Menu Close

May 6, 2024 – News Podcast

WorkCompAcademy

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Resolving Contested 5500.5 Election Requires Evidentiary Record. Business Owner to Pay $688K in Restitution for Comp Insurance Fraud. Nursing Home Chain and Executives to Pay Over $7 Million. San Diego Pharmacy Pays $350,000 for Mishandling Controlled Substances. Sober Living Homes Owner Indicted for $175,000 in Kickback Fraud. 15 Telehealth Legislative Proposals Under Congressional Legislative Review. New Mandatory Autobraking Standard Should Reduce Costly Comp Claims. Walmart Announced Closure of 51 Clinics and Exit from Health Care Services. Two California Hospitals Rank “A” and Three Rank “F” in Hospital Ratings. Sedgwick Announces its Next Phase of AI Technology.

View More

Seeking Attorney Fees in Bad Faith Action Waives Attorney-Client Privilege

WorkCompAcademy

George and Sheila Byers filed a lawsuit against USAA, their homeowners insurer, as well as other defendants (Masters Distribution, Inc.; Clifton Michael Potter; and Crawford and Company). Among other causes of action in their operative complaint, the Byerses allege USAA is liable for breach of contract and breach of the covenant of good faith and fair dealing related to the installation of hardwood flooring at their Orinda home. The complaint’s prayer for relief includes a prayer: “For attorneys’ fees and costs.”

During discovery, the Plaintiffs responded to an interrogatory propounded by USAA, indicating that they were indeed pursuing attorney fees known as “Brandt” fees referring to Brandt v. Superior Court (1985) 37 Cal.3d 813, a California Supreme Court case that provides for attorney fees as damages caused by an insurer’s breach of the covenant of good faith and fair dealing.

USAA then served document requests asking Plaintiffs for production of “each and every fee agreement with YOUR attorneys in the instant litigation” and “each and every billing record, fee statement, invoice, receipt and proof of payment from YOUR attorneys in the instant litigation.”

The Plaintiffs refused to produce any documents for various reasons including “attorney-client privilege and/or work product doctrine.”

Following a hearing on USAA’s motion to compel, the trial court granted USAA’s motion. The Court of Appeal affirmed the trial court in the published case of Byers v. Superior Court -A169321 (May 2024).

On appeal Plaintiffs “assert several interrelated arguments. They contend that the trial court abused its discretion by forcing them to waive the attorney-client privilege during litigation as a condition of seeking Brandt fees.”

The Court of Appeal said that it “determined that writ review is warranted because the Byerses asserted that compliance with the order would violate a privilege or privacy rights and the petition raises ‘questions of first impression that are of general importance to the trial courts and to the profession, and where general guidelines can be laid down for future cases. ‘ “

And it went on to conclude “that the Byerses’ admission that they are seeking Brandt fees as an element of their damages is an implied waiver of the attorney-client privilege at least as to the attorney fees documents that the Byerses plan to rely upon to seek to prove the amount of fees they reasonably incurred to establish their right to benefits under USAA’s insurance policy.”

“The parties have not cited, nor are we aware of, any controlling authority specifically holding that a party claiming Brandt fees impliedly waives the attorney-client privilege as to documentation supporting the fees, including fees agreements and invoices.”

It “is well established in other contexts that ‘[w]here privileged information goes to the heart of the claim, fundamental fairness requires that it be disclosed for the litigation to proceed.’ “

“We agree with the trial court that USAA has a right to learn during discovery of the attorney fees aspect of the Byerses’ alleged damages and that by seeking such damages the Byerses have impliedly waived the attorney–client privilege. The Byerses have put at issue the attorney fees they incurred in an effort to seek coverage under their insurance policy, and disclosure of documents supporting their claim for such fees is necessary to fairly adjudicate the issue of damages.”

View More

Excessive Heat Increases Probability of Work-Related Accidents by 5-6%

WorkCompAcademy

With U.S. officials bracing for another summer of dangerous heat, a new study from the Workers Compensation Research Institute (WCRI) found important effects of excessive heat on the incidence of occupational injuries.

“The study found the probability of work-related accidents increases by 5 to 6 percent when the maximum daily temperature rises above 90°F, relative to a day with temperatures in the 65–70°F range. The effect is stronger in the South and for construction workers. Also, the effect of excessive heat is greater on traumatic injuries, including fractures, dislocations, contusions, and lacerations,” said Ramona Tanabe, President and CEO of WCRI.

