Telehealth / en Thu, 31 Jul 2025 17:48:57 -0500 Mon, 28 Jul 25 15:43:12 -0500 TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities /action-alert/2025-07-28-take-action-engage-lawmakers-august-build-support-key-priorities <div class="container"><div class="row"><div class="col-md-8"><p>The House of Representatives has left Washington, D.C., for its August district work period, and senators could return to their states as early as next week. It is important to engage with your lawmakers while they are home and discuss the impact that the recently passed One Big Beautiful Bill Act and additional policy proposals that are under consideration will have on hospitals’ ability to provide care.</p><p>Funding for the federal government, including certain important health care programs, is set to expire Oct. 1. Congress must pass all 12 appropriations bills by Sept. 30 to fund the federal government for the next fiscal year. If lawmakers fail to meet that deadline, they will need to enact a continuing resolution temporarily extending current funding levels to avoid a government shutdown. However, these health care programs including Low-volume Adjustment and Medicare-Dependent Hospital, telehealth and hospital-at-home waivers — as well as prolonging Medicaid DSH cuts from going into effect — are not guaranteed to be extended. Additionally, Congress needs to act before the end of the year to extend the Enhanced Premium Tax Credits. Meanwhile, some legislators are discussing another reconciliation package on deficit reduction efforts. Those efforts could include additional Medicaid and Medicare cuts. It is important that your legislators understand hospitals and health systems cannot sustain any additional cuts, especially as we are facing the implementation of Medicaid cuts in the <a href="/advisory/2025-07-18-detailed-summary-one-big-beautiful-bill-act-obbba-public-law-no-119-21">OBBBA</a>.</p><p>While your lawmakers are home next month, please make plans to visit them in their offices, speak with them at a community event or invite them to your hospital to show them the importance of supporting policies that allow hospitals to provide care to their communities. And share with them the impact that funding reductions would have on your ability to provide services and care for the people they represent.</p><p>The following are some of the top priority issues and resources that can assist you and your team in conversations with your lawmakers.</p><h2>Advocacy Priorities</h2><ul><li><strong>Extend the </strong><a href="/fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits"><strong>Enhanced Premium Tax Credits</strong></a><strong>.</strong> The Enhanced Premium Tax Credits help individuals and families purchase insurance on the Health Insurance Marketplaces. Policies enabling these credits will expire at the end of 2025. Urge your members of Congress to extend the enhanced premium tax credits that enable millions of people to have health care coverage.</li><li><strong>Reject </strong><a href="/advocacy/advocacy-issues/2023-09-11-advocacy-issue-site-neutral-payment-proposals"><strong>Site-neutral Payments</strong></a><strong>.</strong> Site-neutral payments would compensate hospital outpatient departments the same as independent physician offices and other ambulatory sites of care, ignoring the very different level of care provided by hospitals and the needs of the patients and communities cared for in that setting. Ask your members of Congress to reject efforts to enact additional site-neutral payments proposals.</li><li><strong>Protect the </strong><a href="/fact-sheets/fact-sheet-340b-drug-pricing-program"><strong>340B Drug Pricing Program</strong></a><strong>.</strong> Hospitals depend on the 340B program to manage rising prescription drug costs and expand access to care for patients. Ask your members of Congress to oppose any harmful changes to the 340B program.</li><li><strong>Extend </strong><a href="/fact-sheets/2025-02-07-fact-sheet-telehealth"><strong>Telehealth</strong></a><strong> and </strong><a href="/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program"><strong>Hospital-at-home</strong></a><strong> Programs.</strong> These programs enable providers to care for patients at home, without having to make long drives to a facility. These programs are set to expire Sept. 30. Urge your lawmakers to extend these programs so providers can ensure continuity of care.</li><li><strong>Prevent </strong><a href="/advocacy/advocacy-issues/medicaid-dsh-payment-cuts"><strong>Medicaid Disproportionate Share Hospital</strong></a><strong> Cuts.</strong> The Medicaid DSH program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations, including children and those who are disabled and elderly. The Medicaid DSH cut for fiscal year 2026 is $8 billion and will go into effect on Oct. 1 unless Congress acts. Urge your lawmakers to provide relief from the Medicaid DSH cuts given the vital need for the program.</li><li><strong>Extend the </strong><a href="/advocacy/advocacy-issues/2024-10-31-advocacy-issue-rural-mdh-and-lva-programs"><strong>Low-volume Adjustment and Medicare-dependent Hospital</strong></a><strong> Programs.</strong> The enhanced low-volume adjustment and Medicare-dependent hospital programs provide rural, geographically isolated and low-volume hospitals additional financial support to ensure rural residents have access to care. Without action from Congress, the enhanced LVA and MDH programs will expire Sept. 30. Urge your lawmakers to extend these vital programs.</li><li><strong>Protect </strong><a href="/fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response"><strong>Health Care Workers</strong></a><strong> from Violence.</strong> The Save Healthcare Workers Act (H.R. 3178/S. 1600) is bipartisan legislation (that would make it a federal crime to assault a hospital staff member on the job. Urge your lawmakers to support this legislation.</li></ul><h2>AHA Resources</h2><p>Your voice is extremely important and your legislators listen to you. Be ready to tell your hospital’s story. Prepare for a successful encounter with these <a href="/advocacy/2023-03-07-advocacy-tips-and-best-practices">tips and best practices</a> for meeting with lawmakers and hosting them at your hospital. Visit the <a href="/advocacy/action-center">AHA Action Center</a> for information and resources to assist you in your advocacy.</p><h2>Further Questions</h2><p>If you have further questions, please contact the AHA at <a href="tel:1-800-424-4301">800-424-4301</a>.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.pdf" target="_blank" title="Click here to download the Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities"><img src="/sites/default/files/inline-images/Page-1-Action-Alert-TAKE-ACTION-Engage-Lawmakers-in-August-to-Build-Support-for-Key-Priorities.png" data-entity-uuid="f8d7fe18-60fc-49cc-9704-cacdc239ac3a" data-entity-type="file" alt="Action Alert: TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities page 1." width="695" height="900"></a></div></div></div> Mon, 28 Jul 2025 15:43:12 -0500 Telehealth Chair File: The OBBBA and What’s Next for Health Care /news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care <p>The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue conversation earlier this month to talk about the key provisions that apply to health care. If you missed that episode, you can <a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and">watch the video or listen to the podcast</a>.</p><p>Our health care field, supported by patch after patch since 1965, is not sustainable for today’s world of 2025. Some of the patches that we needed to keep going are gone, and it’s unrealistic to think they’re coming back. This time doesn’t just feel different, it is different. So what should we be focused on as hospitals and health systems?</p><p>First, we have to accept reality and make the smartest choices we can with the resources and constraints we have to maximize our delivery on our mission. The AHA has already begun some of this work and will be assisting hospitals to help individuals retain eligibility for coverage, as well as sharing best practices for improvements and operational efficiencies. We also are looking ahead at several hospital priorities that will need to be addressed before the end of the year — from waivers for telehealth and hospital at home, Medicaid disproportionate share hospital cuts, the Medicare rule making process, regulatory relief and more. Now more than ever, we are here to help you do what you do best: care for our communities.</p><p>While the AHA is pulling all the levers in Washington, D.C., to advocate for priorities that advance health, all of us have an important role to play in engaging our legislators. There’s nothing more powerful than hearing from you, their constituents, about the impact certain policies will have on the people they represent. You can find resources and more information on how to best do this below.</p><p>Our second, and most important, job is to actually reform and transform health care for the long term. We need to do the hard work and create a health care model that is sustainable for the world of 2065, not 1965. We have to start putting proposals on the table that challenge the status quo yet move us forward.</p><p>At the AHA Leadership Summit in Nashville last week, I heard so many incredible stories of how you have started this work. As a field, we are using technology and innovation to transform care delivery, improve quality and patient safety, and meet people where they need care. And that is what makes me hopeful and optimistic.</p><p>We’ve been dealt a difficult hand, but it’s our opportunity to open the door wide for transformation and innovation. We owe it to ourselves, our team members, our patients and our communities to make the very best choices we can today — and to transform our health care system for tomorrow.</p><h2>Helping You Help Communities — Key AHA Resources</h2><ul><li><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025">Advocacy Resources on OBBBA</a></li><li><a href="/advocacy/action-center">AHA Action Center</a></li><li><a href="/advocacy-issues">Key Advocacy Issues and Resources</a></li><li><a href="/advocacy/working-with-congress">Guide to Working with Congress</a></li></ul> Mon, 28 Jul 2025 10:16:20 -0500 Telehealth Rush Health Launches National Direct-to-Consumer Telehealth Membership /aha-center-health-innovation-market-scan/2025-07-22-rush-health-launches-national-direct-consumer-telehealth-membership <div class="container"><div class="row"><div class="col-md-8"><img src="/sites/default/files/inline-images/Rush-Health-Launches-National-Direct-to-Consumer-Telehealth-Membership.png" data-entity-uuid="86f95f40-61d1-47cc-ac79-04a0751b4f01" data-entity-type="file" alt="Rush Health Launches National Direct-to-Consumer Telehealth Membership. A Rush University System for Health clinician displayed on a table screen via a telehealth app helps a patient identify her correct dosage of prescription medication." width="1200" height="751"><p>The recent news that Chicago-based <a href="https://www.rush.edu/" target="_blank" title="Rush University System for Health hoempage">Rush University System for Health</a> was launching a new direct-to-consumer (DTC) <a href="https://www.rush.edu/news/rush-connect-brings-suite-digital-first-care-options-patients" target="_blank" title="Rush: Rush Connect Brings Suite of Digital-first Care Options to Patients">telehealth membership</a> that provides 24/7 access to virtual care across the country grabbed attention throughout the field.