Time for Policymakers, Hospitals to Bet Big on Home-Based Care

It’s time for policymakers, hospitals and everyone else at the health care roulette table to bet all their chips on proactive, pre-acute home-based care.

During the coronavirus pandemic, the U.S. health care system has undergone a massive change marked by the skyrocketing use of telehealth technology and the shift away from brick-and-mortar medical appointments. In fact, from April 2019 to April 2020, telehealth claim lines have increased by more than 8,300% nationally, according to FAIR Health data.

For the most part, though, traditional home-based care has felt like a secondary priority over the past few months, with home health providers and home care agencies largely overshadowed by telehealth trends, hospital capacity concerns and the general state of nursing homes, which continue to be devastated by COVID-19.

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“I think that [policymakers] have been very responsive to the needs in the hospital setting,” a Maine home health executive previously told Home Health Care News. “I do not feel that they fully understand the complexity of the patients seen by home health and hospice providers.”

Health care stakeholders may have missed the opportunity to aggressively invest in home health and home care during the initial coronavirus spike, but that door is opening wide once again. Or rather, it never really closed.

The country’s rolling seven-day average of daily new COVID-19 cases shattered all previous records on Monday for the 28th day in a row, the Washington Post reported. At the same time, hospitals across the Sun Belt are being overwhelmed by coronavirus patients, with Arizona reaching 89% capacity for intensive care unit beds and California, Georgia, North Carolina, Texas and a handful of additional states experiencing unprecedented hospitalization numbers.

The new coronavirus spikes in the South and West aren’t part of a different, second COVID-19 wave. They’re continuations of the first wave that was never properly addressed.

Overall, the U.S. death toll linked to the coronavirus hit 130,000 this week, statistics from Johns Hopkins University show. The number of total infections is approaching 3 million.

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With those numbers in mind, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a leading member of the Trump administration’s coronavirus task force, is calling for urgent action.

“It’s a serious situation that we have to address immediately,” Fauci said during an online interview Monday with Dr. Francis Collins, who leads the National Institutes of Health as its director.

As part of the nation’s renewed response to the coronavirus, home health and home care need to now be front and center. Fortunately, there are several readily available actions out there that the federal government and other health care players can take to support all shapes and sizes of in-home care providers.

When it comes to home health care agencies, in particular, the U.S. Centers for Medicare & Medicaid Services (CMS) can start by reopening its advanced and accelerated payment programs, allowing operators to focus on patient care and not their finances.

Home health agencies experienced huge financial losses during the early days of the coronavirus due to patients canceling visits and the general suspension of elective surgeries. Cash flow disruptions have somewhat stabilized, but the recent resurgence of COVID-19 cases may retrigger the same anxieties and roadblocks that agencies had to previously overcome.

From March through April, CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers. Home health providers received just $1.7 billion of that before CMS shut down the programs — and many home health agencies in emerging hotspots never even had the opportunity to apply for payments, as they’re just now feeling the impact of the coronavirus.

On top of reopening its advanced and accelerated payment programs, CMS should also consider giving home health providers a more robust Medicare rate adjustment. While the National Association for Home Care & Hospice (NAHC) and other industry advocates have called for a 15% rate increase, CMS recently suggested a 2.6% reimbursement bump in its proposed payment rule for 2021.

Many home health providers won’t be able to stay afloat for much longer without additional financial lifelines. In New York alone, home-based care providers expect to lose upwards of $200 million in 2020, according to financial estimates by the Home Care Association of New York State (HCA-NYS).

“These losses have alarming implications for the viability of New York’s home care system and the necessary support it provides for patients,” Roger Noyes, director of communications at HCA-NYS, previously told HHCN.

Meanwhile, when it comes to supporting home care agencies, Congress should start by seriously considering the creation of a fund that helps operators finance hazard pay and other benefits for front-line workers in its next relief package.

It’s an idea that had been floated by House Democrats in their Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act unveiled in May. Specifically, the House bill included a $200 billion fund for hazard pay for all essential workers.

Interim HealthCare Inc. CEO Jennifer Sheets previously told HHCN she would “love to see” government-supplemented hazard pay for health care workers.

“We need to incentivize people to be on the front line, especially in a pool that’s already prone to high turnover,” she said.

Apart from financial assistance, the Trump administration and FEMA should also organize a personal protective equipment (PPE) push for in-home care providers, similar to what they did for nursing home operators back in April. In-home care agencies have had just as difficult a time securing PPE, if not greater, as they’ve been excluded from most priority lists during the COVID-19 crisis.

Outside of the government, hospitals also need to accelerate the shift toward in-home care. Many already have, including North Memorial Health Hospital in Minnesota, which recently partnered with whole-person, home-based care provider Lifesprk to offer a hospital-at-home model.

“With the outbreak and shortage of personal protective equipment (PPE), one of the just really sad things that all of us have witnessed is when someone goes into the hospital right now and is very sick, their loved ones can’t be there with them,” Dr. Carolyn Ogland, North Memorial’s CMO, previously told HHCN. “This is a way to really help our families and our patients stay together when they are sick.”

If the U.S. health care system acts quickly and invests in home-based care, it will emerge from COVID-19 stronger than ever. But the window of opportunity is closing, so stakeholders must act now.

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