Jury still out on telehealth savings

With help from Arthur Allen (@arthurallen202), Brianna Ehley (@Briannaehley) and Mohana Ravindranath (@ravindranize)

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Quick Fix

— Jury still out on telehealth savings: Does telehealth save the health care system money? Years into efforts to bring remote care to patients, we still don’t know.

— FDA warns on cybersecurity: The FDA says software used in many major device manufacturers’ systems is flawed, providing openings to hackers.

— VA sharing records by default: Patients’ records will be shared, as of January 2020, with other providers by default, the department announces.

And more. But first, the jump.

eHealth tweet of the day: Lucia Savage @SavageLucia [on former FDA commissioner Robert Califf heading for Alphabet] “Another HHS -44 Alumni heads west. Must be the wine out here . . .”

WEDNESDAY: Hope everyone’s week is going well. Your correspondent has been chewing on a truly tough problem: despite searches extensive enough to win any hide-and-seek game, he’s been unable to find a truly strong fridge magnet. How is it a major burg like D.C. lacks a simple household good? Share magnet tips at [email protected]. Discuss magnets and how they work socially @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

TELEHEALTH: DOES IT SAVE MONEY? — Telehealth advocates have long argued their tech can bring down costs — but researchers still haven’t bought the idea yet. In fact, the technology can sometimes increase upfront costs or nudge patients to make appointments they wouldn’t have otherwise made.

That’s not necessarily a bad thing; telehealth could encourage treatment-averse patients to seek care and increase access to care for patients in rural or underserved areas. It just means that payers and providers eager to save money with virtual care might need to think more broadly about its benefits, experts say.

“The reason [the calculation] gets really complicated is ... the counterfactual,” Harvard’s Ateev Mehrotra said. It’s difficult to ascertain what patients really would have done if telehealth services weren’t available to them. “We don’t really have much data on how much telemedicine is used as a whole.”

Some sources told Morning eHealth that their own internal data showed stronger savings trends. According to Oscar Health, plan members save an average $129 every time they use telemedicine. Anthem said the company, employers and members saved $201 per health episode when they use telemedicine. There are similar rates of follow-up check-ins after both in-person and virtual visits.

FDA WARNS ON CYBERSECURITY — Certain products from major medical device manufacturers, like GE and Drager, may have cybersecurity faults, the FDA warned Tuesday. Those faults may allow hackers to access the devices or deny them service.

The problem stems to a software component called IPNet, which is used in 11 operating systems. Those systems have been integrated into medical devices ranging from neonatal workstations to insulin pumps.

FDA says it knows of no adverse events stemming from the problems, though it expects to learn of more devices afflicted by the defects. The agency is advising IT staff to monitor their networks, and patients and doctors to discuss their devices about any risks.

— FDA criticized on depression tests: Advocatesurged HHS Secretary Alex Azar and acting FDA Commissioner Ned Sharpless to reverse FDA’s position on using genetic tests to inform treatment for depression and other mental health conditions, our colleague Brianna Ehley reports.

The FDA last year warned that genetic tests couldn’t predict patient responses to antidepressant medications and moved to crack down on developers making those claims. But major mental health advocacy groups argued that FDA’s actions could “inflict greater harm on patients and impede innovation,” given the potential of genetic information and some early positive results from pharmacogenomic testing.

— Califf to Alphabet: Former FDA commissioner Robert Califf is joining Alphabet, the company that owns Google and other tech ventures. Califf, who was previously at Duke, had been assisting with the company’s Baseline project, a long-term study to track patients with all sorts of gadgets and gizmos.

VA TO SHARE RECORDS BY DEFAULT — The Department of Veterans Affairs will share medical records between providers by default, and not requiring explicit patient consent, it announced Tuesday. The department is touting the change, which will take effect January, as a move to cut down on paperwork for patients and providers.