The main goal of the study, Impact of Excessive Heat on the Frequency of Work-Related Injuries, is to measure the extent to which excessive heat has increased the incidence of work-related injuries in recent years by considering injuries like heat exhaustion as well as accidents like falling off a ladder on a hot day. It also answers the following questions:

– – Is there variation in how excessive heat increases the frequency of work-related accidents in various regions of the country?
– – How does excessive heat affect worker populations in a more diverse set of climates than in just a specific state?
– – Is the effect of excessive heat on the frequency of injuries greater in certain industries and on certain injury types?

This study uses claims data and weather data from 2016 to 2021 across 24 states. The study’s findings can inform public policy debates on the importance of preventing the effects of excessive heat.

For more information on this study or to download a copy, visit www.wcrinet.org. The study is authored by Sebastian Negrusa, Olesya Fomenko, and Vennela Thumula.

View More

Physician and Owner of Bellflower Clinic Pleads Guilty to $2.5 Million Fraud

WorkCompAcademy

The owner and sole physician at a Bellflower medical clinic has pleaded guilty to submitting millions of dollars’ worth of false claims to a Medi-Cal health care program that provides family planning services to low-income and uninsured patients, causing more than $2.5 million in losses, the Justice Department announced today.

Robert Eyzaguirre, 77, of Torrance, pleaded guilty to one count of health care fraud, a felony that carries a statutory maximum sentence of 10 years in federal prison.

According to his plea agreement, Eyzaguirre owned and operated Dr. Robert’s Medical Center, a Bellflower-based medical clinic enrolled as a Family Planning, Access, Care and Treatment (Family PACT) provider run through the Medi-Cal public health program that California administered under Medicaid. At this clinic, Eyzaguirre employed and supervised Gary Lee Didio, 54, of Huntington Beach, and Sandra Rios, 51, of South Los Angeles.

From at least December 2013 through January 2020, Eyzaguirre conspired with Didio and Rios to submit more than $4.6 million in fraudulent claims to the Family PACT program for family planning services that were never provided. Specifically, Rios picked random names from an online phone-and-address directory and created fake patient files, including inserting fake vital signs and patient notes.

Eyzaguirre signed the fake patient files, falsely representing that he had provided family planning services to those patients. Eyzaguirre sometimes signed blank patient forms before the false vital signs and notes had been added. The fake patient files were then submitted to the Family PACT program for reimbursement. The Medi-Cal program paid more than $2.5 million on the fraudulent claims submitted by Dr. Robert’s Medical Center.

Eyzaguirre also falsely certified in the fake patient files that laboratory tests were medically necessary. Didio and Rios then referred the names of fake patients to a laboratory in Northern California, which then paid an illegal kickback of $30 cash for each referral. In total, the laboratory paid more than $372,000 in illegal kickbacks for the referrals of fake Family PACT patients from Dr. Robert’s Medical Center. The Medi-Cal program paid more than $1 million on the fraudulent claims submitted by the laboratory related to the scheme.

When Eyzaguirre learned that law enforcement was investigating the fraudulent scheme, he attempted to conceal the criminal activity by instructing Didio to remove the fake patient files from Dr. Robert’s Medical Center and hide them offsite. Once the files had been moved, Eyzaguirre attempted to shred the fake patient files to prevent law enforcement from discovering them.

Eyzaguirre admitted in his plea agreement to abusing his position of trust as a physician and obstructing justice.

Rios and Didio have pleaded guilty to conspiring to receive illegal remunerations for healthcare referrals. They are expected to be sentenced in the coming months.

United States District Judge Jesus G. Bernal scheduled a sentencing hearing for Eyzaguirre on October 28.

The United States Department of Health and Human Services Office of Inspector General and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse investigated this matter.

Assistant United States Attorney Jason C. Pang of the General Crimes Section is prosecuting this case.

View More

NCCI Publishes Third Report on Future of Workplace Safety Technology

WorkCompAcademy

NCCI just announced the release of the third and final installment in its new Insights series, “The Future of Workplace Safety Technology Is Now,” which explores employer viewpoints on the latest trends in safety technology.

In the first installment of its series it shared insights from interviews with four workers compensation carriers in various stages of testing, introducing, and implementing safety technology. In its second installment, NCCI interviewed six technology innovators who are actively working with workers compensation stakeholders to create and provide various types of workplace safety technologies, For this third installment, NCCI interviewed three employers that have adopted innovative safety technology including wearables and video AI/Computer Vision.