</p><p>The membership, called <a href="https://www.rush.edu/services/connectplus" target="_blank" title="Rush: Rush Connect+ landing page">Rush Connect+</a>, will cost consumers $19 per month or $189 a year. The service includes access to a human assistant via live chat or phone for questions and making appointments. In addition, Rush has made enhancements to its other suite of digital health offerings, including a new virtual specialty program that offers same-day or next-day access to specialty care.</p><p>Currently available for eight specialties, patients looking to solve problems ranging from acne to high blood pressure, as well as more private concerns about sexual health and weight loss, can find appointments available almost immediately, the health system states.</p><h2>3 Takeaways on Rush’s DTC program</h2><h3><span>1</span> <span>|</span> Rush plans to provide a concierge-level user experience.</h3><p>Rush Connect is powered by the health tech company <a href="https://www.fabrichealth.com/ai-assistant" target="_blank" title="Fabric:" ai assistant landing>Fabric’s AI assistant</a> and virtual care platform. The seamless navigation experience will expand access to urgent care anywhere in the country, said Paul Casey, M.D., senior vice president and chief medical officer at Rush.</p><p><strong>Other enhancements to the patient experience through Rush Connect include:</strong></p><ul><li>Important health reminders via text or email when patients qualify for certain health screenings, which can be scheduled with just a few clicks.</li><li>Wait time alerts so patients receive real-time text message updates about precisely when they will see their doctors once they arrive at a Rush clinic.</li><li>An easy way to provide feedback through an automatic text message micro-survey that asks about the patient’s visit. If there are any issues, Rush can call the patient to try to make it right.</li></ul><h3><span>2</span> <span>|</span> The hybrid care experience will help increase access.</h3><p>The system aims to create a digitally connected hybrid care experience that provides tools to coordinate care and enhance access to services, regardless of where the patient lives or what time they seek care.</p><h3><span>3</span> <span>|</span> Appointment scheduling gets an upgrade.</h3><p>On Rush’s newly designed appointment scheduling page, patients can enable an AI-powered chatbot and symptom checker to find the right care for their needs and quickly access care in a few clicks.</p><p>Rush also will be adding an app, available to all patients later this year, that will incorporate Epic’s <a href="https://www.mychart.org/" target="_blank" title="MyChart homepage">MyChart</a> for online patient portal access and access to all Rush Connect digital health services, appointment scheduling, care team messaging and help from Fabric's AI-powered assistant.</p></div><div class="col-md-4"><div class="sticky"><p><a href="/center" title="Visit the AHA Center for Health Innovation landing page."><img src="/sites/default/files/inline-images/logo-aha-innovation-center-color-sm.jpg" data-entity-uuid="7ade6b12-de98-4d0b-965f-a7c99d9463c5" alt="AHA Center for Health Innovation logo" width="721" height="130" data-entity- type="file" class="align-center"></a></p><p><a href="/center/form/innovation-subscription"><img src="/sites/default/files/2019-04/Market_Scan_Call_Out_360x300.png" data-entity-uuid data-entity-type alt width="360" height="300"></a></p></div></div></div></div>.field_featured_image { position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } .featured-image{ position: absolute; overflow: hidden; clip: rect(0 0 0 0); height: 1px; width: 1px; margin: -1px; padding: 0; border: 0; } h2 { color: #9d2235; } div.sticky { position: sticky; top: 0; } Tue, 22 Jul 2025 06:00:00 -0500 Telehealth CMS Issues CY 2026 Physician Fee Schedule Proposed Rule /advisory/2025-07-15-cms-issues-cy-2026-physician-fee-schedule-proposed-rule <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) July 14 issued a <a href="https://public-inspection.federalregister.gov/2025-13271.pdf">proposed rule</a> that would update physician fee schedule (PFS) payments for calendar year (CY) 2026. The rule also includes proposals related to the Medicare Shared Savings Program (MSSP) and the Quality Payment Program (QPP), both of which were created by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. It also would create a new mandatory payment model focused on specialists’ care for beneficiaries with heart failure and low back pain. </p><p> CMS will accept comments on the proposed rule through Sept. 12.</p><div class="panel module-typeC"><div class="panel-heading"><p><strong>KEY HIGHLIGHTS</strong></p><p>CMS’ proposed policies would:</p><ul><li>Implement two separate conversion factors: one for alternative payment model (APM) qualifying participants (QPs) and one for physicians and practitioners who are not QPs.<ul><li>The APM QP conversion factor would increase by 3.83% in CY 2026 as compared to CY 2025.</li><li>The non-QP conversion factor would increase by 3.62% in CY 2026 as compared to CY 2025.</li></ul></li><li>Make an efficiency adjustment of -2.5% to certain work relative value units (RVUs).</li><li>Modify the practice expense (PE) methodology to decrease facility PE RVUs and increase non-facility PE RVUs.</li><li>Extend some, but not all, telehealth waivers, either permanently or through 2026.</li><li>Create a new claims-based methodology to remove units of drugs purchased under the 340B program for the purposes of calculating Medicare drug inflation rebates. The agency is also proposing to create a 340B claims data repository allowing voluntary data submission by 340B providers to potentially use for the same purpose.</li><li>Create a new mandatory payment model, the Ambulatory Specialty Model (ASM), focused on specialists who care for beneficiaries with heart failure and low back pain, to begin Jan. 1, 2027, and run for five years.</li><li>Make several updates to the Medicare Share Savings Programs policies on performance and beneficiary assignment methodology.</li><li>Establish a MIPS performance threshold of 75 points for the CY 2026 performance period through the CY 2028 performance period, as well as adopt six new MIPS Value Pathways and make modifications to performance categories under the Quality Payment Program.</li></ul></div></div><h2>AHA TAKE</h2><p>The AHA is pleased that CMS, as directed by Congress, is proposing a positive payment update for physicians, which will be the first in several years. However, we will be closely evaluating the proposed efficiency adjustment and changes to PE RVUs, which both redistribute payments and may inappropriately disadvantage certain providers, including physicians who are largely hospital-based. </p><p>We also thank CMS for its proposal to extend or make permanent certain telehealth flexibilities, such as permanently removing frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations. However, we were disappointed the agency did not propose extending a waiver that allows providers to report practice addresses instead of home addresses when they perform telehealth services from their home. </p><p>We appreciate the recognition of the complexity of identifying Medicare Part D drug units purchased under the 340B drug pricing program. As we review the agency’s proposals in more detail, we caution against any approach that would add unnecessary burden on 340B hospitals or would allow sensitive 340B data to be used outside the scope of the Medicare drug inflation rebate program to diminish the value of the program to 340B hospitals and their patients.</p><p>Finally, while we support moving towards more coordinated and accountable care through APMs, we are concerned about CMS’ proposal to create another mandatory model, as many physicians may not be in a financial position to support the investments necessary to transition to mandatory models.</p><p>Highlights of the PFS rule follow.</p><h2>CY 2026 PROPOSED PAYMENT UPDATE</h2><p>As required by law, beginning in CY 2026, CMS proposes implementing two separate conversion factors: one for APM QPs and one for physicians and practitioners who are not QPs. The rule would increase the APM QP conversion factor by 3.83% in CY 2026 as compared to CY 2025. It would increase the non-QP conversion factor by 3.62% in CY 2026 as compared to CY 2025. These updates include statutory updates of 0.75% and 0.25% for the APM QP and non-QP factors, respectively, another statutory update of 2.5% as required by the One Big Beautiful Bill Act and an increase of 0.55% that CMS states is necessary to account for proposed changes in work RVUs (described below).</p><h3>Efficiency Adjustment</h3><p>CMS proposes an efficiency adjustment to the work RVUs. It states that its proposal is based on an assumption that both the provider’s time directly providing the service to a patient as well as their work intensity would decrease as they develop expertise in performing the service. The agency expects non-time-based codes, such as codes describing procedures, radiology services and diagnostic tests, to become more efficient as they become more common, professionals gain more experience, technology is improved and other operational improvements (including but not limited to enhancements in procedural workflows) are implemented.</p><p>To calculate the efficiency adjustment, CMS proposes using the Medicare Economic Index (MEI) productivity adjustment. This adjustment reflects the most recent historical estimate of the 10-year moving average growth of private nonfarm business total factor productivity, as calculated by the Bureau of Labor Statistics. It is substantively similar to the productivity adjustment used in other Medicare payment systems, such as the inpatient prospective payment system (PPS) and outpatient PPS.</p><p>For CY 2026, CMS would apply the efficiency adjustment using a look-back period of five years. This methodology yields a proposed efficiency adjustment of -2.5%, which will be updated in the final rule. The agency states that, generally, specialties that bill more often for timed codes (such as family practice, clinical psychologists, clinical social workers, geriatrics and psychiatry) would see an increase in RVUs, while specialties that bill more often for procedures, diagnostic imaging and radiology services (such as radiation oncology, radiology, and some surgical specialties) would see a decrease in RVUs. That said, CMS estimates that almost all specialties would experience no more than 1% increase or decrease in RVUs as a result of this proposed policy, although the effect on individual services may be greater. It would be implemented in a budget neutral manner overall, however, and there would be a net increase to the conversion factor because of its implementation. </p><p><u></u></p><h2>Practice Expense Methodology</h2><p>CMS states that over the past two decades or so, there has been a steady decline in the percentage of physicians working in private practice, with a corresponding rise in physician employment by hospitals, as well as growth in the percentage of physicians who practice exclusively, or almost exclusively, in the facility setting. When the PFS was established, the methodology for allocating indirect PE was based in part on an assumption that the physician maintained an office-based practice while also practicing in a facility setting. However, CMS is concerned that this methodology may now overstate the indirect costs incurred by facility-based physicians.</p><p>Beginning in CY 2026, for each service valued in the facility setting under the PFS, CMS proposes to reduce the portion of the facility PE RVUs allocated based on work RVUs to half the amount allocated to non-facility (office-based) PE RVUs. The agency states that specialties that practice primarily in the facility setting would see a decrease in PE RVUs as a result of this redistribution. Specialties that perform services primarily in the non-facility (office-based) setting would see an increase in PE RVUs.