Current Healthcare Policy and Environmental Status of Digital Health Medical Devices in South Korea

Objectives: COVID 19 and increasing unmet needs of health technology had accelerated an adoption of digital health globally and the major categories are mobile-health, health information technology, telemedicine. Digital health interventions have various benefit on clinical efficacy, quality of care and reducing healthcare costs. The objective of the study is to identify new reimbursement policy trend of digital health medical devices in South Korea. Method(s): Official announcements published in national bodies and supplementary secondary research were used to capture policies, frameworks and currently approved products since 2019. Result(s): With policy development, several digital health devices and AI software have been introduced as non-reimbursement by utilizing new Health Technology Assessment (nHTA) pathway including grace period of nHTA and innovative medical devices integrated assessment pathway. AI based cardiac arrest risk management software (DeepCARS) and electroceutical device for major depressive disorders (MINDD STIM) have been approved as non-reimbursement use for about 3 years. Two digital therapeutics for insomnia and AI software for diagnosis of cerebral infarction were approved as the first innovative medical devices under new integrated assessment system, and they could be treated in the market. In addition, there is remote patient monitoring (RPM) reimbursement service fee. Continuous glucose monitoring devices have been reimbursed for type 1 diabetes patients by the National Health Insurance Service (NHIS) since January 2019. Homecare RPM service for peritoneal dialysis patients with cloud platform (Sharesource) has been reimbursed since December 2019, and long-term continuous ECG monitoring service fee for wearable ECG monitoring devices (ATpatch, MEMO) became reimbursement since January 2022. Conclusion(s): Although Korean government has been developed guidelines for digital health actively, only few products had been reimbursed. To introduce new technologies for improved patient centric treatment, novel value-based assessment and new pricing guideline of digital health medical devices are quite required.Copyright © 2023

CLINICAL TRIAL REFORM

[...]CURES' BILL PROMOTES PANDEMIC PREPAREDNESS Congressional leaders are developing the next version of the 21st Century Cures Act, including provisions to advance research related to the COVID-19 crisis as part of initiatives for bringing innovative therapies to market faster (see https://bit.ly/2SKfA4S). Cures 2.0 continues and updates some of the main themes of the first Cures Act: support development of treatments for rare diseases, patient-focused drug development, diversity in clinical trials, expanded use of digital health systems, increased health literacy, and utilization of real-world data. A public education campaign, moreover, would aim to counter concerns about the safety of vaccines to promote widespread vaccination. Because these treatments are costly and unprofitable for biopharma companies to test and market, the legislation proposes additional financial support for both pre-market studies and post-market production and subsidized higher reimbursement rates for antibiotics that address critical needs.

Stakeholder Analysis: Medicare Diabetes Prevention Program Awareness and Implementation

Study Design: We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points More than 5 years after CMS enacted coverage of the CDC-approved Medicare Diabetes Prevention Program (MDPP) in 2018, little is known about why MDPP uptake is so limited. * Findings of our stakeholder analysis with program suppliers and health care providers reinforced existing evidence on insufficient reimbursement and low awareness of the program. * Newer insights include recommendations about lagged payments, ongoing virtual delivery, and formally diagnosing prediabetes among MDPP participants. * Our findings on barriers and facilitators can inform policy to refine the MDPP and research on the MDPP, particularly within the field of implementation science. _____ Population-level strategies to prevent type 2 diabetes are urgently needed for the more than 24 million older adults with prediabetes in the United States.1 Evidence-based lifestyle interventions can prevent diabetes onset, per evidence from the landmark Diabetes Prevention Program trial.2 Thus, the CDC launched the National Diabetes Prevention Program (NDPP) in 2010.3 Significant reductions in weight and medical spending were observed among Medicare beneficiaries who participated in the NDPP,4 prompting CMS to fully cover the Medicare Diabetes Prevention Program (MDPP) starting in 2018.5 Despite unprecedented Medicare coverage for a disease prevention program, MDPP uptake is limited. Regarding awareness, national guidelines recommend referral to lifestyle intervention for adults aged 40 to 70 years with prediabetes.9 Yet less than 5% of adults eligible for a NDPP reported receiving a referral,10 which may stem from limited awareness among health care providers.11 Thus, we conducted a qualitative stakeholder analysis to learn about regional awareness of, referral to, facilitators of, and barriers to the MDPP. The 8 interviewees included 5 program directors (3 from YMCAs, 1 from a private organization, and 1 from a hospital system) and 3 health care providers (2 family physicians and 1 dietitian).