Key insights from this new report include the following:

– – To effectively implement safety technology, an ongoing partnership between the employer, the technology provider, and the insurer is important.
– – Knowing how to interpret and use the data collected from the safety technology was a potential obstacle for at least one employer.
– – The cost of the product was not necessarily an obstacle to implementation.
– – Manufacturing and warehousing are currently the primary industry focus.
– – Employee buy-in and trust are critical for success and can be achieved through education and transparency.
– – The employers’ use of safety technologies also resulted in increased productivity and efficiencies.
– – Use of a single safety technology may not address all workplace hazards or unsafe practices but can be another tool in the toolbox for creating a culture of safety.
– – Safety technologies can be an effective tool for monitoring multiple locations remotely and in real time.

The employers interviewed discussed some of the obstacles to implementing safety technologies, including learning how to manage and act on the data collected and address employee privacy concerns. Interestingly, the cost of the safety technology was not necessarily the biggest obstacle noted by these employers.

An open, honest employer culture is important. According to one employer, employees “buy-in” when there is transparency, management explains the “why,” and wears the device themselves. While not every employee may want to wear the device, the employers believe it was now viewed like any other personal protective equipment such as a hard hat or safety glasses.

As it did for the first two articles, NCCI asked the three employers if safety technology is a “game-changer.” One employer believes that they are a “100% game-changer – especially for a department of one!” A second employer found the ability to monitor a worksite 24/7 to be a game-changer for their operations.

Interested readers can read the full report on the NCCI website.

View More

Despite California’s #37 Best State Ranking, it was #6 in Health Care

WorkCompAcademy

The Best States rankings from U.S. News & World Report show how each of the 50 U.S. states ranks in 71 metrics across eight categories. The data behind the rankings aims to show how well states serve their residents in a variety of ways. In calculating the rankings, each of the eight categories was assigned weights based on the average of three years of data from recent national surveys that asked nearly 70,000 people total to prioritize each subject in their state.

In the Health Care category, California ranked #6 in the nation this year. The top ten were 1. Hawaii, 2. Massachusetts, 3. Connecticut, 4. New Jersey, 5. Rhode Island, 6. California, 7. Maryland, 8. New York, 9. Delaware and 10. Washington.

Out of the eight categories, the Health Care Category follows the following three metric areas:

Health Care Access

– – Population Without Health Insurance: The percentage of adults ages 19 to 64 who reported having no health insurance coverage. (U.S. Census Bureau American Community Survey 1-year estimates; 2022)
– – Child Dental Visits: The percentage of children and young adults enrolled in Medicaid who received past-year preventive dental services among those eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for 90 continuous days. (Centers for Medicare & Medicaid Services; fiscal 2021)
– – Child Wellness Visits: The percentage of children and young adults enrolled in Medicaid and eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit who received screening services among those who should have received such services. (Centers for Medicare & Medicaid Services; fiscal 2021)
– – Adults Without Dental Visit: The age-adjusted percentage of adults who reported not visiting a dentist or dental clinic within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)
– – Adults Without Wellness Visit: The age-adjusted percentage of adults who reported they had not visited a doctor for a routine checkup within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)
– – Adults Deterred From Care Due to Costs: The age-adjusted percentage of adults who reported there was a time in the past 12 months when they needed to see a doctor but could not because they could not afford it. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)

Health Care Quality

– – Preventable Hospital Admissions: The number of preventable hospital admissions per 100,000 Medicare beneficiaries. (Centers for Medicare & Medicaid Services; 2022)
– – Medicare Enrollees With Top-Quality Coverage: The percentage of Medicare Advantage enrollees with a health plan rated 4 stars or better, among plans with a published star rating and number of enrollees. (Centers for Medicare & Medicaid Services; enrollment data as of February 2024, performance data reflective of March-June 2023)
– – Nursing Home Quality Rating: An average index score per state reflecting a proportional scale between nursing homes rated by U.S. News as “high-performing” and those rated as “below average.” (U.S. News Best Nursing Homes; 2023-2024)
– – Hospital Quality Rating: An average index score per state reflecting a proportional scale between hospitals rated by U.S. News as “high-performing” and those rated as “below average,” among hospitals that perform or treat specific procedures or conditions. (U.S. News Best Hospitals; 2023-2024)

