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2 posts from April 2020


Krista Drobac Discusses Sweeping Changes in Federal Telehealth Policy In Response to the COVID-19 Pandemic (April 27th)

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Listeners may be aware that up until recently the Medicare program strictly limited provider use of telehealth services via originating site and other numerous other regulatory rules despite its much wider adoption by other payers and the VA.  (E.g., see my previous interview/discussion with Ms. Drobac.)  Annual Medicare reimbursement for telehealth services equaled approximately 0.003% of annual Medicare spending.  With the onset of the COVID-19 pandemic, the Congress and CMS regulators, recognizing the emergency or dire need to maintain a Medicare beneficiary's ability to access to clinical care in a timely manner, markedly expanded telehealth coverage.  Both the Congress's March 27th CARES Act and CMS' April 6 interim final rule made sweeping reforms to Medicare telehealth policy.   

During this 22 minute conversation Ms. Drobac begins by explaining why the Medicare program significantly restricted use of telehealth.  Moreover, she outlines telehealth policy reforms noted in recent COVID-19-related legislation, moreover the CARES Act, and in CMS' interim final rule.  She discusses take-up or utilization by the provider community subsequent to these reforms, related Stark law issues, the need or persistence of integrity guard rails, and whether telehealth reforms will persist beyond the COVID-19 public health emergency.

Ms. Krista Drobac is the Executive Director of the Alliance for Connected Care, an organization that advocates for telehealth policy reform.  She is also a Partner at the DC-based Sirona Strategies, a health policy consulting firm.  Previously, Ms. Krista-further-away-picture-1Drobac  was Director of the Health Division at the National Governors Association’s Center for Best Practices.  Prior to NGA, Ms.Drobac spent five years on Capitol Hill as a health advisor.  Prior still, she was a Senior Advisor at the Center for Medicare & Medicaid Services (CMS) working in Medicaid and private insurance regulation and also served as Deputy Director of the Illinois Department of Healthcare and Family Services.    Ms. Drobac holds a BA from the University of Michigan and an MPP from the Harvard University Kennedy School of Government.

The Alliance for Connected Care is at: http://connectwithcare.org/.

Telehealth reform policies detailed in CMS' April 6th interim final rule  are at: https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf

The CARES Act is at: https://www.congress.gov/bill/116th-congress/senate-bill/3548/text


200th Podcast Interview: Dr. Rishi Desai Discusses the COVID-19 Pandemic (April 13th)

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Now, exactly one month after President Trump declared a national emergency, the federal government's response to the COVID-19 pandemic has been largely inept.  As of April 12th, the pandemic has infected over 560,000 Americans constituting slightly more than 30% of the world’s total number of infections. The US accounts for 5% of the world’s population, however, it has suffered 20% of worldwide deaths, more than 22,000 (a number that is substantially underestimated), or more than any other country.   Comparatively, Germany has suffered far fewer infections and deaths per capita due in part to early and widespread testing, a capable health care model (Germany has even been accepting COVID-19 patients from Italy, Spain and elsewhere), a population that has uniformly observed social distancing guidelines (and is advantaged by having a chancellor with a Ph.D. in chemistry).   Among other failures, the federal government has not taken leadership in acquiring necessary Personal Protective Equipment (PPE) and medical supplies forcing states to competitively bid, i.e., pay inflated prices, for the them.  Still fewer than 1% of the US population has been tested, in part because the president failed to deliver on  his March 13th promise to establish drive-through testing sites, causing former CMS Administrator, Dr. Don Berwick, to conclude, “we’re in a lot more trouble than we need to be" because "we are flying blind unless we find a way to find the people who are infected.”  Concerning Congressional efforts, this past Friday HHS Secretary Alex Azar announced he was awarding $30 billion of the $100 billion in grant moneys authorized under the March 27th CARES Act to support provider response to the COVID-19 pandemic.  Despite noting in his press press release theses monies were being distributed in a “fair” manner, Kentucky, the home of Senate Majority Leader Republican Mitch McConnell, received $311,000 per COVID-19 case, while New York, the home state of Senate Minority Leader Democrat Chuck Schumer, received $11,800 per case. 

During this 27 minute conversation Dr. Rishi Desai discusses where we are on the infection curve, mortality projections, success to date in practicing social distancing, uniquenesses associated with COVID-19, the development of a vaccine and antibody tests, supply and demand of PPE, the pandemic's disproportionate effects on minority communities and the poor, mental health effects, what lessons have we or will we learn as a result of the public health emergency and what these lessons suggest for necessary health care policy reforms going forward. 

Dr. Rishi Desai (MD, MPH) is a pediatric infectious disease physician with a public health background who currently serves as the Chief Medical Officer at Osmosis, an online medical _ learning platform developer.  He also recently led Khan Academy Medicine.  Dr. Desai had an accelerated education, completing high school and receiving his BS in Microbiology and Molecular Genetics from UCLA by the age of 18.  He completed his medical training at UCSF and went on to work at medical centers including Boston Children's Hospital, Boston Medical Center, Children's Hospital Los Angeles, and Stanford University.  He earned his MPH in epidemiology at UCLA and then spent two years at the Centers for Disease Control and Prevention as an Epidemic Intelligence Service Officer investigating disease outbreaks before beginning his work in online medical education.  Otherwise, Dr. Rishi spends his time taking his 3-year-old son to the park - when allowed, eating raspberries and learning Mandarin.

For information on Osmosis go to: https://www.osmosis.org/

The CARES Act is at: https://www.congress.gov/bill/116th-congress/senate-bill/3548/text

CDC information on COVID-19 is available via the agency's home page at: https://www.cdc.gov/

Stay well.