Telemedicine still little used for substance abuse treatment

With help from Darius Tahir and Mohana Ravindranath

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As unpaid bureaucrats and contractors shiver in the snowed-in capital ... A California health system reports encouraging signs using personal health records to solve the interoperability conundrum. But first:

Techies on fence about Medicaid block grant efficacy: In theory, leaner Medicaid spending could force efficiencies and enhance tech solutions. In theory...

Telemedicine should expand therapy for opioid treatment: Also in theory. But experts aren’t seeing much of an expansion of it yet.

U.S. Digital Service has an ambitious agenda at the VA: They’re largely staying out of the Cerner EHR implementation, but will help build a user interface for veterans to shield them from glitches in transition.

Tweet of the day: Graeme Moffat @graemedmoffat The number of people I’ve seen today hand over all of their genetic information — to a random company they know nothing about — is hilarious and unbelievable. [with photo from Consumer Electronics Shown in Vegas]

Welcome to Monday Morning eHealth, where magical thinking has us continuing to click on the OMB’s regulatory dashboard every afternoon to see if the CMS and ONC interoperability rules have miraculously disappeared and been sent back to HHS. Send ideas for ways out of this mess to [email protected]. Or engage on the Internets @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Techies skeptical of Trump administration Medicaid plans: The Trump administration is planning to bypass Congress with a scheme to provide block grants for states to spend on Medicaid, Pro’s Rachana Pradhan and Dan Diamond are reporting.

Three administration sources say the Trump administration is drawing up guidelines on what would be a major overhaul — with major cuts — of the low-income health program that serves nearly 75 million Americans.

Iyah Romm, CEO of startup Cityblock, which serves Medicaid beneficiaries, said “significant spend compression” (i.e. budget squeeze) could lead to tech-based solutions, but personally he’s not a fan of block grants. ... Adimika Arthur, exec director of Healthtech for Medicaid, says he’s not convinced block granting would provide opportunities for health tech.

TELEMEDICINE HASN’T DELIVERED FOR OPIOIDS—YET: Heartily applauded by telemedicine advocates, the opioid package signed in October carries several virtual care provisions— but experts tell our Mohana Ravindranath the modality hasn’t taken off yet for opioid use disorder treatment.

One provision would expand reimbursement for telemedicine-based substance-use disorder treatment, previously limited to patients in certain geographic areas. Another gives the DEA a deadline for putting out regulations on providers registering to practice telemedicine and prescribe controlled substances.

Providers might be waiting for clarification on reimbursement and the DEA regulations before offering telemedicine services, researcher Haiden Huskamp said.

There isn’t much data about how widely telemedicine has already been used for substance use treatment. A recent analysis in Health Affairs found that telemedicine visits for people diagnosed with substance use disorder grew from 0.62 visits per 1,000 patients in 2010 to 3.05 visits per 1,000 people in 2017. That’s still a drop in the bucket, however.

The American Telemedicine Association trade group has been pushing the DEA to speed up those regulations, says Tania Malik, the co-chair of ATA’s telemental health group.

REPORT OF MOVE TOWARD VA PRIVATIZATION: A piece in Sunday’s New York Times says the Trump administration has been stealthily shaping a plant to give veterans much greater leeway to seek government-funded health care in the private sector. Critics, such as the major veterans service organizations and former Secretary David Shulkin, worry that there’s no way to pay for this expansion without gutting VA services. VA Secretary Robert Wilkie has promised the VA won’t go private on his watch.

Meanwhile, Senate VA Committee Ranking Member Jon Tester has asked the agency’s new CIO, Jim Gfrerer , to make sure the Cerner EHR contract doesn’t go south. While most of the responsibility for the Cerner job belongs to the new Office of Electronic Health Record Modernization, Gfrerer as undersecretary for information and technology is responsible for updating infrastructure at the hospitals before they go on line with Cerner, as well as other projects. “Your leadership is essential if VA is to ultimately achieve a truly interoperable electronic health record for veterans,” Tester wrote.

On Friday, we dropped in on the VA’s 40-member U.S. Digital Service team to get an update on their projects. The VA team leader, Marcy Jacobs, won a coveted Partnership for Public Service “Sammy” award in October for leading the launch of the Vets.gov website. The digital team’s current projects include giving vets insight on pending benefits claims, and bringing together veterans’ data that might be stored in dozens of different places.

According to one source, the VA spends $350 million yearly on mailings to veterans—including things like prescriptions, checks and appeals information — 40 percent of which are returned. It would help if everyone at the VA was kept abreast, at a minimum, of a veteran’s current address.

The Digital Services is largely keeping its hands off the EHR Modernization project, Jacobs and her staff told us. However, her team is helping to build an interface layer to assure that patients seeking health records during the 10-year transition from VistA to Cerner can get them without having to know which EHR has their records.

UC SAN DIEGO HEALTH PATIENTS LIKE THEIR APPLE HEALTH RECORD: UC San Diego Health, an early adopter of Apple Health last year, reported in JAMA Network, that 96 percent of the 132 people who responded to a brief online questionnaire (it was sent to the first 425 patients who activated the personal health record feature) reported they could easily connect their mobile devices to the platform. More than three quarters of those responding liked the feature and said it improved their understanding of their health; 9 in 10 said it made it easier to share personal health information with friends and family.

All very preliminary, of course. “As with many other new products and solutions, such enthusiasm is common from early adopters,” the authors writer. “The platform will need to prove that it is useful, sustainable, scalable, and actually improves health outcomes.”

Apple has reportedly hooked up its API with more than 700 health systems around the country.

. .. ICYMI, Apple CEO Tim Cook on Thursday said in a CNBC interview that the company will be introducing additional health features this year. “If you zoom out into the future, and you look back, and you ask the question, “What was Apple’s greatest contribution to mankind?” it will be about health,” Cook said.

STAT: Vijay Pande and James Madara argue there’s a shortage of doctors in tech startups

The Guardian: Don’t believe all the hype you read about AI

New York Times: Hospitals now must list prices — but it might take a brain surgeon to decipher them.