On Thursday, the Senate approved a bill that will provide $8.3 billion in emergency funds to help mitigate the effects of COVID-19, otherwise known as the coronavirus. Apart from funding, the bill made major changes to telehealth statutes, possibly allowing home-based care providers to both rely heavier on telehealth tools and be properly reimbursed for those services.
Specifically, Congress is allowing the U.S. Department of Health and Human Services (HHS) to waive certain originating-site constraints, such as the ones that restrict telehealth in nonrural settings. Providers will also be allowed to conduct telehealth instruction over telephones with audio and video capabilities.
“Because all of the United States is currently under this public health emergency designation, any Medicare beneficiary would now be eligible for care from a provider via a two-way audio-video mechanism, including a smartphone,” legal experts from Alston & Bird wrote in an advisory note. “This applies anywhere in the U.S. for any Medicare-reimbursable telehealth service — not just for treatment of the coronavirus.”
Since the coronavirus began spreading throughout the United States, many home health industry insiders have pushed for greater use of telehealth technology.
Among them is Raj Kaushal, the founder of Senior Healthways Inc. and a former president at LHC Group Inc. (Nasdaq: LHCG).
“We have to look at delivery of care in the case of an outbreak — and how we can shift it,” Kaushal told Home Health Care News. “Can we utilize a triage system? Can we use telehealth? If we’re an agency that doesn’t have telehealth, can we use telephone and text monitoring systems? Video conferencing? We need to find ways to make sure exposure to the patient and the staff is minimal, if it comes to that.”
Despite opening some new doors, there are still certain limitations to the newly relaxed telehealth requirements. Also, for providers that do use smartphones to connect with patients, existing HIPAA standards will still apply.
So far, the coronavirus has impacted more than 108,000 people around the world. As of Monday afternoon, the number of confirmed cases in the United States was approaching 600.
For providers that have not acquainted themselves with telehealth prior to the coronavirus outbreak, Synzi, a telehealth and telemedicine technology company, is currently offering free basic and temporary services. Synzi has over 50 clients in home-based care.
“We’re offering up our service to non-current customers, because we believe that this outbreak is pretty widespread,” Synzi CEO Lee Horner told HHCN. “And ultimately, we want to make sure that home health organizations have access to technology like ours that allows them to provide guidance to their patient population in the situations that we’re in today. That’s kind of first and foremost.”
Telehealth becoming vital
Telehealth has long been considered a big part of the future for health care providers. As providers’ fears worsen, that future could come sooner by necessity.
The Society for Post-Acute and Long-Term Care Medicine — formerly known as The American Medical Directors Association (AMDA) — represents a community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants and other practitioners working in long-term care settings. Its incoming board president, Dr. David Nace, told HHCN last week that telehealth would play a large role in containing the virus in long-term care settings.
“I think it has to have a very strong role. Even in the nursing home setting, even in the assisted-living setting, you want to minimize the number of individuals that come in contact with an infected individual,” Nace said. “One of the things that can be quite helpful is the use of telemonitoring and telehealth equipment … . I think that is very appealing in the long-term care setting, and it’s been one of the things that we’ve been thinking a lot about.”
Telehealth tools have their limitations, and they won’t ever be able to replace in-person provider care completely.
But having the ability to access patients virtually will allow providers to avoid person-to-person contact unless it’s absolutely necessary.
“I absolutely do believe that [this will speed up the shift to telehealth]. I’m pretty confident, both from the home health organization [perspective] and the potential of CMS opening up different reimbursement models to support this,” Horner said. “I don’t think there’s going to be a choice here.”
There’s already been examples in areas with a large number of cases — such as Seattle — of both patients and nurses refusing to meet with each other in person.
Synzi has already seen a major uptick in the amount of time its clients are spending using its platform. Usage is up 25% across all modalities over the past two weeks, and it expects a greater rise moving forward as patients or nurses refuse to meet with each other in person.
Previously, roadblocks for reimbursement prevented providers from committing more to telehealth. Medicare historically has only reimbursed providers for telehealth under special circumstances.
While policymakers will likely still need to work out details, last week’s language will open more opportunities for providers to be reimbursed for other services in different settings.
In a 2019 study of 159 home health agencies conducted by Definitive Healthcare, roughly 28% of respondents said they had a goal of establishing new telehealth services within the next year or so.
Definitive Healthcare is a Framingham, Massachusetts-based provider of health care data and analytics. Of the 159 participants, roughly 70% were agency-level providers and 30% corporation-type businesses.
In addition to Synzi, other examples of telehealth providers in the home health space include Hoboken, New Jersey-based Health Recovery Solutions and Wixom, Michigan-based HNC Virtual Solutions.
Concierge Home Care, a home health provider and Synzi client with six locations in Florida, began using technology to connect with patients virtually because of the prevalence of hurricanes in the state.
That has given the agency confidence while bracing for the spread of coronavirus, COO Linda Murphy told HHCN.
“If you think about the old days when we had a hurricane come through, you’d have everybody on the phone calling patients as well as staff hitting the road to try to talk to patients and get them prepared,” Murphy said. “With technology today, you can be so much more efficient and provide even more detailed information because you can standardize messaging across the whole arena or make it very specialized depending on the type of patient that you’re dealing with.”
Even before last week’s changes to the telehealth reimbursement process, there were perks to using virtual care as a cost-saving tool. That’s especially true under the Patient-Driven Groupings Model (PDGM), which has more agencies strapped for cash.
“[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,” Sharon Harder, president of C3 Advisors, told HHCN in February. “As we think of home health, generally, all of these innovations are going to help us with our margins when it comes to PDGM.”