GERMANY'S HTA AGENCY SEEKS SUPPORT ON TRANSPARENCY ABOUT COVID-19 AGENTS

"EMA should support the international research community by publishing clinical study reports on medicine and vaccine trials at the time of marketing authorization and to inform treatment decisions." [...]Weiseler and Kaiser are acutely aware of the pressures that regulators are under in the face of a rising death toll, soaring infection and morbidity, and the wideranging economic and social consequences of extensive lock-downs. "Because of the severity of the current situation, regulators are aiming to accelerate the marketing authorization process," IQWiG comments, noting that first treatments have already been evaluated by regulators, as recently seen with the fast emergency use authorization of the antiviral remdesivir by the FDA, and that EMA has also started a "rolling review" of remdesivir. Data-sharing push The international research community is already undertaking coordinated efforts- IQWiG cites the living mapping and living systematic review of COVID-19 studies-to compile all emerging information on medicines and vaccines for the virus, it says, with a view to ensuring the optimal planning and conduct of research.

Clinical Research Needs Greater Participant Diversity

"Minority populations were three times more likely to experience complications from COVID-19 but were not equitably represented in clinical trials for the vaccine," says Greater Gift board member Harsha Rajasimha, PhD, CEO and Founder, Jeeva Informatics Solutions, Inc. "This challenge presents itself across varying disease states. According to a recent article in the Harvard Business Review: "Most clinical trials are not representative of the general population or of those with a particular disease. [...]many may be missing required documentation to obtain an ITIN, such as a passport, which excludes potential trial participation entirely. Since payment received is considered reimbursement vs. compensation, there is no need for W-2 forms, which are often required by sponsors, sites, and CROs. * Relaxing of the regulation that governs principal investigator in-person oversight that greatly limits the locations where clinical trials can be conducted. * Pursuit of federal legislation that will allow reimbursement costs to clinical trial participants to be optional and non-taxable. * Introduce legislation that relaxes requirements that limit mobile clinical trial units from traveling to minority communities.

Evidence Trends in Remote Patient Monitoring and Remote Therapeutic Monitoring

Objectives: To provide an overview of trends in the current evidence landscape of products and services in development that support remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), given the release of new billing codes for RPM and RTM by Centers for Medicare and Medicaid Services (CMS) in 2019. Method(s): A focused literature review was conducted in PubMed. Articles published between January 1, 2013 and January 1, 2023 were eligible for inclusion if reported technologies were classified as RPM (defined as the collection and interpretation of physiologic data digitally stored and/or transmitted by patients and/or caregivers to qualified health care professionals) or RTM (defined as the use of medical devices to monitor a patient's health or response to treatment using non-physiological data), following CMS definitions. RPM and RTM technologies included hardware, software, telehealth, and blockchain applications. Articles were then categorized using a semi-automated software platform (AutoLit, Nested Knowledge, St. Paul, MN) based on disease area, study design, intervention, and outcomes studied. Result(s): Of the 673 records screened, 245 articles were included. Observational studies (19.6%) were the most common study design, followed by systematic or focused literature reviews (11.0%) and narrative reviews (10.6%). The most common disease areas included cardiology (25.7%), coronavirus disease of 2019 (COVID-19;13.9%), and diabetes (9.4%). The most frequent clinical, non-clinical, and patient-reported outcomes were symptom monitoring (20.8%), all cause readmission and hospitalization rates (both 7.3%), and patient experience (7.8%), respectively. Conclusion(s): CMS policy and coding practices for RPM and RTM are evolving, and this trend is likely to continue into the future. This review provides details on the current evidence trends associated with RPM/RTM technologies. Evidence development of RPM and RTM should be assessed as evidence needs for coverage and reimbursement may receive increased payer management.Copyright © 2023

