47% of Providers Believe COVID-19 Will Have a Negative Long-Term Impact on Their Businesses

The coronavirus is making it harder for home-based care providers to stay afloat, mainly by draining basic protective equipment and disrupting organizations’ staffing levels.

More than 72% of home-based care professionals don’t have adequate amounts of personal protective equipment (PPE), while more than half say their organizations are having staffing struggles.

Meanwhile, nearly 58% of home-based care professionals have seen billing and cash flow interrupted over the past two weeks.


The findings — which come from a survey by Dallas-based Axxess, a cloud-based software solutions developer for home health, home care and hospice providers — further support the dire need for federal telehealth reimbursement relief for home health providers. That’s something industry advocates have been pushing for since early March.  

Given the often vulnerable, elderly populations home health providers serve, it seems obvious the Centers for Medicare & Medicaid Services (CMS) would want to make it easier for providers to adopt telehealth when appropriate. 

To some degree, the agency has done that. Last week, CMS took “unprecedented” action to reduce administrative burdens on Medicare providers, which included creating some new telehealth opportunities for home health operators, among other changes.


As a result, agencies can now potentially provide telehealth services to patients by contracting with doctors, who can then bill for telehealth and potentially pay agencies a cut. However, all visits still must be doctor-ordered, so home health agencies can’t make the executive decision to forgo an in-person visit for a virtual one if they want to be paid.

When asked why home health agencies aren’t able to get direct reimbursement for telehealth services on a call with providers last week, CMS said it is statutorily prohibited from paying for remote visits.

But industry leaders such as National Association for Home Care & Hospice (NAHC) President William A. Dombi continue to push back.

“While there remains work to be done, this is progress at such an important time,” Dombi told Home Health Care News last week in an emailed statement. “Additional changes are still needed, particularly around direct reimbursement for telehealth services as home health agencies cannot afford to provide the care for free.”

Axxess’s recent findings — which were compiled using responses from thousands of home-based care providers from March 25 through March 30 — make the need for such changes clear.

In addition to PPE, staffing and cash flow challenges, more than 81% of respondents said COVID-19 has generally impacted their ability to care for patients.

Over 47% predicted the pandemic would have a negative long-term impact on their business, a troubling fact considering home health providers help keep seniors out of already overburdened hospitals.

All three problem areas identified in the Axxess survey — PPE, staffing and billing — could be fixed if telehealth were directly reimbursable. Caregivers could work from home, conserving PPE and alleviating some staffing issues, while agencies would continue to be paid by CMS, in turn keeping them out of the black.

But as things exist today, many agencies are being forced to cover the costs of telehealth services themselves, despite already operating with paper-thin profit margins.

Sometimes it’s a dedicated strategy to cut down on COVID-19 transmission and keep patients and staff safe. Other times it’s not, with more and more seniors turning home health aides away out of fear, forcing agencies to implement virtual care methods as a necessity. 

The findings from the Axxess survey also highlight just how quickly the COVID-19 situation is worsening.

In an HHCN poll conducted earlier this month, just 31% of home-based care organizations said their operations had been affected by the spread of COVID-19. More than 150 providers took part in the poll, which ran online from March 5 through March 13.

With those results in mind, for the livelihood of the industry and the seniors it serves, the federal government needs to act sooner rather than later to get home health providers direct reimbursement for telehealth services, which are vitally important in light of COVID-19.

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