TELEHEALTH BEAT
HTRC's monthly telehealth bulletin
SPECIAL PHYSICIAN ASSISTANT ISSUE
Results of HTRC's 2019 Physician Assistant Telehealth survey
Serious health care shortages have become a reality. At HTRC, we know that telehealth is one of the key solutions for increasing access. As versatile clinicians with team-based care at their core, PAs are well-suited for innovative use of telehealth. However, information about PA perceptions of telehealth is sparse.

In order to better understand the perspectives of PAs on telehealth in the HTRC coverage area, we launched a brief survey in July 2019. A survey link was sent to PAs in Kansas, Missouri in Oklahoma. Below we highlight some of the key findings:
Telehealth use
It appears that not a lot of PAs are using telehealth...so far. Among the sample, only 78.3% had ever used telehealth and only 7.6% of the sample could be described as frequent users - once a week or more.
Facility use
Though 43.5% of PAs reported working at facilities with telehealth, less than half of the PAs working at those facilities were using telehealth. This finding warrants further investigation to understand barriers to PAs who have access to telehealth.
Training
PAs do not feel properly trained to use telehealth. Only 18.5% said they had received sufficient training to provide telehealth. Not surprisingly, those who had used telehealth were significantly more likely to agree that their training was sufficient. Lack of training could help explain why a sizable number of PAs with telehealth available at their facilities are not using it.
Age is just a number
Conventional wisdom is that older practitioners are more resistant to telehealth, however, our sample showed little support for this axiom. After dividing the sample into two groups by age, the eldest respondents showed minimal differences in views on telehealth. In fact, the ages of the respondents who had used telehealth was slightly older than those who had not.
Equipment
Lack of equipment was the most prominent perceived barrier for PAs who had not used telehealth. When providing TA, HTRC has often found that organizations and clinicians overestimate their need for equipment and that low-cost solutions may already exist.
Primary care
PAs working in primary care are more likely to be using telehealth. They were also less likely to practice in urban areas.
Relevance
PAs believe that telehealth is relevant to the jobs of most PAs.
Scope of practice
PAs believe that telehealth can help expand their scope of practice.
Patient discomfort
PAs who have used telehealth are significantly more likely to see patient discomfort with telehealth as a barrier. This was an unexpected finding. It could indicate a need for organizations to do more to promote telehealth to patients and incentivize them to use it.
Positivity abounds
When asked to respond to a neutral, open-ended question, "In what ways do you think telehealth will affect the roles or practices of PAs?" responses were overwhelmingly positive - 89%. For more details about respondents' answers, click here .
With 92 participants, the response was modest, however, until now little data has been publicly available outside of vender-driven efforts. HTRC will use the data to develop new materials for PAs and evaluate current services. For more information about the report or services available from HTRC, call us at 877-643-HTRC.

AAPA announces telehealth committee
The American Academy of Physician Assistants has taken new steps to ensure that PAs stay on trend in the area of virtual care and telehealth. AAPA’s president, David Mittman, PA, DFAAPA, recently announced the appointment of a new ad hoc committee, PAs in Virtual Medicine and Telemedicine.  

The charge of the ad hoc committee is to establish a roadmap for the organization to best focus its legislation and advocacy for PAs who are new to telemedicine and PAs currently using telemedicine. Committee Chair Desmond Watt, PA, said he anticipates that the committee will issue recommendations on training and curriculum, collaboration with other groups, and policy recommendations, which will likely include model legislation. 

“It is critical that PAs remain in the forefront of this emerging trend, and that AAPA be fully engaged in ensuring the ability of PAs to practice fully,” said Watt in a recent AAPA article .  

The ad hoc committee is an outgrowth of a Virtual Medicine and Telemedicine special interest group that was already established in AAPA.

HTRC will keep you apprised of committee developments.
Legislative update for PAs
The legislative landscape for telehealth has been changing rapidly over the past few years, but while PAs have seen some changes to telehealth-related policy, other policies have been slow to change.

Medicare direct bill
Currently, PAs are the only health professionals who cannot directly bill Medicare. This creates challenges for PAs who want to practice in non-traditional health care models. Multiple pieces of legislation, including HR 1052, the Physician Assistant Direct Payment Act, have been introduced in the U.S. Congress to remedy this issue. Participants in the HTRC PA survey were asked whether they would be more likely to use telehealth if HR 1052 were signed into law. Fifty percent said that they would be more likely to use telehealth if the bill became law. An additional 37% said they might be more likely to use telehealth with a direct pay law.