Highlighting the Challenges in the Development, Funding, and Reimbursement of Medical Innovations from a Developer Perspective

Healthcare system is an essential system for any nation as it is responsible for maintaining the health of the individuals and public. However, the outbreak of different viral diseases such as influenza, covid-19 etc. has encouraged medical research in different developing and developed countries. Similarly, in Malaysia, different public and private research centers and biotechnology firms are being promoted to develop new and innovative medical drugs and equipment. However, different challenges are faced by the developers in promoting the development and innovations of medical commodities. Thus, this study was conducted to investigate different challenges in the development, funding, and reimbursement of medical innovations in Malaysia. For this purpose, semi-structured interviews were conducted with 7 developers from different public research and development (R&D) centers and biotechnology firms in Malaysia. After the interviews were conducted, their edited transcription was obtained, and thematic analysis was conducted, and different themes and sub-themes were formulated. The results obtained from this study showed that the lack of innovative environment, strategic compliances and effective funding structure negatively influences medical innovations in Malaysia. It has also been observed that poor reimbursement practices and policies and lack of pricing strategies by the Malaysian government impacts the ROI of the associated firms and developers. Thus, it has been recommended that mega-funds and reimbursement policies should be promoted to overcome these challenges in medical innovations.Copyright © 2023 ThinkBiotech LLC. All rights reserved.

Regulating Digital Therapeutics

Conversely, in Italy DTx are classed as medical devices and must pass International Organization for Standardization (ISO) standards to ensure they are compliant with safety requirements. The new EU MDR should help to simplify the exchange of data on medical devices and improve data collection and post-market surveillance to reinforce end-user confidence in DTx solutions. In Germany, Ireland, and the Netherlands, DTx manufacturers have directly targeted self-insured employer health plans, whereas in France, Belgium, and the United Kingdom, a B2P reimbursement model has proven successful.

Evaluation of the impact of guideline communication from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services among US healthcare providers: COVID-19 prevention counselling guidance.

AIM: To evaluate healthcare provider awareness and uptake of the Centers for Medicare & Medicaid Services (CMS) billing for coronavirus disease 2019 (COVID-19) prevention counselling and the delivery of prevention counselling to patients awaiting severe acute respiratory syndrome coronavirus 2 test results. DESIGN: Cross sectional survey of US-based healthcare providers in February 2021. METHODS: Analysis of associations with healthcare provider-reported awareness of CMS prevention counselling guidance and billing with provider type, specialty, and work setting. RESULTS: A total of 1919 healthcare providers responded to the survey. Overall, 38% (726/1919) of providers reported awareness of available CMS reimbursement for COVID-19 patient counselling and 29% (465/1614) of CMS billing-eligible providers reported billing for this counselling. Among physicians, those aware of CMS guidance were significantly more likely to bill (58%) versus those unaware (10%). Among RNSights respondents eligible for CMS billing (n = 114), 31% of those aware of the guidance reported billing as compared to 0% of those not aware.

COVID-19 impact on the decision process of the Italian Medicine Agency: a quantitative assessment.