</p><h2>Use of Outpatient PPS Data for PFS Rate-setting</h2><p><u> </u></p><p>For several types of PFS services, CMS proposes deviating from its historic use of American Medical Association survey data and instead using auditable, routinely updated hospital data. Specifically, for CY 2026, the agency proposes to:</p><ul><li>Use the relationship between outpatient PPS ambulatory payment classification payment rates to establish PE RVUs for radiation oncology treatment delivery and superficial radiation treatment services.</li><li>Use outpatient PPS cost data to establish the value for the PE portion of remote physiologic monitoring because it believes that these cost data are more accurate than the PE inputs currently used.</li><li>Use hospital outpatient utilization patterns to set payment rates for three categories of skin substitutes.</li></ul><h2>TELEHEALTH SERVICES</h2><p><strong>Medicare Telehealth Services List</strong></p><p>CMS proposes changing its review process for the Medicare Telehealth Services List by removing the distinction between provisional and permanent services. It also would limit its review to whether the service can be furnished using an interactive, two-way audio/video telecommunications system.</p><p><strong>Telehealth Waivers</strong></p><p>The proposed rule would make changes to several telehealth waivers, including:</p><ul><li>Permanently removing frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations.</li><li>Permanently adopting a definition of direct supervision to include virtual presence via audio/video real-time communications technology.</li><li>Extending the ability for federally qualified health centers and rural health clinics to bill telehealth services through Dec. 31, 2026.</li></ul><p>CMS does not appear to address its prior waiver that allowed providers to report practice addresses instead of home addresses when they perform services from their home. In addition, for services provided in metropolitan statistical areas (MSAs), it does not propose to continue to allow virtual supervision of residents when the service is performed virtually across teaching settings. Instead, this would only be allowed for services provided in non-MSAs. </p><h2>MEDICARE PRESCRIPTION DRUG INFLATION REBATE PROGRAM</h2><p>CMS proposes new methodologies to calculate units of Medicare Part D drugs purchased under the 340B drug pricing program that must be excluded from the calculation of Medicare inflation rebates starting on Jan. 1, 2026, as required under the Inflation Reduction Act of 2022. The agency proposes a claims-based methodology that would determine which Part D drug units are 340B-eligible for exclusion from the inflation rebate calculation and solicits comments on two such methodologies: a prescriber-pharmacy methodology and a beneficiary-pharmacy methodology.  One method assumes that any drug that is prescribed by a provider that is affiliated with a 340B provider and is dispensed by a 340B retail pharmacy is a 340B drug. The other assumes that any drug prescribed to a patient of a 340B provider and is dispensed by a 340B retail pharmacy is a 340B drug. The agency notes that these methodologies may overestimate the number of 340B units for exclusion from the inflation rebate calculation.</p><p>As a potential future alternative to the claims-based methodology, CMS proposes establishing a claims data repository to receive voluntary submission from 340B covered entities of certain Part D claims data elements to identify which drug units are 340B-eligible. The agency has issued an Information Collection Request alongside the proposed rule that details the format and process of submitting data elements to the repository.</p><p>The agency anticipates the repository would go live in Fall 2026 with the goal of testing the usability of a 340B repository in identifying and excluding 340B drug units in the calculation of Medicare Part D inflation rebates. The agency encourages all 340B covered entities to participate in the voluntary submission process and notes that it may require mandatory reporting in future rulemaking.</p><h2>AMBULATORY SPECIALTY MODEL</h2><p>CMS proposes creating the ASM, which would focus on low back pain and congestive heart failure. ASM would begin on Jan. 1, 2027, and run for five performance years, through Dec. 31, 2031.</p><p>ASM would include specialists who frequently treat low back pain or heart failure, practice within selected core-based statistical areas or metropolitan divisions, and have historically treated at least 20 fee-for-service (FFS) Medicare patients with low back pain or 20 FFS Medicare patients with heart failure over a 12-month period. Physicians would be assessed individually, not at the practice level. Low back pain specialists would include those practicing in anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation. Heart failure specialists would include those practicing in cardiology.</p><p>ASM participants would be assessed across four categories: quality, cost, care improvement activities and improving interoperability. Their scores across these categories would determine whether they receive positive, neutral or negative payment adjustments on future Medicare Part B claims for covered services. In the first payment year, these adjustments would range from -9% to +9%. All participants would be subject to this risk. Total positive adjustments for high performers would not exceed the total negative adjustments for low performers.</p><p><strong>BEHAVIORAL HEALTH SERVICES</strong></p><p>CMS proposes updates intended to enhance integration of behavioral health into primary care. First, the agency clarifies that marriage and family therapists and mental health counselors can bill Medicare directly for Community Health Integration and Principal Illness Navigation services. Next, CMS proposes creating add-on codes for Advanced Primary Care Management services that complement previously established Behavioral Health Integration or psychiatric Collaborative Care Model services. Lastly, CMS proposes deleting the HCPCS code finalized in the CY 2024 PFS final rule that describes social determinants of health risk assessment and altering language throughout the regulations to refer to “upstream drivers” of health rather than “social determinants.”</p><p>The agency also proposes updates to previously established payment codes for services provided using digital mental health treatment (DMHT) devices, including expanding payment for use of DMHT for attention deficit hyperactivity disorder. CMS seeks comments on other ways to enhance the use of digital tools, such as those used to maintain or encourage a healthy lifestyle; administration of an FDA-authorized eye-tracking technology in the diagnosis of autism spectrum disorder on pediatric patients; and payment policies for the use of software-based clinical decision support technologies (referred to Software as a Service, or SaaS).</p><p><strong>MEDICARE SHARED SAVINGS PROGRAM</strong></p><p>CMS proposes several changes to the Shared Savings Program’s policies regarding performance, financial methodology, beneficiary assignment methodology, participation options and availability of new payment options (among other changes) beginning with performance year 2027. One such change would be to reduce the time an accountable care organization (ACO) can participate in a one-sided model of the BASIC track from seven to five years to encourage participation in two-sided risk models. CMS also would modify eligibility and financial reconciliation requirements related to the statutory requirement that ACOs have at least 5,000 assigned Medicare FFS beneficiaries; the agency believes these changes would allow for flexibility in the minimum number of assigned beneficiaries required in benchmark years.</p><p>CMS also proposes updates to the quality performance standards and other quality reporting requirements in the program. The agency would revise the definition of a beneficiary eligible for Medicare Clinical Quality Measures to overlap more with the beneficiaries assignable to an ACO. CMS proposes to remove the health equity adjustment applied to an ACO’s quality score beginning with performance year 2025 and remove the screening for social drivers of health measure from the APP Plus quality measure set. The agency also would require Consumer Assessment of Healthcare Providers and Systems for Merit-based Incentive Payment System (MIPS) survey vendors to offer the survey via web mode (in addition to mail and phone) beginning in 2027. CMS also proposes to expand the application of extreme and uncontrollable circumstances policies to ACOs affected by cyberattacks.</p><p><strong>QUALITY PAYMENT PROGRAM</strong></p><p>CMS proposes several changes to further the goal of phasing out MIPS in favor of participation in specialty-specific MIPS Value Pathways (MVPs). Several of these are administrative, including a new requirement for the MVP group registration process to include a multispecialty self-attestation requirement and the maintenance of the MVP group reporting option for multispecialty groups with a small practice designation.</p><p>The agency also makes proposals to support clinicians in data collection and reporting. First, CMS would update the MVP inventory to stratify quality measures by clinical conditions and/or episodes of care to help clinicians select the most clinically relevant measures. Next, the agency would allow qualified clinical data registries additional time (i.e., through the CY 2025 performance period) to support finalized MVPs.</p><p>The agency proposes six new MVPs around the following topics:</p><ul><li>Diagnostic radiology.</li><li>Interventional radiology.</li><li>Neuropsychology.</li><li>Pathology.</li><li>Podiatry.</li><li>Vascular surgery.</li></ul><p>CMS also proposes modifications to the following performance categories:</p><p><strong>Quality Performance.</strong><em> </em>CMS proposes establishing an updated inventory of 190 MIPS measures. The agency would remove 10 measures that are topped out, no longer aligned with clinical guidelines, no longer maintained by measure stewards or focused on process. CMS would adopt five new MIPS electronic clinical quality measures as well as measures that focus on outcomes. CMS also proposes substantive changes to 42 MIPS quality measures.</p><p><strong>Cost Performance.</strong> CMS proposes to modify the total per capita cost measure beginning with the CY 2026 performance period. The agency also proposes updating the operational list of care episodes and patient condition groups and codes to reflect recent coding changes. Finally, CMS proposes adopting, beginning with the CY 2026 performance period, an informational-only feedback period for MIPS cost measures with a lookback period of two years.</p><p><strong>Improvement Activities.</strong> In alignment with the administration’s focus on preventive care and well-being, CMS proposes adding a new “Advancing Health and Wellness” subcategory within the improvement activities performance category. Moreover, CMS will add three new improvement activities into the Population Management and Patient Safety and Practice Assessment subcategories and remove the Achieving Health Equity subcategory.</p><p><strong>Promoting Interoperability. </strong>CMS proposes modifying two measures in this category and adopting one new optional bonus measure related to public health reporting. The agency also proposes measure suppression and exclusion processes and seeks comments on other measures in this category.