Growing group of lawmakers want telehealth in coronavirus response

With help from Darius Tahir (@dariustahir)

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Quick Fix

— More lawmakers want telehealth in coronavirus response: Virtual care advocates hope a coronavirus emergency funding package will be a vehicle for telehealth in public health crises.

— False alarm on DEA’s special registration rule: A DEA proposal on narcotics prescription led to confusion as some mistook it for a long-overdue telehealth rule, which, unsurprisingly, is still missing.

— Rep. Eric Swalwell touts precision medicine to cut health costs: At the inaugural Personalized Medicine Caucus briefing this week, the former presidential candidate and his colleague Tom Emmer sought to educate their colleagues on tailored therapies.

eHealth Tweet of the day, linking to this WSJ story on mobile carriers failing to protect customers’ location data: Lindsey Barrett @LAM_Barrettguys I am begging you PLEASE just stick to abusing one dangerous form of my personal information at a time, I ask so little

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Driving the Day

CORONAVIRUS PRESENTS LEGISLATIVE OPPORTUNITY —The Alliance for Connected Care, the The American Telemedicine Association, the eHealth Initiative, and the Partnership for Artificial Intelligence, Automation and Robotics in Healthcare are all throwing their weight behind an effort to allow HHS Sec. Alex Azar to waive telehealth restrictions during national emergencies.

Coronavirus supplemental budget talks have presented a unique opportunity for these groups and sympathetic lawmakers to work in a telehealth provision. The measure would let Medicare pay for virtual visits during national emergencies, regardless of originating site or geographic location. Though Medicare Advantage plans have more leeway to cover these visits, fee-for-service Medicare generally restricts payment. The Alliance for Connected Care in a letter urged House and Senate leaders this week to include the provision— lifted from the bipartisan, bicameral CONNECT for Health Act — in the supplemental package.

The effort is garnering congressional support from CONNECT for Health Act co-sponsors, at least in the House. Rep. Bill Johnson plans to meet with Republican leaders to advocate for its inclusion. Rep. Peter Welch, Rep. David Schweikert, and Rep. Mike Thompson support that, spokespeople told us.

Telehealth “could be a life saver should the spread of the coronavirus become more serious and widespread” domestically, Thompson stated to POLITICO.

Expanding telehealth would “allow the majority of initial screenings to happen outside of the hospital,” and keep in-person care for patients in critical need, the Alliance for Connected Care wrote to lawmakers. Lower-risk patients can start their consultations virtually, executive director Krista Drobac said. The remote screening can help determine who does need to come in for a diagnostic test, and who likely does not have the virus and doesn’t need to come into a crowded medical facility — where coronavirus could be present.

... While there’s widespread support for the provision among telehealth companies, some want it to go further to eliminate reimbursement barriers. Telehealth firm Doctors On Demand, which has its own staff of physicians, said Congress should also consider waiving a lengthy enrollment process telehealth providers must undergo to get paid by Medicare. If “all you do is remove restrictions without addressing enrollment, you are going to significantly limit” telehealth companies’ ability to respond, said Ross Friedberg, the firm’s chief of legal affairs.

DEA’S SPECIAL REGISTRATION RULE IS STILL MIA — An email press statement from Sen. Mark Warner‘s office Thursday applauded DEA’s release of a long-awaited telehealth rule outlining a special registration process allowing doctors to prescribe controlled substances to patients they’ve never met. But the proposal it referenced appeared only to address narcotic treatment centers with mobile components, including trucks, prompting some legal experts to wonder if DEA was proffering an incomplete rule to make up for month-long delays. DEA later confirmed to Morning eHealth that this was a separate, but related rule.

... It’s not clear what led to the confusion. Warner’s office told Morning eHealth that DEA had confirmed that this was the special registration rule; A DEA spokesperson would not address the correspondence, and did not provide any updates about when the telehealth rule will be released.

The Ryan Haight Act, which took effect more than a decade ago, generally prohibits doctors from prescribing controlled substances to patients they haven’t examined in person. But it also directs DEA to come up with a special registration process by which doctors can prescribe controlled substances, including for medication-assisted treatment for substance use disorder. DEA has yet to deliver that rule; increasingly frustrated lawmakers gave the agency an October 2019 deadline in the 2018 opioid package.

