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 Welcome to this Weekend Health it. It's Tuesday News Day where we look at the news which will impact health it. Today the White House asks hospitals to bypass the CDCI. Information blocking clock is ticking, and CMA Verma outlines e early impact of Telehealth on CMS or for CMS. My name is Bill Russell Healthcare, CIO coach, creator of this week in Health.

It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the Covid 19 series has been sponsored by Sirius Healthcare. Now we are exiting the series, and Sirius has stepped up to be a weekly sponsor of the show through the end of the year.

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All right, let's get to the news. So, uh, Twitter went crazy last week over the first story that we're gonna cover. And, uh, let's see what, you know, essentially, uh, I, I have four different stories that I'm looking at here, but they're all the same thing. White House, uh, to hospitals bypass. CDC report, C Ovid 19 data directly to HHS.

Okay, so I'm looking at healthcare IT news. I'm also looking at a handful of other . Sites. 'cause obviously something that's this politically charged, I wanted to, uh, see the different, uh, sources. We've also gone to, you know, we've gone to the, the source, we have information from the HHS website. Also looking at the American Hospital Associations, whatever their announcement that they sent out to their hospitals, uh, as well.

So that's gonna be the primary source that we're, we're pulling from is the ahas, uh, bulletin that they sent out to hospitals. So let's take a closer look and see if all this craziness on Twitter is warranted. So what did they do? The Department of Health and Human Services today announced significant changes to the process for hospitals to fulfill the agency's request for daily reporting on bed capacity utilization, personal protective, our personal protective equipment, PPE, and in-house laboratory testing data.

The most significant changes are detailed below, reporting options, the Centers for Disease Control and Prevention. CDC, national Health Safety, uh, network and HSNC Ovid 19 module will no longer be an option for daily reporting. As of July 15th, hospitals are asked to use one of the other reporting options to fulfill the data reporting requests, including number one reporting data to their state.

Health departments provided that the states have assumed responsibility for reporting hospital data to HHS or number two, report to the HHS TeleTracking portal, an existing option for daily reporting. Okay. So those are the two options for reporting. If you have states like, uh, Oregon has put something together, Arizona has put something together where they are collecting this kind of information at the state level.

Uh, I would assume I, I don't know this for a fact, but I would assume that those states that are collecting that for state response are able to report that in then to the, to HHS. . So the data fields, HHS has made significant updates to the data fields it is asking for in daily reporting. Alright, so let's just, let's go to the HHS document, see what, what kind of fields, what kind of data they're looking for.

So I'm looking at a, uh, a document straight from the HHS website, which outlines this in detail. Here are some of the fields they're looking for. Hospital information, the usual, right? Hospital names CCN State. County, zip. You got it. Uh, the second thing they're looking for is all hospital beds. Third, all hospital inpatient beds.

All hospital inpatient beds that are occupied. ICU beds, ICU bed occupancy. Total mechanical ventilators. Mechanical ventilators in use. Total hospitalized adult suspected of confirmed positive COVID patients. And they also have subsets of some of these things. I'm gonna . Uh, bypass those total hospitalized Pediatric suspected confirmed positive covid patients hospitalized and ventilated covid patients total ICU adult suspected of confirmed positive covid patients hospital onset ed work, uh, ed overflow.

Sorry, not workflow ed overflow and ventilated. Previous days' deaths. Previous days. Adult admissions, that's number 17. 18. Previous days' pediatric C Ovid. 19 Admissions previous days total ed visits. Previous days total c Ovid, 19 related ED visits. Previous days. rem, REM for. I rem to severe. I don't know why I have trouble saying that word, but, uh, I do.

So, uh, current inventory of rems, severe critical staffing shortages today. Critical staffing shortages anticipated within a week. Staffing shortage details, uh, are your PPE supply items. Managed Onhand supply. Onhand supply of. Individual units duration in days. Uh, are you able to obtain these items, yes or no?

And they have a listing of items. If yes to the above, are you able to maintain at least three days supply? And, uh, number 31, does your facility use reusable vulnerable isolation gowns? 32 indicate any specific. Or critical medical supplies or medication shortages for which you are currently experiencing or anticipating experiencing in the next three days.

