WASHINGTON (AP) — Telehealth is a bit of American ingenuity that seems to have paid off in the coronavirus pandemic. Medicare temporarily waived restrictions predating the smartphone era and now there’s a push to make telemedicine widely available in the future.
Consultations via tablets, laptops and phones linked patients and doctors when society shut down in early spring. Telehealth visits dropped with the reopening, but they’re still far more common than before.
Permanently expanding access will involve striking a balance between costs and quality, dealing with privacy concerns and potential fraud, and figuring out how telehealth can reach marginalized patients, including people with mental health problems.
“I don’t think it is ever going to replace in-person visits, because sometimes a doctor needs to put hands on a patient,” said Seema Verma, head of the Centers for Medicare and Medicaid and the Trump administration’s leading advocate for telehealth.
Caveats aside, “it’s almost a modern-day house call,” she added.
“It’s fair to say that telemedicine was in its infancy prior to the pandemic, but it’s come of age this year,” said Murray Aitken of the data firm IQVIA, which tracks the impact.
In the depths of the coronavirus shutdown, telehealth accounted for more than 40% of primary care visits for patients with traditional Medicare, up from a tiny 0.1% sliver before the public health emergency. As the government’s flagship health care program, Medicare covers more than 60 million people, including those age 65 and older, and younger disabled people.
A recent poll of older adults by the University of Michigan Institute for Healthcare Policy & Innovation found that more than 7 in 10 are interested in using telehealth for follow-ups with their doctor, and nearly 2 out of 3 feel comfortable with video conferences.
But privacy was an issue, especially for those who hadn’t tried telehealth. The poll found 27% of older adults who had not had a telemedicine visit were concerned about privacy, compared with 17% of those who tried it.
Those who tried telehealth weren’t completely sold. About 4 in 5 were concerned the doctor couldn’t physically examine them, and 64% worried the quality wasn’t as good.
“After the initial excitement, in the afterglow, patients realize ‘I can’t get my vaccine,’ or ‘You can’t see this thing in the back of my throat over the computer,’ ” said Dr. Gary LeRoy of Dayton, Ohio, a primary care doctor and president of the American Academy of Family Physicians.
For Medicare beneficiary Jean Grady of Westford, Vermont, telemedicine was a relief. She needed a checkup required by Medicare to continue receiving supplies for her wearable insulin pump. Being in a high risk group for COVID-19, Grady worried about potential exposure in a doctor’s waiting room, and even more about losing her diabetes supplies if she missed Medicare’s checkup deadline.
“I would have had to go back to taking insulin by syringe,” she said.
Grady prepared for the virtual visit by calling her clinician’s tech department and downloading teleconference software. She says she would do some future visits by video, but not all. For example, people with diabetes need periodic blood tests, and their feet must be checked for signs of circulatory problems.
Still, quite a few follow-ups “could be done very efficiently and be just as useful to the physician and myself as going in and seeing them in person,” Grady said.
Many private insurance plans, including those in Medicare Advantage, offer some level of telemedicine coverage.
But traditional Medicare has restricted it to rural residents, who generally had to travel to specially designated sites to connect.
Under the coronavirus public health emergency, the administration temporarily waived Medicare’s restrictions so enrollees anywhere could use telemedicine. Patients could connect from home. Making such changes permanent would require legislation from Congress, but there’s bipartisan interest.
Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, says he’d like to see broader access, without breaking the bank.
“Our job should be to ensure that change is done with the goals of better outcomes and better patient experiences, at a lower cost,” said Alexander, R-Tenn.
That’s a tall order.
Payment will be a sticky obstacle. For now, Medicare is paying clinicians on par for virtual and in-person visits.
“Policymakers seems to be in a rush to pass legislation, but I think it is worth taking a little more time,” said Juliette Cubanski, a Medicare expert with the nonpartisan Kaiser Family Foundation. “Fraud is one big area that policymakers need to be cognizant of.”
Telehealth is so new that “we don’t have at this point a real sense of where the huge risks lie,” said Andrew VanLandingham, a senior lawyer with the Health and Human Services inspector general’s office. “We are sort of in an experimental phase.”
Despite the risks, advocates see opportunities.
Expanded Medicare telehealth could:
—help move the nation closer to a long-sought goal of treating mental health the same as physical conditions. Sen. Ron Wyden, D-Ore., wants to use telemedicine as a springboard to improve mental health care. IQVIA data shows 60% of psychiatric consults took place by telehealth during the shutdown.