</p><p>The agency would continue using the CY 2017 performance period (2019 MIPS payment year) to establish the performance threshold, which would be 75 points for the CY 2026 performance period (2028 MIPS payment year) through the CY 2028 performance period (2030 MIPS payment year).</p><p>Finally, CMS seeks comments on several topics related to digital quality measurement in MIPS, specifically the use of Fast Healthcare Interoperability Resource (FHIR)-based quality reporting.</p><h2>REQUEST FOR INFORMATION: EXECUTIVE ORDER 14192 ‘UNLEASHING PROSPERITY THROUGH DEREGULATION’</h2><p>On Jan. 31, 2025, President Trump issued Executive Order 14192, “Unleashing Prosperity Through Deregulation,” which states the administration’s policy to significantly reduce the private expenditures required to comply with federal regulations. Accordingly, CMS is soliciting public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries and other interested parties participating in the Medicare program. CMS is <a href="https://www.cms.gov/medicare-regulatory-relief-rfi">collecting</a> responses and requests stakeholders submit comments through the provided web link.</p><h2>FURTHER QUESTIONS</h2><p>CMS will accept comments on the proposed rule through Sept. 12. The final rule will be published around Nov. 1. The policies and payment rates will generally take effect Jan. 1, 2026.</p><p>If you have further questions, contact Joanna Hiatt Kim, AHA’s vice president of payment policy, at <a href="mailto:jkim@aha.org">jkim@aha.org</a>. </p></div><div class="col-md-4"><a href="/system/files/media/file/2025/07/cms-issues-cy-2026-physician-fee-schedule-proposed-rule-advisory-7-15-2025.pdf" target="_blank" title="Click here to download the Regulatory Advisory: CMS Issues CY 2026 Physician Fee Schedule Proposed Rule PDF."><img src="/sites/default/files/2025-07/image-cms-issues-cy-2026-physician-fee-schedule-proposed-rule-advisory-7-15-2025-638-px.png" data-entity-uuid data-entity-type="file" alt="Regulatory Advisory: CMS Issues CY 2026 Physician Fee Schedule Proposed Rule Cover." width="NaN" height="NaN"></a></div></div></div> Tue, 15 Jul 2025 17:09:53 -0500 Telehealth Technology-enabled Care Resources | Care Transformation Framework: Clinical Settings: /care-delivery-transformation/clinical/technology-enabled-care <div class="cdt-banner-wrap"><div class="clinical-banner-wrap"><div class="clinical-banner-wrap-content"><h1 class="text-align-center">Technology-enabled Care</h1><h2 class="text-align-center">Care Delivery Transformation Framework<br><span>Clinical Settings</span></h2></div></div></div> Wed, 11 Jun 2025 04:44:42 -0500 Telehealth Telehealth Resources | Care Transformation Framework: Community Settings /care-delivery-transformation/community/telehealth <div class="cdt-banner-wrap"><div class="community-banner-wrap"><div class="community-banner-wrap-content"><h1 class="text-align-center">Telehealth Resources</h1><h2 class="text-align-center">Care Delivery Transformation Framework<br><span>Community Settings</span></h2></div></div></div> Wed, 11 Jun 2025 00:48:25 -0500 Telehealth AHA makes 100 suggestions to Trump administration on providing regulatory relief  /news/headline/2025-05-12-aha-makes-100-suggestions-trump-administration-providing-regulatory-relief <p>The AHA May 12 <a href="/lettercomment/2025-05-12-aha-response-omb-deregulation-rfi">responded</a> to the Office of Management and Budget's April 11 request for <a href="https://v">information</a> on regulatory relief, making 100 suggestions to the Trump administration to help reduce burden on hospitals and health systems. “The Trump administration has rightly pointed out that the health status of too many Americans does not reflect the greatness or wealth of our nation,” said AHA President and CEO Rick Pollack. “Excessive regulatory and administrative burdens are a key contributor, as they add unnecessary cost to the health care system, reduce patient access to care and stifle innovation.”  <br><br>The AHA’s recommendations fall under four categories: billing, payment and other administrative requirements; quality and patient safety; telehealth; and workforce. </p> Mon, 12 May 2025 15:12:50 -0500 Telehealth AHA Response to OMB Deregulation RFI /lettercomment/2025-05-12-aha-response-omb-deregulation-rfi <p>May 12, 2025</p><table><tbody><tr><td>Honorable Robert F. Kennedy Jr. <br>Secretary<br>U.S. Department of Health and Human<br>200 Independence Ave SW<br>Washington, DC 2001<br> </td><td>Honorable Russell T. Vought<br>Director<br>Office of Management and Budget<br>725 17th Street NW<br>Washington, DC 202503</td></tr><tr><td>Honorable Mehmet Oz, M.D.<br>Administrator<br>Centers for Medicare & Medicaid Services<br>7500 Security Boulevard<br>Baltimore, MD 21244-1850</td><td> </td></tr></tbody></table><p><br><em><strong>RE: Request for Information: Deregulation (FR Doc. 2025-06316)</strong></em></p><p>Dear Secretary Kennedy, Administrator Oz and Director Vought:</p><p>On behalf of the Association’s (AHA) nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, we applaud you for seeking recommendations on how to free the health care system from burdensome administrative requirements that prevent Americans from accessing the care they need to live their healthiest lives.</p><p>The Trump administration has rightly pointed out that the health status of too many Americans does not reflect the greatness or wealth of our nation. Excessive regulatory and administrative burdens are a key contributor, as they add unnecessary cost to the health care system, reduce patient access to care and stifle innovation. </p><p>For example:</p><ul><li>More than a quarter of all health care spending goes to administrative tasks — topping more than $1 trillion annually.<sup>1</sup> Providers, in particular, face excessive costs to check patients’ eligibility for coverage, bill for payment, and process prior authorizations and appeals of coverage denials.</li><li>Hospitals and health systems spend billions of dollars annually just on collecting and submitting quality measures, with one survey estimating annual per-hospital costs of $3.5 to $12 million.<sup>2,3 </sup>The physicians with whom hospitals partner in delivering high-quality care face similarly daunting costs, with physicians in just four specialties — general internal medicine, family medicine, cardiology and orthopedics — spending an estimated $15.4 billion annually on quality measurement.<sup>4</sup></li><li>Prior authorization requests reached nearly 50 million in 2023 for Medicare Advantage beneficiaries alone, an increase from 42 million in 2022.<sup>5</sup></li><li>Most claims initially denied by insurers (70%) are ultimately paid, meaning a significant amount of administrative cost is a complete waste.<sup>6</sup></li><li>The Centers for Medicare & Medicaid Services (CMS) regulations restrict the ability of certain advanced practice providers to independently practice more than is allowable in some states, which are responsible for clinician licensure and scope of practice.</li></ul><p>Addressing unnecessary administrative burdens and costs would go a long way to not only lower health system costs but support the accessibility of care. Many hospitals are financially unstable, with nearly 40% operating with negative margins.<sup>7</sup> This has led to closures of services and even entire hospitals, and the resulting loss in access to care is felt by entire communities.</p><p>The AHA, therefore, enthusiastically shares its top 100 ways that the administration could reduce the burden on hospitals and health systems. To put together this list, the AHA collected more than 2,700 ideas from an AHA member survey. Hospitals across the country, along with our Board of Trustees and other member advisors, identified outdated, burdensome, duplicative and expensive regulations that do not improve quality and patient safety and, in some cases, impede hospitals’ ability to offer the highest quality, most efficient care. Many of the items here also would remove administrative complexity to ensure that health care workers spend their time on patients, not paperwork. Some of these suggestions will require partnership with Congress, but many will not. Enacting even half of them would make a real difference throughout the health care system.</p><p>Our recommendations are grouped into four categories:</p><ul><li>Billing, Payment and Other Administrative Requirements.</li><li>Quality and Patient Safety.</li><li>Telehealth.</li><li>Workforce.</li></ul><p>While the full list is attached, below are the top actions we urge the administration to consider in each area.</p><h2>BILLING, PAYMENT AND OTHER ADMINISTRATIVE REQUIREMENTS</h2><p>Research estimates that between 25-30% of all health care spending goes toward administrative tasks, not patient care.<sup>8</sup> These tasks include verifying patients’ insurance and coverage status, conducting prior authorizations, and acquiring and managing the personnel and technology to comply with different payment models and payer requirements. To reduce billing and payment-related burden, we recommend the following.</p><p><strong>Make all Center for Medicare and Medicaid (CMMI) models voluntary, and specifically the Transforming Episode Accountability Model (TEAM) (42 CFR 512.5) and repeal the mandatory Increasing Organ Transplant Access (IOTA) Model (42 CFR 512.412) and the Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration.</strong> While we strongly support innovation to improve the quality and accessibility of health care at lower costs, some of the CMMI models, as designed, could have an immediate detrimental impact on the quality of care or on patients’ access to care by overburdening their providers.</p><p>The IOTA Model is a complex mandatory payment model that purports to test whether hospital performance-based incentive payments will increase access to kidney transplants; however, these payments are designed to incentivize volume, not quality, and, in doing so, could lead to lower quality transplants and thus a higher risk of failure.</p><p>The TEAM would mandate that over 740 acute care hospitals receive bundled payments for five types of surgical episodes, irrespective of whether the hospitals are able to implement the bundles and whether they will improve patient care. The model particularly targets hospitals with low levels of existing experience with alternative payment models, increasing the risk that participating in such a model could financially destabilize them, threatening access to care for everyone in the community.</p><p>Finally, under the IRF Review Choice Demonstration, IRFs will have 100% of their Traditional Medicare claims subject to unnecessary and onerous pre- or post-claim review for at least six months. This will add considerable staffing costs to providers who are already struggling under rising input costs and unstable revenue.</p><p><strong>Repeal the excessive, confusing and imbalanced provider disincentives included in the June 2024 final rule “21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking” (RIN 0955-AA05).</strong> Under the final rule, hospitals and providers found to engage in information blocking may face reductions in Medicare payment updates, adjustments to reimbursement rates, lower performance scores and potential ineligibility for certain incentive programs. We believe in the importance of making critical health information available to patients, the clinicians treating those patients, and those with appropriate reasons for having access, among which are payment, care oversight and research. However, the disincentive structure in this rule is excessive, so much so that it may threaten the financial viability of economically fragile hospitals, including many small and rural hospitals. In addition, the processes by which the Office of the Inspector General will determine if information blocking has occurred are unclear, including the appeals process, giving this proposed rule the appearance of being arbitrary and capricious.