Doctor in Duluth asks policymakers to make COVID telehealth changes permanent

The Duluth News Tribune runs a letter to the editor from Dr. Sarah Manney is the chief medical information officer at Essentia Health in Duluth…

We didn’t conduct our first virtual visit until mid-March 2020. Within weeks, we were performing thousands per day, peaking at more than 3,500. One year later, we have surpassed 400,000 virtual visits. Further, 80% of our mental health encounters were done via virtual visits this last year. For those patients, when one of the biggest hurdles is simply getting out of the house to seek help, that initial obstacle was rendered obsolete by the accessibility of virtual visits.

We’ve also done more than 100,000 e-visits, which are targeted at 20 of the most common conditions, pushing Essentia’s telehealth encounters in a single year well north of half a million. And this was only the first year; imagine how many more people will benefit from these innovative offerings as they become more prevalent.

Right now in Minnesota, we have a tremendous opportunity to increase that access. We can make permanent some of the temporary advances that occurred because of COVID-19 through bipartisan legislation — specifically, Senate File 1160 and House File 1412. The bills are sponsored by Republican Sen. Julie Rosen and DFL Rep. Kelly Morrison, one of two physicians in the Legislature.

While previous law required patients to visit a health care provider site to access telehealth, this bill would continue to allow providers to deliver telehealth services directly to a patient’s home setting via audio-only telephone calls or secure two-way audio-video services on a tablet or computer. The legislation would allow scheduled visits to be conducted by phone when a patient does not have internet access or the appropriate electronic device.

These care-delivery practices are currently in effect due to COVID-19. But we feel strongly that they should become a staple of 21st century health care, even after the pandemic. They let patients receive treatment that may prevent the worsening of chronic health issues and may reduce potentially avoidable emergency-room visits.

Aitkin County interested in extending waivers that support telehealth

Aitkin Age reports

Last March, Gov. Tim Walz declared a peacetime state of emergency, issuing waivers to health care providers that temporarily granted them increased flexibility in responding to the COVID-19 pandemic. Across Minnesota, standard regulations for treatment location, telehealth services, and administrative activities were relaxed.

The state of emergency is set to expire on April 14. It is not known whether Walz will extend it beyond that date.

Cynthia Bennett, the director of Aitkin County Health and Human Services, said that a number of the waivers, such as more flexibility in terms of remote work, should stay in place.

“We had to make all these adjustments because we were not supposed to be face-to-face and we needed to comply with the governor’s executive orders for social distancing,” she said. “And it worked out well, so we would like to continue that, because we found cost savings for taxpayers.”

The waiver are what made telehealth possible and affordable during the pandemic. The increase in use is one of the silver linings of the pandemic allowing more patients to be seen and reducing drive times for patients and often for family or friends who would drive them to appointments out of town.

EVENT April 7: World Health Day Symposium 2021

Global Minnesota is hosting a meeting next week and broadband will be a featured topic – because broadband is key is health equity, especially during a pandemic..

Global Minnesota hosts an important virtual symposium to mark World Health Day on April 7. The official theme for the day is Health Equity.

This enormous topic extends all the way from local grassroots issues to global policy initiatives. With its reputation for health care, organizations and companies based in Minnesota are in a unique position to share expertise in improving global health. As the facilitator of this symposium, Global Minnesota serves as a conduit of information that can take local innovations and extend their reach across the world.

What projects around the globe can shape solutions that support developing health equity? How can the United States and Minnesota learn from global innovators?

Register now to hear the perspectives of local, national, and international organizations and corporations that provide leadership in health care, research, and policy.

The list of speakers include some folks well steeped in the world of broadband, such as…

  • Ali Dalio – Managing Partner, United Ventures; Managing Director, United Capital Group
  • Juan José Gómez Camacho – Ambassador of Mexico to Canada
  • Jean-Paul Smets, PhD – Founder, Nexedi; Founder RapidSpace; CTO, Blutel Wireless

COVID19 opens the doors for continued legislative support for telehealth

Minneapolis Star Tribune reports

The use of electronic devices in patient care, known as telehealth, has long held promise as the next big thing in the industry, but not until the coronavirus hit, raising a host of safety concerns, did it become commonplace.

Nearly 30% of health care visits are now conducted electronically, much of it made possible because federal and state regulators, as well as insurance providers, responding to the pandemic emergency, relaxed some of the rules and requirements that made it more difficult to use telehealth.

For example, under Minnesota law, some patients had to drive to a clinic or hospital to use that facility’s secure telecommunications equipment if they wanted to talk with a doctor located at another site. In the past year, that rule has been waived.