Background: Since the COVID-19 pandemic has placed more attention on drugs' approval process and the importance of rapid decision-making in the healthcare sector, it is crucial to assess how time to market (TTM) of drugs varied. Objective: To estimate the impact of the COVID-19 pandemic on TTM of drugs in Italy. Methods: An IQVIA database was used to retrieve information on drugs that obtained positive opinion from the Committee for Medicinal Products for Human Use between January 2015 and December 2021. The available observations were divided into three groups (Pre COVID, Partially COVID, and Fully COVID) according to the timing of their negotiation process. Differences in average TTM among the three groups were analyzed in three steps: (1) descriptive statistics; (2) univariate analysis; (3) multivariate analysis, using a matching estimator. Results: A total of 363 unique combinations of molecule and indication met the inclusion criteria: 174 in the Pre COVID group, 69 in the Partially COVID group, and 123 in the Fully COVID group. Descriptive statistics and univariate analysis found a statistically significant difference in TTM among the three periods, with average TTM increasing during the pandemic (+136 days, p = 0.00) and then decreasing afterward (-23 days, p = 0.09). In the matching analysis, results for the Partially COVID period were confirmed (+108 days, p = 0.00) while results for the Fully COVID period lost significance but maintained a negative sign. Conclusions: The results suggest that after an adjustment phase in the Partially COVID period, a return to the status quo was reached.

Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?

Background: A steep increase in the use of delivery of virtual care occurred during the COVID-19 public health emergency (PHE) because of easing up of payment and coverage restrictions. With the end of PHE, there is uncertainty regarding continued coverage and payment parity for the virtual care services. Methods: On November 8, 2022, The Mass General Brigham held the Third Annual Virtual Care Symposium: Demystifying Clinical Appropriateness in Virtual Care and What's Ahead for Pay Parity. Results: In one of the panels, experts from Mayo Clinic led by Dr. Bart Demaerschalk discussed key issues related to "Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?" The discussions centered around current policies around payment and coverage parity for virtual care, including state licensure laws for virtual care delivery and the current evidence base regarding outcomes, costs, and resource utilization associated with virtual care. The panel discussion ended with highlighting next steps targeting policymakers, payers, and industry groups to help strengthen the case for parity. Conclusions: To ensure the continued viability of virtual care delivery, legislators and insurers must address the coverage and payment parity between telehealth and in-person visits. This will require a renewed focus on research on clinical appropriateness, parity, equity and access, and economics of virtual care.

Temporal Analysis of Medicare Physician Reimbursement for Common Gastroenterology Procedures From 2007 to 2022

Introduction: As the U.S. population ages, gastroenterologists will provide care for an increasing number of older patients - many of whom use Medicare. In recent years there have been significant policy changes surrounding Medicare reimbursement for physicians. Understanding reimbursement trends can help reveal the financial impact of these policies on gastroenterologists. Our study aims to analyze the trends in Medicare reimbursement of common gastrointestinal (GI) services from 2007 to 2022. Method(s): The top 10 GI procedures and their respective CPT codes were identified through a joint list published by the American College of Gastroenterology, American Society of Gastrointestinal Endoscopy, and American Gastroenterological Association. The top 5 5 CPT codes relating to office/inpatient visits provided by gastroenterologists to Medicare Part B beneficiaries was identified using data from CMS. The Physician Fee Schedule Look-Up Tool from CMS was queried for the selected CPT codes from 2007 to 2022, to determine the facility reimbursement rate by Medicare for each service. The reimbursement data were adjusted to January 2022 U.S. dollars using the U.S. Department of Labor's Bureau of Labor Statistics' consumer price index inflation calculator. Result(s): The unadjusted physician reimbursement for GI procedures exhibited an average decrease of 7.0% (95% CI, 29.9% to 24.1%) from 2007 to 2022. After adjusting for inflation, the mean decrease in physician reimbursement for procedures was 33.0% (95% CI, 235.1% to 230.9%). The mean annual growth rate in reimbursement was 22.6% (95% CI, 22.8% to 22.4%). The unadjusted physician reimbursement for inpatient and outpatient visits exhibited an average increase of 32.1% (95% CI, 4.8% to 59.3%). After adjusting for inflation, physician reimbursement for patient visits exhibited a mean decrease of 4.92% (Figure 1). Conclusion(s): The analysis revealed a steady decline in adjusted and non-adjusted reimbursement between 2007 and 2022. Decreasing Medicare reimbursement may impact health outcomes, healthcare access, and patient satisfaction. Reimbursement policies must be scrutinized particularly in the light of high inflation and increased costs due to additional costs associated with care during the COVID-19 pandemic, staffing shortages, and increased staffing salaries. (Figure Presented).