</p><p><strong>Standardize more insurance-related administrative transactions, starting with operationalizing the Interoperability and Prior Authorization Final Rule (CMS-0057-F) to establish standard electronic prior authorization processes in Medicare Advantage, the Health Insurance Marketplaces and Medicaid. </strong>Hospitals often have hundreds if not thousands of contracts with different insurance plans. Each of these plans include different rules and processes, including the way to communicate requests and share associated documentation with plans (e.g. phone, fax, proprietary portal), the services that are subject to prior authorization, and the clinical criteria a plan will use to adjudicate prior authorization and coverage requests, among other things. There is tremendous opportunity to streamline many of these rules and processes to both improve patient’s access to care while also reducing the costs and burden on providers associated with compliance. For example, prior authorization is frequently applied inappropriately in ways that delay care and harm patients. CMS has taken significant steps to move many health plans towards standardized electronic prior authorization processes. These rules are intended to go into effect in 2026 and 2027, and we urge the administration to ensure robust and timely implementation.</p><h2>QUALITY AND PATIENT SAFETY</h2><p>High-quality, safe care is the core of hospitals’ missions. While many regulations originated out of an interest to improve care quality or patient safety, those same regulations, over time, have often become obsolete or redundant. Hospitals and health systems spend billions of dollars annually just on collecting and submitting quality measures, with one survey estimating annual per-hospital costs of $3.5 to $12 million.<sup>9,10</sup> The physicians with whom hospitals partner in delivering high-quality care face similarly daunting costs, with physicians in just four specialties — general internal medicine, family medicine, cardiology and orthopedics — spending an estimated $15.4 billion annually on quality measurement.<sup>11</sup> To reduce burdens related to quality measurement and reporting, we recommend the following.</p><p><strong>Repeal outdated COVID-19 reporting mandates.</strong> As noted above, data reporting is an incredibly time intensive activity that pulls clinicians away from patients and costs a considerable amount in both staff time and technology to complete. While we are deeply committed to ensuring the highest quality care — which requires evaluating performance and acting on the findings — it is imperative that we direct our limited resources to the highest impact areas. Unfortunately, hospitals are subject to significant outdated reporting requirements, in particular with respect to the COVID-19 public health emergency. Eliminating this unnecessary reporting would reduce costs in the health care system and enable providers to spend more time with their patients. Our immediate recommendation is to eliminate the requirements for post-acute care providers to report COVID-19 vaccine rates for patients/residents and staff (86 FR 42489, 86 FR 45446, 86 FR 42396, 88 FR 51009, 88 FR 53233, 88 FR 59250, 88 FR 77767), for hospitals to report staff COVID-19 vaccination rates (86 FR 45382), and for hospitals and skilled nursing facilities to report data on acute respiratory illnesses, including influenza, COVID-19, and RSV, once per week, with more frequent and extensive data reporting required during a public health emergency (42 CFR 482.42(e), 42 CFR 483.90(g), 42 CFR 485.426(e) and 42 CFR 485.640(d)).</p><p><strong>Replace the sepsis bundle measure, as required at 79 FR 50241 and 88 FR 59801, with a measure of sepsis outcomes.</strong> Hospitals have spent considerable effort — and achieved significant results — in mitigating the incidence and severity of sepsis, saving lives in the process. Unfortunately, research has demonstrated that the sepsis bundle measure has not led to better outcomes yet entails an enormous administrative burden. We encourage the administration to work with hospitals on a measure that will help them further advance the fight against sepsis, while reducing unnecessary burdens in the system.</p><p><strong>Eliminate duplicative “look back” validation surveys of accrediting organizations (AOs) at 42 CFR 488.9 and permanently adopt concurrent validation surveys.</strong> As part of its oversight process, CMS conducts a full re-survey of hospital compliance with Medicare Conditions of Participation on a representative sample of hospitals each year, comparing each hospital’s results with the most recent accreditation surveys. Instead of fulfilling CMS’ goal of assessing AO performance, the validation surveys result in rework and disruption for hospitals and health systems. CMS should instead permanently adopt concurrent validation surveys that would allow the agency to directly observe AO performance.</p><p><strong>Resume conducting low-risk complaint surveys virtually.</strong> During the COVID-19 pandemic, CMS adopted a policy in which accrediting organizations and state survey agencies could conduct complaint surveys of low-risk quality issues virtually. Since then, CMS has instructed AOs to conduct most complaint surveys in person, regardless of severity, and hospitals incur costs for each AO visit. Virtual surveys for low-risk complaints would enable more efficient use of survey resources and reduce administrative costs.</p><p><strong>Facilitate whole-person care by eliminating 42 CFR Part 2 requirements that hinder care team access to important health information and protect patient privacy under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).</strong> Despite regulatory changes in the past several years, the regulations in Part 2 are outdated, fail to protect patient privacy and erect sometimes insurmountable barriers to providing coordinated, whole-person care to people with a history of substance use disorder (SUD). Specifically, the regulations require the separation of records pertaining to SUD information, which prevents the integration of behavioral and physical health care because the patient data cannot be used and disclosed like all other health care data.</p><h2>TELEHEALTH</h2><p>As technology and consumer preferences have evolved, more care can safely be delivered via telehealth. However, numerous regulations restrict the use of virtual care, impeding innovation and our ability to deliver care more efficiently. While there are numerous ways to expand access to care using telehealth, we recommend starting with the following.</p><p><strong>Remove telehealth originating site restrictions within the Medicare program at Sec. 1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C. 1395m) and 42 CFR 410.78(b)(3) to enable patients to receive telehealth in their homes.</strong> Under current rules, patients must be in a clinical site of care, which completely undermines the value of telehealth for patients, limits its adoption and adds costs for providers.</p><p><strong>Remove telehealth geographic site restrictions within the Medicare program at Sec. 1834(m)(4)(C)(i) of the Social Security Act (42 U.S.C. 1395m) and 42 CFR 410.78(b)(4) to enable beneficiaries in non-rural areas to have the same access to virtual care as those in rural areas.</strong></p><p><strong>Remove the in-person visit requirements for behavioral health telehealth at Sec. 1834(m)(7) of the Social Security Act (42 U.S.C. 1395m) and 42 CFR 410.78(b)(3)(xiv), which is unnecessary, adds a barrier to access and creates a disparity between physical and mental health services.</strong></p><p><strong>Remove requirements at Sec. 3132 of the Affordable Care Act (42 U.S.C. 18001 et. seq.) and 42 CFR 418.22(4) that require hospice recertification to be completed in person to allow for hospice recertification to be completed via telehealth.</strong> This change would alleviate the burden on patients and their caregivers, as well as on clinicians.</p><h2>WORKFORCE</h2><p>The health care system’s greatest asset is our workforce. Unfortunately, doctors, nurses, technicians and others are increasingly burned out and leaving the profession, often citing excessive administrative burden that pulls them away from patient care. We recommend the following.</p><p><strong>Streamline care plan documentation requirements at 42 CFR 483.23(b)(4). </strong>To provide higher quality, more holistic care, patients are increasingly cared for by interdisciplinary teams. These teams may include a range of clinical professionals, such as nurses, therapists, and social workers. When used, these teams develop what is known as an interdisciplinary care plan. Yet, outdated regulations require nursing-specific care plans. Hence, as more care moves to interdisciplinary teams, clinicians must create duplicate paperwork to document the care plan.</p><p><strong>Eliminate the telehealth physician home address reporting requirement, which is currently under waiver as referenced at 89 FR 97110. </strong>Without continued waivers or removal, telehealth providers must list their home address on publicly available enrollment and claims forms when performing telehealth services from their homes, compromising their privacy and safety.</p><p><strong>Eliminate nurse practitioner and other advanced practice practitioner (APP) limitations at 42 CFR 485.604(a)(2), 42 CFR 485.604(b)(1)-(3), and 42 CFR 485.604(c)(1)-(3).</strong> These regulations impose limits on the scope of care APPs may provide that are often more restrictive than under state licensure, despite states having primary responsibility for clinical scope of practice rules. In these cases, hospitals and health systems are constrained in their ability to increase patient access to care through the greater use of APPs.</p><p><strong>Remove requirements at 42 CFR 410.61 that require outpatient physical therapy plans of care to be signed off by a physician or non-physician practitioner every 90 days. </strong>While CMS made an exception to the treatment plan signature requirement in the calendar year 2025 Physician Fee Schedule for initial care plans where there is a signed referral, the requirement for physicians to sign and date plans of care every 90 days creates an additional administrative burden.</p><p>Our attached recommendations also identify ways in which the administration can help reduce burdens caused by private sector stakeholders. While significant consolidation in the insurance industry exists, each insurer can offer thousands of unique health plan configurations, each often with its own rules and processes, such as which services are covered and the clinical criteria used to determine coverage. While we support the innovation and choice that these private entities bring to the health care system, this level of variation creates a tremendous amount of burden on providers. Fortunately, there are actions the administration can take to ease the cost and burden on providers of working with these payers, including addressing insurer consolidation that has given these companies the ability to unilaterally impose considerable burdens on providers.</p><p>Thank you for your consideration. We look forward to working with the administration on the much-needed effort to reduce regulatory red tape so that America’s hospitals and health systems can best support the health of their communities.<strong> </strong>Please contact me if you have questions, or feel free to have a member of your team contact Ashley Thompson, AHA’s senior vice president for policy analysis and development, at (202) 626-2688 or <a href="mailto:athompson@aha.org">athompson@aha.org</a>.