Okay, so those are the 32 items they're trying to collect. Nothing crazy here. Nothing. You know, this is what they need in order to put together a. A response to what's going on in each state as they surge determining where they, they allocate resources. Right. Makes sense. The AHA strongly urges, I'm going on in the AHA, I'm going back to the AHA, uh, bulletin that they sent out.

The AHA strongly urges all hospitals to review the announcement and report the data to HHHS as requested. HHS stressed in the announcement. The importance of reporting the requested data on a daily basis to inform the administration's ongoing response to the pandemic, including the allocation of supplies, uh, treatments, and other resources.

In addition, the agency notes, it will no longer ask for one-time requests for data to aid in the distribution of REM dvir and any other treatments or supplies. Okay. So that's the end of the, that's the end of that bulletin. That's essentially what's happened, right? So we were directing all that information to the CDC.

Now we're directing it to the HHS. Why is that a big deal? Because the CDC data essentially is an open database that's available to, uh, researchers and everybody else. HHS is not as open. So that's the big, that's the big catch here. So what's the, so what? On this, first of all, I think we have to talk about the CDC for a moment before we go into this.

The first is, you know, the CDC really had egg on their face from the get go in this, in the pandemic, right? So the covid testing fiasco early on in the, in the process came out of the CDC. And, uh, so they started behind the eight ball. The other thing is the CDC pandemic preparation from a technology perspective has been a topic on the show they're asking for.

In the beginning, they were asking for too much irrelevant information, and then their practices are still kind of antiquated, right? So there's still information going into the CDC via fax, via mail, not email, via mail. Like stamp and you know, that whole thing. Um, so they're still using that kind of thing as a way to collect, you know, and it's not outside the realm of possibility that the CDC is technology challenged and not able to produce the reports and information that are needed to effectively coordinate a response.

Yeah. Right. So that's not, not outside the realm of possibility. It's also not outside the realm of possibility that this administration would like to control the narrative. And the, and the CDC and the data sources do not allow for that. So here's the thing. Is it a political move? Probably. But it is most likely not only a political move, it is probably also rooted

In less than timely reporting, missing bad data, poor compliance on gathering the information, uh, you know, it's, again, it's likely connected to the CDCs capabilities, the CDCs modernization of their platforms, uh, their technology, their methods, their practices. It's probably rooted in both, you know, am I trying to straddle the line?

Probably. But if I've learned anything from being in the room where decisions get made, they're rarely as simple and linear as they get interpreted by the public. So yes. Is it political? Yes. Is it technology based? Probably. So the two are probably correct. It's not one or the other. That's how I'm viewing this.

And at the end of the day, hey, we're trying. I, I always ask myself on these political topics, if an administration that I was for made this request, would I be for this? And if the answer is yes, I don't care which administration's in from a technology, from a pragmatic standpoint, from a coordinating the response in the local, uh, markets and, and even potentially controlling the narrative.

I'm okay with that. If it, if it allows for a, a more coordinated effort, a better controlled effort in order to bring about the best outcomes, I, I can be convinced. Uh, to go in that direction. So if my administration, whichever one that is, is in power, and they would make this request, how would I respond?

And if I say, yeah, I'd be okay with this, then if the other administration's in power that I may not agree with how they're gonna use the data or whatever, then I just, you know, I have to coach myself to say, you know, this is just, uh, this is just the way it is. Alright, let's, let's move off from this story.

Again, lot of craziness on Twitter about that one. Of course, there's always craziness out on Twitter, so we will, we'll just move on from there. The next story, early Impact of CMS expansion of Medicare Telehealth during c Ovid 19. Uh, this is a health affairs blog article. CIMA Verma Waves Weighs in. Uh, I always really enjoy reading SEMA Burma's stuff, and she had a lot of good things to say about telehealth.

As you know, she has been a strong proponent. Of the expansion of telemedicine even before c Ovid 19, and now since c Ovid 19, she has really championed the, the, the allowances that have made the expansion of telemedicine possible. So let's go into this article a little bit. Again, it's health affairs.org and, uh, I think if you just search that site under Sema Verma, you'll find this article.

It is entitled Early Impact of CMS Expansion of Medicine Telehealth during C Ovid 19. Alright, so during the Coronavirus pandemic, the centers to CMS has taken unprecedented action to expand telehealth to Medicare beneficiaries. Since people were advised to stay at home and reduced the risk of exposure to C to 19, there was an urgency to increase access to telehealth.

