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.
Apple to launch first online store in India next week
NEW DELHI (AP) — Apple announced Friday that it will launch its first online store in India next week, as it seeks to increase sales in one of the world’s fastest-growing smartphone markets.
The company at present uses third-party online and offline retailers to sell its products in the country.
Apple CEO Tim Cook said in a tweet that the company “can’t wait to connect with our customers and expand support in India.”
The Sept. 23 launch comes ahead of India’s major Hindu festival season beginning next month.
With a nearly 1.4 billion people, including millions of new Internet users every month, India has become a key focus of tech giants over the last few years.
In August, three contract manufacturers for Apple iPhones and South Korea’s Samsung applied for large-scale electronics manufacturing rights in India under a $6.5 billion incentive scheme announced by the government.
Apple assembles some smartphones at Foxconn and Wistron’s plants in two southern Indian states.
Phone flip: New Quibi series ‘Wireless’ empowers the viewer
NEW YORK (AP) — Most directors insist on having final edit approval of their films. Not the creators of “Wireless.”
The series on the mobile-platform Quibi employs an ingenious way to tell a story on a smartphone: You see different things on the screen depending on whether you hold your phone vertically or horizontally.
Horizontally, a traditional cinematic film follows a college student navigating the snowy Colorado mountains. But flip your phone vertically and you see his smartphone as he scrolls through photos, checks the map or calls his mom.
That means that the viewer becomes the editor. And each viewer sees a slightly different film, depending on at what points they rotate the phone.
“You’re never going to have the same experience as somebody else watching the show,” said Zach Wechter, the director, co-creator and co-writer. “It really is in our viewers’ hands when they’re going to turn the phones at any given moment.”
The 10-episode series that launched this week has the backing of director Steven Soderbergh, an eager adopter of nascent technology whose influential films include “Sex, Lies and Videotape” and “Traffic.”
He signed on to be an executive producer after seeing “Pocket,” a short film by Wechter and his creating partner Jack Seidman that experimented with the two-screen technology.
“It was the first thing I’d ever seen that I felt was designed to be watched and experienced on the phone and absolutely worked,” Soderbergh said.
The show signals a technological jump for Quibi, which launched during the pandemic offering mobile-friendly installments of movies and TV in 10 minutes or less.
The platform initially got fewer subscribers than hoped, despite landing celebs like Chance the Rapper, Chrissy Teigen and Jennifer Lopez. Even so, it heads into the weekend Emmy Awards with an impressive 10 nominations.
The technological leap with “Wireless” means it waves goodbye to passive entertainment. By letting viewers rotate their phones and choose their perspective, Wechter is empowering the audience, letting them feel like they’re controlling the story.
“I’d like to think that our project is something that will inspire filmmakers and artists to consider the possibilities of this new frontier — a new landscape for storytelling,” Wechter said.
“Wireless” stars Tye Sheridan as a college student with an unhappy past and a secret habit who is driving to a New Years Eve’s party to try to rekindle a relationship with his ex-girlfriend.
As he drives over the mountains, we watch what he does on his phone: Scrolling through Instagram, checking maps, firing up Tinder, texting friends, asking Siri questions and cuing up the band Brockhampton on the stereo. The human in horizontal mode and the technological on vertical are fused.
The filmmakers have so seamlessly integrated the phone-in-the-phone that our hero listens to his old voicemail messages and looks at photos from happier times to give context for his emotions. They’ve even created a fake, chirpy online commercial for a fictional vehicle, the Chevy Colorado.
Wechter said he was inspired to create the show based on how much time everyone spends on their phone these days, and says we have almost an emotional relationship with our devices. Soderbergh agrees, calling them “an additional appendage.”
“I think the ubiquity of smartphones is one of the most impactful parts of our lives nowadays,” Wechter said. “It really just was birthed out of realizing how essential these devices have become in our day-to-day lives.”
Soderbergh laughs that filmmakers these days are lamenting how putting their work on a phone is a depreciation of their work. “This is a complete inversion of what you typically hear a filmmaker say: To experience it NOT on your phone would be a diminishment.”
He hopes viewers will watch the thriller and then re-watch it, flipping their phone for more looks at the in-screen phone during the second time or focusing more on the actor’s perspective. “I hope other people will seize on the ability to do their own edits.”
In an interesting twist, Andie MacDowell, who starred in the indie “Sex, Lives and Videotape” 31 years ago, voices the college student’s mom in this Quibi show. Soderbergh laughs at the old technology of that film, which used video confessionals. “Think about how quaint that seems,” he said. “It’s like a Jane Austen novel compared to what we are experiencing now.”
By MARK KENNEDY AP Entertainment Writer.
Celebs join Instagram ‘freeze’ to protest Facebook inaction
LONDON (AP) — Kim Kardashian West, Katy Perry, Leonardo DiCaprio and other celebrities are taking part in a 24-hour Instagram “freeze” on Wednesday to protest against what they say is parent company Facebook’s failure to tackle violent and hateful content and election misinformation.
Hollywood stars and influencers are lending their backing to the “#StopHateforProfit” movement’s latest campaign. The movement asks people to put up a message highlighting what they called the damage Facebook does but otherwise refrain from posting on Instagram for a day.
“I can’t sit by and stay silent while these platforms continue to allow the spreading of hate, propaganda and misinformation – created by groups to sow division and split America apart – only to take steps after people are killed,” Kardashian West posted on her Instagram account on Tuesday.
Facebook declined to comment but pointed to recent announcements about what it’s doing to limit the reach on its platform of groups that support violence and its efforts to protect the U.S. election in November.
With 188 million followers, Kardashian West is one of the most influential people on Instagram and support from her and other big names for the boycott saw Facebook shares slide in aftermarket trading late Tuesday. They were down 1.7% ahead of the market open on Wednesday.
The organizers behind “#StopHateforProfit,” including civil rights groups such as the Anti-Defamation League, the NAACP and Color Of Change, had previously led a campaign that got hundreds of brands and nonprofits to join a Facebook advertising boycott in July.
Ashton Kutcher, Mark Ruffalo, Kerry Washington, Rosario Dawson, Jamie Foxx and Sacha Baron Cohen were among about two dozen Hollywood stars and celebrity influencers supporting the campaign, the organizers said.
DiCaprio said he was standing with the civil rights groups to call “on all users of Instagram and Facebook to protest the amplification of hate, racism, and the undermining of democracy on those platforms.”
Facebook, which earned nearly $70 billion in advertising revenue last year, is facing a reckoning over what critics call indefensible excuses for amplifying divisions, hate and misinformation on their platforms.
“We are quickly approaching one of the most consequential elections in American history,” organizers said. “Facebook’s unchecked and vague ‘changes’ are falling dangerously short of what is necessary to protect our democracy.”
The movement also singled out for criticism Facebook’s handling of online material ahead of the shootings in Kenosha, Wisconsin last month. CEO Mark Zuckerberg has said the company made a mistake in not removing sooner a page belonging to a militia group that called for armed civilians to enter the town. It only took the page down after an armed teenager killed two people after violent protests sparked by the police shooting of Jacob Blake, who is Black.
BY KELVIN CHAN AP Business Writer.
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