</p><p>Sincerely,</p><p>/s/</p><p>Rick Pollack<br>President and CEO</p><p><strong>Attachment: 100 Ways to Free Hospitals from Wasteful and Burdensome Administrative Requirements to Provide the Highest Quality, Most Efficient Care to Patients </strong></p><p>View the letter and attachment below.</p><div><p>__________</p><div id="ftn1"><div id="ftn1"><div id="ftn1"><p><small class="sm"><sup>1</sup> “Active steps to reduce administrative spending associated with financial transactions in US health care,” Sahni, N., et. al., Health Affairs Scholar, Volume 1, Issue 5, November 2023, qxad053, </small><a class="ck-anchor" href="https://doi.org/10.1093/haschl/qxad053" id="https://doi.org/10.1093/haschl/qxad053"><small class="sm">https://doi.org/10.1093/haschl/qxad053</small></a><br><small class="sm"><sup>2</sup> “The volume and cost of quality metric reporting,” Sarawasthula A et al. Journal of the American Medical Association. Volume 329, Number 21. June 6, 2023. 1840-1847.</small><br><small class="sm"><sup>3</sup> “Observations from the field: Reporting Quality Metrics in Health Care.” Dunlap NE et al. National Academies Press; 2016. </small><a class="ck-anchor" href="https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf" id="https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf"><small class="sm">https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf</small></a><br><small class="sm"><sup>4 </sup>“US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures.” Casalino LM et al. Health Affairs. Volume 35, Number 3. March 2016</small><br><small class="sm"><sup>5</sup>  </small><a class="ck-anchor" href="https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/" id="https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/"><small class="sm">https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/</small></a><br><small class="sm"><sup>6</sup> </small><a class="ck-anchor" href="https://premierinc.com/newsroom/policy/80-premier-members-call-for-medicare-advantage-changes-to-address-payment-denials-and-delays" id="https://premierinc.com/newsroom/policy/80-premier-members-call-for-medicare-advantage-changes-to-address-payment-denials-and-delays"><small class="sm">https://premierinc.com/newsroom/policy/80-premier-members-call-for-medicare-advantage-changes-to-address-payment-denials-and-delays</small></a></p><p><small class="sm"><sup>7</sup> </small><a class="ck-anchor" href="https://www.kaufmanhall.com/insights/thoughts-ken-kaufman/implications-national-hospital-flash-report-hospital-operations" id="https://www.kaufmanhall.com/insights/thoughts-ken-kaufman/implications-national-hospital-flash-report-hospital-operations"><small class="sm">https://www.kaufmanhall.com/insights/thoughts-ken-kaufman/implications-national-hospital-flash-report-hospital-operations</small></a><br><small class="sm">8 </small><a class="ck-anchor" href="https://www.healthaffairs.org/content/forefront/administrative-spending-contributes-excess-us-health-spending" id="https://www.healthaffairs.org/content/forefront/administrative-spending-contributes-excess-us-health-spending"><small class="sm">https://www.healthaffairs.org/content/forefront/administrative-spending-contributes-excess-us-health-spending</small></a><br><small class="sm"><sup>9 </sup> “The volume and cost of quality metric reporting,” Sarawasthula A et al. Journal of the American Medical Association. Volume 329, Number 21. June 6, 2023. 1840-1847.</small><br><small class="sm"><sup>10</sup> “Observations from the field: Reporting Quality Metrics in Health Care.” Dunlap  NE et al. National Academies Press; 2016. </small><a class="ck-anchor" href="https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf" id="https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf"><small class="sm">https://nam.edu/wp-content/uploads/2016/07/Observations-from-the-Field-Reporting-Quality-Metrics-in-Health-Care.pdf</small></a><br><small class="sm"><sup>11</sup> “US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures.” Casalino LM et al. Health Affairs. Volume 35, Number 3. March 20</small>16. </p><hr><p class="text-align-center">Attachment<br><br><strong>100 Ways to Free Hospitals from Wasteful and Burdensome Administrative Requirements to Provide the Highest Quality, Most Efficient Care to Patients </strong></p><h2>BILLING, PAYMENT AND OTHER ADMINISTRATIVE REQUIREMENTS </h2><p>Research estimates that between 25% and 35% of all health care spending is on administrative tasks, with billing and collections, which include coverage and eligibility verification, being one of the costliest areas. The following changes could dramatically lower administrative costs; many would also improve patient access to care. </p><h3>Interactions with Health Plans</h3><ol><li>Eliminate duplicative and costly billing infrastructure within hospitals, health systems and other providers by shifting cost-sharing collection responsibilities to insurers — the entities that set co-pay, deductible and co-insurance amounts.</li><li>Reduce variation in prior authorization processes by enforcing the interoperability and prior authorization final rule, which will streamline electronic prior authorization processes across many payers.</li><li>Eliminate billions in excess health care system costs, resulting from providers chasing payment from insurers, by establishing prompt pay requirements in all forms of health care coverage, including Medicare Advantage.</li><li>Implement a standardized claims attachment to allow plans to request and providers to transmit necessary medical records via a safe electronic transmission standard.</li><li>Reduce the time providers waste tracking down the unique criteria that each Medicare Advantage plan uses to adjudicate claims by establishing a single clinical standard for both Traditional Medicare and Medicare Advantage.</li><li>Reduce the time patients spend waiting for post-acute care placements by disallowing plans from implementing prior authorization requirements for these services in certain circumstances.</li><li>Eliminate duplication and data collection burdens on providers by establishing a single national provider directory and requiring plans to exclusively use the national database rather than create their own.</li><li>Remove requirements for payers and plans to have separate credentialing processes and allow for payers to instead recognize hospital credentialing.</li><li>Adopt a standard process for providers to appeal a Medicare Advantage plan denial of a prior authorization request or claim.</li><li>Minimize the burden of managing pharmaceutical supplies while improving patient safety by prohibiting insurers from unilaterally adopting policies that force providers to use pharmaceuticals provided by the insurer’s affiliated pharmacy benefit manager rather than using their own supply (also known as “white bagging”).</li><li>Establish and enforce network adequacy requirements for post-acute care on Medicare Advantage plans to enable patients to begin necessary post-acute care as timely as possible while freeing up inpatient capacity.</li><li>Improve the flawed and cumbersome No Surprises Act Independent Dispute Resolution process while retaining the patient protections against surprise billing to allow insurers and out-of-network hospitals and health systems to work together more efficiently to determine appropriate reimbursement.</li><li>Remove the prior authorization requirement for non-emergent Veterans Affairs community care network services, which requires providers to submit a form that takes at least three days to process, therefore unnecessarily delaying care.</li><li>Expand access to alternative coverage options for employees, such as through Individual Reimbursement Arrangements, which would reduce the administrative burden on employers.</li></ol><h3>Information Technology and Coding</h3><ol start="15"><li>Repeal the excessive and confusing “information blocking” rule that would impose unjustified penalties on providers.</li><li>Modify the HIPAA cybersecurity rule of December 2024 to make the requirements voluntary.</li><li>Modify the HIPAA Breach Notification Rule to remove the requirement to report breaches affecting fewer than 500 individuals.</li><li>Eliminate billing and coding requirements for psychiatric care at 42 CFR 483.102as they are overly stringent and not based on medical criteria.</li><li>Streamline the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) code sets to standardize reporting across all payors.</li><li>Eliminate unique HCPCS codes for generic drugs, which adds burden by complicating the billing process. </li></ol><h3>Administrative and Regulatory Barriers to Care</h3><ol start="21"><li>Repeal the Food and Drug Administration Laboratory Developed Tests final rule that will hamper hospital labs’ ability to continue developing high-quality in-vitro tests that have increased access to care and reduced costs.</li><li>Repeal the Institutions for Mental Disease exclusion within the Medicaid program so that hospitals and other providers can ensure Medicaid patients who need inpatient behavioral health care can get the most effective care efficiently.</li><li>Similarly, repeal the 180-day lifetime limit on inpatient psychiatric facility services under Medicare.</li><li>Allow inpatient rehabilitation facilities (IRFs) to care for more than just inpatient rehabilitation patients when capacity is an issue (such as during a pandemic), which could reduce patient wait times for care.</li><li>Eliminate the observation hours “carve-out” policy for diagnostic or therapeutic services.</li><li>Simplify the detailed and complex reporting process of the Medicare Cost Reports.</li><li>Modernize the Stark Law and Anti-kickback Statute regulations to better protect arrangements that promote value-based care.</li><li>Repeal the requirement that Critical Access Hospital (CAH) based ambulance services only receive cost-based reimbursement if they are the sole ambulance provider within 35 miles. Instead, all CAH-based ambulance providers should receive cost-based reimbursement.</li><li>Modify Environmental Protection Agency project building timelines that significantly delay the construction of new sites of care.</li><li>Expand hospitals’ ability to utilize swing beds.</li><li>Improve the timeliness and efficiency of 340B child site registration by re-adopting the prior policy of allowing hospitals to register child sites under the 340B program even if they are not included on their most recently filed cost report.</li></ol><h3>Medicare Payment and Processes</h3><ol start="32"><li>Repeal the IRF Review Choice Demonstration under which IRFs will have 100% of their traditional Medicare claims subject to either pre- or post-claim review for at least six months.</li><li>Repeal the Center for Medicare and Medicaid Innovation’s (CMMI) Increasing Organ Transplant Access mandatory kidney transplant model that purports to better align payment with quality but over-focuses on quantity over quality.</li><li>Make voluntary all CMMI models with particular focus on the recently announced Transforming Episode Accountability Model, which will mandate that some of the most vulnerable hospitals transition to bundled payments for five types of surgical episodes.</li><li>Eliminate the skilled nursing facility three-day length of stay requirement that often delays patients from transitioning to the most appropriate site of care.</li><li>Simplify and expedite discharge processes by removing the requirement that hospitals provide patients with a list of post-acute care (PAC) providers from which to select when hospitals already work with patients and PAC providers for appropriate placement.