. But Americans must be able to trust that their personal health data is protected if this technology can meet its full potential,” said Dr. Cassidy. “HIPAA must be updated for the modern day. This legislation starts this process on a pathway to make sure it is done right.”
“Folks across Wisconsin and the country are rightfully concerned about the security of their personal information, especially individual health care data, and it is time to give Americans better protection over these records,” said Senator Baldwin. “I am excited to introduce the bipartisan Health Data Use and Privacy Commission Act to help inform how we can modernize health care privacy laws and regulations to give Americans peace of mind that their personal health information is safe, while ensuring that we have the tools we need to advance high-quality care.”
This legislation is supported by American College of Cardiology, Association for Behavioral Health and Wellness, Association of Clinical Research Organizations, athenahealth, Inc, Epic Systems Corporation, Executives for Health Innovation, Federation of American Hospitals, Heath Innovation Alliance, IBM, National Multiple Sclerosis Society, Teladoc Health and United Spinal Association.
The Health Data Use and Privacy Commission Act would establish a commission to –
Conduct a coordinated and comprehensive review and comparison of existing protections of personal health information at the state and federal level, as well as current practices for health data use by the health care, insurance, financial services, consumer electronics, advertising, and other industries;
Provide recommendations to Congress on whether federal legislation is needed to modernize health data privacy, and if so, how to do it; and
Be charged with submitting a report to Congress and the President six months after all members are appointed, and include 17 members to be appointed by the Comptroller General.
Specifically, the Commission is charged with drafting recommendations and conclusions on the following:
The potential threats posed to individual health privacy and legitimate business and policy interests.
The purposes for which sharing health information is appropriate and beneficial to consumers and the threat to health outcomes and costs if privacy rules are too stringent.
The effectiveness of existing statutes, regulations, private sector self-regulatory efforts, technology advances, and market forces in protecting individual health privacy.
Recommendations on whether federal legislation is necessary, and if so, specific suggestions on proposals to reform, streamline, harmonize, unify, or augment current laws and regulations relating to individual health privacy, including reforms or additions to existing law related to enforcement, preemption, consent, penalties for misuse, transparency, and notice of privacy practices.
Analysis of whether additional regulations may impose costs or burdens, or cause unintended consequences in other policy areas, such as security, law enforcement, medical research, health care cost containment, improved patient outcomes, public health or critical infrastructure protection, and whether such costs or burdens are justified by the additional regulations or benefits to privacy, including whether such benefits may be achieved through less onerous means.
The cost analysis of legislative or regulatory changes proposed in the report.
Recommendations on non-legislative solutions to individual health privacy concerns, including education, market-based measures, industry best practices, and new technologies.
Review of the effectiveness and utility of third-party statements of privacy principles and private sector self-regulatory efforts, as well as third-party certification or accreditation programs meant to ensure compliance with privacy requirements.
February 9, 2022
Senator Bill Cassidy
520 Hart Senate Office Building
Washington, DC 20510
Senator Tammy Baldwin
709 Hart Senate Office Building
Washington, D.C. 20510
Dear Senators Cassidy and Baldwin,
We write to thank you for your leadership in introducing the Health Data Use and Privacyv Commission Act. The Commission established by this bill will make recommendations to Congress to help modernize health data use and privacy policies to ensure clear, consistent, and reliable patient protections while simultaneously ensuring health data gets where it needs to go to improve care and outcomes.
As the nation continues to adopt new and evolving technologies that surround everyday life and digitize nearly every interaction we have, personal privacy has never been a more important issue for policymakers. Congress is considering comprehensive privacy reform – and we support
these efforts – but most of these conversations are focused on consumer technology and data.
Health data is either carved out of these proposals or included in a new category of “consumer health data” which could lead to many entities being subject to duplicative requirements. The Health Insurance Portability and Accountability Act (HIPAA) law that led to today’s HIPAA Privacy Rule was passed over 25 years ago, and while HIPAA is still functioning well, it does not address the growing concerns regarding third-party applications or other technologies accessing health data that fall outside of HIPAA’s reach. Providers, health plans, and other covered entities and their business associates covered by the Privacy Rule as well as the patients they serve need clarity and consistency in health data privacy and use rules.
Given the advancements Congress has made in improving the interoperability of health care information and systems, your efforts to ensure robust consideration of health care data and privacy through the Health Data Use and Privacy Commission will provide useful perspective to the ongoing privacy debate. Secure and private health information should not be the enemy of medical innovation, clinical process improvement, or public health response. Careful consideration of these issues by the commission will inform policy makers to achieve the necessary balance of data liquidity and confidentiality necessary for a highly functional and trusted health system.
According to the International Association of Privacy Professionals (IAPP), “state-level momentum for comprehensive privacy bills is at an all-time high.”1 The patchwork of proposals across all 50 states could lead to further complexity and compliance burdens. According to the Information Technology and Innovation Foundation, should all 50 states pass privacy legislation in the absence of a federal law, compliance costs “could exceed $1 trillion over 10 years, with at least $200 billion hitting small businesses.”2 All of this stresses the need for a federal law governing data privacy, and there are at least 24 proposals related to data privacy before the 117th Congress according to the IAPP.3
As Congress considers privacy reform, your privacy commission will add much needed recommendations specific to the future of health information privacy and use. This issue is far too important to the functioning of our health care system and the trust of patients to get wrong,
and we appreciate your thoughtful legislation to help get these policies right. We look forward to working with you on passing the Health Data Use and Privacy Commission Act into law.
American College of Cardiology
Association for Behavioral Health and Wellness
Association of Clinical Research Organizations
Epic Systems Corporation
Executives for Health Innovation
Federation of American Hospitals
Heath Innovation Alliance
National Multiple Sclerosis Society
United Spinal Association