Hundreds of hospitals and health care centers from Washington state to Louisiana are expanding telehealth infrastructure thanks to $200 million that Congress appropriated for the Federal Communications Commission in emergency legislation.
In some cases, hospitals are supplementing the federal funds from the $2 trillion coronavirus relief law enacted in March with their own money to expand health care delivery through remote devices, cameras and software with patients remaining at home during the pandemic.
The combined government and private investment could make it incumbent upon Congress to permanently remove barriers to widespread use of telehealth even when the pandemic ends. Bipartisan legislation introduced in the House and the Senate already promises to do that and also provide more federal funding to boost infrastructure connecting patients and doctors.
In March, the Department of Health and Human Services waived restrictions as an emergency measure so that Medicare and Medicaid beneficiaries could consult with doctors remotely without having to travel to designated sites. Before that waiver, Medicare would pay for telehealth only when the person receiving the service was in a designated rural area and went to a designated location to get a telehealth consultation.
The emergency actions taken by the federal government and almost all state governments to expand telehealth need to start becoming permanent features of the U.S. health care system, said Kyle Zebley, director of public policy at ATA, an industry group that advocates for expanding telehealth.
Even after the pandemic emergency ends, "we think we should add certainty, we should add permanency to this growing industry to make sure that it continues to be there to provide care for the millions of Americans that have grown dependent upon it for good reason," Zebley said.
Physicians involved in implementing telehealth programs said although many hospitals and health care centers have handled patients remotely for years, the pandemic has shown not only the utility but also the effectiveness of telehealth.
The federal government’s easing of restrictions has "been absolutely critical on two fronts," said David Houghton, medical director for telehealth and digital medicine at Ochsner Health, a health care provider based outside New Orleans that serves patients throughout Louisiana and in neighboring Mississippi.
"One, to practically be able to take care of patients in their greatest time of need," Houghton said. "Secondly, it answered a lot of questions about quality and utilization and satisfaction" in using telehealth platforms.
The increased dependence on telehealth since the pandemic struck, Houghton added, "has pushed us forward leaps and bounds over a course of just several months to really demonstrate that this is a viable and feasible, and in some circumstances even improved, method to be able to take care of patients in an efficient manner."
Tracking the FCC funds
Ochsner Health is one of more than 500 hospitals, clinics and community health centers in 47 states plus the District of Columbia and Guam that would receive the $200 million from the FCC. Each facility would receive different levels based on need.
Ochsner is one of 21 hospitals that would get $1 million each. Hospitals in New York would receive the most funding, totaling about $32.5 million, followed by $10.5 million for health care facilities in Ohio and $9.95 million for hospitals in California.
The commission approved applications from health care facilities after reviewing detailed documentation that outlined how they intended to use the money to expand telehealth services, said Katie Gorscak, a spokeswoman for the FCC.
"After the health care provider purchases the devices or services, they are required to provide invoices to the FCC in order to claim the reimbursement, showing the services or devices they purchased, at what price, when and where it was delivered and used," Gorscak said.
Ochsner plans to use the FCC funds to expand telehealth in three areas, said Houghton and April Radford, vice president of telehealth at Ochsner.
About one-third of the money would go toward buying and distributing health monitoring devices made by TytoCare to patients, Radford said.
TytoCare, a company based in New York and Israel, makes a handheld exam device for home use along with an app that can help a parent, for example, examine a child’s ears and throat, listen to the lungs and send information to a physician, or conduct the exam under the guidance of a doctor.
Ochsner is placing such devices across its network of urgent care locations and community centers as well as places of worship where patients can access them to send information to doctors, Radford and Houghton said. The devices are being distributed to patients’ homes across Louisiana and Mississippi, especially in cases where there are multiple patients under one roof, they said.
Another one-third of the money would go toward buying and distributing Bluetooth-connected blood pressure monitors and glucometers, which assess a patient’s blood sugar levels, they said. Ochsner plans to equip about 1,000 patients, particularly those dependent on Medicaid, "to allow them to have additional access for management of their chronic diseases," Houghton said.
The remainder of the funds would go toward a digital medicine platform called "connected mom," to help pregnant women track their health without having to show up at clinics for routine monitoring, Houghton said. Data from such monitoring devices is combined with artificial intelligence-based programs that offer advice to women on how to better care for themselves, he said.
Ochsner already had been investing on its own to expand telehealth, and the FCC funding would supplementthat investment, Houghton said.
Addressing problematic software
In some instances, health care facilities plan to use part of the FCC funding to build a software platform that combines telehealth tools and patients’ electronic health records, as in the case of Wright Center for Community Health in Scranton, Pennsylvania.
The Wright Center, which has been approved for nearly $630,000 from the FCC, had been building the platform on its own for the past year, but progress was slow because telehealth consultations were not being reimbursed by the federal government and private insurers as well as in-person visits, said Jignesh Sheth, the chief medical officer for Wright Center.
In the absence of a single platform, doctors doing telehealth consultations had to “use two separate screens, one that has the video, one that has your chart, and the two systems don't talk to each other, which brings up the scheduling nightmare,” Sheth said.
Scheduling staff had to enter the same patient appointment on two different systems and make sure they were in sync, he said. Physicians also had to toggle between two systems while they had a patient on a video screen, causing more confusion and wasting doctors’ time, Sheth added.
The goal of building an all-in-one software platform is it "allows you to have a combination of video and in-person visits, all on one schedule, all in one electronic software, and all in one scheduling software," Sheth said.
Wright would also use part of the FCC funds to pay for software that tracks chronic patients, Sheth said. Instead of seeing a diabetic patient once every few months, a group of nurses track about 1,000 patients on a regular basis to monitor their intake of medicine and food as well as their blood sugar levels, he said.
A similar model is also being developed for tracking and monitoring patients undergoing behavioral health treatments or in managing their addictions, Sheth said. And a part of the FCC funds also would go toward blood pressure and sugar level monitors that would be distributed to patients, he said.
The convenience and ease of access that patients have come to expect from telehealth can’t be taken away once the coronavirus crisis ends, Sheth said.
"Going forward, the people are not going to give up the service, I think they'll be asking for it," Sheth said. Bringing back pre-COVID-19 restrictions on telehealth would be like giving "a kid a candy and then saying, I'm gonna take it back.'"