We've covered that a lot on the show. Uh, today we're gonna share the highlights. No, and they're just gonna go through it. So telemedicine, which includes telehealth and other virtual services, allows patients to visit with clinicians remotely using virtual technology. Innovative uses of this kind of technology in the provision of healthcare are increasing with advances in telehealth platforms and remote patient monitoring technology.

All right, so CMS actions to expand telemedicine before Covid to 19 by law of Medicare, can only pay for most telehealth services in limited circumstances when the person receiving the services is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for telehealth services.

A telehealth service must use an interactive audio and video telecommunication system that permits real-time communication between the distant site practitioner who's remotely furnishing the service such as a physician, nurse practitioner, or physician assistant, and the patient at a local medical facility.

They have been pushing this. Okay, so c Ovid 19 hits CMS efforts to expand telehealth. Prior to Covid 19, public health emergency serves as a strong foundation, which is true. CMS temporarily expanded the types of healthcare providers, types of healthcare providers that can offer telehealth to broaden patient access across the board.

All right, so they, they. Increase the number of codes that can be used. They increase the number of people that could actually deliver this care. They, they have allowances for the locations that can originate these services. Obviously, some of these physicians were not in hospitals. They were in their homes, so they, they did an awful lot of things.

So what did we see? We saw an unprecedented increase in telemedicine. Let me give you some numbers. Before the public health emergency, approximately 13,000 beneficiaries in fee-for-service, Medicare received telemedicine in a week. In the last week of April, nearly 1.7 million beneficiaries received telehealth services.

Okay. According to Medicare fee for service claims, data beneficiaries, regardless of whether they live in rural or urban areas, are seeking care. During the pandemic through telemedicine services in rural areas, 22% of beneficiaries use telehealth services and 30% of beneficiaries in urban areas did so also.

All right. So, and that's the biggest change, right? Urban areas is the biggest change. We already had a fair amount of telehealth capabilities and ability to pay for it in, uh, remote rural areas, but now we opened it up in the cities in order to protect, you know, safety, right? For safety reasons is why we did this.

Let's see. She goes into a little bit more of a breakdown. I'm not sure I need to go into, you know, 30% are female beneficiaries. 25% are male beneficiaries. It's across all age groups. 25 to 34% of beneficiaries have received a telemedicine service. 34% among beneficiaries be below the age of 65, 25, among beneficiaries between the age of 65 and 74, 20 9%, 75 to 84, and 28% older than 85.

So that's an interesting split. She goes into more of the split in terms of demographics. Asians, blacks, Hispanics, whites, 30% Asians, 34% of blacks, 33% of Hispanics, 35% of whites, uh, 31% among others, and these are among dual dually eligible beneficiaries. There are no significant differences across race or ethnicity of those seeking telemedicine.

Which is really interesting. Evaluation and management visits. Uh, anyway, she goes into a lot of detail in this story. It's, it's probably worth it if you are in the middle of trying to make the case for telemedicine in your health system. There's a lot of data in here. We should be collecting claims data.

We should be collecting, um, internal, uh, data. We should be collecting satisfaction data. With our providers. Any kind of data that you can get your hands on, we should be collecting so that we can make the case for this to become permanent. Okay? So looking ahead, telehealth will never replace the gold standard of in-person care.

Alright? So that needs to be just driven home. I'm sort of doing the so what as I go through this story that needs to be driven home. , right? We are not trying to replace in-person care. We're trying to, we're trying to put place telemedicine and place remote patient monitoring and those kind of things in key places along that care journey, along that care continuum so that we can provide more efficient, better care, more, more personalized care all throughout the process, right?

So if we're only talking to them. 1, 2, 3 times, you know, a month. Now we have more data points. If we have remote patient monitoring, we're collecting more information. If they're able to just routinely have a weekly . You know, video visit of 10 minutes to touch base with a physician assistant or a nurse practitioner, or even the physician, or even a care team, as we were gonna talk about in some shows coming up.

You know, this is an opportunity to really change the model of care, to have more of a care team approach to caring for the individual, because we can bring more providers in contact with each individual patient. . All right. So however Telehealth serves as an additional access point for patients, she goes on to talk about that the data has shown that telehealth can, uh, be an important source of care across the country, not just for those living in the rural areas.

