Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.
New Telehealth Bills Roll in
With a new administration in Washington came a slew of new and re-introduced telehealth bills, mHealth Intelligence reported.
The Protecting Access to Post-COVID-19 Telehealth Act, a bill aiming to make permanent some emergency access and coverage rules put in place during the COVID-19 pandemic, was reintroduced by Congressional Telehealth Caucus members and once again earned the support of the American Telemedicine Association.
The act specifies that Medicare will reimburse providers for either ordering “a test … to an eligible telehealth individual an amount equal to the amount that such physician or practitioner would have been paid for a diagnostic laboratory test,” or furnishing “an assistive telehealth consultation to an eligible telehealth individual an amount equal to the amount that a physician or practitioner would have been paid for such telehealth service.”
The bill died in committee last year, but many people are “hoping that a new administration and Congress can make telehealth a priority this time around,” mHealth Intelligence noted.
Other telehealth legislation introduced this year includes the ACCESS (Advancing Connectivity during the Coronavirus to Ensure Support for Seniors) Act, which would allocate $50 million for HHS to expand Medicare and Medicaid coverage of telehealth services in nursing facilities; the START (Safe Testing at Residence Telehealth) Act, which would mandate Medicare coverage for virtual care COVID-19 tests; and the Ensuring Telehealth Expansion Act, which would extend several provisions of last year’s CARES Act until 2025.
A Watch on Parkinson’s
A smartwatch-based monitoring system detected motor changes in Parkinson’s disease patients, said Adeeti Ullal, PhD, of Apple Inc., and co-authors, in Science Translational Medicine.
The study used smartwatch inertial sensors to track fluctuations continuously in resting tremor and dyskinesia in 343 patients, including 225 who were followed for 6 months. During in-clinic tasks, smartwatch measurements correlated to clinical evaluations of tremor severity (ρ=0.80) and mapped to expert ratings of dyskinesia (P<0.001). The measurements also captured symptom changes in response to treatment that matched clinicians’ expectations in 94% of patients.
Quality of life in Parkinson’s patients correlates with a clinician’s ability to precisely titrate medications, Ullal and colleagues noted. Clinic assessments provide a snapshot view once every few months. “For out-of-clinic symptom tracking, clinicians rely on patient recall of symptoms, which is often error prone, particularly for medication-induced symptoms like dyskinesia,” the team said.
The smartwatch system focused on resting tremor and detecting dyskinesia, but future versions could incorporate postural tremor, dyskinesia severity, and periods of simultaneous tremor and dyskinesias, the researchers added.
“Assessment of other motor symptoms such as bradykinesia, gait, and posture may also be needed to capture the complete patient phenotype,” the investigators wrote, pointing out that while the underlying hardware — the Apple Watch — is not a medical device, FDA clearance may be necessary for the system to be used widely.
The technology has promise both clinically and as a research tool, the team suggested: “Clinicians could use smartwatch symptom profiles to improve treatment plans, motivate patients to remain adherent, or quantify post-surgery improvements. Researchers could passively assess disease progression or treatment efficacy without symptom journals, which may burden participants and confound results by increasing patients’ awareness of symptoms.”
Endocrinology, Gastroenterology, Neurology Top Telehealth List
Endocrinology, gastroenterology, and neurology had the greatest uptake of telemedicine after Medicare expanded telehealth coverage in 2020, reported Michael Barnett, MD, MS, of Harvard T.H. Chan School of Public Health in Boston, and co-authors in Health Affairs.
From March 18 to June 16, telemedicine was used at least once by 68% of endocrinologists, 57% of gastroenterologists, and 56% of neurologists, Barnett and colleagues said. About half of pain management physicians, psychiatrists, and cardiologists also used virtual visits at least once.
The analysis was based on claims data from 16.7 million commercially insured and Medicare Advantage enrollees who had an average age of 45. Specialties with the least virtual engagement included optometry (3%), physical therapy (7%), ophthalmology (9%), and orthopedic surgery (21%).
Across common conditions, the percentage of visits provided by telehealth ranged from 53% for depression to 3% for glaucoma, the researchers noted.
About 30% of all healthcare visits were provided by telemedicine in the 3-month period. Telehealth use was lower in communities with higher rates of poverty.
“Although there was variability in the magnitude of changes across different patient populations and clinical disciplines, every segment of the health care system experienced a drop in the overall volume of care, including important common chronic conditions such as diabetes and hypertension,” Barnett and co-authors wrote.
The healthcare system may struggle to catch up with the large amount of deferred care, they added: “Lost volume from chronic condition management could lead to worse downstream outcomes if more patients experience poor control of their disease, as seen with care disruptions in past natural disasters.”