Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.
Telehealth Legislation Introduced
Members of the House Telehealth Caucus recently introduced bipartisan legislation to extend telehealth waivers permanently for Medicare patients, reported.
The would continue telehealth use beyond the COVID-19 public health emergency, making telemedicine more flexible and removing geographic restrictions to allow a patient's home to be an originating site.
In a blog, Seema Verma, MPH, administrator of the Centers for Medicare & Medicaid Services, weighed in: "As the health care system enters a new normal it is important to consider whether allowing people with particularly acute needs to be seen by a clinician for the first time via telemedicine, instead of in-person, will result in the best possible outcomes."
During COVID-19, Medicare has reimbursed providers the same rate for telehealth as in-person visits and it's unclear whether this will continue, HealthLeaders Media noted. The administration has just that allowed the waivers, which will now expire in October, according to Politico.
Through April, Medicare beneficiaries had 1.7 million telehealth visits. "That's plenty enough data now for the CBO [Congressional Budget Office] to be able to really, truly understand the impact ... as well as the potential cost savings or cost drivers," said Tom Leary, vice president of government affairs for Healthcare Information and Management Systems Society.
This bill includes most priorities outlined in a signed by the American Telemedicine Association and 340 national and regional organizations last month, which include ensuring that federally qualified health centers and rural health clinics can continue to offer virtual visits after the COVID-19 public health emergency and allowing the Department of Health and Human Services (HHS) to waive restrictions during future pandemics and disasters.
Case Study: Remote COVID Care
A program that integrated a dedicated team of 24/7 telemedicine clinicians with automated text message check-ins was able to monitor COVID-19 patients at home and quickly support those whose symptoms grew worse, a showed.
Outcomes from the first 3,000 patients invited to participate in the University of Pennsylvania Health System program showed that 83% of confirmed or suspected COVID-19 patients were managed by the automated program; only 17% escalated to needing clinical care, reported Anna Morgan, MD, MSc, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues.
COVID Watch included twice-daily text messages that triggered calls from telemedicine clinicians when needed.
On any given day, approximately 2% of patients escalated to a telemedicine nurse. Peak participation at any one time was about 1,000 patients; at that point, COVID Watch generated approximately 20 escalations daily, mostly during typical waking hours.
"Automated systems for patient care are likely to be more effective, and have more use cases, if paired with human care in the form of escalation or exception management," Morgan and co-authors wrote. "Vigilant evaluation is required for these programs starting out -- not just for new diseases like COVID-19, but because patient responses to clinical automation are not always anticipated."
Access for Aging Populations
Many older patients are unable to participate in telemedicine, (KHN) reported, but solutions are emerging.
When SCAN Health Plan, a California-based Medicare Advantage HMO, surveyed its most vulnerable members, it learned one-third didn't have access to technology needed for telehealth. Nearly 40% had vision issues that hindered their ability to use digital devices and 28% had a clinically significant hearing impairment. Language barriers also were a problem, said Eve Gelb, SCAN's senior vice president of health care services.
Likewise, in-home care company Landmark Health found that fewer than 25% of its patients had appropriate remote technology and knew how to use it, KHN noted. "Telehealth is not the panacea, especially for this population," said Nick Loporcaro, Landmark's CEO.
One solution is GrandPad, a tablet with apps designed for people 75 and older, KHN noted. These devices have been "remarkably successful" in facilitating video-streamed interactions and allowing nurses and social workers to address patient needs, said Roger Anderson, director of operational support and innovation of the PACE Southeast Michigan program for older adults.
"We need to target interventions to help these people," Gelb said. SCAN is considering sending community health workers into patients' homes to help them conduct virtual visits. Landmark is looking at what Loporcaro called "facilitated telehealth," in which nonmedical personnel would bring devices to patients' homes to manage telehealth appointments.
'As if He Were in the Operating Room'
An Italian surgeon successfully performed a delicate vocal cord procedure on a cadaver 15 km away using robotic technology and a 5G network, according to an report.
5G is a "critical enabling technology" for telesurgery, said Leonardo Mattos, PhD, of the Istituto Italiano di Tecnologia in Genoa, and co-authors. Telesurgery is not new, but its growth has been stymied by limited availability of surgical robots and a lack of fast, reliable network connections, they pointed out.
During the experiment, an expert otorhinolaryngologist used a teleoperated, surgical robotic system to expose the cadaver's vocal cords, then performed a type I cordectomy on the left vocal fold followed by a type IV cordectomy on the right vocal fold.
The surgeon had effective control of the robot, forceps, and laser to perform the procedures confidently, Mattos and colleagues said. The experience "allowed the surgeon to manipulate the cadaver's vocal cords as if he were in the operating room directly operating on a patient," they observed.
As technology and medicine rapidly evolve, 5G is set to play a critical role in not just telesurgery, but teleassistance and telementoring too, they added.