With help from Mohana Ravindranath (@ravindranize)
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Quick Fix
— HHS says the emergency will continue: The public health emergency declaration will be renewed again, HHS officials indicated Tuesday, meaning looser rules in telehealth and digital health will persist.
— Funding boosts: HHS, FDA, and digital health startups would enjoy fresh infusions of cash via venture capital and the House's proposed spending bills.
— HHS rules finalized: The department's health IT rules are now effective, the agency announced, starting the clock for enforcement.
And more. But first, the jump.
eHealth tweet of the day: Pearl Freier @PearlF “OH on Zoom: I'm not a doctor but I play one on Twitter”
WEDNESDAY: Hoping everyone had a nice, restful Fourth of July weekend. It’s a bit of a cliché, but your correspondent had a happy break hiking and watching Hamilton for the first time. Share your Fourth experiences by email at [email protected]. Discuss the Fourth socially @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.
Driving the Day
VIRUS EMERGENCY DECLARATION TO CONTINUE, OFFICIALS SAY — In a move that could assuage concerns that pandemic telehealth coverage will end abruptly in a matter of weeks, Vice President Mike Pence signaled to governors the administration’s plans to extend the public health emergency before it expires, our colleagues Rachel Roubein and Adam Cancryn report.
Without an extension, temporary flexibilities encouraging rapid telehealth adoption would expire, including Medicare’s waiver to pay for more telehealth services for more patients. Federal law typically limits telehealth coverage to rural patients; Medicare went from covering a few thousand telehealth visits a week to more than a million a week during the pandemic period.
The emergency also gives FDA authority to usher through a breadth of digital health products aimed at easing care from a distance.
Uncertainty about whether these allowances will last past the emergency may be discouraging clinics from investing in telehealth long-term, and some are already returning to in-person care as the end date of the current emergency declaration approaches, recent research suggests. HHS must renew public health emergencies every 90 days; the current one expires July 25.
Powerful lobbying groups including the American Medical Association and the American Hospital Association have urged regulators and policymakers to make some of the recent telehealth changes permanent or to at least temporarily extend some waivers.
The recent flexibilities “provided for a better patient experience and high-quality outcomes in the long term, regardless of whether they are operating in a public health emergency environment,” AHA said to CMS last month.
FUNDING BOOSTS — Several health institutions are going to enjoy funding boosts, even amid these straitened times:
— Startups: Many veteran digital health watchers expected economic uncertainty and turbulence to keep startup funding grounded in 2020 — and those observers are, at least so far, wrong. Investors at Rock Health say the digital health sector’s boom times have continued, with startups raising $5.4 billion through the first half of the year. That’s a record — and more than the sector raised in the entirety of 2016.
Funding is particularly concentrated in behavioral health, on-demand health care and monitoring, dovetailing well with the demands of the pandemic: a need to attend to mental health, while not crowding people together.
It’s not all sunshine for startups: Exits have mixed news. The investors say acquisitions of startups are on a downward trend, which complicates the process for investors’ cashing out. Stock markets’ boffo performance — with digital health companies surging by 30 percent — surely cheers investors and their startups.
— Appropriations: HHS and FDA are in line for modest funding boosts — at least if the Democratic-controlled House of Representatives has its way. Under the House appropriations draft bills, HHS funding would rise by $1.5 billion, while FDA would get a more modest $40 million bump.
HHS RULES FINALIZED — HHS quietly finalized its landmark health IT rules, with both taking effect June 30. That process starts the clock ticking on future compliance and enforcement of the wide-ranging regulations, whose effects include making patient data available for downloading to smartphones and enforcing information blocking.
Portions of the rules will become applicable at the end of the year; enforcement of the application programming interface rules — which will allow more apps to access patient data — will begin July 2021 under current timelines.
As we’ve previously written, HHS delayed enforcement of the rules back in April amid concern that compliance with the rules would unduly stress providers and hospitals while they’re trying to manage the coronavirus pandemic.
CONTACT TRACING BLUES — Contact tracing continues to pick its way through tricky ground:
— Apps have weak security: The early contact-tracing apps are easy prey for hackers, with vulnerabilities allowing them to scoop up sensitive health data. The data could also be used for mischief — for example, by flooding regions with spurious coronavirus positives, disrupting elections or other activities.
The problem is international. In the U.S., where the technology is starting to ramp up, the patchwork of apps has privacy weaknesses — for example, North Dakota’s app sent location data to social media firm Foursquare.
“The speed and scale transitioned at such a rate that they didn't really consider security in the beginning,” one expert told our Cybersecurity colleague Tim Starks. “It was a topic for them, but not top of mind.”
— Subpoenas for contact tracing compliance?: Rockland County in New York has been using subpoenas to ensure cooperation with contact tracing, our colleague Amanda Eisenberg reports. Eight individuals had been withholding information from the tracers about a recent party they’d gathered in.
— Flights lagging: Data-sharing on the passengers of international flights has stalled, complicating efforts to contact trace, our colleague Brianna Gurciullo reports. It’s been difficult for airlines and travel websites to funnel information to the CDC.
What We're Reading
Big tech companies have health ambitions — but haven’t been doing much visible work to bridge racial disparities, STAT reports.
Google searches can reveal coronavirus hotspots before official government statistics, OneZero reports.
ONC should prioritize measurement efforts to track the effects of its big health IT rules, a trio of UCSF officials write in Health Affairs.
Price transparency won’t pave the way to a low-cost health system, researchers write in the British Medical Journal.
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