Telehealth in home care

Part 1: Home health poised for explosive growth in virtual visits during public health emergency

Editor’s note: Today’s blog post kicks off a series of posts exploring the impact of the coronavirus on telehealth in the home health field. Additional posts will explain what is and isn’t allowed by CMS, evaluate the benefits to agencies and provide pointers on how agencies can ramp up telehealth usage. For years home care providers have weighed the pros and cons of investing in telehealth services against a backdrop of mounting evidence that remote patient monitoring improves patient outcomes and keeps patients out of the hospital. But cost and connectivity challenges made telemedicine too large a gamble for many agencies under restrictive Medicare rules limiting reimbursement opportunities. Now the COVID-19 pandemic is shattering those obstacles, creating a medical environment where patients are frightened by the risk of infection from in-person visits, and health insurers and hospitals are worried about the burden the coronavirus could create for emergency rooms and physician offices. “Telehealth is taking a huge leap forward in home health, with many more agencies embracing it – especially now that Medicare has temporarily loosened the rules,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care. Among the new rules:

  • The Centers for Medicare and Medicaid Services (CMS) issued a blanket waiver last month to reimburse physicians for telehealth visits at in-person rates. CMS is allowing telehealth to be used for the face-to-face encounter between patient and physician (or certain other designated providers) which is required for home health services to begin.

  • In an April 29 update to the blanket waiver, CMS expanded the list of who can provide and bill for telehealth services to include physical therapists, occupational therapists, speech language pathologists and others. (Home health, however, remains unable to bill for virtual visits from these practitioners at this time. The waiver applies to Part B Medicare billing.)

  • Clinicians can now conduct the initial assessment via telehealth. CMS has said it expects home health agencies to incorporate telehealth visits into the plan of care, as long as the virtual visits do not replace routine in-person visits to the home.

  • Virtual visits aren’t just for patients who meet traditional and strict home health eligibility requirements. To make certain that patients who are ill from COVID-19 can receive services in their homes, CMS has temporarily relaxed the rules about who can qualify for home care.

  • Although CMS generally requires both audio and video for virtual visits, the newest update to the blanket waiver allows audio-only equipment to suffice for some evaluation and management services, behavioral health counseling and educational services. (See designated codes here.) However, note that the face-to-face encounter must still include video as well as audio for compliance.

“All these changes mean we are poised right now to see explosive growth in the use of telehealth in the home health field,” J’non said. The numbers are growing Some industry analysts have estimated that 2020 could see as many as 900 million virtual health care visits related to COVID-19. (That number is not just for home health, but includes all other health care segments.) Telemedicine provider Teladoc has reported video requests have already spiked to more than 15,000 per day during the coronavirus public health emergency. Teladoc uses telephone and videoconferencing technology to provide on-demand remote medical care via mobile devices, the internet, video and phone. Even as the stock market staggers under the implications of massive unemployment and shelter-in-place orders across the country, Teladoc has seen robust stock performance this spring -- although news of re-openings in many states over the past few days has slowed that performance somewhat. Overall, health care technology has been predicted by stock market analysts to be a smart space for investors during the pandemic. SVB Leerink, a specialist investment bank focusing on the healthcare sector, has predicted revenues in this sector could possibly double in the near term and should remain strong even after the coronavirus crisis. “Any reservations home care providers may have had about telehealth are disappearing quickly, as agencies understand how helpful and cost-effective it can be,” J'non said. "COVID-19 has illustrated the crucial role that remote patient monitoring will play in home health as we go forward.” She believes some of the temporary measures CMS is allowing during the public health emergency may be allowed to continue after the pandemic. “Some of the measures we are seeing right now are of course only temporary, and business as usual will resume after the coronavirus. But the convenience of virtual visits for patients who do not have to make a trip to a doctor’s office – particularly for homebound patients who cannot safely or easily get there -- and the positive impact of virtual visits on patient outcomes could encourage CMS to allow some of these measures beyond the pandemic." Funding available One strong indication that telehealth will continue to flourish beyond the public health emergency ends is new financial incentive from U.S. Congress for health care providers to focus their attention on telehealth projects.

The Coronavirus Aid, Relief and Economic Security (CARES) Act passed by U.S. Congress on March 27 included $200 million in funding to health care providers who can demonstrate how telemedicine directly aids in the prevention of pandemic spread. Home health agencies are among seven types of health care providers eligible for the funds, and applications must show that the proposed telehealth program will target low income patients and veterans. Other restrictions apply. Click here to read the application details. "This is an exciting time for agencies who are figuring out the role will play in their organizations now and in the future ," J'non said. "Remote patient monitoring is going to make a significant difference in the well-being and recovery of our patients." NEXT IN OUR TELEHEALTH SERIES:

A look at what CMS is and isn’t allowing for agencies (coming Monday, May 4)

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