Licensure compact
Several health care professions have mounted efforts, with some successes, to establish licensure compacts to make it easier for clinicians to be licensed in multiple states. However, PAs have not yet taken this step. Though we did not ask specifically about licensure compacts, 67% of respondents to the HTRC survey said they would be more likely to use telehealth if it were easier to be licensed in multiple states.
Kansas
Kansas PAs took a step forward in 2018 when the Kansas Telemedicine Act was signed into law. The bill explicitly names PAs as eligible providers and will ensure that private ensurers cover services provided by telehealth. Fifty-four percent of Kansas PAs surveyed by HTRC said they would be more likely to use telehealth because of the bill's enactment. Read more about the Kansas Telemedicine Act.

Missouri
In 2016, Missouri removed language listing eligible providers to avoid a piecemeal approach where the law would have to be amended to add new provider types. Instead the law states that "any licensed health care provider shall be authorized to provide telehealth service such services are within the scope of practice for which the health care provider is licensed." However, Missouri supervision laws require that the PAs work in the same physical location as the supervision physician for at least four hours every 14 days.

Oklahoma
Oklahoma does not have a requirement for PAs to work in the same facility as the collaborating physician. PAs can easily consult with their supervisors through telecommunication exclusively – the supervising physician does not have to be physically present. Their law eliminates the barrier of the need for a constant or partial physical presence by a physician.
EVENTS
Mark your calendar for the 2019 Oklahoma Telehealth Summit August 26-28, keynoted by Julie Hall-Barrow, Ed.D. Hall-Barrow is the Senior Vice President of Network Development and Innovation for Children’s Health System in Dallas, Tex. She works to integrate telehealth into Children’s Health, the country’s eighth-largest pediatric health care provider. She has been working in telemedicine for over twenty years and has been a major advocate of reimbursement for telemedicine in schools. Her talk will illuminate how telehealth has disrupted modern health care. 

Also on August 27, Ragan DuBose-Morris, Ph.D., will share her experiences developing curriculum for students, providers, administrators and policy makers on technology deployment and public policy implementation. Her session will describe the d evelopment of the SC Center for Telehealth and its role in workforce development.

On August 28, Joseph Johnson, D.O., will update attendees on Project ECHO. Johnson currently serves as Associate Dean and Chief Medical Officer for Project ECHO. He'll detail Project ECHO's success in meeting the specialty care needs in rural Oklahoma and improving health care outcomes in ten specialty tracts. In only two years the program has served over 26,000 patients.

The Summit will open with a reception Monday evening, followed by a day and a half filled with presentations, plenaries, breakout sessions and networking opportunities. You'll hear updates on the legal landscape, reimbursement and the business of telehealth. Visit the links below for the full agenda and registration information. We hope to see you there!

Implementation of Applied Behavioral Analysis over Telehealth: The OASIS Approach
HTRC Webinar
September 10, 2019
12-1 p.m.

Presenter: Dr. Linda Heitzman-Powell
To register, please email jgracy@kumc.edu.
National Telehealth Research Symposium
Chicago, Ill.
September 11-13, 2019

The Society for Education and the Advancement of Research in Connected Health (SEARCH) started in 2016 as a small team of academics, researchers, and clinical professionals who meet to discuss the need for:
  1. A society of connected health researchers—free from commercial bias—to prove (or disprove) the benefits of telemedicine
  2. An annual meeting of open discussion revolving around telemedicine research, findings, and national priorities with the goal to share the findings and foster research collaborations among researchers and organizations who wish to define and develop the field of connected health research.
National TRC Webinar: ETHAN: Emergency Telehealth and Navigation
September 19, 2019
11 a.m.

In December of 2014, EMS launched an innovative program called ETHAN (Emergency Telehealth and Navigation Program) that utilizes advanced video/audio conferencing technologies. The video conferencing application connects the patient with an emergency physician for patient assessment and evaluation analogous within a hospital emergency room. While the encounter is taking place, the field crew remains on-scene to assist the physician with any additional patient information. This community-based mobile integrated healthcare system provides individuals who call 911 with low-acuity complaints to be triaged by telehealth emergency physicians for non-ambulance (taxi-cab, self-transport) and/or non-ED destinations (primary care clinic, home care) based on individual depositions. ETHAN has successfully increased efficiency and reduced the cost of emergency care by minimizing the use of EMS and EDs.