But privacy hawks aren’t pleased. Nancy Anthracite, internist and privacy advocate, said there will be backlash from veterans. “The VA is going down the same path of destroying patient privacy rights as the federal and state governments,” she said.

CMS TOUTS ACO SAVINGS — Administrator Seema Verma is bullish on the latest cost-savings results from the accountable care organization program, bragging that the effort saved the government $740 million last year. Her agency recently rejiggered program incentives to make ACOs take on more “downside risk.”

ACO groups were also generally pleased. “These numbers put to rest any notion that ACO savings are ‘modest’ and illustrate the strong performance of the leading Medicare alternative payment model,” said Clif Gaus, president of NAACOS, the trade group for accountable care organizations.

… And the agency pushes ahead on wellness: CMS is also inviting 10 states to participate in a demonstration of wellness programs for individual insurance markets, the agency announced. While the programs often result in consumers getting access to wearables and other gadgets, evidence that the programs work is rather thin — and there have been suggestions they compromise privacy.

In a Health Affairs blog post, Georgetown professor Katie Keith summarizes the evidence for, and legal questions about, such programs, concluding that “it now appears that wellness programs are less than effective and raise significant concerns for consumers who, for a variety of reasons, may object to or be unable to comply with such a program.”

MONEY KEEPS ON COMING — Digital health startups are on pace for another strong year in fundraising, investors Rock Health say. While the third quarter of 2019 saw a slightly slower pace, startups have nevertheless brought in $5.5 billion so far this year. That total is still the third-highest annual sum in their records.

Behavioral and women’s health startups are doing particularly well this year. Sixteen behavioral health startups have raised money in 2019, up from just one in 2012. Between 2014 and 2018, funding for women’s health startups has increased eightfold.

COURT MOSTLY OK’s FCC NET NEUTRALITY RULE — The D.C. Circuit Court of Appeals mostly upheld the Federal Communications Commission’s rollback of Obama-era rules on net neutrality Tuesday. However, the court is allowing states to craft their own regulations on net neutrality.

— Also in FCC world: The College of Healthcare Information Management Executives says it supports the FCC’s proposed telehealth fund, but shared some suggestions in a letter to the agency this week. Among them: to consider reimbursing grantees for the administrative costs of running a telehealth program. Such costs could discourage providers from adopting telehealth, the group argued.

While FCC’s proposed pilot wouldn’t pay for end user devices or apps, CHIME argued that it’s difficult to separate broadband costs from device and subscription costs. “[I]t needs to be all or nothing,” it wrote.

RADIOLOGISTS WANT AI GUIDELINES — The U.S., Canadian, and European radiology societies are calling for guidelines on the ethical use of imaging data and artificial intelligence. The joint statement, appearing in the Journal of the American College of Radiology and other publications, notes that imaging-interpreting software has many theoretical boons, but also pitfalls. Software trained on one hospitals’ x-rays may perform poorly in other institutions.

“I could build an AI algorithm, feed it my data and it would tell me, cancer/not cancer. It’s almost spooky how well it works. But just because I can do that on my own data doesn’t mean I can distribute it widely … and expect it to have good results,” said Raymond Geis, director of the American College of Radiology’s Data Science Institute.

LOCAL NEWS — DCH Health Systems hospitals in the Tuscaloosa, Alabama, area were only accepting the most critically ill patients due to a ransomware attack as of Tuesday. It’s the second publicly known bout with ransomware in recent weeks, with Wyoming’s Campbell County Memorial Hospital also going on reduced service … Virginia state Del. Dawn Adams is under fire after the Richmond Times-Dispatch revealed she shared sensitive patient information from her health care consulting work with a legislative aide.

What We're Reading

Artificial intelligence in health care needs to consider data directly capturing patient experiences, a startup executive writes in Stat.

Surveillance of medical devices can be improved with deep learning analysis of EHRs, a paper in Nature - Digital Medicine states.

More consideration of “AI developed drugs” from a Science blogger.