</li><li>Eliminate the CAH 96-hour rule as a condition of participation (CoP) which requires an annual average length of stay of 96 hours or less and eliminate the 96-hour condition of payment rule that requires physicians in CAHs to certify upon admission that an inpatient can be reasonably expected to be discharged or transferred to another hospital within 96-hours.</li><li>Eliminate the requirement that a hospital operate for at least six months under the prospective payment system before converting to CAH status.</li><li>Eliminate the “must-bill” policy for dual eligible beneficiaries, which requires providers to bill both Medicare and Medicaid even though no Medicaid payment may be expected.</li><li>Allow for exceptions to the requirement that Medicare overpayments are returned in 180 days, given that providers may need additional time to complete investigations.</li><li>Allow Medicare bad debts to be written off as contractual allowances, which is consistent with standard accounting practices and was permitted under prior policies.</li><li>Eliminate the policy that to receive Medicare bad debt reimbursement for dual eligible beneficiaries, providers must bill the state Medicaid program AND receive/submit the remittance advice listing any Medicaid payment, which is burdensome and not always possible.</li><li>Standardize coverage, coding and billing criteria among Medicare Administrative Contractors (MACs).</li><li>Remove the restriction that disallows hospitals from choosing a different MAC.</li><li>Streamline the Medicare appeals process to allow uploading of medical records at the time of claim filing.</li><li>Streamline Medicare mandatory notices to patients, including eliminating where applicable rules require providers to give notice both in-person and via paper notices. Examples of such notices include the Important Message from Medicare, Advance Beneficiary Notice of Non-coverage, and Medicare Outpatient Observation Notice, the Notice of Medicare Non-Coverage and Medicare Change of Status Notice.</li><li>Rescind Centers for Medicare and Medicaid Services (CMS) regulations requiring hospitals to report detailed information about drug invoices on their cost reports beginning in 2026. Manufacturers should be required to report the additional pricing information necessary for CMS to create average sales prices.</li><li>Revise Medicare drug price negotiation guidance to prohibit drug manufacturers from implementing retrospective rebate models in the 340B Drug Pricing Program, which would add considerable administrative costs to hospitals serving the most vulnerable communities.</li><li>Strengthen Medicare-dependent and Sole Community Hospitals by allowing participating hospitals to choose from an additional base year when calculating payments. </li></ol><h3>Price Transparency </h3><ol start="50"><li>Eliminate the convening provider requirement as part of good faith price estimates given to patients, because there is no technical solution to operationalize it.</li><li>Create a more streamlined and accurate process for patients to access pricing information by having insurers serve as the “source of truth” by publishing the negotiated rates and requiring hospitals to post cash price and chargemaster rates. </li></ol><h2>QUALITY AND PATIENT SAFETY </h2><p>High-quality, safe care is the core of hospitals’ missions. While many regulations originated out of an interest to improve care quality or patient safety, those same regulations, over time, have often become obsolete or redundant. However, in many cases, they remain required despite having outlived their usefulness. The following changes would support hospitals’ efforts to adapt to continue offering the highest quality, safest care. </p><h3>Quality Reporting </h3><ol start="52"><li>Repeal the onerous and now outdated CoP that requires hospitals to report data on acute respiratory illnesses, including influenza, COVID-19 and RSV, once per week, with more frequent and extensive data reporting required during a public health emergency.</li><li>Reduce administrative burden by eliminating the outdated requirement for post-acute care providers to report COVID-19 and influenza vaccine rates for patients/residents and staff.</li><li>Similarly, remove the outdated requirement for hospitals to report staff vaccination rates.</li><li>Remove the sepsis bundle measure, which evidence shows has not led to better outcomes but entails an enormous administrative burden, from all hospital quality reporting and value programs, replacing it with a measure of sepsis outcomes.</li><li>Eliminate (or at minimum streamline) the Meaningful Use (now Promoting Interoperability) program as it has outlived its usefulness.</li><li>Eliminate (or, at a minimum, significantly streamline) the onerous Hospital Consumer Assessment of Healthcare Providers and Systems (patient satisfaction) survey of hospitals, as the quality of the instrument and use of the results have degraded due to low response rates.</li><li>Support quality and patient safety while reducing burdens by reducing the required reporting of electronic clinical quality measures to a more targeted set of core measures.</li><li>Remove the requirement for hospitals to report reflecting screening for social determinants of health measures that are not linked to better outcomes.</li><li>Eliminate the mandatory requirement for Accountable Care Organizations to report quality data electronically, versus allowing reporting via a web interface.</li><li>Eliminate the Hospital Readmission Reduction Program, as performance has topped out.</li><li>Suspend the Medicare hospital star ratings program as the methodology is inadequate, including distorted comparisons of hospital performance and a significant time lag.</li><li>Remove quality measures from the inpatient psychiatric quality reporting program that are not directly relevant to inpatient psychiatric care, such as whether the facility offers smoking cessation services.</li><li>Remove all structural measures from hospital quality reporting programs that have little evidence tying their use to better care or outcomes, including the Patient Safety Structural Measure, Health Equity Structural Measure and Age-Friendly Hospital measure.</li><li>Remove (or, at a minimum, make voluntary) the reporting of hybrid hospital readmissions/mortality measures and hip/knee arthroplasty patient-reported outcome measures due to significant feasibility issues.</li></ol><h3>Surveys and Accreditation</h3><ol start="66"><li>Minimize in-person hospital surveys for low-risk complaints and resume them virtually.</li><li>Permanently adopt concurrent validation surveys for CMS accrediting organizations, eliminating duplicative “lookback” surveys that require a full resurvey of hospital compliance with CoPs.</li><li>Allow hospitals time to ensure adequate staffing and resources during surveys without compromising the integrity of those surveys by eliminating the prohibition on accrediting organizations providing same-day notification of a survey.</li><li>Eliminate punitive removals of “deemed status” when a hospital has one or more condition-level citations on a validation survey, which is unnecessary for adequate oversight. </li></ol><h3>Other</h3><ol start="70"><li>Repeal the nursing home staffing rule that would not improve quality or safety and would require nearly 80% of all nursing homes — including those with five stars — to increase staffing.</li><li>Revise the obstetrical care CoP by removing requirements that are not directly relevant to improving obstetrical care and redundant with existing requirements, such as requirements focused on non-obstetrical emergencies, supplies and training.</li><li>Reduce unnecessary burden while ensuring adequate emergency response preparation by reducing the number of required hospital emergency preparedness drills to once a year.</li><li>Remove the requirement that hospitals provide translation services for patients in 15 different languages and instead allow hospitals to ensure adequate translation for the populations they serve.</li><li>Enable inpatient psychiatric facilities (IPFs) to provide appropriate monitoring of patients at risk of suicide without overburdening the workforce or adding unnecessary costs by eliminating the requirement that IPFs have one-to-one monitoring of patients at risk of suicide.</li><li>Eliminate 42 CFR Part 2 requirements providing special privacy protections for behavioral health patients and protect their privacy under HIPAA.</li><li>Eliminate the Occupational Safety and Health Administration (OSHA) “walkaround rule” that allows union representatives to accompany OSHA inspectors.</li><li>Enable hospitals to reduce costs by limiting the requirement to purchase supplies through CMS-approved vendors to only medical devices and other aspects of direct patient care and exempting non-clinical items such as office furniture and supplies.</li><li>Support providers’ access to cheaper drugs by enforcing rules to prevent gaming of patents and other policies that stifle pharmaceutical competition. </li></ol><h2>TELEHEALTH </h2><p>As technology and consumer preferences have evolved, more care can safely be delivered via telehealth. However, numerous regulations restrict the use of virtual care. Addressing the following areas would not only reduce unnecessary burdens on the health care system but also improve clinician capacity, increasing access to care. </p><ol start="79"><li>Remove telehealth originating site restrictions to enable patients to receive telehealth in their homes.</li><li>Remove telehealth geographic site restrictions to enable beneficiaries in non-rural areas to have the same access to virtual care as those in rural areas.</li><li>Remove restrictions on telehealth modalities to enable a wider range of services (e.g., audio only) to be safely delivered via telehealth.</li><li>Similarly, remove restrictions on the provider types eligible to perform telehealth.</li><li>Remove restrictions on the types of distant sites eligible to perform telehealth services.</li><li>Allow hospital outpatient departments to bill for telehealth services when patients are in their homes (assuming statutes are updated to allow for telehealth to patients' homes permanently).</li><li>Remove the in-person visit requirements for behavioral health telehealth.</li><li>Remove restrictions to allow new patients to receive remote physiologic monitoring.</li><li>Remove case-by-case approval of new telehealth services; instead, include all Medicare-covered services as eligible telehealth services and remove them on a case-by-case basis.</li><li>Remove in-person visit requirements prior to prescribing controlled substances by establishing a special registration process for virtual prescribers.</li><li>Remove requirements for hospice recertification to be completed in person to allow for telehealth-based recertification.</li></ol><h2>WORKFORCE</h2><p>The health care system’s greatest asset is our workforce. Unfortunately, doctors, nurses, technicians and others are increasingly burned out and leaving the profession, often citing excessive administrative burden that pulls them away from patient care. The following regulatory relief ideas would support our workforce.</p><ol start="90"><li>Eliminate the telehealth physician home address reporting requirement, which compromises workforce safety.</li><li>Remove requirements for outpatient physical therapy plans of care to be signed off by a physician or nurse practitioner every 90 days.</li><li>Reform nursing and allied health education payments to relax the CMS interpretation of "director control.”</li><li>Eliminate or raise the tax-free limit of $5,250 on employer-provided funds spent to train employees in high-demand services like radiology.