Medicaid proposal paves way for telehealth

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MEDICAID PROPOSAL PAVES WAY FOR TELEHEALTH: A CMS proposed rule would make it easier for telehealth-heavy providers and plans to get approved for Medicaid and CHIP managed care. Will plans and providers exploit telemedicine to pinch pennies by limiting the size of their provider networks? Maybe yes, maybe no, one expert says .

Today, states deciding whether to approve private plans are required to consider the time it takes for beneficiaries to reach a provider and the distance they travel. But enrollees could be “well beyond a normal time and distance standard” and still easily access many different providers on a virtual basis,” the proposal released Thursday notes. Under a new system, states could choose other benchmarks to reflect accessibility; states with lots of telehealth providers, such as New Mexico, might opt for different metrics (such as the time it takes to get a virtual appointment) compared to the ones chosen by more densely populated states.

The proposal cited a 2017 USC-Brookings Schaeffer Initiative for Health Policy report arguing that telemedicine could make proximity measures irrelevant or counterproductive. The proposed rulemaking’s impact on patients “depends on how aggressively it’s implemented,” says Mark Hall, an author of that report.

“You could imagine a scenario [in which] a plan says, ‘for cost saving reasons, we’re going to farm out all of our psychological therapy services to teletherapy … for everything and everybody,’” Hall said. “I don’t know if regulators would allow that.”

A CMS spokesperson emphasized that the agency is still gathering comment and that the proposal was in response to states who felt the time and distance standards were too restrictive.

Alex Shekhdar, vice president for policy at the Medicaid Health Plans of America, said the proposal gives health plans more options, but that states still have the authority to deny them.

.. .In other CMS news, the agency wants to make sure doctors are on-board with its latest regulatory changes intended to give them a break from laborious documentation. In a letter distributed Thursday, administrator Seema Verma unpacked the recent rules intended to overhaul the evaluation and management codes.

Over the summer, CMS tried overhauling the rule by collapsing five levels of codes into two. That proposal was roundly castigated by doctors’ groups, as we reported. The agency responded in its payment rule by putting off the more radical proposals until at least 2021.

eHealth Tweet threadof the day: Lisa Bari @lisabari Someone tell me why we can’t just ship Smart on FHIR apps for reporting, templates, forms, whatever, that providers integrate into their EHRs? Never wanted to skip forward in time so much. Grr.

[Reply to @lisabari] Nick Dawson @nickdawson One big reason: may EMR vendors including Epic charge a per hit access to their APIs.

Lisa Bari @lisabari [Replying to @nickdawson] Yeah, that’s bad. But maybe (?) temporary? “Without special effort”

IT’S FRIDAY at Morning eHealth. Your author is very curious about the role of sentiment analysis in medicine. Got any interesting use cases? Pass them along to [email protected]. Reach the rest of the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

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GOOGLE HEALTH TO GET NEW ALPHA: David Feinberg has confirmed that he is leaving the top spot at Geisinger to oversee Google’s health care projects, the Wall Street Journal reports. Feinberg was reportedly among the top picks to lead the Amazon-Berkshire Hathaway-JP MorganChase health care endeavor (now led by Atul Gawande.) And our colleague Dan Diamond reported from the Milken Institute Future of Health Summit, Feinberg’s had tech on the mind for a while.

WHITE HOUSE MEETING STILL ON: Though the original date was October, the White House still plans to convene technology executives including Google CEO Sundar Pichai for a roundtable on concerns about the industry, our colleague Ashley Gold reports.

Abigail Slater, a special assistant to the president for tech, told a panel Thursday that the administration is also willing to work with Congress on data privacy legislation and will write a draft bill “if asked to.”

PRIVACY, PRIVACY AND MORE PRIVACY: The White House has yet to take a public stand on what it wants out of any new privacy rules. The Commerce Department’s National Telecommunications and Information Administration in September starting gathering public input on privacy principles it plans to formulate.

“It’s not a completely blank hall pass; we will expect to see certain parameters in the legislation, and the devil is going to be in the details,” Slater said.

— Intel has offered an unsolicited draft of its thoughts on the subject. The company outlined provisions requiring entities to notify people before collecting any data related to their geolocation, biometrics, physical or mental health, sexual life and genetics.

