VNA Health Group was one of the first home health care agencies to candidly speak about its experience with the coronavirus — and it has been a vocal industry advocate on the topic ever since.
President and CEO Dr. Steven Landers detailed some of the organization’s financial and regulatory challenges for Home Health Care News back in mid-March. Then, last week, he shared the agency’s story with Congress.
VNA Health Group bills itself as the largest independent, nonprofit provider of home-based health services in New Jersey, northeast Ohio and southeast Florida. So far, the organization has served more than 650 COVID-19 positive seniors — and counting.
That number is growing almost as rapidly as the organization’s processes and regulatory priorities are being forced to change.
For example, back in March, Landers was pushing for flexibility on face-to-face documentation requirements and cash flow relief, both of which the Centers for Medicare & Medicaid Services (CMS) have since granted.
These days, he has his eyes set on personal protective equipment (PPE) regulation, COVID-19 testing guidance and telehealth reimbursement — the lattermost of which could see some movement soon.
Landers recently reconnected with HHCN to discuss all that and more, including his appreciation-pay initiative for COVID-19 caregivers and the main factors driving his organization’s ever-evolving coronavirus strategy.
You can find that conversation below, edited for length and clarity.
HHCN: You connected with HHCN a little over two months ago to discuss your organization’s approach to the coronavirus. What’s changed since then?
Landers: We’ve been through a lot.
We’ve seen a lot of good things in terms of our people stepping up, and that’s helped us be able to continue to care for people with COVID-19 and others.
Also, there’s been a pretty strong policy response. We’ve gotten a variety of new policies that have been supportive — the Provider Relief Fund that was part of the Cares Act, the waivers that CMS has initiated, the new allowance for nurse practitioners (NPs) and physician assistants (PAs) to sign off on home health care.
We’ve seen a lot of movement there, and it looks like … senators are interested in doing more. That’s very positive, so I feel more supported than we did back in March, when it was unclear what was going to happen.
You highlighted NP and PA flexibilities as huge help for the home health industry during a recent congressional hearing. What other policy changes have excited you?
The Provider Relief Fund in the Cares Act is really important. I’m hoping that’s just a short term thing, and we don’t need that type of support long-term. But we still have high rates of COVID-19 infection, all these issues around PPE and testing expenses, so I think that type of support is important.
Long-term, the adjustment around nurse practitioners and physician assistants is very important because that’s going to improve access to home health care and ease some of the paperwork burden on physicians.
Then, a new policy by CMS has allowed physicians, nurse practitioners and physician assistants to do face-to-face encounters via telehealth. That has also helped with access during this crisis. I think that’s also something that should be extended.
Speaking of the Provider Relief Fund, how much money did VNA Health Group get as a result of that, and how will you use it?
Across all of our different agencies, thus far, we’ve received approximately $9 million from the Provider Relief Fund.
We are using that to address all of the new expenses related to COVID-19 care, like the massive amounts of PPE that we’re purchasing and the real expense of tests for our employees. That’s going to go up because it’s going to become more and more important to do aggressive employee testing to try to protect the employees and the people they care for. We’ve also seen an impact in our volumes due to the discontinuation of elective surgeries and patients not wanting our field staff to enter their home.
We are doing a fair amount of telehealth for COVID-19. We’re not getting reimbursed for that right now, and then also you’ve got some episodes where there are low-utilization payment adjustments (LUPAs) because of that.
For some of our employees who are taking on the more difficult assignments, where there’s high rates of COVID-19, we’ve given them some extra pay. That’s another thing the Provider Relief Fund is helping make possible.
Have you guys taken advantage of other financial assistance programs out there, like the Paycheck Protection Program (PPP) or the Accelerated and Advance Payment Program?
We have taken advantage of the accelerated and advance payments, and a couple of our smaller joint venture agencies have been given PPP support.
We’re still finalizing exactly how much of those funds we should use. We want to make sure that we don’t do anything outside of any of the rules, so there’s a lot of careful analysis going on to make sure that is all handled appropriately.
You’ve shared some shocking numbers when it comes to PPE. You told Congress your organization goes through 17,000 surgical masks and 3,500 N95 masks per week, with PPE costs seven to 10 times higher than usual. How are you navigating those challenges?