</li><li>Repeal the Federal Trade Commission's Non-Compete Clause Rule.</li><li>Reform rules related to “fair market value” to ensure that hospitals can obtain access to necessary specialist services.</li><li>Eliminate nurse practitioner practice limitations that are more restrictive under CMS rules than under state licensure.</li><li>Promote medical licensure reciprocity to allow practitioners to work across state lines.</li><li>Do not promulgate Occupational Safety and Health Administration federal workplace violence regulations that would be duplicative of the rigorous accreditation requirements hospitals already face and add an administrative burden.</li><li>Reduce unnecessary costs in the system by pursuing medical liability reform by eliminating joint and several liability.</li><li>Similarly, cap non-economic and punitive damages as part of medical liability. </li></ol></div></div></div></div> Mon, 12 May 2025 11:39:47 -0500 Telehealth Fact Sheet: Telehealth /fact-sheets/2025-02-07-fact-sheet-telehealth <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/New-normal-vast-majority-of-hospitls-continue-to-use-telehealth.png" data-entity-uuid="4982c706-02b2-4af6-8ee7-9d6bea526a6e" data-entity-type="file" alt="New normal: vast majority of hospitals continue to use telehealth. Percent of hospitals offering telehealth services, 2018 to 2022. 2018: 72.6%. 2019: 78.3%. 2020: 85.1%. 2021: 86.0%. 2022: 86.9%. Note: AHA analysis of survey respondents to the 2018-2022 AHA Annual Survey. Telehealth services may be offered through the health system, a joint venture, or through the hospital itself." width="377" height="408" class="align-right">Telehealth is now a routine way for patients to access health care services and for providers in remote and other areas to access specialty consults that expand their ability to treat patients in their local communities. Telehealth adoption has grown significantly over the past five years due to waivers that enabled more services to be delivered via telehealth under more circumstances and for the providers of those services to be reimbursed. It has been proven safe and effective, and both patients and clinicians report high satisfaction. Prior concerns that telehealth would add utilization — and therefore cost — to the health care system have not been borne out.</p><p>Unfortunately, without congressional action, patients and providers may soon lose access to important telehealth services. <span><strong>We urge Congress to not send the health care system backward and instead make permanent the telehealth flexibilities granted during the pandemic.</strong></span></p><h2>AHA Position</h2><p>As outlined in our <a href="/fact-sheets/2025-02-07-fact-sheet-2025-telehealth-advocacy-agenda">telehealth advocacy agenda</a>, the AHA supports:</p><ul><li><span><strong>Permanently adopting expanded access to telehealth:</strong></span> Permanent adoption of telehealth flexibilities will provide a firm foundation to preserve access and support further reform. We urge Congress to lift geographic and originating site restrictions, allow Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expand practitioners who can provide telehealth, remove arbitrary in-person visit requirements for behavioral health, and allow the continuation of audio-only telehealth services.</li><li><span><strong>Expanding the telehealth workforce:</strong></span> Expanding the telehealth workforce will serve as a force multiplier to increase access for areas with health care staffing shortages. Specific policies (like codifying virtual supervision flexibilities), removing barriers to cross-state licensure and eliminating dangerous reporting requirements (like provider home addresses) will increase the telehealth workforce.</li><li><span><strong>Ensuring fair and adequate telehealth reimbursement:</strong></span> Virtual care still has costs, including for both personnel, technology, and office space out of which many telehealth providers work. Appropriate reimbursement is necessary to preserve increased access to care.</li><li><span><strong>Supporting telehealth for rural and medically underserved areas:</strong></span> One barrier to expanding telehealth to these populations has been a lack of access to enabling technologies (like broadband, reliable Wi-Fi or smartphones), as well as education to support digital literacy. As such, we encourage cross-agency collaboration to develop training and infrastructure investment. Additionally, arbitrary requirements, like mandatory in-person visit requirements for behavioral health or prior to prescribing of controlled substances, have limited access for communities that may not have a practitioner available in person. We have urged for the development of a new, streamlined special registration process to waive in-person visit requirements for prescribing controlled substances.</li></ul><h2>Key Facts</h2><ul><li>Recent data from the Kaiser Family Foundation indicates that while utilization of telehealth has declined since 2020, utilization remains higher than pre-pandemic levels. In the last quarter of 2023, over 12.6% of Medicare beneficiaries received a telehealth service.<a href="#fn1"><sup>1</sup></a></li><li>There is a growing body of evidence showing that telehealth does not result in additive or duplicative care. A study of over 35 million records by Epic found that for most telehealth visits across 33 specialties, there was no need for an in-person follow-up visit within 90 days of the telehealth visit.<a href="#fn2"><sup>2</sup></a></li><li>Recent data suggest that the United States will face a physician shortage of up to 86,000 physicians by 2036.<a href="#fn3"><sup>3</sup></a> Telehealth is a critical supporting element to address the growing shortage of physicians.</li><li>Patients across geographies and settings, including both rural and urban areas, have benefited from the increased access and improved convenience provided by telehealth services since patients could receive care from their homes. In fact, data from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) showed that most patients using telehealth in 2020 (92%) received telehealth from their home.<a href="#fn4"><sup>4</sup></a> >/li></li><li>The availability of audio-only telehealth is a critical option to ensure access to care when patients may not have access to technology or bandwidth for video visits. A 2021 report from ASPE found that the majority of surveyed respondents 65 and older used audio-only visits (56.5%) compared to video visits, partly driven by the fact that over 26% of Medicare beneficiaries reported not having computer or smartphone access at home.<a href="#fn5"><sup>5</sup></a></li><li>The lack of broadband infrastructure exacerbates access challenges for certain areas. The Federal Communications Commission reports that over 22% of Americans in rural areas lack access to appropriate broadband (fixed terrestrial 25/3 Mbps) compared to 1.5% in urban areas.<a href="#fn6"><sup>6</sup></a></li><li>Misperceptions about telehealth contributing to fraud, waste and abuse are not supported by data. A recent Office of the Inspector General report found that only 0.2% of all telehealth providers were “potentially high-risk” for fraud, waste and abuse previously.<a href="#fn7"><sup>7</sup></a> Policies should support the 99.8% of providers safely and compliantly delivering services.</li></ul><h2>Resources</h2><ul><li><a href="/news/perspective/2024-10-18-taking-action-extend-telehealth-and-hospital-home-programs">Taking Action to Extend Telehealth and Hospital-at-home Programs</a></li><li><a href="/lettercomment/2024-03-20-aha-urges-cms-remove-telehealth-provider-home-address-reporting-requirements">CMS Urged to Remove Telehealth Provider Home Address Reporting Requirements</a></li><li><a href="/lettercomment/2023-09-11-aha-comments-cms-physician-fee-schedule-proposed-rule-calendar-year-2024">AHA Comments on CMS’s Physician Fee Schedule Proposed Rule for Calendar Year 2024</a></li><li><a href="/news/headline/2024-04-10-aha-urges-congress-make-telehealth-flexibilities-permanent">AHA urges Congress to make telehealth flexibilities permanent</a></li><li><a href="/2024-08-12-aha-comments-340b-drug-pricing-program-irf-payments-physician-fee-schedule-and-telehealth">AHA Comments on 340B Drug Pricing Program, IRF Payments, Physician Fee Schedule and Telehealth</a></li><li><a href="/2023-10-10-aha-letter-support-senate-connect-health-act-2023-s-2016">AHA Letter of Support for Senate CONNECT Health Act of 2023 (S. 2016)</a></li><li><a href="/lettercomment/2023-01-30-ahas-feedback-senate-re-connect-act">AHA’s Feedback to the Senate Re: The CONNECT Act</a></li><li><a href="/lettercomment/2022-12-01-aha-letter-dea-regarding-request-release-special-registration-telemedicine-regulation">AHA Comments on the SUPPORT for Patients and Communities Reauthorization Act</a></li><li><a href>AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation</a></li></ul><hr><h3>Notes</h3><ol><li id="fn1"><a href="https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-coverage-of-telehealth/" target="_blank">https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-coverage-of-telehealth/</a></li><li id="fn2"><a href="https://epicresearch.org/articles/telehealth-visits-unlikely-to-require-in-person-follow-up-within-90-days" target="_blank">https://epicresearch.org/articles/telehealth-visits-unlikely-to-require-in-person-follow-up-within-90-days</a></li><li id="fn3"><a href="https://www.aamc.org/media/75236/download?attachment" target="_blank">https://www.aamc.org/media/75236/download?attachment</a></li><li id="fn4"><a href="https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf" target="_blank">https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf</a></li><li id="fn5"><a href="https://aspe.hhs.gov/sites/default/files/documents/4e1853c0b4885112b2994680a58af9ed/telehealth-hps-ib.pdf target=">https://aspe.hhs.gov/sites/default/files/documents/4e1853c0b4885112b2994680a58af9ed/telehealth-hps-ib.pdf</a></li><li id="fn6"><a href="https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2020-broadband-deployment-report" target="_blank">https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2020-broadband-deployment-report</a></li><li id="fn7"><a href="https://oig.hhs.gov/oei/reports/OEI-02-20-00720.pdf" target="_blank">https://oig.hhs.gov/oei/reports/OEI-02-20-00720.pdf</a></li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/Fact-Sheet-Telehealth-20250207_0.pdf" target="_blank" title="Click here to download the Fact Sheet: Telehealth PDF." system files media file><img src="/sites/default/files/2025-04/cover-fact-sheet-telehealth-april-2025.png" data-entity-uuid data-entity-type="file" alt="Fact Sheet: Telehealth page 1." width="695" height="899"></a></div></div></div> h2 { color: #003087; } h3 { color: #9d2235; } Mon, 21 Apr 2025 16:41:00 -0500 Telehealth Senators reintroduce bipartisan bill expanding telehealth services /news/headline/2025-04-04-senators-reintroduce-bipartisan-bill-expanding-telehealth-services <p>A bipartisan group of 60 senators April 2 <a href="https://www.schatz.senate.gov/news/press-releases/schatz-wicker-lead-bipartisan-group-of-60-senators-in-introducing-legislation-to-expand-telehealth-access-make-permanent-telehealth-flexibilities">reintroduced</a> the CONNECT for Health Act, AHA-supported legislation that would expand patient access to telehealth services through Medicare while removing barriers to adoption. The bill would also make permanent COVID-19 telehealth flexibilities currently set to expire Sept. 30. The lead sponsors of the bill are Sens. Brian Schatz, D-Hawaii, Roger Wicker, R-Miss., Mark Warner, D-Va., Cindy Hyde-Smith, R-Miss., Peter Welch, D-Vt., and John Barrasso, R-Wyo. </p> Fri, 04 Apr 2025 16:03:33 -0500 Telehealth