Between the Patient-Driven Groupings Model and the COVID-19 virus, home health providers are arguably facing the most volatile environment in their industry’s history. At the same time, millions of people are now looking for safer and simpler ways to receive care, which only boosts demand for in-home care services.
Looking back, rapidly evolving technology, legislation and patient behavior have all propelled home health care to an inflection point, industry insiders believe.
As far as legislation, providers have gained small victories since March. But they have also experienced frustrating setbacks, especially when it comes to telehealth and securing a vehicle for reimbursement.
Despite home health providers being encouraged to use more telehealth and ongoing discussions taking place in Washington, D.C., not much progress has been made since the start of the public health emergency.
“We’re still at the point where we were early on, where there is no reimbursement flow for providers in the home health space,” Joanne Cunningham, the executive director of the Partnership for Quality Home Healthcare (PQHH), said last week at Home Health Care News FUTURE conference.
Operating in the dark
One small victory for providers early on included the U.S. Centers for Medicare & Medicaid Services (CMS) allowing non-physicians — such as nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) — to certify home health services. But there are limitations to that win, as many states have their own regulations for what NPs and PAs can lawfully do.
Another victory was CMS allowing home health providers to satisfy physician face-to-face requirements via telehealth technology.
While valuable neither of those points is the grand prize that home health providers are truly searching for: reimbursement for telehealth.
“Our folks are still trying to figure out the scope and span of what this next COVID relief bill will look like,” Cunningham said. “And telehealth is certainly in the mix there. But it is left to anybody’s crystal ball as to whether the big policy issues will get worked out and whether a package will come together that does include telehealth.”
In other words: Until there is concrete legislation that providers can count on moving forward, they’ll have to operate in the dark.
All that agencies can do until thenis invest in technologies and practices that drive better patient outcomes and achieve operational efficiencies.
“There’s some decision-making and portions of our investment decisions that we can still anchor on, even without perfect visibility as to how that regulation evolves,” Sandra Schrauf, the senior vice president of innovations at Amedisys Inc. (Nasdaq: AMED), said at FUTURE. “We’re also constrained by them as well, though. Not just from a reimbursement standpoint; we have to operate within the boundaries of what is allowed, in terms of what CMS considers appropriate for how this should be used as a part of patient care.”
With 526 care centers in 39 states and D.C., the Baton Rouge, Louisiana-based Amedisys is one of the largest home health and hospice providers in the country.
Home health providers have been tasked with navigating PDGM, heightened infection protocols, personal protective equipment (PPE) procurement and a slew of additional shifts in how to best care for patients.
Through the uncertainty, however, industry advocates and executives have mostly remained optimistic about both the present and future.
“I’ve been in the home health policy advocacy space for many, many years,” Cunningham said. “And one of the things that has always struck me about the home health sector is that these providers are problem-solvers by nature.”
An antidote to chaos
A large portion of home health agency employees had to work remotely when the COVID-19 crisis took over the U.S., and many are still doing so.
Meanwhile, COVID-19-positive patients, increased Low Utilization Payment Adjustments (LUPAs) and telehealth billing uncertainty have caused their own challenges..
Generally speaking, home health providers that are technologically advanced have the best odds of navigating all of those obstacles.
“There’s been an adherence to equipment and technology use in branch offices for these providers across the country, so we saw a massive investment in optimization tools,” said Forcura CEO Craig Mandeville, also at FUTURE. “There’s just been a seismic shift, to say the least, in investments and technology from January to today.”
Jacksonville, Florida-based Forcura is a technology company that helps post-acute providers with streamlining workflow and documentation management.
For Amedisys, its goal is to harness the digital and virtual momentum that it has kickstarted during the COVID-19 pandemic to drive better practices moving forward.
That starts with communication between the virtual care and direct care colleagues on patient cases, and between Amedisys and its clinical provider partners. Both of those relationships have improved at relaying information during COVID-19 due to a more virtual workplace environment.
While there’s still a lot of interoperability challenges in health care, Schrauf said, the communication patterns have been given a boost over the last seven months or so.
On the patient side, the seismic shift has also opened up how seniors and their families feel about using text and video to interact. They’ve gained comfortability with technology due to circumstance, which will help outcomes no matter the situation.
“There’s going to be a lot of opportunity for us in home health to think through how we can help patients take advantage of that new digital ecosystem,” Schrauf said. “And even with our own personal care partners, we’re thinking, ‘How can we coordinate with them to make sure that we’re working together to serve patients across the continuum?’”
For providers that may be more hesitant to invest in technology, whether it’s due to price or viability concerns, finding the right technology partner may ease those reservations, Mandeville said.
“For a provider, it’s about finding the right partner to really understand the issues at hand and analyzing that return on investment aspect from the onset,” he said. “That way, you can garner potentially higher reimbursements and then even higher margins by cutting costs [elsewhere].”
That’s why investing in the right technology now, even when margins are thin, could pay dividends.
“Technology is here to stay,” Cunningham said. “So find out how you can incorporate it successfully and learn the lessons from some of the thought leaders on this, because it’s going to be a hallmark of the health care system going forward in an even larger way.”