- Telehealth and telemedicine can make a positive impact on the nation’s healthcare system if they demonstrate improvement in health outcomes, processes and cost, quality measures are widely accepted and the definitions of measurement are consistent.
That’s the gist of a National Quality Forum report issued Aug. 31, which aims to set a national framework for measuring and supporting success in telehealth and telemedicine.
“Telehealth is a vital resource, especially for people in rural areas seeking help from specialists, such as mental health providers,” Marcia Ward, PhD, director of the Rural Telehealth Research Center at the University of Iowa and co-chair of NQF’s Telehealth Committee, said in a release accompanying the 81-page report. “Telehealth is healthcare. It is critically important that we measure the quality of telehealth and identify areas for improvement just as we do for in-person care.”
To evaluate a program, the NQF laid out four basic categories: access to care, financial impact to patients and their care providers, patient and clinician experience, and effectiveness of both the clinical and operations systems. The group then charted six priority topics: travel, timeliness of care, actionable information, the impact of telehealth in providing evidence-based practices, patient empowerment and care coordination.
On top of that framework, the committee highlighted 16 NQF-endorsed measures that can be used to “assess the use of telehealth as a means of care delivery and its impact on quality of care.” They include COPD, high blood pressure, coronary artery disease, diabetic retinopathy, mental illness, impairments to the elbow, wrist, hand, foot or ankle, general orthopedic impairments, hip or knee impairments, lumbar or shoulder impairments, melanoma continuity of care and preventative care and screening for tobacco use and cessation.
“For many patients, telehealth can mean the difference between seeing their doctor or receiving no care at all,” Judd Hollander, MD, associate dean for strategic health initiatives at Philadelphia’s Thomas Jefferson University and co-chair of NQF’s Telehealth Committee, added in the press release. “NQF’s framework for measuring telehealth quality will be key to helping ensure quality care no matter where people access it.”
The report also took a stab at defining how telehealth and telemedicine is included in the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) new Merit-based Incentive Payment System (MIPS). It noted that telehealth and telemedicine were included in the final rule in terms of providing expanded practice access and encouraging population management.
A key component of MIPS is an improvement activity (IA), or an action that improves clinical practice or care delivery. The NQF’s Telehealth Committee identified how telehealth or telemedicine could be figured into the nine sub-categories that define an AI:
- Expanded practice access: expanded practice hours, telehealth services and participation in models designed to improve access to services.
- Population Management: participation in chronic care management programs, rural and Indian Health Services programs and community programs with other stakeholders to address population health, as well as the use of a Qualified Clinical Data Registry (QCDR) to track population outcomes.
- Care coordination: the use of a QCDR to share information, timely communication and follow-up, participation in various CMS models designed to improve care coordination, implementation of care coordination training and plans to handle transitions of care, and active referral management.
- Beneficiary engagement: the use of electronic health records to document patient-reported outcomes, enhanced patient portals, participation in a QCDR that promotes patient engagement tools and the use of QCDR patient experience data to inform efforts to improve beneficiary engagement.
- Patient safety and practice assessment: the use of QCDR data for ongoing practice assessments and patient safety improvements and tools such as the Surgical Risk Calculator.
- Participation in an alternative payment model (APM) including a Medical Home Model: An APM can be an innovative payment model, a Medicare Shared Savings Program under an Accountable Care Organization (ACO) or a Medicare Demonstration Model. Participating providers are eligible for bonus payments as long as they use quality measures under MIPS and certified EHR technology and assume more than a “nominal financial risk” or they are a medical home expanded under the Center for Medicare and Medicaid Innovation (CMMI).
- Achieving health equity: seeing new and follow-up Medicare patients in a timely manner and using QCDR for demonstrating performance of processes for screening for social determinants.
- Emergency response and preparedness: participation in disaster medical teams or domestic or international humanitarian volunteer work.
- Integrated behavioral and mental health: tobacco intervention and smoking cessation efforts and integration with mental health services.
In concluding its report, the NQF Telehealth Committee identified three key factors affecting the success – or failure – of the technology.
First, the platform must demonstrate a positive effect on quality health outcomes, processes and cost. Second, existing quality measures have to be widely adopted and impactful.
“While a number of measures identified by [Agency for Healthcare Research and Quality], NQF and [the Centers for Medicare and Medicaid Services] relate to telehealth, it is difficult to ascertain which measures would suffice to assess whether telehealth is comparable to, or an improvement over, in-person care,” the report stated. “Additionally, the use of existing measures to assess telehealth should not add any additional burden to the collection and reporting of data from providers, and should contain data that match the specifications of the measure.”
Finally, the definitions have to be consistent.
“Consensus to define terms and measures for proposed measure concepts or existing measures for which there are no common definitions remains essential,” the report concluded. “Without a standard, uniform definition for measures, it will be difficult to synthesize findings and assess telehealth’s impact.”