Public Health

– – Infant Mortality Rate: The number of infants who died before turning 1 year old, per 1,000 live births. (Centers for Disease Control and Prevention; 2021)
– – Mortality Rate: The number of age-adjusted deaths per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data)
– – Obesity Rate: The age-adjusted percentage of obese adults, based on self-reported height and weight. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)
– – Smoking Rate: The age-adjusted percentage of adults who are current smokers, based on self-reported tobacco usage. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)
– – Poor Mental Health: The age-adjusted percentage of adults who reported their mental health was not good for 14 days or more in the past 30 days. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022)
– – Suicide Rate: The age-adjusted rate of suicides per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data)

Sadly, despite California’s high ranking in health care, it ranked #37 in terms of “Best States Overall.” This global category is based on ranking of the 8 sub-categories which includes health care. The California rankings in each of the 8 sub-categories was #34 Crime & Corrections, #34 Economy, #23 Education, #42 Fiscal Stability, #6 Health Care, #32 Infrastructure, #33 Natural Environment, and #50 Opportunity.

And out of the 30 Worst Places to Live, San Francisco was 3rd worst. The City by the Bay is one of the most expensive places to live in the U.S. The median income is higher here, but so are the costs for gasoline and utilities, which fall well above the national average. Job growth hovers just above 1%. Renters pay an average of $4,030 per month for a place to live. About 10% of the population lives below the poverty level. As for crime, the city experienced more than 50 murders and nearly 4,000 assaults in 2021.

View More

GPO Drug Middlemen Blamed for Chronic Drug Shortages – Evade Senate Bill

WorkCompAcademy

According to a report by The American Prospect, the big three Group Purchasing Organizations (GPOs) – Premier, Vizent and HealthTrust use sole-source contracts to require hospitals to purchase virtually the same amount from suppliers every year. If a supplier cannot snag one of these contracts, they cannot sell to nearly all hospitals, and they cannot go forward as a business. This dramatically shrinks the manufacturers available for particular sterile injectable drugs, any of which can be thrown offline by the slightest imperfection.

The GPO structure therefore limits competition for these drugs, and exacerbates resiliency challenges. It also can increase prices, because the determining factor of getting a contract is often the highest fee a manufacturer can provide. These fees cut into supplier margins and induce them to take shortcuts to ramp up production, making the system even more vulnerable to supply shocks.

Hospitals have favored the scheme because they get paid too, through “share-backs” from the GPOs. This secures their participation and keeps the system stuck with supply challenges.

Ending the anti-kickback safe harbor would shift the GPO compensation model. They would be paid by hospitals as co-op purchasers, for finding the cheapest prices for medical supplies, rather than being paid by suppliers as for-profit operators, hunting the biggest fees for access. A market with suppliers competing for business rather than paying GPOs to get into hospitals would reduce what hospitals pay, studies have shown.

The Senate Finance Committee is releasing a bipartisan discussion draft this month that aims to tackle the epidemic of drug shortages, mostly in low-margin generic injectables used in hospitals. It attempts to reckon with the broken market structure that has created the most drug shortages in America on record.

The discussion draft uses Medicare and Medicaid payments to incentivize reform of contracting practices that put generic injectables and other drugs at heightened risk for shortages. In particular, Senate Finance Committee chair Ron Wyden (D-OR) has taken aim at group purchasing organizations (GPOs), three of which handle bulk purchasing for 90 percent of all hospitals. Sole-source contracts and profit-skimming by GPOs (and large wholesalers, which also have extreme concentration, with three controlling 90 percent of purchases) have been blamed for creating the conditions where low-margin drugs are no longer profitable to most manufacturers, thinning out the supply chain and opening it up to regular disruptions.

Yet the bill does not take what some have identified as the easiest path to breaking the power of GPOs: removing the safe harbor from anti-kickback laws that allows the companies to maintain their dominance by taking fees from hospital suppliers in exchange for inclusion in their guaranteed sale contracts.

Instead, it creates a new framework starting in 2027 called the Medicare Drug Shortage Prevention and Mitigation Program. Hospitals and other providers would be eligible for incentive payments under the program, but only if they commit to a variety of contracting reforms to ensure that certain generic drugs are no longer chronically in shortage. This includes injectables like saline, and chemotherapy drugs that have recently gone into short supply.

Some critics see that as a missed opportunity. “This draft is a convoluted, unworkable, nonsensical, overly complex mess,” said Phillip Zweig, co-founder and executive director of Physicians Against Drug Shortages, which has highlighted anti-competitive contracting practices and kickbacks as the source of the problem.

That there’s a draft at all reflects renewed attention to the problematic function of middlemen in the health care system, both on prices and the timely dispensation of treatment. Pharmacy benefit managers (PBMs), which play a similar role for prescription drugs purchased at pharmacies, have also come under scrutiny in Washington. Federal regulators are currently examining both GPOs and PBMs.

