Rural, community clinics pick up patients left behind by telehealth

With help from Darius Tahir (@dariustahir) and Alexandra S. Levine (@Ali_Lev)

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Quick Fix

— Rural, community clinics pick up patients left behind by telehealth: Safety net providers are getting creative to virtually treat patients who don’t have smartphones, internet or data plans.

— ACLU demands info on HHS’ location tracking talks: The American Civil Liberties Union has filed a FOIA request on HHS’ and CDC’s discussions on the use of location data.

— Facebook nudges users to HealthCare.gov: The social network said it’ll prompt users who have lost their jobs or insurance to check their ACA eligibility during the pandemic.

eHealth tweet of the day: Jennifer Sullivan MD MPH @confectionsmd “Today I received a note that one of our mental health providers went from 8 to 760 telehealth interactions/day in just a week.”

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Driving the Day

COULD TELEHEALTH WIDEN THE HEALTH GAP? — It’s an open question, says Josh Gordon, who heads the National Institute of Mental Health. Especially during the pandemic, when health care providers are taking most of their appointments online, "[w]e certainly should be concerned about the possibility that rapid shifts to telehealth could exacerbate existing access-to-care disparities,” he said.

The Trump administration and Congress have sought to make telehealth easier to access during the pandemic, boosting payments and relaxing privacy rules. But providers, including rural hospitals and community health clinics, say they’re getting left behind, especially when there’s no guarantee their patients have the technology.

... Under the second stimulus package, rural clinics and federally qualified health centers will be able to bill Medicare for telehealth. But CMS still hasn’t published rates or guidance, and most telehealth visits still require both audio and visual components to be covered — which is a high bar for patients who don’t have WiFi or data plans or only have flip phones or landlines.

While providers wait for more guidance from the Trump administration, they “are still doing telehealth visits based on the hope that they will get paid,” said Bill Finerfrock, executive director of the National Association of Rural Health Clinics.

... “We had a weekend to completely reinvent ourselves,” said Susan Kalson, CEO of Pittsburgh’s Squirrel Hill Health Center, which each year treats about 8,000 patients who largely don’t speak English and are covered by Medicaid. The clinic ordered blood pressure cuffs and other medical devices to patients’ homes so they can relay vital signs to doctors over the phone. “We were going to do what we needed to do to take care of our patients and figure out compliance and billing on the back end,” Kalson said.

North Carolina’s Roanoke Chowan Community Health Center, where about half of patients have internet at home, set up a hot spot connection in its parking lot so patients could video chat with doctors and nurses from their cars.

Video visits give clinicians a much richer picture of a patient’s condition, but some patients are only reachable on a flip phone or a landline, said CEO Kim Schwartz. Connectivity is “really a health equity issue,” she said.

... Speaking of equity, Rep. Rosa DeLauro, chair of the Appropriations Committee, asked HHS secretary Alex Azar this week for any data CMS has on coronavirus testing related to race, ethnicity and other demographics. She asked if HHS needed additional resources to expand that data collection.

... Also on telehealth, a study in the Journal of Medical Internet Research finds that two-thirds of VA patients either preferred, or were equally satisfied with, video visits as compared to in-person ones. Patients with chronic conditions were less likely to prefer video visits.

And the FCC on Thursday approved the first set of Covid-19 telehealth program applications, unlocking funding for health care providers’ virtual services in some of the areas hit hardest by the outbreak.

SENATORS CALL FOR VIRTUAL MEDICARE DIABETES PREVENTION PROGRAM — A bipartisan group of 12 senators is calling on CMS to expand reimbursement to virtual diabetes prevention program providers, in a new letter released Thursday.

The agency has used its expanded powers under the coronavirus pandemic, but in a limited way, only allowing reimbursement for virtual sessions from bricks-and-mortar providers.

The letter’s signatories, however, would like the agency to expand to virtual providers — who have been shut out of the Medicare diabetes prevention program — as a way to continue delivering care while minimizing risk of transmission of the disease.