We’ve become very proficient in connecting with all sorts of brokers, vendors and people all over the world that sell PPE.
Fortunately, a few of our longtime vendors and some others that we’ve found have been able to come through. It hasn’t always been at a great price, and there have also been times when it was questionable quality.
We’ve been waiting on supplies to come in, hoping that they will come through. The good news is that we’ve been able to keep them coming, but it hasn’t been easy.
I don’t see that changing too much immediately. Even though we’ll see some decline in the infection rates, as best I can tell, there’s not going to be a total wipeout of the virus.
I’m also really interested in that extra hazard pay you mentioned. How does that work?
Initially, we launched a COVID-19 SWAT team across our locations. These were the nurses that would be going out to take care of the people coming home from the hospitals and emergency rooms with COVID-19. We wanted to make sure people doing that type of dangerous work got appropriate recognition and compensation.
That was both out of our own values and also out of necessity to make sure that we could get people to do that type of work, which is difficult and scary. Fortunately, we have not seen those workers get infections because they’ve got the equipment they need.
We’re now evaluating whether or not we can expand that type of premium pay. So far, we’ve focused on people that are doing the special care for people with COVID-19, but we also recognize that people doing care, in general, right now are working under difficult circumstances.
Has that helped you on the retention and recruitment front?
I think so. We’ve not seen a lot of people walk away.
The turnover was not above normal during this stretch, but I do think we’re going to see some retirements and some people adjusting course over time, but I don’t have data on that.
I know numbers can be hard to nail down because the situation is changing so rapidly. For example, on May 19, VNA Health Group sent out a press release about treating its 600th COVID-19 patient, then by May 21, you told Congress that number had surpassed 650.
We actually internally drafted the press release for the 500th patient.
Then after some back and forth amongst the team of what to put in there and making sure we got everybody’s perspective, we’d already gotten up over 600. By the time we got that one out, we were already over 650.
There’s definitely still a lot of people with COVID-19 who need care.
Where are those patients coming from?
Largely in north and central New Jersey. Almost all of them are coming from hospitals or skilled nursing facilities.
We’re fortunate that we’ve had strong relationships with our partnering hospitals and health systems, and I think this will even heighten the ability to collaborate.
We’ve talked a lot about the successes that your organization has triumphed. What are the biggest challenges you’re facing?
There’s been continual change in public health guidance around PPE and testing for our workforce and the people that we take care of.
So, are our protocols and our approaches the best in terms of protecting everybody? For me, that’s job No. 1.
Going back to [the HHCN interview I did in March], I was very concerned about the financial health of our organization. The policy response has really given me confidence that we will get through this financially, especially if Congress continues to work on some of the things they’re talking about. I’m optimistic that the financial picture really gets better.
As far as further action by Congress, what would you still like to see for home health providers?
I would like to see a more clear cut game plan for testing and funding for it.
Right now, it still feels like it’s every locale for itself in terms of getting enough tests. Getting more of the saliva testing and some of the rapid testing out there, I’d like to see that prioritized more.
Same with PPE. We’re getting the PPE, and that’s a good thing, but it’s like the Wild West. We’re having to hustle for it. That means the pricing is high, and we’re not always getting the same brand and supply we got in the previous shipment.
Those are things I think require focus going forward. Then telehealth reimbursement — I’m very grateful that Sen. Susan Collins (R-Maine) is really focused on this.
The biggest advance during this crisis has been telehealth, and quite frankly, all types of virtual services throughout the whole economy. Home health agencies have not been given enough support to do telehealth to the extent that it could benefit the people we care for.
This is overdue — to provide reimbursement to home health agencies for telehealth. I’m optimistic from the [recent congressional] discussion that something might get done.
What’s next for you guys, especially now that we’re seeing so many states start to transition back to normal?
We’re focused on continuing to be able to provide care, so making sure our employees have the equipment they need and that they can continue to do their jobs.
Then we’re starting to make some plans for our office-based employees — when and how they should come back to our offices. We’ve learned to do a lot of the back office work remotely, and we’re actually thinking about ways to keep that going, so it might not go back exactly the way it was before.
We’re not there yet, but we think that’ll happen over the coming weeks.