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

[Is the Supply of Medicines in Danger?] / Arzneimittelversorgung in Gefahr?: Erklärungen aus Sicht der Industrie.

The healthcare system in Austria is currently affected by supply chain problems for certain drugs. These are mainly low-priced drugs, but they are of great importance for our health system. A sudden, excessive demand cannot be compensated by the drug manufacturers in the short term. The reasons are the complex and highly regulated manufacture of drugs, drastic supply chain problems for all components of the product as a result of the coronavirus crisis and the Ukraine conflict and, of course, dependence on active ingredients and finished medicinal products from countries such as India or China. The medium-term goal must be to reduce this dependency. Appropriate framework conditions must be created, such as coordination on an European basis or faster approval procedures. Another important issue from the point of view of a company producing in Austria is also a rethinking of the pricing policy for reimbursed drugs. Fair prices are the basis for ensuring that the Austrian pharmaceutical market can be well supplied and that pharmaceutical production in Austria can be secured.

The battle over state lines: Leveraging an interstate compact to ensure continuity of care

Background: As a result of COVID-19-related precautions, states temporarily relaxed certain restrictions on telehealth services during the pandemic, including waiving licensing requirements so physicians could serve patients across state lines, but many states ended this flexibility in 2021. According to two online surveys fielded by the Cystic Fibrosis Foundation (CFF) to accredited centers in 2020 and 2021, 65% of programs reported providing care to patients living in another state. Of these, 18.5% reported that some of their out-of-state (OOS) patients were not able to access telehealth services because of licensure-related issues [1]. CFF Compass fielded 20 calls from people with cystic fibrosis (CF) in 15 states requesting assistance in accessing their OOS care center, accounting for more than 25% of all network adequacy inquiries received during that time. CFF recognized the need for policy change to improve access to OOS care for people with CF. Method(s): In 2021, we interviewed five CF care centers about their experiences with telehealth and OOS licensing. The administrative burden of applying for multiple state medical licenses was a key barrier to providing remote OOS care, and CFF identified the Interstate Medical Licensure Compact (IMLC) as one solution. The IMLC streamlines the licensing application process for physicians who want to practice in multiple states. From January 2021 to March 2022, CFF supported legislation in 10 states to join the IMLC by sending letters with 31 care center director co-signers. CFF also hosted a webinar in June 2021 to educate CF care centers about the IMLC as away to pursue multiple medical licenses with one application. We shared follow-up information about the IMLC through CFF COVID-19 digest emails. CFF sent a survey in March 2022 to all CF care centers to understand current use of and barriers to telehealth for CF care teams. Data from this survey are forthcoming. Result(s): Before CFF's engagement in January 2021, 30 states and the District of Columbia were members of the IMLC. As of April 8, 2022, five additional states have passed legislation to join the IMLC, reflecting a 17% increase in state participation from January 2021 to March 2022. Within the 35 participating states at present,126 CF care center programs will have the potential to use the IMLC. CFF has supported legislation in all six states with pending legislation to join the IMLC in 2022. Increased physician awareness of IMLCwas evidenced by physician participation from 20 states in thewebinar, aswell as broad distribution of the recording via the COVID- 19 digest to 288 CF programs in 49 states afater the session. Conclusion(s): Although more states taking action to join the IMLC is an important step, challenges persist. Even in IMLC member states, CF providers express concerns about the cost and administrative burden of maintaining licenses in multiple states. Permanent regulations regarding use of and reimbursement for telehealth remain uncertain. To better understand current challenges and opportunities for telehealth and remote OOS care, CFF is supporting additional research and advocacy.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Legal and regulatory primer for the practice of telemedicine in the United States

