Despite Benefits, Reimbursement Roadblocks Still Slowing In-Home Telehealth Adoption

Despite the benefits of telehealth services, the general lack of reimbursement under Medicare has created persistent roadblocks when it comes to widespread adoption among U.S. home health providers.

Over the past several years, telehealth services have proven their value when it comes to improving access to care for patients and lowering overall health care costs. As a result, federal policymakers have tried to encourage greater adoption, but those efforts, thus far, haven’t led to major changes.

“It’s not a panacea by any means, but it is an appropriate tool to facilitate lower costs, increased quality, patient and provider satisfaction, and increased access,” Dr. Christopher Davis, an assistant professor at the University of Colorado School of Medicine, told Home Health Care News. “My organization is making a long bet that this is where health care is heading in the future. How we practice in a decade will be radically different than it is now.”

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In addition, to his role at the University of Colorado, Davis is a member of the American Telemedicine Association, a Washington, D.C.-based nonprofit that includes more than 400 organizations.

In the in-home care space, Health Recovery Solutions (HRS) has aided in telehealth and remote patient monitoring efforts by working with home health organizations and health systems to implement its tools.

“Telehealth has shown that it can significantly reduce hospital readmission,” HRS CEO Jarrett Bauer told HHCN. “You are seeing the most innovative in-home agencies putting reducing readmissions at the forefront [of their priorities]. There are a lot of organizations that know they should be using telehealth, but are waiting on the sidelines because it’s still a fee-for-service industry.”

Currently, traditional Medicare reimburses for some in-home telehealth services under special circumstances, including for patients with end-stage renal disease kidney disease or some mental health conditions.

As part of its business model, Hoboken, New Jersey-based HRS partners with in-home care agencies, helping such organizations set up remote patient monitoring platforms that include everything from pulse oximeters to blood pressure monitors.

The company began working with Valley Home Care over four years ago. Since then, the Paramus, New Jersey-based home health provider has since seen its monthly hospital readmission rates drop to as low as 2%.

More recently, Norfolk, Virginia-based Sentara Home Care saw a 9.09% 30-day all-cause readmission rate for its telehealth patients over seven months after working with HRS. For context, that’s lower than the state average by 39%.

Overall, HRS’s platform is utilized by 140 medical organizations.

More broadly, many home health providers have shown interest in launching telehealth tools. In fact, roughly 28% say they have a goal of establishing new telehealth services within the next year or so, according to a study conducted by Definitive Healthcare.

With the launch of the Patient-Driven Groupings Model (PDGM), some experts believe that telehealth may be the answer to navigating new therapy reimbursement policies. Under PDGM, therapy volume no longer automatically drives payment, meaning providers could look for creative alternatives to in-person visits.

“[The Centers for Medicare & Medicaid Services] (CMS) wants post-acute care, including home health, to keep patients out of the hospital,” Sharon Harder, president of C3 Advisors, told HHCN. “For home health, we don’t really know what’s going on with a patient until we are in that home. When we start using remote monitoring and other telehealth [tools], all of a sudden we don’t need to be there in person to know how the patient is doing.” 

C3 Advisors is a Chicago-based consulting firm that specializes in home health and hospice compliance.

Telehealth may be a value-add, but restrictive reimbursement policies mean some providers still steer clear.

“[Telehealth] certainly adds an element of non-reimbursable costs, but it also saves on that visit and it still gives us the potential to achieve the quality outcome that we are looking for,” Harder said. “As we think of home health, generally, all of these innovations are going to help us with our margins when it comes to PDGM.”

Reimbursement may be restrictive, but some progress is being made. Last October, for example, a group of senators introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019.

If passed, the legislation would expand Medicare coverage for telehealth services and require the Medicare Payment Advisory Committee (MedPAC) to report on which telehealth services would be appropriate for home-based care. With six co-sponsors, the legislation was last referred to the Committee on Finance.

On the Medicare Advantage (MA) side, CMS expanded the coverage of allowable telehealth benefits for 2020 last April.

Only time will tell how much forward movement the home health industry will see in terms of telehealth reimbursement under Medicare.

“I’m not sure that will happen very soon,” Harder said. “Telehealth is reimbursable in some settings, but the underpinning of Medicare is centered on that direct patient-clinician interaction. That doesn’t mean telehealth isn’t a worthwhile expense for home health agencies looking to find a more complete way to care for patients and achieve outcomes.”

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