A recently proposed rule by federal policymakers expanding access to telehealth services through Medicare Advantage (MA) plans would likely be a major boon to home health providers and technology vendors alike, industry insiders say.
Currently, the Centers for Medicare & Medicaid Services (CMS) largely restricts telehealth reimbursement to clinical settings in rural areas, apart from certain exceptions in Alaska and Hawaii. While that regulatory landscape has opened the door for telehealth use in skilled nursing facilities (SNFs) operating in sparsely populated, non-urban markets, it has mostly shut out the home health industry and slowed providers’ innovation pace.
Other roadblocks have hurt industry adoption as well, Lee Horner, CEO of Clearwater, Florida-based virtual care company Synzi, told Home Health Care News via email.
The label “telehealth” broadly applies to the provision of health care remotely by means of telecommunications technology.
“Although there have been many strides in adopting and using virtual care and telehealth within the past year, there is considerable opportunity for the home health industry to more fully embrace the power and value of this technology,” Horner said. “Barriers include the fear of a new technology being disruptive to current workflows, lack of an IT infrastructure which can support patients’ evolving digital health habits, and reimbursement policies.”
In October, CMS proposed a rule that would give MA plans more flexibility to offer government-funded telehealth benefits to all enrollees, regardless of whether they live in rural or urban areas. In addition to eliminating the market restriction, CMS’ proposal would also allow MA enrollees to receive telehealth services from home, rather than requiring them to go to a clinic, SNF or other health care facility.
If implemented, the proposed changes would go into effect for the 2020 plan year. In part, CMS is proposing the changes, according to the agency, because the Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” as part of government-funded “basic benefits.”
Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019.
“Expanded access and coverage for virtual care will benefit the entire health care ecosystem,” Horner said. “The use of technology to allow visiting nurses and home health providers to deliver care remotely will optimize productivity by turning ‘drive time’ to ‘patient time,’ while also helping agency owners and administrators better hire, train and retain talent.”
‘A step in the right direction’
Spun out of Stratus Video’s telehealth division at the beginning of 2018, Synzi is an example of the impact telehealth can have on home health providers’ operations. Synzi’s tech platform uses a combination of video, email and secure messaging tools to help home health providers stay in touch with patients.
Trilogy Home Healthcare, a Florida-based home health company with roughly 3,000 patients and about 700 employees, began using Synzi in June across a handful of its locations.
“The feedback we have received from referral sources has been very positive,” Trilogy CEO Dale Clift told HHCN. “The accounts that are using the Synzi platform appreciate that we are being proactive in case managing our shared patients.”
Trilogy is not yet able to quantify how telehealth has improved its operations, Clift said, but promising findings have been reported in a number of past pilot programs.
One telehealth home health pilot program in Colorado, for example, reported a 62% reduction in 30-day re-hospitalizations related to congestive heart failure, chronic obstructive pulmonary failure and diabetes. Over a 60-day episode of care, emergency department use also fell sharply, as did nurse home visits and costs of care.
“Anytime CMS approves and reimburses for additional services that will enable the patient to get better comprehensive care and engages them in their own outcomes is a step in the right direction,” Clift said. “Right now, telehealth is an incurred cost and an investment by the agency. I think with the current landscape, one needs to be a ‘big picture’ and forward-thinking type of agency in order to validate the return on investment.”
Not all research into telehealth has been promising.
A Mayo Clinic trial tracked the effects of telemonitoring for older adults with multiple chronic conditions at risk of hospitalization. In the trial, researchers found no difference in rates of hospitalization, emergency department visits and hospital length of stay for older adults who received telemonitoring services and those who did not.
‘A natural fit for the home health market’
Additional telehealth benefits under Medicare Advantage will increase access to patient-centered care by giving enrollees more control to determine when, where and how they access benefits, according to CMS.
“Telemedicine is a natural fit for the home health market,” Mordy Eisenberg, COO for Stratford, Connecticut-based Tapestry TeleHealth, told HHCN. “These are elderly, frail patients, especially when you’re dealing with those with chronic medical conditions. Taking them out of the house to the doctor is very difficult.”
Tapestry TeleHealth predominately works with SNFs located in rural areas, but it’s in the process of building relationships with home health providers, too, Eisenberg said, adding that CMS’ proposed rule change presents major business upside.
The telehealth company is already in the midst of at least one home health pilot program.
“If we can … remove the rural designation and open up home care as an acceptable site of care, that really gives us the ability to run these programs for Medicare Advantage patients,” Eisenberg said. “Ultimately, a lot of these [initiatives] start out with Medicare Advantage … then end up translating to traditional Medicare as well, with big payers coming on board.”
LeadingAge, an industry association that represents more than 6,000 not-for-profit senior care providers, has been among the organizations urging CMS to provide further support for telehealth.
In fact — earlier in October, before the CMS proposal was announced — LeadingAge sent a letter to the Senate Special Committee on Aging outlining how identified telehealth demonstrations would moderate health care costs in eligible nursing facilities and improve health outcomes among Medicare beneficiaries.
“We’ve been advocating for telehealth for a long, long time,” Majd Alwan, senior vice president of technology and executive director of the LeadingAge Center for Aging Services Technologies, told HHCN. “We believe in its effectiveness, both remote patient monitoring as well as two-way video conferences and behavioral monitoring.”
CMS is recognizing the potential for telehealth with its new proposal, but doing so through MA plans makes it appear policymakers are cautious about “the woodwork effect” and potential abuse, Alwan said.
Written by Robert Holly