After two years of the COVID-19 pandemic, telemedicine has become a critical and permanent component of the global healthcare spectrum. With the rising acceptance of telemedicine globally and the importance of providing patients with high-quality care via virtual technology, this chapter aims to educate the reader on the significant and emerging legal and regulatory issues related to the practice of telemedicine. The chapter provides a step-by-step summary of the primary legal and regulatory considerations that must be addressed in order to advance and maintain an effective and high-quality telemedicine platform. As explained herein, the current legal and regulatory landscape remains fluid and challenging. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Community pharmacist-provided test and treat programs for acute infectious conditions

Community pharmacists' roles have expanded in recent years to include offering test and treat programs where they perform testing on Clinical Laboratory Improvement Amendment (CLIA)-waived point-of-care testing (POCT) devices to diagnose specific acute infectious conditions, such as influenza and group A streptococcus (GAS) pharyngitis, and then potentially prescribe and dispense appropriate antimicrobials. Availability of these services in pharmacies has several benefits, including increased access to care, decreased overutilization of other health care services, and decreased antimicrobial resistance. States have different requirements for collaborative practice agreements and reimbursement for these clinical services in community pharmacies. Several studies have looked at outcomes related to community pharmacies implementing test and treat programs for influenza and/or GAS. Other studies looked at outcomes related to implementing testing for SARS-CoV-2 and referring for treatment. Most studies described successful implementation and barriers to integration of these programs into pharmacy workflow. Some studies showed that patients want these services to be offered in community pharmacies and are willing to pay for the services. Data show that these services are cost effective compared to physician provider-based treatment. Newer CLIA-waived POCT technology may increase implementation of these services, but studies are needed to evaluate their utility in community pharmacies. Pharmacy schools should implement widespread training on these devices, and research should continue in this area to test the use of newer technology (i.e., multiplexed devices) and their economic impact.Copyright © 2023 Pharmacotherapy Publications, Inc.

Thanks to the derogatory development during the COVID-19, telemedicine in France is better legally regulated and more accessible

Telemedicine has existed since the 1980s and puts a patient in contact with a doctor or health professional at a distance who exchanges digital data using computer tools. The Ordre des Médecins considers that new technologies facilitate access to care and specialised expertise, even if it goes against fundamental ethical principles. It is a substitute for the traditional medical act, and one must question its relevance and whether the conditions of implementation bring a benefit to the patient. During the COVID-19 epidemic, the conditions for telemedicine were relaxed and the health insurance system facilitated its reimbursement in a derogatory manner. Healthcare professionals, healthcare institutions and patients were able to appreciate the new possibilities offered by telemedicine and recognize its limitations. However, safety is not the main concern of patients, who make extensive use of IT tools to surf the Internet and consider remote medicine as an easily accessible exercise without knowing its limits. They do not distinguish between medically supervised clinical telemedicine and e-health services offered over the Internet, which are commercial wellness offerings. In this presentation, we will first describe the evolution of telemedicine, which has long been implemented in France in various forms, and then the spectacular development of teleconsultations during the COVID-19 epidemic, the beneficial consequences of which allow better accessibility and reimbursement by social security. Copyright © 2023 Anne-Marie Duguet.

Building on Telehealth's Momentum

[...]the overwhelming majority of provider organizations had little or no experience with telehealth prior to the pandemic. Because these organizations rely so heavily on fee-for-service reimbursement, the complex regulation of telehealth left them with little curiosity about the technology until COVID-19 struck. Since most of this latter group is waiting to find out what the regulation and reimbursement will look like, the answers will determine what they do next. [...]handwringing about potential fraud by telehealth companies, plus preliminary data on quality of care that offered mixed support for telehealth, became the rationale for a recommendation to limit some of the telehealth expansions to only those clinicians participating in Advanced Payment Models (APMs) rather than to all fee-for-service clinicians.