Telehealth in home care


Part 3: The benefits of virtual visits and remote patient monitoring

Editor’s note: Today’s blog post is the third in a series of posts exploring the impact of the coronavirus on telehealth in the home health field as we evaluate the benefits to agencies and provide pointers on how agencies can ramp up their telehealth usage. Telehealth has been widely praised for its potential to generate improved outcomes in patients with chronic conditions and its ability to help home care providers cost-effectively manage therapy services under Medicare’s new Patient-Driven Groupings Model (PDGM). But a lack of reimbursement for virtual visits has been a roadblock for many home health agencies. Even during the current coronavirus public health emergency, as the Centers for Medicare and Medicaid Services (CMS) loosens its telehealth rules and encourages agencies to make use of virtual visits as part of an overall effort to mitigate infection risks, CMS has not made virtual visits billable for home health. “CMS has been very clear that it does not want virtual visits to take the place of regular visits to the home, and that agencies should use virtual visits as part of the overall plan of care,” 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.

“For example, your plan of care might call for four nursing visits each week, two in person and two via telehealth. But there is no reimbursement for the virtual visits.” While some private insurance companies do reimburse for remote patient monitoring, Medicare’s lack of reimbursement remains a significant deterrent to many agencies as they weigh the cost of setting up services to capture, transmit and store health data. Connectivity issues are an additional problem, as many patients in rural areas may have limited internet access.

The real value Home health experts say the real value in telehealth may lie beyond an agency’s ability to bill for it, shoring up overall patient outcomes through increased patient engagement, encouraging better self-management skills for chronic disease and medical conditions, and improving a patient’s overall satisfaction with home care services. “When virtual visits are provided as part of the overall plan of care, a patient may feel that the provider is more responsive – even that a higher quality of care is being provided,” J’non said. “And in many cases, telehealth can encourage the patient to do a better job of self-monitoring, becoming more actively engaged in maintaining and improving his or her health in between visits to the home.” Increased patient engagement may also result in fewer emergency room visits and hospital readmissions, she said. Fewer hospital admissions How significant is telehealth as a means of reducing hospital admissions? Various studies show impressive results:

· A three-year study using telehealth monitoring of more than 43,000 veterans nationwide had almost a 20 percent reduction in hospital admissions. The patients had diagnoses of hypertension, congestive heart failure, chronic obstructive pulmonary disease, depression, post-traumatic stress disorder (PTSD) and other conditions. The study reported a 25 percent reduction in days of inpatient care.

· In Mississippi, a pilot study by the University of Mississippi Medical Center had even better results: no diabetes-related hospitalizations or emergency room visits at all for diabetes patients who participated. Additional benefits for patients in the study, who communicated with health care practitioners solely by tablet computers, including significant drops in blood glucose levels and early recognition of diabetes-related eye disease.

· In Louisiana, patients using smart watches as part of a pilot study on managing hypertension were twice as successful as non-participants in achieving target blood pressure levels and improving patient engagement.

“There’s plenty of evidence to support these types of benefits from telehealth,” J’non said.


Referral relationships


One additional benefit to agencies using telehealth may be considered less often, but it still important, according to J’non. Referral sources may see an agencies providing remote patient monitoring as more responsive to patient needs.


Quality measures and resource usage are two of the factors facilities are required by CMS to consider during discharge planning when helping patients and their families or representatives make a decision about which post-acute care setting would best match patient needs after discharge.


CMS has temporarily waived many of its discharge planning requirements to avoid clogging the health care system during the COVID-19 pandemic, but the discharge planning rules will resume when the public health emergency ends.


“These changes became effective in November of 2019, when CMS revised the Conditions of Participation to require facilities to assist patients in finding the best care provider for the next step after discharge,” J’non said.


“To do that, they must consider the goals, needs and treatment preferences of the patient and try to match those to a home health agency’s quality measures and resource usage. They may look at an agency’s star ratings, specialty programs and services designed to really address patient needs. In a competitive market, remote patient monitoring capabilities might be something that gives an agency an edge.”



Cost-effectiveness


COVID-19 may have spotlighted the role of telehealth, with numerous patients declining in-person home health visits due to fear of infection, but 2020 had already placed telehealth front and center on the home health stage.


This year’s launch of PDGM, Medicare’s new payment model, eliminated old therapy thresholds and left home care providers scrambling to re-evaluate therapy utilization in a way that made sense for patient needs and profit margins. Remote patient monitoring for therapy was already on the rise prior to the public health emergency.


“All of this is working together to make 2020 the year agencies have to figure out the role telehealth is going to play in their organizations going forward,” J’non said.



NEXT IN OUR TELEHEALTH SERIES: Some pointers for agencies looking to ramp up their telehealth usage


Did you miss Parts 1 or 2 in this series on telehealth? Read Part 1 by clicking here or read Part 2 here.



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