“While patients’ medical data is regulated by HIPAA, there is data from outside the clinical area that can reveal information about a person’s health that may fall through the cracks. A comprehensive privacy bill would cover all personal data,” Intel’s global privacy officer David Hoffman stated to Morning eHealth.

As Darius reported last week, lawmakers have held their own discussions on privacy, including health aspects. (Pros can Read Darius’s story here.)

— And the push for privacy legislation could get new momentum in the Democrat-held House. Lawmakers could focus even more on privacy and other health IT topics in 2019, Darius reports.

“On the House side, with Democrats in power, I think we’ll see a big focus on privacy,” said Janet Marchibroda, health innovation fellow at the Bipartisan Policy Center. Frank Pallone (D-N.J.), the presumptive Energy and Commerce chairman, circulated a list of priorities Wednesday that included data privacy. Pallone opposed the 42 CFR Part 2 rule change, which passed the House earlier in the year but was not included in the opioid bill signed by President Donald Trump.

Both consumer advocates and big business are seeking privacy rules, though with different objectives. Privacy hawks would like tougher regulation, while businesses seek simple national standards to follow. Pros can read the rest of Darius’s story here.

TELEMEDICINE ABORTION CHALLENGE IN KANSAS: The Center for Reproductive Rights has filed a lawsuit challenging a Kansas law set to take effect next year that bans the administration of abortion medication via telemedicine.

The ban has “no medical basis” and would simply “create more hurdles for Kansas women seeking an abortion,” Center for Reproductive Rights CEO Nancy Northup said in a release. In states that allow telemedicine abortion, licensed providers can prescribe abortion medication to patients without being in the same room; consultations can happen via video-chat.

...In other telehealth news, the Interstate Medical Licensure Compact Commission is seeing growing numbers of physicians applying though its expedited licensure process, the group announced Thursday. So far 24 states have enacted legislation to join the compact, which makes it easier for doctors to treat patients via telemedicine in states where they aren’t licensed. Since the compact was launched in 2017, member state medical boards have issued almost 3,500 licenses; the IMLCC itself has processed almost 2,000 licenses and renewed almost 500.

VA TAKES A WHACK AT VA UNION MEMBERS: The Veterans Affairs Department plans to reassign more than 400 physicians who work for government unions, our POLITICO colleague Ian Kullgren writes. “President Trump has made it clear — VA employees should always put Veterans first,” Jacquelyn Hayes-Byrd, VA’s acting assistant secretary for human resources and administration, said in a written statement.

The VA said the changes will take effect Nov. 15 and could affect more than 10,000 employees who do union work.

The reassignments may add to the complications of the VA’s Cerner implementation. As Morning eHealth’s Arthur Allen has reported, VA officials have said “change management” — getting clinicians who generally like their EHR to accept the new EHR system — is the biggest challenge in the $16 billion, decade long implementation. Pros can read the rest of Ian’s story here.

WILL PRECISION MEDICINE LEAVE EHRS BEHIND? Doctors seem to think so, according to a new report from KLAS Research. Almost three-quarters of providers interviewed said they didn’t think EHRs would play a primary role in precision medicine — mostly because they didn’t think that current health IT is capable of handling the data needed to tailor treatment to individual patients’ genetic and environmental history. Providers said smaller niche vendors were more likely to be able to handle that level of complexity; two respondents who said EHRs would figure prominently in their precision medicine strategy were using a specialty oncology EHR product.

ON TAP TODAY — ATHENAHEALTH EARNINGS: After delaying its earnings report by more than week, the practice management, billing, and EHR company is scheduledto release its third quarter revenue numbers after markets close today. The delay had some customers worried that executives have only bad news to report, they tell Morning eHealth. Leadership is also in the middle of acquisition deliberations, which could have contributed to the delay. The Watertown, Mass.-based company founded by firebrand Jonathan Bush is reportedly in talks to be acquired by Veritas Capital and Elliott Management, the activist investor that made an unsolicited bid for the company in the spring.

—Oliver Kim’s advice in Health Affairs for governments rolling out health care initiatives

—More of Amazon’s Web Services’ tools are HIPAA compliant, MobiHealthNews reports

CORRECTION: The Nov. 8 edition of Morning eHealth misstated Frank Pallone’s position on reform of 42 CFR Part 2. Pallone was opposed to the 42 CFR Part 2 rule overhaul.