Uh, I think we've seen that, that it can and will be adopted in urban areas. In fact, I would say if probably gonna see a bigger uptake in urban areas, especially now after the pandemic, or as the pandemic continues, I should say, not after the pandemic. So she goes on to say Medicare spending and impact on the healthcare delivery system itself.

First, it's important to assess whether the mode of telehealth service delivery is clinically appropriate. So this, these are some of the things that that CMS is reviewing right now to see if the temporary changes, uh, should be made. The flexibilities should be made permanent, right? So first, they're going to assess whether the mode of telehealth service delivery is clinically appropriate.

Right. So we're, we're searching out is is it appropriate, is it the best use of, uh, funds and resources? Are we actually driving better care through the use of telehealth? They're also looking for fraud, obviously. The second is we need to assess Medicare payment rates for telehealth services. During the public health emergency, Medicare paid the same rate for Telehealth visits as it would've paid for an in-person visit.

Given the unique circumstances outside of the pandemic by law, Medicare usually pays. For telehealth services at rates similar to what professionals are paid in the hospital setting, setting for similar services. Further analysis could be done to determine the levels of resources involved in telehealth visits outside of the public health emergency, right?

So that what they're looking at. Is, you know, does it require, will they do, uh, research to determine how much resources actually needed to do a, uh, telehealth visit? And finally, it is vital that beneficiaries and taxpayer dollars are protected from unscr scrupulous actors as more healthcare providers use telehealth to treat beneficiaries.

CMS. It's examining our data for many, for many of these angles, right? So they're looking for fraud as we talked about earlier. You know, there's that CMS database that's out on the Wall Street Journal website, and if you actually go into that, it is just amazing. You look at, you know, you, you could to the, to the untrained eye.

I will, I, I will. I will caveat this by saying, by the untrained eye, it would appear to me that there are some doctors that have figured out how to really work Medicare. and where they can really maximize their revenue. I'm not calling it fraud, but they're maximizing their revenue. By, by recommending certain procedures that can be done over and over again and still get paid, and you're seeing some Medicare only doctors making 5, 6, 7, $8 million a year doing these, uh, procedures.

Again, I don't know if it's fraud, but to the untrained eye, you look at that and you're going, that seems very interesting to me. And I think that same data does exist. I think, uh, CMS has the ability to really look closely at that to determine, uh, the best. Place for it to go. So what's my so what on, uh, telehealth?

At this point, I believe this stuff is gonna be made permanent. I don't think there's anything to worry about. I would be making plans on where you are going to insert telehealth across the board. How do you coalesce that? The, the advantages that we've seen during Covid. How do you, um, find your champions and really keep it moving internally?

I would not, I would not worry about the funding for telehealth. I think it's gonna be there. I think if you wait . To really bring it all together. First of all, you're gonna lose the momentum. The second thing is you will be behind the eight ball because this is going through, you should assume it's going through, you should plan for it going through.

You should plan for it being funded, maybe not at a hundred percent, but you should plan on it being funded and you should figure out where it's gonna go. What do you have to do for your platform? What do you have to do for your training? What do you have to do, uh, for compensation and other things? All those things should be on the table and the conversation should be underway.

So those are just, wow. Those are just the first two stories. That's an awful lot. Uh, going on. I'm already at 24 minutes. I'm gonna keep going though. Oh, well let's do this one. Health Catalyst announced agreement to acquire Health Finch. Health Catalyst, who is a sponsor of the show as a. Just getting that out there.

Let's pull up that story. So this is, you know, health Finch does, uh, clinical workflow optimization. Health Catalyst is doing a lot of population and health stuff. And so Health Catalyst has a, I don't know if it's called a division or what it's called, but they have a focus on, uh, clinical insights delivered directly, uh, within the EHR.

And that's where Health Finch is gonna come in. Come into play. So you take a very powerful data analytics operating system and you take the ability to put those things and actually inform clinical workflow. I think this is a the so what on this is, I think it's a. Phenomenal acquisition for Health Catalyst.

They need those capabilities anyway. I think it strengthens their, their, their approach to the market and, uh, only moves them, you know, further down the road in terms of making those insights and analytics actionable. In the care continuum. So if you're a Health Catalyst client, I would, uh, hit them up, figure out, uh, you know, what, what Health Finch is doing and where that can, um, be integrated into your model.