Even before the coronavirus outbreak hit, the agency had been struggling to deliver the program to a wider population, serving far fewer than the projected 110,000 in 2019.

FACEBOOK TO LET PEOPLE KNOW WHEN THEY’VE SEEN FAKE COVID NEWS — Millions of users will be notified if they see online posts containing misinformation about the coronavirus pandemic, Facebook announced Thursday. The company will notify users beginning in the next three weeks, our colleague Mark Scott writes.

“Through this crisis, one of my top priorities is making sure that you see accurate and authoritative information across all of our apps,” Mark Zuckerberg, the company’s chief executive, wrote on his Facebook page.

The decision comes after campaign group Avaaz found that over 40 percent of the coronavirus-related misinformation on the platform, which had been debunked by fact-checking groups working with Facebook, remained up despite being told that they were false. Avaaz said these posts, which propagate fake remedies and myths, had been shared collectively more than a million times across six languages.

“Facebook, given its scale, is the epicenter for misinformation,” Fadi Quran, Avaaz’s campaign director, told POLITICO.

... Elsewhere on Facebook, unemployed users will be directed to the Obamacare website to check their coverage eligibility, our colleague Cristiano Lima reports. The Labor Department reported that Americans filed 5.2 million jobless claims last week, bringing the four-week total to more than 22 million.

ACLU SPOTLIGHTS CONTACT TRACING PRIVACY RISKS — The group’s newest white paper outlines principles by which public health groups, policymakers, patients and developers can assess privacy risks brought on by contact tracing technology, just a few days after Google and Apple’s unprecedented agreement to collaborate on a Bluetooth system that works across both iOS and Android technology. Among ACLU’s recommendations: apps that aim to figure out who positive patients have come into contact with should be voluntary, non-punitive and built in collaboration with public health professionals.

The group noted that there are several “technology-assisted contact tracing” proposals that do purport to be privacy-friendly. Still, ACLU warned, “technologists, policymakers, and others should keep in mind that there is a very real chance these systems will simply not prove practical in real world conditions” — human interactions may be far too complex and generate too many false alarms, for instance.

... ACLU also demanded today that the federal government hand over any correspondence it’s had about location tracking during the pandemic, as well as records about waiving HIPAA enforcement.

Also on contact tracing, San Francisco is running a contact tracing pilot in collaboration with Massachusetts software company Dimagi that could serve as a model for the rest of California and the country, our Victoria Colliver writes. Gov. Gavin Newsom said this week that tracing the virus’ spread would be crucial in easing lockdown restrictions.

... Under the pilot, people who test positive for coronavirus will be asked who they’ve had contact with recently, and outreach workers will follow up remotely with those people. “We are hopeful that this effort will not just be limited to San Francisco, that we could train hundreds if not thousands of workers across the region for a collaborative effort that will help us address the pandemic for the medium- as well as perhaps the long-term,” said Grant Colfax, director of San Francisco’s public health department, during a briefing on Wednesday.

Over in Europe, governments and the European Commission have published their own set of safeguards they say should be used for contact tracing and warning, POLITICO’s Vincent Manancourt reports. The so-called toolbox recommends that apps should be fully compliant with EU data protection rules, use “privacy-enhancing” technology, use anonymized data and be interoperable across the EU.

SILICON VALLEY LEADERS LAUNCH TRIAL MATCHING SITE — Tech and health execs this week unveiled WorldWithoutCOVID.org, which matches visitors to clinical trials related to coronavirus vaccines and treatment. The project seeks patients who test positive, as well as those who don’t. Once they fill out an online form, users could be directed to one of a few hundred trials culled from clinicaltrials.gov. Lyft chief strategy officer Raj Kapoor and VSC co-founder and CEO Vijay Chattha launched the site along with Clara Health cofounders Evan Ehrenberg and Sol Chen.

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What We're Reading

— Patricia Calhoun and Patricia Carreiro detail HIPAA litigation risks brought on by de-identified data in in a Stat opinion piece.
— Christian mindfulness and meditation apps have seen a spike in users during the pandemic, Emily McFarlan Miller reports for Religion News.