—increase access for people living in remote communities, in low-income urban areas and even nursing homes. Medicare’s research shows low-income beneficiaries have had similar patterns of using telehealth for primary care as program enrollees overall.
—improve coordination of care for people with chronic health conditions, a goal that requires patient and persistent monitoring. Chronic care accounts for most program spending.
University of Michigan health policy expert Mark Fendrick says Medicare should figure out what services add value for patients’ health and taxpayers’ wallets, and pay just for those.
Telehealth “was an overnight sensation,” said Fendrick. “Hopefully it’s not a one-hit wonder.”
By RICARDO ALONSO-ZALDIVAR Associated Press.
Twitter CEO defends Trump ban, warns of dangerous precedent
Twitter CEO Jack Dorsey defended his company’s ban of President Donald Trump in a philosophical Twitter thread that is his first public statement on the subject.
When Trump incited his followers to storm the U.S. Capitol last week, then continued to tweet potentially ominous messages, Dorsey said the resulting risk to public safety created an “extraordinary and untenable circumstance” for the company. Having already briefly suspended Trump’s account the day of the Capitol riot, Twitter on Friday banned Trump entirely, then smacked down the president’s attempts to tweet using other accounts.
“I do not celebrate or feel pride in our having to ban @realDonaldTrump from Twitter,“ Dorsey wrote. But he added: ”I believe this was the right decision for Twitter.”
Dorsey acknowledged that shows of strength like the Trump ban could set dangerous precedents, even calling them a sign of “failure.” Although not in so many words, Dorsey suggested that Twitter needs to find ways to avoid having to make such decisions in the first place. Exactly how that would work isn’t clear, although it could range from earlier and more effective moderation to a fundamental restructuring of social networks.
In Dorsey-speak, that means Twitter needs to work harder to “promote healthy conversation.”
Extreme measures such as banning Trump also highlight the extraordinary power that Twitter and other Big Tech companies can wield without accountability or recourse, Dorsey wrote.
While Twitter was grappling with the problem of Trump, for instance, Apple, Google and Amazon were effectively shutting down the right-wing site Parler by denying it access to app stores and cloud-hosting services. The companies charged that Parler wasn’t aggressive enough about removing calls to violence, which Parler has denied.
Dorsey declined to criticize his Big Tech counterparts directly, even noting that “this moment in time might call for this dynamic.” Over the long term, however, he suggested that aggressive and domineering behavior could threaten the “noble purpose and ideals” of the open internet by entrenching the power of a few organizations over a commons that should be accessible to everyone.
The Twitter co-founder, however, had little specific to say about how his platform or other Big Tech companies could avoid such choices in the future. Instead, he touched on an idea that, taken literally, sounds a bit like the end of Twitter itself — a long-term project to develop a technological “standard” that could liberate social networks from centralized control by the likes of Facebook and Twitter.
But for the moment, Dorsey wrote, Twitter’s goal “is to disarm as much as we can, and ensure we are all building towards a greater common understanding, and a more peaceful existence on earth.”
SAN FRANCISCO (AP) — By DAVID HAMILTON
US blacklists Xiaomi, CNOOC, Skyrizon, raising heat on China
The U.S. government has blacklisted Chinese smartphone maker Xiaomi Corp. and China’s third-largest national oil company for alleged military links, heaping pressure on Beijing in President Donald Trump’s last week in office.
The Department of Defense added nine companies to its list of Chinese companies with military links, including Xiaomi and state-owned plane manufacturer Commercial Aircraft Corp. of China (Comac).
U.S. investors will have to divest their stakes in Chinese companies on the military list by November this year, according to an executive order signed by Trump in November.
Xiaomi did not immediately respond to a request for comment.
Xiaomi Corp. overtook Apple Inc. as the world’s No. 3 smartphone maker by sales in the third quarter of 2020, according to data by Gartner. Xiaomi’s market share has grown as Huawei’s sales have suffered after it was blacklisted by the U.S. and its smartphones were cut off from essential services from Google.
Separately, the Commerce Department put China National Offshore Oil Corp. (CNOOC) on the entity list, an economic blacklist that forbids U.S. firms from exporting or transferring technology with the companies named unless permission has been obtained from the U.S. government. The move comes after about 60 Chinese companies were added to the list in December, including drone maker DJI and semiconductor firm SMIC.
CNOOC has been involved in offshore drilling in the disputed waters South China Sea, where Beijing has overlapping territorial claims with other countries including Vietnam, the Philippines, Brunei, Taiwan, and Malaysia.
