Telemedicine advocates find opportunity in the opioid crisis

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

TELEMEDICINE ADVOCATES FIND OPPORTUNITY IN THE OPIOID CRISIS: Next week will see continued Congressional discussion on legislation addressing the opioid crisis, including a hearing Tuesday on making changes to 42 CFR Part 2, which restricts the sharing of behavioral health data. Telemedicine advocates are paying special attention to provisions — in both the House and Senate versions of the opioid package -- that would ease restrictions on reimbursement for telemedicine-based substance abuse treatment, and that could make it easier for providers to virtually prescribe controlled substances. Many see opioid treatment as a way for the industry to open the door to wider uses of the technology in behavioral health.

“Given the opportunity around the fact that opioid legislation is moving, why not take this approach to opioids?” Krista Drobac, executive director of the telemedicine trade group, the Alliance for Connected Care, tells Morning eHealth. Lawmakers and lobbyists have been pushing for years to expand Medicare reimbursement for telemedicine. Now, some are narrowing their focus to substance abuse disorders — seeing an opportunity to capitalize on congressional attention to the opioid epidemic.

Speech therapy startup TalkPath Live is among a growing group of companies starting to market its product as a vehicle for substance abuse consultations. President and CEO Michael Kaufman says the company could bring more substance abuse specialists into its network and facilitate addiction prevention among its patients, many of them K-12 students.

Video-based consultations could be especially helpful because they let providers observe visual cues — whether the patient exhibited signs of misusing medication, for instance — when offering treatment, says Anne Woodbury, executive director of Advocates for Opioid Recovery. One version of the opioid bill, which could become law this summer, contains a provision that would clarify the Drug Enforcement Administration’s authority to allow providers to prescribe controlled substances via telemedicine. The bill could incentivize more companies to enter the market, making telemedicine services more accessible. “If there’s a benefit to the opioid crisis, maybe that’s it,” Woodbury says. Pros can read the rest of the story here.

MORE ON MYHEALTHEDATA: CMS administrator Seema Verma continues to promote the ambitious White House and CMS effort to give patients access to their health records, dubbed “MyHealtheData.” In a writeup in RealClearHealth, Verma says CMS’s recent proposed overhaul of the Medicare EHR Incentive Program and its recommendation this week that hospitals post their services charges online are “only the beginning,” and that the agency plans to “pull every lever in Medicare and Medicaid” to prioritize patients.

CMS is also consulting with an offshoot of the U.S. Digital Service, a White House tech troubleshooting team, on the effort. Shannon Sartin, executive director of HHS’s USDS branch, tells Morning eHealth that her team is advising CMS on ways to implement a provision within the 21st Century Cures Act governing APIs. That law directs EHR vendors to make patient data accessible to outside groups “without special effort.”

At least for APIs, USDS advocates for an “outcomes-based policy” in which “less regulation is better,” Sartin says. Instead of proposing technical requirements for vendors -- technology evolves too quickly, she says -- her goal is to create ”guidance that gives maximum flexibility for technologists to do what they do best, which is innovate.” That might include setting timelines by which data should be made accessible, instead of pushing requirements that vendors include specific mechanisms in their products.

HOUSE RELEASES VA CHOICE BILL: House Veterans Affairs Chairman Phil Roe has released a slightly revised version of the VA Choice bill that would streamline and expand programs for veterans to obtain care in the private sector, and which will be marked up on Tuesday, Morning eHealth’s Arthur Allen reports.

That bill contains health IT-related provisions that would allow veterans to get telemedicine from any authorized provider across state lines, require that records of controlled substance use be shared through state prescription drug monitoring programs and order greater data sharing among community and VA providers.

One section of the bill would authorize at least $50 million a year for a new VA Innovation Center, which the VA secretary can use to order up to 10 pilots a year testing new health care and payment options. Pros can read Arthur’s full story here.

eHealth Tweet of the day: Hal Burstein, MD @DrHBurstein The “best solution” is not to hire scribes, human or robotic. The best solution is to move away from a health system based on outrageous documentation for billing purposes that swamps the “care” given to people.