As the number of COVID-19 cases begins to rise once again in Minnesota, there is bipartisan support at the Legislature to make permanent many of the changes that have driven the increase in telehealth, with both chambers advancing bills to rewrite the state’s telehealth laws.

That’s quite an increase…

Before the pandemic, telehealth accounted for 3% of patient visits, according to a Minnesota Medical Association survey.

And there are benefits…

“The addition of virtual care clearly was a benefit to the patient, their satisfaction went up, quality went up and overall costs went down because we really architected our system to take advantage of virtual care,” he said.

The virtual visits worked best with patients who already had an established relationship with the physician and clinic and where hands-on care, such physical exams or blood draws, were not needed.

Telehealth also has been extremely popular in mental health and substance use treatment, with many health care systems reporting high volumes of therapy visits.

But providers need the reimbursement to make it happen…

Providers say it is important that they get the same insurance reimbursement payments as in-person visits because overhead costs are the same for virtual visits.

“It is not bricks and mortar costs as much as the infrastructure and all the people behind it to do that work,” said Ingham. “You can’t have virtual visits without those foundational costs.”

Telecom bill introduced in MN House: HF2215 911 funds for creating GIS

According to MN House Chief Clerk’s Office on March 15…

Edelson introduced:

HF. 2215,A bill for an act relating to public safety; directing that unspent funds in the 911 emergency telecommunications service account be used for grants to counties to design, develop, implement, operate, and maintain the geographic information system; appropriating money; amending Minnesota Statutes 2020, section 403.11, subdivision 1.

The bill was read for the first time and referred to the Committee on Public Safety and Criminal Justice Reform Finance and Policy.

Here is the full bill

A bill for an act
relating to public safety; directing that unspent funds in the 911 emergency
telecommunications service account be used for grants to counties to design,
develop, implement, operate, and maintain the geographic information system;
appropriating money; amending Minnesota Statutes 2020, section 403.11,
subdivision 1.

Continue reading

MN Legislators look for ways to extend telehealth policies

Mankato Free Press reports

Accessing health care has drastically changed over the past year thanks to the COVID-19 pandemic. Lawmakers are working to make many of those state-mandated changes permanent.

At the halfway point of this year’s legislative session, the Minnesota Legislature is working out the kinks in expanding telehealth access for people across the state. Legislators are discussing several bills on the issue, from interstate telehealth access to addressing how telehealth services are financially reimbursed.

Sen. Julie Rosen, R-Fairmont, is sponsoring an overarching telehealth bill to help codify many of Gov. Tim Walz’s executive orders on telehealth as many Minnesotans turn to video appointments or phone calls for medical help. …

Rosen’s bill, and a similar bill sponsored by Democratic Rep. Kelly Morrison of Deephaven in the House, would help streamline the state’s telehealth policies and expand coverage for mental health practitioner and substance use counselor visits. The bills would get rid of a limit on telehealth visits and would also ensure health care professionals get reimbursed at the same rates for telehealth services as they would for in-person appointments.

Rosen noted telehealth services have been especially useful for mental health and substance use disorder care. While there are still some challenges in wording certain areas, such as children’s mental health case management, many health-care experts and advocates say the proposal is a necessary step to help residents throughout the state.

EVENT Mar 8: MN Legislature on Health care service and consultation telehealth coverage (HF1412)

The MN House Schedule reports that Health Finance and Policy will be discussing HF1412 (Morrison) Health care service and consultation telehealth coverage modified….

Monday, March 08, 2021 , 1:00 PM

Health Finance and Policy

Chair: Rep. Tina Liebling
Location: Remote Hearing
Agenda:

