Over the past few weeks, nursing home operators have been working in overdrive, trying to avoid a fate similar to the Kirkland, Washington-based long-term care facility devastated by COVID-19.
While home health providers are also gearing up for increased patient capacity and challenges associated with the coronavirus, their operations remain mostly stable — for now. But for that to continue, the entire industry will need to quickly come together with government officials to streamline discharge protocols, alleviate burdensome requirements and secure vital supplies.
Just 31% of home-based care organizations say their operations have been affected by the spread of COVID-19, an HHCN survey of about 150 provider representatives found. HHCN conducted the survey online from March 5 through March 13.
Advocates are doing everything in their power to keep that figure low.
“We’ve been in very regular conversations with members of the COVID taskforce at the White House and with the Centers for Medicare & Medicaid Services (CMS) about what they could do to assist home health care in being more nimble and flexible to combat the virus, perhaps facilitating regulatory waivers and other [forms of] relief,” Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare (PQHH), told Home Health Care News. “I would say the entire home- and community-based sector has been working together.”
Established in 2010, Washington, D.C.-based PQHH represents some of the largest home health providers in the country, including LHC Group Inc. (Nasdaq: LHCG), Encompass Health Corp. (NYSE: EHC), Bayada Home Health Care, among others.
Despite the measured impact thus far, nearly 60% of those surveyed by HHCN believe home-based care providers should be “very concerned” about the coronavirus and its potential operational disruption.
Another 38% of respondents think providers should be “moderately concerned” about the virus.
Of the roughly 150 individuals who participated in the HHCN survey, just four say they’re “not concerned” about COVID-19’s possible impact.
“I think the entire home health care community has been on high activation and is … getting increased outreach from all of their hospital, health system, physician, public health partners who are looking for home health to play a meaningful role in the treatment of COVID-positive patients,” Cunningham said. “The safest place for many folks is at home, particularly when you have to deal with such an infectious disease and virus.”
What needs to happen now
During a Friday national address, President Donald Trump and a group of health care representatives outlined several actions the federal government planned to take to “flatten the curve,” or mitigate the rapid spread of COVID-19.
Actions included European travel restrictions and calling for mobile testing sites.
LHC Group Chief Strategy and Innovation Officer Bruce Greenstein represented the home health industry, standing behind the president and briefly speaking during the nationally televised address.
“The home health industry has been treating patients and seniors in the safety and comfort of their own homes for decades,” Greenstein said. “We’re very proud to be part of the equation for testing in their own home. For Americans that can’t get to a test site, or live in rural areas far away from the retail establishment, we’re here to help.”
There are numerous steps the health care system can take to support home health providers in their fight against coronavirus, Cunningham said.
On a basic level, hospital officials and those who control the flow of patients across settings should immediately prioritize diversion into the home.
And from a regulatory perspective, waiving Medicare’s “homebound requirement” should be priority No. 1 for CMS, which, at the moment, has more leeway to quickly make changes. Under current Medicare rules, individuals are only eligible for home health services if they can’t leave their homes due to illnesses or injury — or if leaving their homes requires “a considerable and taxing effort.”
“I think a top issue that is front and center is waiving the homebound requirement,” Cunningham said. “If you’re trying to make sure that you can get patients in the home who are appropriate for treatment, the homebound requirement needs to be looked at very flexibly, and CMS totally understands that.”
CMS should also consider waiving face-to-face documentation requirements.
“It was kind of a big reg change a few years back,” Cunningham said. “And it’s pretty onerous, especially in times of crisis, where — if you have a patient who is coded positive, they’ve tested and they do have the virus — they may not have been seen by a physician to complete the face to face encounter.”
The National Association for Home Care & Hospice (NAHC) has made similar recommendations to CMS.
Thinking three steps ahead
Judging from how PQHH members are responding to the COVID-19 pandemic, Cunningham confirmed the idea that home health providers aren’t “stretched thin” right now.
Even so, many decisionmakers are preparing for worst-case scenarios.
“They’re thinking three steps ahead — if we start getting thousands of test-positives and symptomatic patients, how do we manage them?” she said. “I know Partnership companies are doing screenings of all their employees. They’re doing screenings of all their patients to be ahead of the game. They’re thinking through [personal protective equipment] and figuring out how to stock up.”
Ensuring home health providers have sufficient supplies — PPE — is another priority PQHH is addressing with CMS.
Of those who responded to HHCN’s survey, more than 40% believe having enough clinicians or caregivers to care for patients will be the biggest challenge during the coronavirus pandemic. About 30% say maintaining an adequate stockpile of supplies will be most challenging.
Slightly more than 21% of respondents say actually caring for patients exposed to COVID-19 will be the top challenge.
While regulatory and policy action will certainly be key to navigating the ongoing public health crisis, the majority of HHCN survey respondents believe that educating clinicians and caregivers is most essential to success moving forward.
“Home health providers are already so patient-focused,” Cunningham said. “And now they’re kicking into an entirely new gear of, ‘How do we manage this? How do we help? How do we step into this and leverage our clinical expertise of caring for people in the home?’”