But solutions have been elusive, and while the committee is optimistic that they could really get something done, critics argue that there are much simpler alternatives available: in this case, making pay-to-play GPO schemes illegal again.

View More

April 29, 2024 – News Podcast

WorkCompAcademy

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Court of Appeal Affirms WCAB Application of Commercial Traveler Rule. Appellate Court Reduces Interest on Workers Attorney Fee Award. PAGA Plaintiff No Longer Required to Have an Individual Claim. Tustin Man to Serve 15 Months in Prison for Patient Brokering. DWC Updates and Posts Time of Hire Notice. Cal/OSHA Cites Construction Company $371K for Fatal Trench Collapse. Cal Hospital Association Sues Anthem Blue Cross for Authorization Delays. Accreditation Agencies Launch New Telehealth Care Standards. UFW Announces a Mini-Series Documentary on Farmworker Risks & Dangers.

View More

Jury Awards $971K to Female L.A. County Sheriff Captain for Discrimination

WorkCompAcademy

The Malibu Times as well as a story in the Conejo Valley Acorn, reports that Malibu/Lost Hills Sheriff’s Capt. Jennifer Seetoo has won her lawsuit against Los Angeles County implicating former Sheriff Alex Villanueva. Villanueva was accused of discrediting Seetoo by spreading false rumors about her and denying her the opportunity to interview for a promotion. In just under two hours of deliberations, a jury awarded Seetoo just over $971,000 in damages.

The trial unfolded over nine days of testimony from April 8 to 19 at the Stanley Mosk Courthouse in downtown L.A. Among the witnesses were Seetoo herself and former L.A. County Sheriff Alex Villanueva, under whose administration the alleged mistreatment occurred. Villanueva himself was not named as a defendant in the lawsuit.

Seetoo started with LASD as a custody assistant in 1997 at age 20. She was first in her class at the academy and rose through the ranks, arriving at Malibu/Lost Hills sheriff station as operations lieutenant, or second-in-command, in November 2018.

On her first day the captain, Josh Thai, suffered a medical emergency, making her acting captain. That same week saw the Borderline mass shooting and the Woolsey fire, with Seetoo leading the station’s response to that historic disaster.

In early December Villanueva was sworn in as sheriff, having campaigned on a promise to let local communities choose their captains.

According to Seetoo’s original complaint, filed in January 2020, she soon began to face accusations from higher-ups that she was jockeying for the absent captain’s job. These included false comments about an “inappropriate relationship” with the city manager in one of the municipalities in her jurisdiction, insinuations which Seetoo believed came from the office of the sheriff himself.

Seetoo was removed as acting captain and told she owed additional time as watch commander to be eligible for promotion. But this policy of Villanueva’s was not consistently applied to male officers, her suit alleged. She was also prevented from transferring to the detective bureau for a similar reason.

When the captain position at Lost Hills opened in June 2019, Seetoo applied but did not get an interview. The 10 candidates selected to interview were all male.

City officials told Seetoo they had sent a letter to LASD demanding that she be considered, which made her concerned about the potential repercussions. After Agoura Hills honored her Woolsey fire work by asking her to ride in the Reyes Adobe Parade, new Lost Hills Capt. Matt Vander Horck was allegedly directed to remove Seetoo from the operations lieutenant position he had asked her to fill, as well as her role as Malibu liaison.

At that point, in October, Seetoo complained about the unfounded rumors and retaliation in an email to a commander. Shortly thereafter Vander Horck told her the decision had been made to transfer her to West Hollywood. Sending employees to work at stations far from their homes as punishment is a familiar tactic in the sheriff’s department, known as “freeway therapy.” Vander Horck himself was abruptly removed as captain and transferred in Feb. 2020.

Although Villanueva was not named as a party in the lawsuit, he was accused of spreading an unfounded rumor that the married Seetoo, then the Malibu Sheriff’s liaison, was having an affair with a city manager in Agoura Hills, a city in her jurisdiction. Villanueva did testify at the trial, but so did a Villanueva colleague, an assistant sheriff who contradicted Villanueva’s testimony. That witness testified that he heard the rumor directly from Villanueva, who stated it as if it was a fact. The former Agoura Hills city official, who now works for another nearby municipality, testified in support of Seetoo, a mother of two, that the rumor was completely baseless and unsubstantiated.