HF1412 (Morrison) Health care service and consultation telehealth coverage modified.
HF745 (Hornstein) HIV prevention or treatment medications exempted from medical assistance and MinnesotaCare co-payments.
HF855 (Hollins) HIV preexposure prophylaxis and HIV postexposure prophylaxis dispensing by a pharmacist without a prescription authorized.
HF1904 (Boldon) Drug formulary and prior authorization provisions modified, preferred drug list requirements modified, and Formulary Committee reorganizing report required. (Informational-Only)
Agenda items may be added/removed.
Members of the public interested in testifying on should email Patrick McQuillan at Patrick.McQuillan@house.mn by 1 pm on Sunday, March 7th. Testimony will be limited to two minutes per person. Written testimony will be accepted.
This meeting will be held in accordance with House Rule 10.01, which may be viewed here: https://www.house.leg.state.mn.us/comm/docs/HmNgjtZ_KkKBF3cKO2DXmw.pdf
Public Viewing Information:
This remote hearing will be live-streamed via the House webcast schedule page: https://www.house.leg.state.mn.us/htv/schedule.asp
NOTE: Channels HTV 1 and HTV 2 will provide live closed captioning. Video archives of meetings streamed on HTV 3, 4, and 5 will have closed captions added. Other reasonable accessibility accommodations may be made with advance notice.
Meeting documents will be posted on the House Health Finance and Policy Committee website at https://www.house.leg.state.mn.us/Committees/Home/92011.
If you have questions about the accessibility of remote hearings or require an accommodation, please contact Jenny Nash at: jenny.nash@house.mn or by leaving a message at 651-296-4122. For other questions, please contact Patrick McQuillan (patrick.mcquillan@house.mn).

The MN House of Representatives is currently working on establishing the processes and technology that allow remote meetings to be held that are accessible to the public. Thank you for your patience as we adapt.

Can your Fitbit help with early detection of COVID19?

Internet Innovation Alliance reports

While Fitbit’s wearable devices started out tracking a user’s steps and movement, the company’s newest devices now include sensors that can track body temperature, oxygen levels, and heart rate fluctuations – data that can help detect signs of depression and a range of other diseases. Early studies of the wearable technology suggest that it can even be used to help detect COVID-19 one to two days before symptoms start.

University of Minnesota uses telehealth to treat heart attacks in the field

mHealth Intelligence reports…

Much like telestroke vehicles bring emergency treatment to stroke victims in the field, a new vehicle being developed by the University of Minnesota Department of Medicine aims to treat heart attack patients the same way.

The UM’s Minnesota Mobile Resuscitation Consortium (MMRC) is getting ready to roll out a mobile health van that can treat patients on the scene via extracorporeal membrane oxygenation (ECMO). The process uses a machine that oxygenates a patient’s blood outside the body, allowing the heart and lungs to recover, then pumps that blood back into the body through cannula.

It’s great news…

MMRC officials note that the common procedure for treating patients in cardiac distress is CPR, but if a patient’s heart rhythm isn’t returned to a sustainable rate within 30 minutes, they’re in a refractory period and need an ECMO machine to revive them. Every 10 minutes after that point reduces the survival rate by 15 percent to 25 percent.

So instead of bringing patient to the ECMO machine at the university, the university is bringing the machine to the patients.

MN Dep of Human Services reports on increased telehealth in 2020 and lessons learned

The Minnesota Department of Human Services report (Telemedicine Utilization Report: Telehealth and Telemedicine during the COVID-19 Pandemic) looks at increased use of and decreased regulation on telehealth during the pandemic. Their high level assessment…

Recommendations for further consideration by DHS include:

  • integrating telemedicine as a permanent modality in delivery of services, developing specific guidance on licensing standards around telemedicine;
  • investing resources in understanding comparatively low level of utilization of telemedicine by Black, Indigenous, and People of Color (BIPOC) communities;
  • advocating and prioritizing funding for telehealth infrastructure development; and
  • supporting legislation to allow Medical Assistance (MA) and MinnesotaCare enrollees to have more than three telemedicine visits in a week.

The report is direct, easy to read and includes information that supports the recommendations. I’m going to try to pull out the salient points by segment, which means I’m removing some context to provide a quicker look at the data but again, you can go to the full report for more detail.

From the Contextual analysis: a brief review of contemporary literature

  • Telehealth and telemedicine have shown to increase access to patients, communities, and vulnerable populations, including adolescents, adults, seniors, veterans, rural patients, persons diagnosed with a disability and/or a mental health condition, and persons with transportation barriers and mobility issues.
  • The provision of health care services via telehealth and telemedicine has been shown to decrease the wait times for emergency departments, an appointment with a general practitioner, and referrals to several medical specialties, such as behavioral health and Ear, Nose and Throat (ENT).
  • Telehealth and telemedicine can be utilized to provide prevention and early intervention services and to support follow-up care for chronic conditions.

From the Initial stakeholder feedback summary

  • Telehealth made it easier to access services, and easier to involve other family members in healthcare services.
  • Telehealth freed-up time to serve more clients/patients in need of services since healthcare staff could provide services from one location, eliminating drive-time between provider sites.
  • Patient/client attendance was improved by fewer “no-shows” and late arrivals.
  • Some patients who would otherwise not access care due to their illness, travel distance, lack of transportation, lack of child/senior care, or level of motivation, can more easily access services in the comfort of their home.
  • The input from metro county ethnic minority groups and rural tribal recipients were positive for telehealth service provision, noting that telehealth improves equity in access to healthcare.
  • Responses from ethnic minority groups and rural tribal recipient groups mentioned a preference that telehealth be provided by telephone and not via the internet.

