The COVID-19 emergency has triggered a rise in the use of telehealth strategies to deliver care, especially virtual visits.
In fee-for-service Medicare alone, the number of virtual visits delivered each week in the U.S. skyrocketed from 14,000 pre-coronavirus to more than 1.7 million during the pandemic’s peak, according to Department of Health and Human Services (HHS) Secretary Alex Azar.
Although in-person visits still dominate in the space, many home health providers have added virtual visits to their operating mix, with many planning to continue them even after the pandemic subsides.
Despite their benefits, virtual visits pose unique challenges for providers carrying them out for the first time. To avoid unexpected speed bumps, there are several best practices home health agencies and other providers should consider.
In some ways, the public health emergency has exposed the shortcomings and limitations of current health care delivery systems, Kim Putnam, telehealth supervisor at ProMedica Home Health Care, said Thursday at the Vision to Virtual event, hosted by Health Recovery Solutions (HRS).
“I’m not going to say there’s anything good about this pandemic,” Putnam said. “However, it has certainly catapulted the term ‘telehealth’ out into the public.”
ProMedica Health System includes 13 hospitals across Michigan and Ohio. ProMedica Senior Care, the company’s post-acute care arm, includes skilled nursing facilities (SNFs), outpatient rehab, hospice and home health care.
For providers that are implementing telehealth programs, technical and functionality preparation is crucial.
That includes keeping IT teams connected and updating them about any technical issues that pop up during telehealth implementation. Doing so will go a long way in establishing a provider’s credibility when setting up their telehealth program, according to Putnam.
“When you begin your endeavor to do telehealth, … your IT departments have got to meet, and they’ve got to have support from each other and from your vendor,” she said. “There’s got to be interoperability so that when you get out to the home, you’re not having the frustration of the technology not working. There’s nothing more frustrating for the installer, the nurse and the patient when you get out there and something doesn’t work.”
It’s also important for providers to set up a “telehealth hub,” or central location in the office specifically for virtual visits.
At one of ProMedica’s locations, the telehealth hub is a back area that is walled off from the main office. The necessary equipment is also set up in this space, according to Putnam.
“You want to ensure that you’ve got a quiet zone,” she said. “You want to make sure that others are aware that the virtual visit is occurring. We have a little sign that we put up outside that says ‘virtual visit in progress,’ because there are folks that walk through this area. This ensures they’re not carrying out a conversation that could be overheard by the patient that’s in the home.”
Putnam also emphasized the importance of setting aside time for new nurses to practice using the equipment. This can be achieved by facilitating “mock” virtual visits.
“They may be a little intimidated at first,” Putnam said. “They’re kind of fumbling with the equipment, but once they get a comfort level … that kind of anxiety seems to step away.”
To this end, creating scripted scenarios can also be helpful in getting new nurses acclimated.
When working with patients, Putnam stressed the importance of calling them by their name, making sure they have the provider’s undivided attention and conducting a follow-up call with them the next day.
“Our overall goal should be patient engagement,” Putnam said.
One company, Banner Health Home Care, has been able to leverage virtual visits to better serve their clients that receive social work services.
“We have more patients than social workers,” Mandy Johnson, care coordination and post-acute senior manager at Banner Health Home Care, said during the event. “By using video visits, we’re able to connect with more patients than if we had to drive to each of their homes. We still do in person visits, but this allows us … to meet them where they’re at or to do those check-ins.”
Banner Health Home Care has six branches in Arizona and Colorado. The company’s average daily census is roughly 2,500 to 3,000 individuals served.
The opportunity for increased patient engagement is a key benefit of virtual visits, according to Johnson.
“When you talk to a patient over the phone, you’re not always able to tell if they’re engaging in the conversation,” she said. “You can’t always tell if they’re interested in what you have to say, or if they’re at a place in time where they’re ready to hear that information. By being able to see them, you can truly check and understand that they’re hearing you and they understood what you said.”