Seetoo did not allege discrimination by her direct superiors, but rather from the very top of the department. Her complaint mentioned “spies” planted by the sheriff to watch her work. It also spoke of a larger pattern of discrimination against female sworn officers in the LASD under Villanueva.

In May 2022 Seetoo finally became the first female captain at Lost Hills.

Jurors found in Seetoo’s favor after deliberating for just over one and a half hours. The bulk of the jury award – $750,000 – was for non-economic losses including harm to her reputation and emotional distress. An additional $221,369 was awarded for lost earnings and benefits, bringing the total to $971,369. Seetoo also won legal fees.

Seetoo’s attorney, Kathleen Erskine, said, “It has been a highlight of my career to represent Jennifer Seetoo. She led the Malibu/Lost Hills Station with bravery and skill during the Woolsey Fire, one of the most devastating events in its history. Rather than allowing her to compete for the promotion she deserved, former Sheriff Alex Villanueva and his high-ranking executives discriminated and retaliated against her.”

The ongoing case is Jennifer Seetoo v County of Los Angeles et. al assigned to Hon. Rupert A. Byrdsong in Department 28 Stanley Mosk Courthouse.

View More

15 Telehealth Legislative Proposals Under Congressional Legislative Review

WorkCompAcademy

On March 13, 2020, President Trump declared a national state of for COVID- 19, initiating the expansion of Medicare’s telehealth benefits under the section 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.4

The Centers for Medicare & Medicaid Services (CMS) worked with Congress to waive Medicare’s restrictions on telehealth utilization, such as geographic restrictions and provider reimbursement. Prior to the public health emergency (PHE), an average of 13,000 fee-for- service (FFS) Medicare beneficiaries received telehealth services per week. At the end of April 2020, the number of FFS beneficiaries receiving telehealth services per week reached 1.7 million.

The flexibilities that Congress expanded in order to increase patient access to telehealth services during the COVID-19 Public Health Emergency were extended through the end of 2024 in the Consolidated Appropriations Act of 2023. Additionally, CMS has also continued certain telehealth regulatory flexibilities to align with the statutory extensions. Notable flexibilities that are set to expire at the end of 2024 include:

– – The ability for Medicare patients to receive telehealth services in their home;
– – Removal of geographic restrictions for originating site for non-behavioral/mental telehealth services;
– – Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are permitted to serve as a distant site provider for non-behavioral/mental telehealth services;
– – The ability to deliver certain non-behavioral/mental telehealth services using audio-only communication platforms;
– – Removing the requirement for an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter; and
– – Allowing telehealth services to be provided by all eligible Medicare providers.

During an hours-long House Energy and Commerce subcommittee hearing this week, lawmakers considered 15 different legislative proposals surrounding telehelath access, noting changes in Medicare will impact decisions of private insurers.

“There’s an urgent need to extend these flexibilities because it’s going to run out,” said Rep. Anna Eshoo, D-Calif. “We need to take action on this.”

Lawmakers lauded the benefits of telehealth during a hearing Wednesday, but House members also raised questions about cost, quality and access that still need to be answered as a year-end deadline looms. As a December deadline draws closer, legislators are working to hash out details about extending or making pandemic-era telehealth flexibilities in Medicare permanent.

Telehealth offers promising support to providers struggling to keep pace with current workforce shortages. The Health Resources and Services Administration (HRSA) projects a shortage of 139,940 physicians by 2036. Currently, there are 39.8 primary care physicians per 100,000 people in rural areas, compared to 53.3 primary care physicians per 100,000 people in urban areas

Telehealth and remote patient monitoring can help alleviate some of these workforce challenges. According to a 2022 survey, 8 in 10 practitioners reported that retaining telehealth for health care practitioners would make them more likely to continue working in a role that maintains flexibility.

According to the testimony at Wednesday’s hearing of Eve Cunningham, M.D., group vice president and chief of virtual care and digital health at Renton, Washington-based Providence health system said: “Telehealth has become an integrated part of Providence’s care delivery system making up about 20% of ambulatory care visits. Telehealth services are deployed across 93 acute care hospitals, including 42 hospitals from other health systems, and two high schools, with more than 1.2 million telehealth visits annually,”

“Telehealth is no longer a nice to have, but a core function of our healthcare delivery,” Cunningham said. She added, “Telehealth expands access to high-quality, coordinated care to more people in more places. Telehealth enables us to offer specialty services in remote and rural areas like Kodiak, Alaska, while also allowing us to care for underserved communities in urban areas like Los Angeles,” she said.

View More