From the Claims data analysis

  • Of the individuals who utilized telemedicine for all health care services, 20% used telemedicine-only, 15% started services after the PHE and have continued follow-up via telemedicine, approximately 50% of individuals stopped services (submitted no claims after the PHE).
  • Results indicate that of the 87.3% of individuals who received health care services, approximately 25% of the recipients engaged in telemedicine care. Moreover, 14.3% of patients receiving Medicaid who needed care and did not utilize in-person visits were able to utilize telemedicine-only services after the PHE. Further investigation on these particular utilization groups is warranted and could illuminate how to better engage individuals with telemedicine health care services.
  • Results suggest changes in telemedicine utilization which impact age groups differently. Specifically, individuals within age groups 0-5 years old and 66+ years old had more telemedicine claims compared to individuals 6-65 years old. This is inconsistent with the CMS Medicaid and CHIP snapshot data, which found that working age adults were more likely to utilize telemedicine services.
  • To measure provider and service patterns at a more gradient level, next steps will utilize longitudinal method with monthly and/or weekly time points starting in January 2020 to more accurately identify telemedicine trends in provider and services.
  • Age and additional demographics warrant further investigation based on volume based on services received.
  • Further examination on service patterns based on services being utilized by individual differences including racial and ethnic groups and geographic location.

From Focus groups (Provider recommendations)

  • Clear guidelines from DHS on billing and payment, patient notes and any other aspects of care or charting which may be audited or should be standardized across practitioners.
  • State assistance (grants, legislation, etc.) to ensure access to high speed Internet statewide, both for providers and facilities and for patients, especially in rural areas.
  • Providers particularly want to ensure that telephone continues to be viewed as a viable form of treatment and billable on par with video treatment options.
    • This is especially important as Internet availability and reliability continue to be a barrier for many patients in accessing remote medicine via video services.
  • Move to a single or greatly reduced number of HIPAA compliant, easy to use, affordable platforms as the vast number of different programs used currently can create difficulties in coordination of care among facilities, providers and other agencies as well as difficulties for patients who see multiple providers utilizing different systems.
  • One idea is to create a public- private partnership between DHS and a telemedicine platform company which would allow for a low-cost, HIPAA compliant system used by most Minnesota providers. o Pursue interstate licensure for telemedicine so providers close to state borders can serve more patients.
    • Promote collaboration with insurance companies and the state insurance commissioner to ensure equity in billing of telemedicine for patients across Minnesota-based insurance companies.
  • Interpreters are an important part of providing mental health and substance use care, and these providers urged that they be included in supporting a successful telemedicine model in Minnesota.
    • These providers stressed that interpreters who are providing ancillary support to providers should be included in any grant funding for devices, Internet provision or other technological assistance as they are currently left to cover these costs themselves.
    • Likewise, if there is to be any standardization of care guidelines or regulations created by DHS, they should take into account the need for interpreters and having a three-way video call, phone call or other means of utilizing interpreter services.

Lessons learned

  • Integrate telemedicine as a permanent modality in delivery of services
  • Provide training, assistance and clarification in provider manual regarding use of telemedicine
  • Offer specific guidance for Office of Inspector General on review of licensing standards around telemedicine
  • Invest resources in exploring reasons behind comparatively low level of utilization of telemedicine by Black, Indigenous, and People of Color (BIPOC) communities
  • Use of telephone-only as a telemedicine modality for clinical services needs to be examined further and independently of other telemedicine modalities. o Possibly keep this as an option for future public health emergencies.

HealthPartners surpasses 1 million video visits in MN since COVID-19 began

WCCO Radio reports

When the COVID-19 pandemic took center state in Minnesota in March 2020, hospitals and clinics rushed to alter how they offered clinic visits due to worries about patient and provider safety.

Video visits quickly replaced traditional in-person clinic visits at HealthPartners locations in Minnesota. In fact, video visits reached their peak last May accounting for 50 percent of all visits.

“We were able to train 2,000 clinicians on how to do video visits and create training materials in the matter of days,” said Dr. Annie Ideker, a family physician at the HealthPartners clinic in Arden Hills. “Literally in one day a small team of us actually developed this strategy and completed five video visits by the end of the day. That was on March 19.”

