Providence — one of the largest health care systems in the nation — is the closest thing the U.S. has to a COVID-19 pioneer. One of its hospitals based in Washington state treated the country’s first COVID-19 positive patient back in February.
Since then, the coronavirus has made its way down Providence’s care continuum, all the way to its home health and hospice arms, which are currently treating 119 positive patients, with another 127 who could have the virus under investigation.
Rachel Manchester, director of nursing at Providence Home Health in Washington state, shared those numbers on a recent webinar hosted by the National Association for Home Care & Hospice (NAHC). It’s just one of many data points she has at her disposal.
In Manchester’s view, data tracking is a key tool that can help guide agencies through the COVID-19 emergency. That includes everything from success metrics to denials of care, all of which could come in handy in a post-coronavirus world, especially from a financial perspective.
It’s no secret that the coronavirus has wreaked havoc on home health agencies’ bottom lines. Visit volumes are down, supplies costs are up and the Centers for Medicare & Medicaid Services (CMS) isn’t reimbursing providers for telehealth visits.
Providence Home Health is grappling with the same problems.
“Our volumes have also suffered,” Manchester said on the webinar. “People are afraid to go into the hospitals, and then that feeds our home health system. That’s one reason. The other reason is just that a lot of facilities aren’t letting us in, and that’s a big book of business for us.”
Many senior housing and skilled nursing facilities (SNFs) are scared that outside entrants — even caregivers following CMS and CDC guidelines — could bring the coronavirus into their buildings. They worry about ending up like Life Care Center of Kirkland, Washington, a nursing home where an outbreak killed at least 35 people.
But turning away home health workers who provide necessary care isn’t always appropriate.
“My advice is just to really partner with your department of health to help get you in,” Manchester said. “You must track declined visits. If there’s any financial recovery for you as an organization, you really want to track that.”
Providence uses a spreadsheet to keep track of which facilities turn away caregivers, how many times they do it and their reasoning, along with other factors.
Doing so gives providers some ammunition to argue against things like unavoidable Low Utilization Payment Adjustment (LUPA) claims, which would be out of their control.
Overall, for Providence, visit volume is about two-thirds of what it normally is, Manchester said on the webinar. But many of those are telehealth visits, which come with their own set of problems.
For one, CMS isn’t reimbursing for remote visits, claiming the agency is prohibited from doing so. Plus, remote visits don’t count against providers’ LUPA thresholds.
“It’s safer for [the 30% of our workforce that is high-risk] to perform that care, and it’s also providing a very valuable service,” Manchester said. “But right now, except for Medicaid … those aren’t reimbursable visits.”
Then there are the non-reimbursement-related costs that come with telehealth. For example, getting it up and running to begin with.
“We weren’t using telehealth hardly at all [in January], and as March hit, that number has skyrocketed,” Manchester said. “Even our very elderly are learning how to navigate telehealth.”
But to make it happen, Providence had to work with outside tech companies, make training videos for caregivers and clients, and redistribute high-risk workers to telehealth command centers — all of which take time and money.
“Then the Zoom and FaceTime use and policies had to be created,” Manchester said. “We were so lucky that we were able to consent patients using FaceTime or Zoom technologies to keep them safe. I felt like more patients said yes [to treatment because it’s remote].”
That’s another thing Providence is tracking: factors like patient satisfaction and willingness to accept telehealth. It’s helped them gauge how they’re doing so far.
“Find a way to track your success,” Manchester said. “One of the things that was really important to us is that our patients were still finding value in us as home care, as well as the way that we were deploying telehealth.”
Additional costs Providence is dealing with in light of COVID-19 include increased infection control planning, new documentation and consent practices and additional contractors being hired to help supplement staffing. Again, these are all areas the agency is receiving no direct reimbursement for.
And while there’s no guarantee CMS will try to help make agencies whole again for stepping up in light of the coronavirus, Providence will have its receipts — or rather, spreadsheets — ready if it does.