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NYS Hep C Telemedicine Workgroup – Meeting Notes

May 15 (10 – 11 AM) via Webinar
In attendance at this meeting: See below notes

Workgroup Chair: Andrew Talal, MD, University at Buffalo, ahtalal@buffalo.edu
Workgroup goals:
 Short term: Identify, assess, document and disseminate current strategies and opportunities to provide hepatitis C treatment in substance use treatment facilities, via telemedicine. Long-term: Develop a NYS Telehealth network to provide a forum for ongoing learning and sharing of best practices to promote hepatitis B and C care and treatment through telehealth.

Meeting Notes

NYC Health Department Telehealth Implementation Support in NYC in Response to COVID-19

Matt Gannon | Senior Manager, Strategic Projects, NYC REACH, Bureau of Equitable Health Systems – mgannon@health.nyc.gov

  • See presentation slides (attached)
  • Training Strategy for Providers: webinars, office hours
  • Communications: outbound communications
  • Technical Assistance: what NYC Reach offers on a 1:1 basis to help practices get rolling
  • To join NYC Reach email: nycreach@health.nyc.gov

Discussion: Hepatitis Implementation Experiences

  • There are challenges to implementation e.g. the first in-person visit should be waived.
  • CMS is contemplating which measures implemented during the pandemic that could be sustained.
  • The workgroup gathered recommendations for CMS on measures to keep and improve that are beneficial to patients:

Centers for Medicare and Medicaid Services,

The NYS Hepatitis Telehealth Workgroup, chaired by Andrew Talal, MD, MPH, has compiled the following recommendations to submit to Centers for Medicare and Medicaid Services to request implementation of regulations to sustain improvements to telemedicine made possible due to COVID19, after the national emergency is officially declared over.

Andrew Talal, MD, MPH, Prof of Medicine, University at Buffalo, has been conducting a 12 site randomized trial throughout New York State of telemedicine compared to offsite referral for hepatitis C management among substance users on methadone sponsored by PCORI. In light of lessons learned as a result of conducting telemedicine evaluations for several years as well as during the COVID-19 pandemic, we would recommend that the following telemedicine regulations be implemented in order to maximize the sustainability of telemedicine.

Recommendations

1.Expand allowable provider and patient access to telemedicine:

    • Eliminate requirement for an initial in-person visit as a prerequisite for telemedicine evaluations. As long as patients are aware who has referred them for a telemedicine evaluation, an initial in person visit should not be required.
    • Allow health care providers to provide telemedicine services to new and established patients.
    • Patients in all settings, including in their home, not just in rural settings should be able to receive telemedicine services.

2. Expand allowable telemedicine platforms, and refine to ensure patient and provider access and protections:

    • Only HIPAA compliant telehealth delivery platforms should be utilized for telemedicine evaluations. Prior to implementing this measure, assess potential patient access barriers and cost of applications to programs.
    • Allow telemedicine services to be delivered via audio-only (telephonic) telemedicine to accommodate patients with less access to computer or smart phone technology, including E+M, behavioral health, education and counseling
    • Implement specific measures for patients with limited English proficiency who need an interpreter. Telemedicine “apps” should have functionality for a 3rd party call, or some other way of integrating interpreter service, as minimum criteria.

3. Improve telemedicine billing and reimbursement:

    • Reimburse telemedicine visits at an equivalent rate as in person visits.
    • Provide clear guidance and support for telemedicine billing
    • Allow healthcare entities to bill as “distant sites,” waiver to allow urban area providers (i.e., non-designated rural areas) to bill for telemedicine service

4. Permit co-administration of medication for treating infectious diseases and substance use disorders via telemedicine:

    • For example: Hepatitis C or HIV treatment should be permitted in conjunction with medication assisted treatment for substance use disorder (buprenorphine, methadone, other medications). Reimbursement for co-administration of these medications should be provided to methadone programs (possible SAMHSA billing code recommendation).

5. Provide support and funding to develop innovative telehealth/telemedicine virtual healthcare delivery models to maximize access and reduce cost.

For further information, please contact Andrew Talal, MD, MPH, SUNY Research Foundation ahtalal@buffalo.edu

Resources

Attendance

  1. Andrew Talal, MD, The Research Foundation for SUNY, ahtalal@buffalo.edu
  2. Meg Chappell, MPH, Empire Liver Foundation, megchapell@empireliverfoundation.org
  3. Diana Toussaint Porteous, Bed Stuy Family Health Center dtoussaint@bsfhc.org
  4. Eli Camhi, Healthcare Consultant, ecamhi@generes.com
  5. Frank Winter, Centers for Medicaid and Medicare Services, Frank.Winter@cms.hhs.gov
  6. Jessie Schwartz, RN, MPH, NYC DOHMH, jschwartz2@health.nyc.gov
  7. Julia Hunter, Binghamton General Hospital, julia.hunter@nyuhs.org
  8. Kathleen Davis, NP, U of Rochester Medical Center, kathleen_davis@urmc.rochester.edu
  9. Katy Cook, AHI Health, kcook@ahihealth.org
  10. Lucy Vega, Hep C Navigator, Bed Stuy Family Health Center, lvega@bsfhc.org
  11. Nadine Kela-Murphy, MPH, NYC DOHMH, nkelamurphy@health.nyc.gov
  12. Nirah Johnson, LCSW, NYC DOHMH, njohnso2@health.nyc.gov
  13. Sandeep Krishnan, MBA, MS, Med Tech International  sandeep.krishnan@medtecintl.com                      
  14. Sara Lorenz-Taki, MD, Greenwich House, staki@greenwichhouse.org                     
  15. Sheila Reynoso, MPH, Montefiore, sreynoso@montefiore.org
  16. Colleen Flanigan, RN, NYSDOH, colleen.flanigan@health.ny.gov
  17. Aisha Khan, DO, Hudson River Health Care aikhan@hrhcare.org
  18. Alvin Chu, MA, MPH, START Treatment and Recovery Centers, achu@startny.org
  19. Courtney Dower Bronx, MBA, Bronx Lebanon, cdower@bronxleb.org
  20. Marc Badura, The Research Foundation for SUNY, mbadura@buffalo.edu
  21. Dan Shappee, AbbVie, daniel.shappee@abbvie.com
  22. Daanish Shaikh, START Treatment and Recovery Centers, dshaikh@startny.org
  23. Ramcharan Osherbhoder, Revnue Cycle Manger, START oramcharan@startny.org
  24. Laura Shannon, Hudson River Healthcare, lshannon@hrhcare.org
  25. Matt Gannon, NYCDOH mgannon@health.nyc.gov
  26. Aarathi Nagarajal, MD,  Hudson River Healthcare, anagaraja@hrhcare.org
  27. Darlene Meyer, The Research Foundation for SUNY, dkmeyer@buffalo.edu

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