Lawmakers including Warner, Elizabeth Warren, Patty Murray and Rep. Ann Kuster have all recently pressed the agency on the rule.

POST PRESIDENTIAL RUN, SWALWELL ZEROES IN ON HEALTH CARE— At this week’s Personalized Medicine Caucus inaugural briefing, co-chair Rep. Tom Emmer told staffers that individualized treatment could dramatically increase survival rates for serious illnesses, but that “unsurprisingly, Congress is struggling to keep up.” He urged his colleagues to come up with regulations that foster new treatments, but also make them accessible to “more than just a lucky few.”

... Emmer’s co-chair, Rep. Eric Swalwell, said he wished precision medicine were a larger part of the national conversation on health care costs, especially on the heels of this week’s Democratic debate. Swalwell re-introduced a bill in September that would evaluate whether Medicaid coverage for genetic and genomic testing improved clinical outcomes and cut costs; it would also direct HHS and the National Academy of Medicine to examine other ways the federal government could reduce barriers to genetic and genomic testing.

“The cost has come down so much to analyze [gennomic and genetic] tests,” Swalwell told us earlier this week. “As they reach a point where they’re quite affordable, I think the federal government could reimburse for them particularly for kids in poverty, or seniors, on the diagnostic end ... giving people more information so they’re not on a diagnostic odyssey.”

“So first, get it a stamp of approval and then consider once we’re at that point whether the federal government is going to be reimbursing, or increasing federal research dollars,” he said.

WILKIE SETS JULY 2020 “GOAL” — VA secretary Robert Wilkie set a July 2020 “goal” to roll out the department’s new Cerner EHR at a House Veterans Affairs Committee budget hearing Thursday.

The goal — not a firm timeline yet — confirms that the department will miss its previously scheduled March go-live. The VA had earlier announced it was delaying testing of the EHR, a prerequisite to actually launching the whole thing in Spokane, Wash.

The secretary attributed the delay to two incomplete components of the software related to travel reimbursement and community care, though committee chair Mark Takano said during questioning that the department’s justifications had been shifting over time.

MEDSTAR TROTS OUT HEART RISK CALCULATOR — In other EHR news, the health system has a new tool assessing patients’ personal risk for heart disease, stroke and other cardiovasculr conditions — all embedded directly into their electronic health records. More than 500 MedStar doctors are expected to use the system to show patients the impact their blood pressure, cholesterol and other factors have on these risks.

TECH GIANTS DEFINE AI TERMS — The Consumer Technology Association— whose members include Doctor on Demand, mentioned earlier, as well as IBM, Amazon, Microsoft and Intel — this week established common definitions for AI terms such as “assistive intelligence” (a type of software that “informs” or “drives” diagnoses while leaving the decisions up to the clinician.)

“As health systems and providers use AI tools such as machine learning to diagnose, treat and manage disease, there’s an urgent need to understand and agree on AI concepts for consistent use,” CTA’s vice president of policy and regulatory affairs, Rene Quashie, said in a release.

‘TRUSTWORTHINESS’ RATINGS SPARK FTC COMPLAINT — The Electronic Privacy Information Center called Airbnb’s “trustworthiness” ratings for customers, based on a proprietary algorithm, a violation of consumer protection and reporting law in an FTC complaint filed this week, our colleague Leah Nylen reports. “An algorithm cannot assess a particular individual’s relative ‘goodness’ or ‘badness.’ The flawed premise of Airbnb’s scoring system calls into question its reliability, provability, and fairness,” EPIC said. EPIC also said Airbnb’s use of the algorithm violates the FTC’s ban on unfair practices and the Fair Credit Reporting Act.

NAMES IN THE NEWS — Former VA secretary David Shulkin and former FDA commissioner Andy Von Eschenbach are joining the advisory board of DataVant, a company focused on data sharing for health care.

What We're Reading

— Shoshana Wodinsky writes for Gizmodo about GoodRx’s practice of sharing prescription data with third parties; Thomas Germain has more on the topic for ConsumerReports.

— Joanne Finnegan writes in FierceHealthcare about patients who lie to doctors.