Are doctors abandoning telehealth?

With help from Darius Tahir (@dariustahir)

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Quick Fix

— Are doctors abandoning telehealth?: New data suggests virtual care is waning despite strong uptake earlier in the pandemic.

— How health IT delays diagnoses: Researchers find that over-reliance on health records’ messaging systems, among other issues, contributes to dangerous diagnostic delays.

— CMMI head in line to join Domestic Policy Council: Health care entrepreneur Brad Smith took the top spot at the Center for Medicare and Medicaid Innovation in January.

eHealth tweet thread of the day, on the end of the Massachusetts eHealth Collaborative: Aaron Miri @Aaron Miri @mickytripathi1⁩ “and the entire team deserve a standing ovation at their amazing work that benefited all of #healthcare. They are also showing us that HIEs and other legacy structures need to morph their business models to stay ahead of the curb.”

Claudiawilliams @claudiawilliams “Completely agree. I believe HIEs of the future will be public-private utilities, deeply serving the needs of Medicaid, aggregating, matching and cleaning data for population analytics, supporting data sharing between providers and plans.”

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Driving the Day

TELEHEALTH VISITS DIP AMID UNCERTAINTY — Virtual visits have begun to decline after an initial peak in mid-April, according to a new analysis from Harvard and health tech company Phreesia analayzing more than 50,000 clinicians.

Telehealth visits made up about 14 percent of visits during the week of April 19, but that number had fallen to 7 percent in mid-June. Researchers emphasized that despite the decline, telehealth use is still substantially higher than it was pre-pandemic.

What’s driving the decline? In a Stat opinion piece, authors Ateev Mehrotra, David Linetsky and Hilary Hatch argue that some clinicians believe virtual care is not worth the long-term investment. While they may have cobbled together telehealth programs during lockdown, re-opening makes in-person care a viable option once again.

Uncertainty about financial sustainability isn’t helping, they wrote. Many recent policies allowing for the expansion of telehealth — including Medicare’s increased coverage for virtual services — are designed for the pandemic. It’s not clear whether insurers will continue to pay for virtual care at the same levels once it’s over, and clinicians are frustrated by low telehealth payment rates for Medicaid patients.

“All of this is occurring in the context of a huge drop in revenue for physician practices,” authors wrote. “They are struggling financially, especially smaller ones. When you are struggling to keep the lights on, there is no appetite for uncertainty. You do what you know will allow you to you survive.”

Their ask to policymakers is simple, Mehrotra told Morning eHealth: “Clarify your post-pandemic plans for payment and regulations ASAP.”

... It’s a familiar refrain. Last week, more than 70 groups including the Connected Health Initiative, American Medical Association, Intel, CHIME and HIMSS urged top lawmakers to permanently waive geographic restrictions on Medicare’s payments for telehealth, which typically have been restricted to rural patients.

“Pulling these expanded digital health capabilities away from Medicare patients ... at the end of the [public health emergency] would be a grave mistake for patients, providers, and government,” they wrote to top congressional leaders.

Coming up this week: CHI is hosting a virtual briefing on the topic on Wednesday.

POOR EHR DESIGN, WORKFLOW LEAD TO SAFETY PROBLEMS — A new analysis in JAMA Network Open finds that “sociotechnical factors” and poor design are contributing to diagnostic delays. Key issues were data entry problems, the system’s failure to track test results, and clinicians’ problems managing EHR inbox notifications and messages, the study found. Researchers examined Department of Veterans Affairs data from 2013 to 2018.

... In one case, a clinician missed a message from a specialist to order a mammogram; in another the clinician processed several test results at once, leading them to miss one that would have required a follow-up colonoscopy. A mental health clinician included some important information about a patient’s handoff to primary care in a lab note instead of relaying the message verbally, which delayed the diagnosis of a life-threatening infection, authors wrote.

Authors attributed some of the issues to “information overload from excessive notifications.”

... “A poorly designed system increases cognitive demands on individuals and heightens opportunity for human error,” they wrote, and suggested re-designing EHR inboxes, coming up with new features to flag missed test results, and changing the way diagnostic results are displayed.

AZAR CALLS FOR MASKS AMID TEXAS, FLORIDA AND ARIZONA OUTBREAKS — Health and Human Services Secretary Alex Azar warned this weekend that recent outbreaks across several states could spiral without immediate intervention, Health’s Alice Ollstein reports.

“The window is closing,” Azar said on NBC’s “Meet the Press.” “We have to act, and people as individuals have to act responsibly. We need to social-distance. We need to wear our face-coverings if we’re in settings where we can’t social-distance, particularly in these hot zones.”

... He didn’t endorse mask mandates, but his call for universal mask use goes beyond any remarks by President Donald Trump or Vice President Mike Pence.

Several Republicans have urged Trump to signal support for masks. “I wish the president would wear a mask, because millions of Americans admire him and would follow his lead,” Sen. Lamar Alexander (R-Tenn.) lamented on CNN. “It also would help get rid of this political debate that if you’re for President Trump you don’t wear a mask and if you’re against President Trump you do wear a mask. The stakes are much too high for that.”

DOMESTIC POLICY COUNCIL’S NEWEST HEALTH POLICY AIDE? — The White House is planning to tap Brad Smith for a health role on the Domestic Policy Council, POLITICO’s Adam Cancryn and Dan Diamond report. Smith, a senior adviser to Azar on payment reform, has also emerged as a key figure in coronavirus response.

“White House officials were said to be impressed by Smith’s work on ramping up testing and supplies as part of a group convened by White House senior adviser Jared Kushner,” Adam and Dan write.

The White House has yet to finalized the decision. If Smith joins, he’ll replace Maria Bonner, who left the administration last week to return to the private sector.

EU, US PRIVACY FIGHT LOOMS — The Trump administration is ramping up attacks on the European Union’s sweeping privacy law known as the General Data Protection Regulation, which it says threatens public health and shields cyber criminals, our colleague Nicholas Vinocur writes.

... U.S. Deputy Assistant Secretary of State for Cyber Rob Strayer told POLITICO he was raising concerns about GDPR with counterparts in Brussels and EU capitals as a “top diplomatic issue.”

His lobbying focuses on “fixing interpretations” of the GDPR, which he and other groups — including EU law enforcement officials — have said protect fraudsters and scammers, Nicholas writes.

“We do have serious concerns about [the GDPR’s] overly restrictive implications for public safety and law enforcement,” said Strayer. “We definitely find that divergent interpretations [of the law] are also an issue, chilling some of the commerce that could be taking place.”

... “The GDPR makes it much more difficult to identify people,” said Dennis Dayman, a cybersecurity expert and member of M3AAWG, an international tech forum that works to reduce the threat of online attacks. “That is a big problem at a time when we are seeing an increase in phishing attempts, a lot more blocking on IP addresses because people are at home.”

What We're Reading

— The Massachusetts eHealth Collaborative is winding down operations, HealthcareItNews’ Mike Miliard reports.

— CNBC’s Chrissy Farr reports on Ro’s record sales.