Despite a vital need for palliative care in community settings, home-based care providers have been slow to invest in such services. Providers have often cited financial concerns as a roadblock.
Yet those providers that have turned their attention to palliative care frequently see positive returns. TRU Community Care, for example, saw its palliative care segment grow by 103% over the course of nine months, partly due to the implementation of new telehealth tools.
Founded in 1976, Lafayette, Colorado-based TRU Community Care is a Medicare- and Medicaid-certified, nonprofit health care organization. The company’s service lines include home health, hospice, assisted living and palliative care.
At the end of 2019, TRU Community Care began its process of revamping its palliative care program. This meant expanding the programs to include physicians, NPs, RNs, social workers, chaplains and care navigators.
It also meant forming a partnership with Boulder Community Health, which created a strong referral pipeline.
But the secret sauce was adopting remote patient monitoring technology, through Vivify Health, enabling TRU Community Care to transition from in-person to virtual visits in December, according to Michael McHale, the company’s president and CEO.
“More and more people are living with advanced illness. And now because of COVID-19, people are feeling so isolated from their health care resources,” McHale told Home Health Care News. “I think that our expansion into telemedicine enabled them to have a connection back to the health care community.”
Currently, TRU Community Care serves roughly 820 patients across Boulder, Broomfield, Adams, Jefferson, Denver and Weld counties in Colorado.
Typically, palliative care services provide specialized treatment focused on relieving symptoms, often for patients with serious illnesses.
“When you look at traditional palliative care, obviously providers and social workers going out and making visits, we do it based on acuity, whether that be weekly, monthly or bi-monthly,” Chad Hartmann, director of palliative care at TRU Community Care, told HHCN. “With the remote patient monitoring, it gives us the opportunity to oversee those patients and what’s going on with those patients every single day.”
Since providing palliative care through telehealth, TRU Community Care has completed over 15,000 minutes of virtual visits.
Prior to adding virtual visits, nurses entering patients’ homes were able to complete a maximum of five visits daily. This number jumped to nine patients daily after adding virtual visits.
The new process allowed TRU Community Care to more easily track and trend patients’ disease progression over time, but it also was an added benefit in responding to the COVID-19 emergency.
“It’s really a mutual desire to limit folks coming into the home and then limiting exposure to COVID-19,” McHale said. “Right now, as in most of the country, Colorado is seeing an uptick in COVID diagnoses. We’re finding that more and more people don’t want someone coming into their home.”
Last year, TRU Community Care participated in a mHealth Impact Lab, University of Colorado study. The study found that TRU Community Care was able to save $40,000 through the use of virtual visits.
Historically, palliative care has not been associated with strong reimbursement, however.
Last month, the National Association for Home Care & Hospice (NAHC) publicly stated the organization’s plans to push for the recognition of palliative care as one of the services provided under the Medicare home health benefit.
TRU Community Care went the telehealth route because of the Centers for Medicare & Medicaid Services (CMS) “Patient Care First (PCF) – Seriously Ill Population (SIP)” demonstration. The payment model, part of the Primary Care First initiative, has yet to publicly announce which providers have been accepted to participate.
Still, the organization saw the program — and use of telehealth — as a way to achieve cost-effectiveness.
“The only way that we could see it make sense is if the majority of our visits were done telephonically,” McHale said. “Once you start putting in travel time, your visit cost increases. You have to pay that nurse or social worker that hourly rate for the time that they’ve traveled to the patient’s home and the cost of care that’s delivered while they’re in the home.”
Looking ahead, TRU Community Care is reaching out to other nonprofits in hopes of forming potential partnerships.
“The infrastructure that we’ve set up potentially could benefit them at a much lower cost and enable them to do more of this supportive service out in the community,” McHale said.