“China’s reckless and belligerent actions in the South China Sea and its aggressive push to acquire sensitive intellectual property and technology for its militarization efforts are a threat to U.S. national security and the security of the international community,” U.S. Commerce Secretary Wilbur Ross said in a statement.
“CNOOC acts as a bully for the People’s Liberation Army to intimidate China’s neighbors, and the Chinese military continues to benefit from government civil-military fusion policies for malign purposes,” Ross said.
CNOOC did not immediately comment.
Chinese state-owned company Skyrizon was also added to the economic blacklist, for its push to “acquire and indigenize foreign military technologies,” Ross said.
Beijing Skyrizon Aviation, founded by tycoon Wang Jing, drew U.S. criticism for an attempt to take over Ukraine’s military aircraft engine maker Motor Sich in 2017. The concern was that advanced aerospace technology would end up being used for military purposes.
HONG KONG (AP) — By ZEN SOO
Microsoft ousts rivals from CES marquee as show moves online
This week, Microsoft had a big test on its hands — how to help transform the world’s biggest gadget show into an online-only event.
The choice of Microsoft to power this year’s CES and create a virtual showcase for its 1,800 exhibitors gave the tech giant a big promotional boost over its best-known cloud computing rivals, Amazon and Google.
But it also posed reputational risks, as organizers of this week’s event tried to cobble together a trove of web content and mostly prerecorded panel discussions in a way that could at least partially evoke the gaudy, high-energy convention that takes over the Las Vegas strip each January.
At times, it was hard to pretend this year’s virtual CES was a live event.
“Don’t tell people we’re recording in December,” said panel moderator and venture capitalist Rajeev Chand, jokingly admonishing a Twitter executive after his comments revealed that their debate on user privacy, aired Tuesday, was taped nearly a month earlier.
The Consumer Technology Association, the trade group that runs CES, said it made a final decision in July that its premier event would be virtual, then put out a request for bids and evaluated more than 40 digital platforms before announcing its choice of Microsoft in October. The tech company already had some experience hosting its own big events virtually during the pandemic, including last year’s Build and Ignite conferences, each of which had roughly 200,000 participants.
But Microsoft’s marquee involvement in CES is a change from recent years when Google and Amazon dominated the annual Las Vegas convention with ubiquitous marketing and splashy displays — even a theme park-style ride — as they competed against each other to showcase their digital voice assistants.
Microsoft, by contrast, has kept a lower profile as it’s shifted from a consumer-focused business to one focused on selling its software and services to big organizations.
“Microsoft as a partner might have affected a couple of companies who view themselves as competition, I’m not sure,” said Gary Shapiro, president and CEO of the CTA.
Neither Google nor Amazon has said if they had sought to win the contract to run this year’s digital CES, but both companies were mostly sitting out the show this year and showcasing their latest wares elsewhere.
“We talked to all the leading tech companies,” said Jean Foster, CTA’s senior vice president of marketing and communications. “Many of these companies were taking the physical world and putting it online. They had avatars walking around a virtual show floor. That’s just not consistent with what we’re doing.”
The event also needed a cloud computing provider that could handle a huge volume of attendees from around the world. And it needed to be able to create a system to register, bill and authenticate attendees.
“We needed high performance and security, so obviously that’s built into the Microsoft brand,” Foster said.
But the job required Microsoft to accomplish some tasks that went beyond what it did for its own events – namely, to recreate, or replace, the experience of a giant showcase of gadgets and technology.
“How could we bring a large group of exhibitors together and show off what they had to say and their value propositions in a way that’s not an expo,” said Bob Bejan, the Microsoft executive who runs its global events and production studios and is leading the CES project. “Because you can’t translate this stuff. You have to reinvent in this medium.”
Anchored at Microsoft’s production studio in Redmond, Washington, the event is designed to turn a typical directory of exhibitors into an interactive digital experience using a mix of video, audio and chat. It’s a test for Microsoft products such as Teams, the workplace communications app that the company is trying to make a must-have service for workplaces during the pandemic.
Conference attendees could send each other messages — no more than 250 of them — and use Teams for virtual meet-and-greet sessions that Bejan said was supposed to work like a “digital parallel to what you would do at an expo or a hotel lobby bar.”
Even when the pandemic wanes, Bejan said Microsoft is pivoting to a future in which he expects digital experiences will remain an important component of conferences and other live events.
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