Telehealth usage has flooded into home-based care in an exponential fashion.
Across all of health care, telehealth claim lines increased 8,336% from April 2019 to April 2020, according to data from FAIR Health’s Monthly Telehealth Regional Tracker.
Generally, the concern with telehealth has often been centered around the patient and how seniors will react to the technology. A lesser consideration has been made, however, for the workforce deploying it.
That should not be the case, industry insiders caution.
MaineHealth Care at Home has been working with telehealth in one form or another since the turn of the century. Over the years, the in-home care provider realized it needed to have a triage team dedicated to telehealth, President and CEO Donna DeBlois told Home Health Care News.
“Our telehealth visits are predominantly done by our telehealth triage team,” DeBlois said. “That way, it doesn’t take away from the productivity in the field, which works out well.”
Saco, Maine-based MaineHealth Care at Home offers home health services to eight different counties in the Pine Tree State. Its typical average daily census is 1,600 patients.
Like most home health providers, “typical” days are difficult to come by amid the ongoing public health emergency caused by the coronavirus. On its end, MaineHealth Care at Home has cared for 24 COVID-19-positive patients this year, often leveraging telehealth services to provide treatment.
On average, each telehealth visit takes only 10 minutes. It can be even less for patients further along in their care plan, DeBlois said.
But across the home health industry, not every agency has a team dedicated to telehealth like MaineHealth Care at Home. Additionally, some leaders actually prefer that team members work in both telehealth and in-person capacities.
Dr. Ethan Booker, the medical director of the MedStar Telehealth Innovation Center, is one of them.
“We think that there is tremendous value in being able to have a collection of tools to be able to take care of patients, and that includes telehealth,” Booker told HHCN. “But it obviously still includes the ability to see people in the office. We think the vast majority of providers are going to use telehealth to augment their ability to take care of patients, but will still be doing a good amount of their work in person, and that it would be a real rarity for someone to be doing just telehealth work.”
There’s “a lot of value” in being able to move back and forth, he added.
MedStar Health is an integrated health system that offers a wide range of services — including home health care — in the greater Baltimore and Washington, D.C., areas.
Moving back and forth between in-person and remote work will be the future for a lot of health care workers — particularly during the COVID-19 crisis, but likely after as well.
Clinically, working in both areas ends up being beneficial for both the patient and the provider, Booker believes. Clinicians strictly dedicated to telehealth, particularly outsiders, may not grasp the overall system as much as someone who works at both and thus understands the ins and outs of it.
“And so if you’re a doctor who’s working in the office, seeing patients periodically in the hospital, and also interacting via telehealth, you know the system really well and you can navigate people through it,” Booker said.
During the New England COVID-19 surge, Norwell, Massachusetts-based NVNA and Hospice spent a great deal of time coordinating schedules for clinicians to help juggle telehealth and in-person visits.
Full-time clinicians would work with their managers to shuffle patients around appropriately and safely so that they could have a field day and then a virtual day, NVNA Telemedicine Clinical Manager Cheryl Nelson told HHCN.
“That did several things,” Nelson said. “It was a day that they could kind of stay in and only focus on the telehealth visits and it was certainly a day of minimizing their exposure.”
NVNA offers home health, hospice and palliative care, among other services, to residents of Massachusetts. It is Medicare-certified home health agency but also deals with managed care organizations, which is a problem some home health providers across the nation deal with.
Managed care, in many cases, will pay for telehealth visits as if they were in-person. It’s been well documented that the Centers for Medicare & Medicaid Services (CMS) has not made that leap just yet.
So even though a clinician may bring the same effort to the table on a remote visit, the money coming in for the agency is not the same. Or, in NVNA’s case, it’s only sometimes the same.
That raises a question over how an agency should pay its workers while dealing with that reality.
While NVNA makes sure to keep track of which telehealth visits it’s being paid for (and which it’s effectively delivering for free), it’s more about finding the right plan of care. The agency does not change payment for full-time clinicians based on whether it got paid for the remote visits that were or weren’t conducted.
“At the height of COVID-19, [we cared most] about what was best for the patient,” Nelson said. “So the field clinicians were not paid more or less based on what type of care they provided, just assuming that the care they were providing was practice and what was best for the patient.”
Curbing workforce shortages
Coinciding with the growing amount of seniors who will need care over the next decade in the U.S. is the daunting reality of the home-based care worker shortage.
Nursing shortages have been a topic of discussion during COVID-19. Projections suggest that the industry will need to add a staggering amount of front-line workers in the next 10 years — anywhere from 630,000 to over 1 million.
The situation is so dire that presumptive presidential candidate Joe Biden unveiled a $775 billion plan for boosting the caregiver economy on Tuesday.
The workforce realities are one of the biggest reasons why DeBlois finds telehealth to be so imperative.
“I am a huge proponent of telehealth,” she said. “Particularly in nursing, we are looking at a workforce that’s limited. There are not enough nurses for the aging population that we have in front of us or that we’re caring for now. We have got to figure out how to embrace telehealth and do less touch points, get the same outcomes and the same patient engagement as we do with in-person visits.”
Some home-based care insiders believed that the mass unemployment would help with that deficit.
But if the demand is high enough, agencies may have to turn to telehealth in the future to do more with less.
“We don’t have a choice anymore,” DeBlois said. “In Maine, we happen to have an older nursing workforce — we’re already challenged with that. … We have got to figure out how to do this differently. And our only option really is technology and telehealth is right on the forefront with that.”