I think it's a, uh, pretty good thing. The final ONC, final Rule compliance clock is ticking. I might come back to that story. Let's hit the future remote work. according to startups. Again, one of my favorite things, as you have heard, is these visual capitalist graphics infographics that I've been getting. I now get the, uh, daily infographic and, you know, these guys are great.

They're just artists. They take a question, and this one happens to be about around the future of remote work. According to startups, and they talk about, they're specifically looking at startups. I think some of this is applicable to healthcare providers and those kind of things. I've, I've seen a couple of these now, which just talks about

You know, essentially how long it takes for people to feel comfortable working from home, one to three months, three to six months, six to 12 months, or never one, one of those options, how many weekdays would you choose to work remotely? It's interesting because, well, actually, lemme give you the previous one.

You know, 31% says they can get comfortable working remotely in the first three months, the 34%, it gets added in three to six month timeframe. So if you work from home for three to six months, better than 66% of those people . We'll start to feel comfortable. 21% uh, gets added to that after six to 12 months.

Alright? So by that point you have 80 some odd percent of your people feeling comfortable working from home. Just something to consider. How many weekdays would you choose to work remotely? These are the kind of questions you should be asking your staff, by the way, as we try to determine what the new normal is.

And you know, is it one day? Is it two days? Is it three days? I don't think it's zero days. I don't think zero days is gonna work, but we've gotta, we've gotta explore how much of this work can be done. Uh, remotely, at least for the foreseeable future. How and where would you like to work and what's the balance?

Let's see, 81% would like a balance of office and remote. Only 10% want remote. Full-time. Only 10% want office full-time. Interesting. Right. If you, if you want the perfect. Bell curve, there it is. 10% full-time under the office, 10% remote, full-time, 81% office and remote balance. So I think that's what we're gonna be looking at post covid, and we're gonna have some conversations about that in the fall.

It's one of the topics I've given to, uh, potential guests to have a conversation around how productive are you with remote work, I think is also pretty interesting. You know, how productive during c Ovid 19. 23% say they're considerably more. 32%. Say slightly more. All right, so 54% of people say they're more productive.

17% say no change. Only 22% say slightly less and and 5% say considerably less productive. Okay. Which would correspond to the number of people that really want to, you know, be at home or be at, uh, in outta the office full time. Alright. Work hours during C Ovid 19. I think this is interesting, either 50 . 5% say they are working more hours than normal.

And that's the thing that's hard for us to get our arms around is that it's hard. I've worked out of my home of actually most of my career if I thought about it and either on the road or out of my home. And it takes a certain amount of discipline to not work, right, because the computer's there, your office is there, the mobile phone is there.

The, you know, the alerts, you don't turn 'em off at five o'clock. They just continue to pop up. It's really easy to start scheduling meetings earlier in the morning, so 55% are struggling with that. Quite frankly, they're working more hours than normal. Again, pretty good graphic remote work. The good and the bad.

You know, they talk about, you know, the worst part about remote work is, uh, less spontaneous connection with your peers. And that's the thing we have to think through of, as we have people work from home, how do we facilitate those chance meetings, those chance conversations that lead to new ideas and new thinking, right?

The best part, no commute. Flexibility, more family. Uh, uh, lifetime. What do you miss? Social interactions face-to-Face collaboration work-life separation. All right. So, hey, this is worth, uh, pulling up visual capitalist.com, the future of remote work according to startups. And all those words have hyphens in between them, but, uh, you can hit that, that is, uh, worth taking a look at.

And, uh, information blocking to block or not to block is good article. I'm gonna come back to that in the next show. . I hope to, that is a story Dr. Craig Joseph gives, gives that on. He's the chief medical officer for Nordic and he gives a rundown. It's a good story. I don't wanna shortchange that and we're gonna come back to that.

Remind me if I don't send me an email and say you want me to cover that story and then we are gonna talk. Next time we get together, we'll talk about the ONC. Final Rule. Compliance clock is ticking. and it is ticking. And uh, I'm gonna start covering that in much more detail as we head into the head into the fall because I think a lot of us have been focused in on some other things, rightfully so.

And now we are really starting to get our backs up against the wall in terms of . The compliance around information blocking and other things, and we have to get our, you know, get our work lined up and get those things ready, as that becomes the law of the land. That's all for this week. Don't forget to sign up for clip notes.

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