As of February 15, HealthPartners had completed over 1 million video visits since the start of the pandemic.

While the numbers have dropped off, 22 percent of all visits at HealthPartners are done via video.

MN House introduces two bills to expand coverage of telehealth (HF1411 and HF1412)

Minnesota Legislature website (and Revisor’s Office) report…

 

Morrison introduced:

  1. F. 1411,A bill for an act relating to health; expanding telehealth; changing telemedicine to telehealth in certain statutes; amending Minnesota Statutes 2020, sections 62A.671, subdivision 9; 147.032, subdivisions 1, 2; 147.033, subdivision 1.

The bill was read for the first time and referred to the Committee on Health Finance and Policy.

Morrison introduced:

  1. F. 1412,A bill for an act relating to health care; modifying coverage for health care services and consultation provided through telehealth; amending Minnesota Statutes 2020, sections 147.033; 151.37, subdivision 2; 245G.01, subdivisions 13, 26; 245G.05, subdivision 1; 245G.06, subdivision 1; 254A.19, subdivision 5; 254B.05, subdivision 5; 256B.0625, subdivisions 3b, 46; proposing coding for new law in Minnesota Statutes, chapter 62A; repealing Minnesota Statutes 2020, sections 62A.67; 62A.671; 62A.672.

The bill was read for the first time and referred to the Committee on Commerce Finance and Policy.

The first bill seems to mostly be a change from telemedicine to telehealth. Here’s an excerpt of the changes that I think get to the point – where the crossed out portion is replaces by the underlined…

…with respect to providing medical services to state residents.

(e) For the purposes of this section, telemedicine means the practice of medicine as
defined in section 147.081, subdivision 3, when the physician is not in the physical presence
of the patient.

(f) A physician providing medical services through interstate telehealth under this section
is engaged in the practice of medicine as defined in section 147.081, subdivision 3.

And here’s full text of HF1412… Continue reading

Google is opening an office in Rochester MN to be close to the Mayo Clinic

Healthcare IT News reports

Google announced Thursday that it would open first office in Minnesota – a new Rochester-based space that will enable employees to work more closely with the Mayo Clinic on an array of ongoing cloud and artificial intelligence projects.

They have been working for a while…

Since launching their 10-year partnership in September 2019 Mayo Clinic and Google have worked closely on a wide array of clinical and operational use cases – pushing troves of data to the cloud, harnessing artificial intelligence for imaging and decision support and exploring novel approaches to COVID-19 treatment and public health.

Even before the collaboration was launched, Mayo Clinic was already a major machine learning innovator. James D. Buntrock, the health system’s vice chair of IT enterprise technology services, noted this past year that Mayo launched an internal workgroup to find new AI opportunities – but “to our surprise, we identified more than 200 activities that were using some sort of AI or machine learning methodology.”

It’s good news to have collaboration between Mayo and Google. It’s good for Rochester to attract a success, innovative and well known company like Google. With any luck that will promote and facilitate more partnerships in the area. It is interesting, at a time when so many people are working entirely online and thinking about making that permanent, that a move like this was made.

OPPORTUNITY: Minnesota COVID-19 Vaccine Connector – sign up to get on the list

The State of Minnesota has just unveiled the COVID-19 Vaccine Connector. It’s a portal to get people connected to get their COVID vaccines. Here’s the gist ( from the flier)…

The Minnesota COVID-19 Vaccine Connector is a tool that helps you find out when, where, and how to get your COVID-19 vaccine. Insurance and identification are not needed, and signing up is free. When you become eligible to get the vaccine, the Vaccine Connector will:

let you know you are eligible.

connect you to resources to schedule a vaccine appointment.

notify you if there are vaccine opportunities in your area.

How do I sign up?

Signing up for the Vaccine Connector is easy, safe, and secure. All Minnesotans should sign up, regardless of whether they are currently eligible to get vaccinated.

Online Sign up at: mn.gov/vaccineconnector

By Phone: Translation is available. If you are unable to sign up online, you can sign up over the phone. Translation is available by phone in all languages. Call: 651-318-0989 or 833-431-2053

I just signed up. It didn’t take five minutes and there was nothing I needed to look up.

This is another example of the importance of broadband, a device and the skills to use it! Someone could make a trip to friend’s house or public kiosk to get signed up – although not encouraged during a pandemic. But more than a barrier to signing up; lack of access will hinder the ability to get and receive notices.

One of the questions asks if you would be able to respond quickly if an opportunity arose – inherent in the question is do you have the technology to respond.