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The ECHO Act: Implications for Mental Health and Substance Use Disorder Treatment


Email Alert

December 28, 2016

By Benjamin Lipschitz*

The Expanding Capacity Health Outcomes (ECHO) Act (S.2873) was signed into law on December 14, 2016, after unanimous passage in both the House and Senate.

The quick passage of and significant bipartisan support for the ECHO Act was driven in large part by the current opioid epidemic. The law follows naturally from the increased presence of technology as both a support and benefit of modern health care. It emphasizes telehealth, a term which encompasses the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.1

Specifically, the ECHO Act requires the Department of Health and Human Services (HHS) to study and report on telehealth long-distance health care models that use videoconferencing for collaboration and case learning among health care professionals. These telehealth models, with their focus on medical education and care delivery, are distinct from telemedicine, which is generally limited to communicating with or treating patients. The ECHO Act requires study of how such models address health issues, including mental health and substance use disorders, and health care workforce issues, public health programs, and delivery of services in medically underserved and health professional shortage areas and to underserved populations.

The HHS report, required no later than two years after enactment of the ECHO Act, will include analysis of integration efforts, provider retention efforts, and the quality of, and access to, care for patients under such telehealth models. Additionally, the report will review the impact of such models on the ability of local health care providers and specialists to practice to the full extent of their education, training, and licensure; the effects on patient wait times for specialty care; and the efficiency and effectiveness of practices adopted under such models. Lastly, the report will offer recommendations to reduce barriers to such models, to improve integration, and to increase adoption of such models, and will examine existing funding of such models in HHS programs, including Medicare.

According to the Healthcare Information and Management Systems Society, Medicare reimbursed less than $12 million for telemedicine in 2013, which stands in stark contrast to the more than $1 billion of federal grant funding available to support telehealth networks. The sponsors and supporters of the ECHO Act are optimistic that the report under the ECHO Act will lead to greater acceptance and increased reimbursement for telehealth and for telemedicine, particularly under Medicare.

Of particular importance for the treatment of patients with mental health and substance use disorders, telehealth offers such patients the option to get treated closer to home, with a provider they trust, which encourages critical follow-up treatment.2 The American Medical Association also noted that the ECHO Act’s support of collaborative clinical education helps medical professionals better relate to such patients, which may help to reduce the stigma associated with mental health and substance use disorders that can result in treatment avoidance.

As part of its ECHO Act study, HHS is instructed to consult with entities that have implemented telehealth collaborative education models. Notably, the ECHO Act is based on Project ECHO at the University of New Mexico, which initially focused on hepatitis C, but has since expanded to address numerous health conditions. Project ECHO now operates in at least 28 states and 16 countries, offering telehealth via hub-and-spoke knowledge-sharing networks that link specialty clinicians with primary care clinicians located in rural and underserved communities.

The opportunity to build on the success of Project ECHO generated wide bipartisan legislative support and broad support from health care professional organizations.3 The sponsors and supporters of the ECHO Act promoted the benefits of telehealth as a means to increase patient access to care, and to allow health care professionals “to share innovations and new discoveries in an efficient, timely manner,”4 to “decrease costs and improve outcomes,” and “to stay in underserved areas where they are needed the most.”5 Other supporters specifically highlighted the ECHO Act’s potential “to increase the number of docs able to prescribe for opioid abuse”6 and to result in “increased use of evidence-based tools and reduced prescriptions for high-dose opioids. . . . [that] will contribute toward combating our Nation’s devastating opioid abuse and heroin epidemic.”7

*We would like to thank Benjamin Lipschitz for authoring this email alert. We also would like to thank Nazanin Tondravi, JD, MPH, LHRM (Miami, FL) and Amy Sanders Morgan (Bass Berry & Sims PLC, Nashville, TN) for reviewing this email alert.

1 42 U.S.C. § 254c–16(a).
2 162 Cong. Rec. S6524-S6525, 2016 (statement of Sen. Orin Hatch).
3 162 Cong. Rec. H7198-H7199, 2016 (statement of Rep. Michael C. Burgess).
4 162 Cong. Rec. S6524-S6525, 2016 (statement of Sen. Orin Hatch).
5 Id. (statement of Sen. Brian Schatz).
6 Supra note 2.
7 162 Cong. Rec. H7198-H7199, 2016 (statement of Rep. Doris Matsui).

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