[in response to the following Tweet] Bob Wachter @Bob_Wachter My new piece in @WSJ: the #EHR has turned doctors into expensive & unhappy data entry clerks. Best solutions to date: scribes. But digital scribes – combining advances in #AI & voice recognition – may yet save the day https://on.wsj.com/2vWoOSJ @WSJhealth @WSJTech @UCSF @augmedix

And this endorsement from POLITICO health editor Joanne Kenen: @JoanneKenen So engrossed in today’s@Morning_eHealth that I missed my metro stop @dariustahir@ArthurAllen202@ravindranize#runninglatenow

IT’S FRIDAY at Morning eHealth. Your author plans to spend the weekend catching up on all the WHCD think-pieces she missed during the week. Send your favorites, and news tips, to [email protected].Tweet at @arthurallen202,@dariustahir,@ravindranize, @POLITICOPro, @Morning_eHealth.

NEW CMMI HEAD BOEHLER SPEAKS: In his first public remarks since taking the helm at the CMS Innovation Center, Adam Boehler said his $10 billion office can hit its goals without putting doctors and hospitals at risk of losing money if they fail to hold down Medicare spending, our colleague David Pittman reports.

The question of risk — how much providers should be forced to take on, and when, as an experimental incentive to limit spending — is an ongoing debate in the nation’s move toward value-based care.

“Risk, when done right, adds value. But that’s one way to add value,” Boehler said at the Medical Device Manufacturers Association annual meeting in Washington. He added that improving quality and outcomes, like reducing mortality, are other ways to add value.

The three big goals by which Boehler said CMMI will judge its work — improving the affordability of health care, and bettering both quality and access — are known in this field as the so-called “triple aim,” although he didn’t use that term during his 45-minute address to the conference. “Whoever focuses in on that mission,” Boehler said, pointing to hospitals, payers, drugmakers and device companies, “is very attractive.”

Pros can read the rest of David’s story here.

MAYO CLINIC PREPS FOR EPIC GO-LIVE: The Mayo Clinic’s Rochester unit is officially converting to the Epic EHR system tomorrow -- it’s a $1.5 billion investment, and required the Rochester Public Utilities to set up a substation to power all the related machinery, according to an op-ed in the Post Bulletin. A source tells Morning eHealth that the implementation team is scrambling to ensure the massive rollout goes smoothly, and that Mayo is still slated to roll it out at sites in Florida and Arizona later in the year.

FDA SEARCHING FOR AN EHR SYSTEM: The Food and Drug Administration has posted a request for quotation for health record systems that it could mine to assess the safety of FDA regulated products, Modern Healthcare reports. FDA researchers plan to analyze VA data, which currently exists in its homegrown EHR system VistA, on adverse drug reactions.

The announcement is part of an “extraordinary shift in software strategy that has taken place at FDA over the past several years,” and represents a federal agency committing to collaborative and open solutions, especially since VistA is open source, open health advocate Roger Maduro writes in a blog post.

NIH HEAD FRANCIS COLLINS’ BIGGEST PEEVE? EHRs: In an interviewwith STAT, Francis Collins, who has led the NIH for nine years, described his frustration with EHRs and a lack of data sharing.

“I thought by now we’d be in a circumstance where those would be interoperable and portable, so patients would have easy access to their own records,” he told STAT’s Meghana Keshavan at the Milken Institute Conference in Las Vegas this week.

Some groups are beginning to embrace the open source approach, he said -- NIH has been working with the private sector in studying Alzheimer’s, Parkinson’s, and other diseases, and “they make data accessible, not just to the people doing the work, but to anybody else.”

The 21st Century Cures Act gives the NIH director “more authority than before to require that from our grantees. I had to previously cajole them,” he said.

ICYMI: Our colleague Brianna Ehley took a deep dive for POLITICO Magazine into West Virginia’s public health commissioner’s use of data to track down and attack the causes of opioid-related fatalities. Rahul Gupta’s staff pored over Medicaid rolls, birth certificates, criminal records and public databases to find out who was at the highest risk of overdose. Their goal was to create a data-driven plan for driving down the death rate. Read Brianna’s story here.


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