Here’s the situation: Amid the coronavirus, a home health provider needs to figure out how to source enough personal protective equipment (PPE) so that its 3,000 caregivers can serve roughly 9,000 senior patients. While looking for supplies, it must also consider that pricing is 10 times higher than usual and the fact the organization has been burning through about 17,000 surgical masks per week.
The problem may sound like something out of an elementary school math textbook, but it’s exactly what VNA Health Group has been troubleshooting since the COVID-19 outbreak took the nation by storm in March.
VNA Health Group is the largest independent, nonprofit provider of home-based health services in New Jersey, northeast Ohio and southeast Florida. So far, it has provided in-home care to more than 650 COVID-19 positive seniors.
President and CEO Dr. Steven Landers shared the organization’s story Thursday during the first congressional hearing to discuss the coronavirus’s impact on seniors specifically. As part of the hearing, lawmakers sought to figure out what further federal action is needed to help keep vulnerable elderly populations safe in the weeks to come.
Post-acute care experts who testified during the hearing lauded home-base care as the answer, with Landers stressing the importance of PPE regulation and telehealth reimbursement, in particular. Many home health stakeholders have called for similar actions in recent weeks — and now Sen. Susan Collins (R-Maine) is promising to deliver on the latter point.
“We’re using, in my organization, 17,000 surgical masks a week, 3,500 N95 [masks] per week, [and] thousands of isolation gowns and goggles,” Landers said. “We’ve had to pay seven to 10 times the normal price and use vendors from all over the world that we could not always vet and verify — just hoping the shipments would arrive.”
VNA Health Group isn’t the only organization turning to unverified vendors. One East Coast long-term care provider this month discussed sourcing PPE from “a stranger in a parking lot,” while the U.S. Department of Veteran Affairs was recently burned in a shady $34.5 million deal for six million N95 masks.
On its end, VNA Health Group has been able to secure the PPE necessary to continue providing care, but it has been difficult. That’s why Lander urged lawmakers to “make sure home health agencies have the needed PPE at a reasonable price” going forward.
Affordability of PPE is especially important when you consider the impact the coronavirus has had on home health providers’ bottom lines. Because elective surgeries were paused and telehealth is not being reimbursed, home health revenues are down across the board, while expenses related to PPE and testing have skyrocketed.
Meanwhile, canceled visits have also triggered a surge in low-utilization payment adjustment (LUPAs), which effectively lower the Medicare payment a home health provider receives for an episode of care.
A way to offset some of those losses is to reimburse home health providers for telehealth visits.
Lack of home health reimbursement for telehealth has been a point of contention for stakeholders industry-wide, not just Landers. However, the Centers for Medicare & Medicaid Services (CMS) told agencies it doesn’t have the power to pay them for virtual visits and that the ball was in Congress’s court.
Sen. Susan Collins (R-Maine) is working on it.
“I plan to introduce a bill soon to create a framework to reimburse for telehealth services provided by home health agencies,” she said during Thursday’s hearing.
National Association for Home Care & Hospice (NAHC) President William A. Dombi hinted that congressional action on telehealth reimbursement may be on the horizon last week during a Home Health Care News webinar.
“I think we’re getting closer to making it happen,” Dombi said.
Medicaid home health also got a shout out during the hearing, as testimony after testimony spoke to the deadly toll the coronavirus is taking on the nation’s seniors living in nursing homes, 65% of whom are primarily supported by Medicaid.
While nursing home residents make up less than 1% of the general population, they’ve accounted for approximately one-third of all COVID-19 deaths nationwide. However, that might not be the case if more of these vulnerable seniors were being cared for at home, suggested Tamara Konetzka — a professor of health economics and health services research at the University of Chicago who specializes in post-acute care.
“We need to enhance the ability of Medicaid beneficiaries to receive home-based services instead of institutional services,” she said.