Congress examines telehealth policies, data disparities

With help from Mohana Ravindranath (@ravindranize)

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Quick Fix

— Today in Congress: Both chambers take up the Trump administration’s response to the coronavirus.

— Newest in contact-tracing apps: The technology comes under worldwide scrutiny.

— Latest from NIH: The institutes are offering more data for coronavirus research.

eHealth tweets of the day: Lisa Bari @lisabari “One of the most well-worn tropes about Medicare beneficiaries is that they’re so old they ‘don’t know how to use apps or the internet’. CONSIDER THIS INSTEAD: 1)Many Americans don’t have high-speed internet, concentrated in people with low incomes and those living in rural areas.

“ALSO: Even if someone has, for example, a cell phone with a data plan, lower-income people may not have unlimited data plans, or good signal/access. Those low-cost data plans like Metro PCS are MVNOs, which get secondary or tertiary priority on cell networks.”

WEDNESDAY: Your correspondent has been a very happy user of local free little libraries of late; in fact, they all seem to be bursting with more good books than ever before. Have you noticed the same? Share by email at [email protected]. Discuss socially at @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

TELEHEALTH, DISPARITY DATA UNDER THE MICROSCOPE — Panels in both the House and Senate today examine the federal government’s response to the pandemic:

— The Senate: American Telemedicine Association President Joe Kvedar, slated to testify in front of the Senate health committee, says he expects the costs of virtual care will be part of today’s discussion on how to make telehealth policy permanent.

HHS has loosened telehealth rules during the pandemic — lifting payment restrictions on virtual care and easing licensing barriers, among other changes — and providers and telehealth proponents have warned that those policies will end abruptly once the public health emergency does.

ATA is among several groups urging lawmakers to make those policies permanent. “We know there’s pressure to sunset the public health emergency, and we understand why folks might want to do that,” Kvedar told Morning eHealth. But “we can’t see the volume of patients in our offices that we could before, because of proper social distancing ... we really need those telehealth provisions to stay in place.”

As states open up, many practices resuming in-person treatment are limiting the number of people in waiting rooms and elevators. They also need to disinfect exam rooms after each patient, he said.

ATA has also lobbied for a permanent change to Medicare policy: removing geographic restrictions on payment for virtual care. Uncertainty about telehealth policy has meant that some practices can’t spend time or money installing robust virtual care systems, Kvedar said. “I can see where people may be getting discouraged.”

The ERISA Industry Committee also submitted testimony supporting permanent changes. But it also pushed back against a House bill requiring health plans to cover telehealth for services at the same rate as in-person care, arguing that it would hinder competition.

— And the House: Meanwhile, House Energy and Commerce’s Health subcommittee will scrutinize health care inequality, with a focus on racial and ethnic disparities. Officials from the Palo Alto Medical Foundation and the National Medical Association, among others, are slated to testify.

NEWEST IN APPS — Contact-tracing apps are pinned under the eyes of public officials for privacy and other concerns:

— State Attorneys General: Thirty-nine state prosecutors urged Apple and Google this week to verify that contact-tracing apps on their app stories are associated with public health authorities, and to remove the ones that aren’t. The two companies are partnering on their own contact tracing technology, but have also allowed other developers to sell apps on their platforms, the AGs noted in their letter to the tech giants.

Earlier this week, New York AG Letitia James pressed the companies to ensure that any contact tracing apps on their app stores don’t inappropriately collect or store sensitive information.

— Norway: Norwegian health officials suspended their contact-tracing app due to privacy and effectiveness concerns. Only 14 percent of individuals had downloaded the app — well below the estimated 60 percent needed for effectiveness. That made the privacy trade-offs not worth it.

LATEST FROM NIH — The nation’s medical research agency is stepping up its coronavirus game:

— All of Us: NIH’s precision medicine project, All of Us, is launching a coronavirus project. Approved researchers will have access to coronavirus-specific data from the nearly 350,000 participants signed up so far, starting with antibody testing of the most recently joined participants, but also including EHR and survey analysis.

— New database: The NIH is launching a new database for scientists to understand coronavirus. Using data from 35 sites, the database will collect demographic, medications, lab test results, and outcomes data for five years, allowing scientists to track patients (in de-identified fashion) and potentially predict who might develop kidney failure, or figure out therapies.

CONTACT TRACING SCUFFLES — Contact tracers in New York City aren’t having a lot of success so far, with most New Yorkers who test positive for Covid-19 not giving names of potential exposures, our colleague Erin Durkin reports.

Most of the people reached are claiming they have no contacts at all, said Ted Long, head of the Test and Trace Corps. “It’s not that they’re refusing to give us contacts, but they’re telling us that they don’t have any,” he said.

People might be staying at home; but it’s also possible privacy and trust concerns are stopping them from being forthcoming. If it’s the latter, it’s emblematic of an emerging concern: that patients may not use apps or government services for fear of compromise.

“We’ve experienced hiccups starting out this program and we have individuals who do not trust and initially don’t want to accept the call,” said Annabel Palma, chief equity officer of the coronavirus tracing effort run by NYC Health + Hospitals. “We again give them time and go back to them — trying to build that trust, trying to make sure that folks are comfortable to talk.”

Health IT Business Watch

LANDMARK VIDEO GAME APPROVED FOR ADHD — EndeavorRx, a video game intended to help children manage ADHD, was authorized as a treatment this week by the FDA. It’s a landmark move, the first video game approved to treat a condition.

Business types were bullish: Banking analysts at Evercore noted that the video game, developed by Akili Interactive, poses fewer side effects to kids than medication. The analysts also noted that the authorization shows the importance of validating performance with clinical trials; the authorization should also pave the way for additional products.

SURGISPHERE GOES *POOF* — The data firm behind two major withdrawn coronavirus studies seems to have disappeared from the internet, with its webpage going poof Monday.

The startup, called Surgisphere, supposedly had data from dozens of hospitals stretched across six continents. Using that data, several researchers delivered blockbuster studies on the effects of ACE inhibitors and hydroxychloroquine on coronavirus. But while its hydroxychloroquine study was politically provocative — showing that the anti-malarial was worse than useless against coronavirus — its results were immediately questioned for multiple errors and ethical issues.

The questions proved to be too much: The startup wasn’t able to provide data for auditing, leading to the withdrawal of the research. Other subsequent developments — like the NHS Scotland claiming its data did not contribute to the data set — have also unsettled the startup’s credibility.

Beyond the impact of multiple studies being withdrawn, public health communicators are worried the back-and-forth will only implant more doubt in the public’s mind on scientists.

Health IT Business Watch

TOP CANCER STARTUP GOES ON LOBBYING SPREE — Grail, a richly funded startup hoping to use blood tests for early cancer detection, is building up its lobbying team, our colleagues at POLITICO Influence report. The startup, which raised a fresh jolt of $390 million (not a typo!) in May, hired seven lobbyists: Alexander J. Beckles, Avenue Solutions, Forbes Tate Partners, the Mathis Harple Group, the McManus Group, Miller Strategies and Todd Strategy.

The company was not terribly expansive about its reasons for hiring the lobbyists, saying, “As policymakers seek to learn more about multi-cancer early detection and its significant potential in meeting patient needs and saving lives, we look forward to sharing our perspective.”

TELEHEALTH STATS — Most health executives were doing less than 25 virtual visits a day before the pandemic — now the majority are doing more than 50 per day, and a third are doing more than 250, finds a CHIME survey of nearly 200 health execs.