The COVID-19 pandemic has transformed telehealth utilization here in Iowa and around the country. Thanks to a significant influx of funding, an expansion of coverage, and an easing of long-standing regulatory barriers, more clinics in our state are providing a greater variety of telehealth services than ever before. In this week’s IMS Close-Up, we look at a new IMS project to help support and sustain these telehealth expansions, and how this new work builds upon years of IMS advocacy in this area.
The Telehealth Initiative
This past June, IMS received notification of selection to participate in the second cohort of The Telehealth Initiative (TTI), a program created in collaboration between The Physicians Foundation and the American Medical Association (AMA) to bolster implementation support at the state-level by equipping state medical societies with telehealth programming that can further support physicians and practices in implementation and optimal use of telehealth. Components of TTI participation include:
- Access to the AMA Telehealth Immersion Program that will provide foundational information about the telehealth landscape, clinical instruction, technology integration, quadruple aim accomplishment, care continuity and expanded care access, and improved clinical outcomes. Participants are able to achieve a certification of recognition as part of the AMA STEPS ForwardTM Innovation Academy.
- Additional technical assistance will be provided to a targeted selection of engaged practices, focusing on the AMA’s Return on Health framework through chosen quality improvement initiatives to demonstrate the value of telehealth.
Through this initiative, IMS will be able to offer greater educational resources to all Iowa practices, as well as targeted technical assistance to a handful of practices looking to expand their telehealth offerings or considering making permanent some of the telehealth services they stood up during the pandemic. In partnership with the AMA, IMS will assess physicians’ experience with telehealth during the pandemic and work to identify additional barriers to sustainable utilization moving forward.
For more information on The Telehealth Initiative and how your clinic can take advantage of these resources and support, please contact Kady Reese with IMS.
Telehealth Advocacy
Support for expanded telehealth utilization has long been an advocacy priority for the Iowa Medical Society. In 2015, IMS worked in partnership with the Iowa Board of Medicine to stand up Iowa’s first telehealth practice standards, which were based in part upon guidelines from the AMA and other national experts. These board rules were intentionally designed to allow for an evolution of technology and utilization practices, while still ensuring minimum standards for appropriate telehealth services in our state. That same year, IMS successfully pushed for enactment of Medicaid coverage and payment parity to ensure that telehealth services provided to Medicaid patients were covered at the same rate as in-person services.
In 2017, a group of IMS member physicians and medical students submitted a request to the Policy Forum for IMS to pursue commercial telehealth parity legislation the following year. This policy request resulted in a successful 2018 legislative push to enact commercial coverage parity to further extend the policy underpinnings to support greater telehealth utilization. This also marked the beginning of a multi-year push for commercial telehealth payment parity to extend the same payment equity now in place under the Medicaid program.
In 2019, IMS partnered with the Iowa Association of School Boards to craft legislation to enact a regulatory framework to allow for an expansion of behavioral health services delivered via telehealth in a school-based setting. This nontraditional service delivery model represents a larger commitment to creatively approaching both Iowa’s provider workforce shortage and broadband access problems. By building upon the ICN fiber optic network that is connected to every Iowa school and ensuring appropriate safeguards to utilization, this legislation, which took effect in 2020, further expanded the number of sites in rural Iowa that are now able to offer pediatric behavioral health services.
With the onset of COVID-19, IMS worked closely with the Governor’s Office to successfully push for the inclusion of numerous telehealth expansion and flexibility measures, including enactment of temporary full commercial payment parity. IMS also worked with Iowa’s Congressional Delegation and our federal agency partners to push for telehealth policy flexibilities including coverage for audio-only telehealth services and an easing of site restrictions, as well as an expansion of covered services. As Iowa practices demonstrated the true possibility of expanded telehealth services, we also built the case for making permanent several of these temporary measures. This has included two successive years of CMS expansions of permanent telehealth coverage options as part of the Physician Fee Schedule payment rule and legislative action earlier this year to enact full commercial payment parity for behavioral health services delivered via telehealth.
Our advocacy work in support of greater telehealth utilization is not done. IMS is working now with the Iowa Board of Medicine to update their telehealth practice standards to recognize the important role audio-only telehealth can play as a service delivery option. We continue to pursue commercial payment parity for physical health services and we continue to explore options to make permanent the temporary policies and flexibilities that have proven so critical during the pandemic. In addition, IMS is working closely with our federal partners to ensure the billion in new funding to support telehealth infrastructure is awarded in such a manner so as to maximize its impact on telehealth access across our state.
For more information IMS advocacy efforts in support of telehealth, please contact Dennis Tibben with IMS.