Telehealth adoption has dramatically increased across health care during the COVID-19 crisis, including in the home-based care space.
On their end, home health providers have built out their telehealth programs to make more comprehensive and safer care plans for their patients. Unlike other health care practitioners, however, it is much more difficult for a home health provider to get paid for virtual visits.
That has forced them to get creative.
For instance, Ohio Living Home Health, a large home- and community-based services provider that conducts over 170,000 home health visits per year, has been able to bill for palliative care remote patient monitoring under Medicare Part B.
It has been unable to bill for those remote services in home health, but still conducts those virtual visits anyway.
“The [reimbursement] is provided under the palliative care program, not home health,” Yvette Valentine, director of office operations at Ohio Living Home Health, said last week at the Vision to Virtual conference hosted by Health Recovery Solutions. “So the patient is on home health, and we’re still billing our home health services under Part A. And then if the patient is on palliative, that billing is done under Part B, along with remote patient monitoring.”
In order to recoup some reimbursement for telehealth labor, it has also worked with commercial groups, such as UnitedHealthcare and other Medicare Advantage payers.
Fairhaven, Massachusetts-based Southcoast Visiting Nurse Association has had similar experiences to Ohio Living Home Health. It is unable to receive reimbursement for home health remote visits, but still receives some payments from the U.S. Centers for Medicare & Medicaid Services (CMS) on its palliative care side of the business.
The agency — which serves over 9,000 patients per year in Massachusetts — is also expanding its home health telehealth services, despite the lack of reimbursement.
“We are not currently receiving reimbursement through CMS for home health remote patient monitoring,” Jessica Magalhaes, the agency’s telehealth program leader, also said at the conference. “But we’re working to expand the program by partnering with Southcoast’s ACO group.”
Broadly, palliative care has become increasingly prevalent among home- and community-based organizations’ service lines.
A 2019 report published in the Journal of Pain and Symptom Management highlighted that serious health-related suffering will almost double by 2060 in the U.S. Those projections suggest that an emphasis is needed on palliative care.
That’s also reflected in recent changes to Medicare Advantage supplemental benefits over the last few years. More and more MA plans are paying agencies to provide palliative care to their beneficiaries, which could provide tailwinds for both home health and home care agencies in the future.
CMS last expanded the list of telehealth services that Medicare fee-for-service will pay for during the coronavirus public health emergency on Oct. 14. As a result of the expansion, Medicare now pays for 144 services performed via telehealth.
Between mid-March and mid-August 2020, over 12.1 million Medicare beneficiaries – or over 36% of people with Medicare fee-for-service — have received a telemedicine service.
Not all home health providers are new to telehealth. As a provider that deals with patients on a slew of islands in the Northeastern part of the U.S., telehealth has been a part of MaineHealth Care at Home’s business since the turn of the century.
Its experience is an advantage in the space. So is the state it operates in, as Medicaid does currently reimburse for telehealth services in Maine.
Still, while telehealth is a must for the organization, its reimbursement still lags, especially in home health care.
“We’re doing quite a bit [of telehealth] in rural Maine,” MaineHealth Care at Home Donna DeBlois said at the conference. “We’re not getting paid very well, but we are trying to pursue partnerships with our Maine medical partners to be able to do Part B billing for telehealth.”
But COVID-19 has helped its patients and their families become more comfortable with telehealth overall, and the strides made over the last year, DeBlois hopes, will pay dividends moving forward.