Over the last two years, telehealth usage has increased significantly. During the peak of the pandemic, virtual visits suddenly became the only way to reach some patients. Telehealth services grew by more than 1,000% in March of 2020 and more than 4,000% in April of that year, according to a study. Although, from January to February 2021, it was reported that telehealth usage decreased by 16%, indicating that the momentum has slowed down. Nevertheless, the application of telehealth will most likely never return to where it was pre-pandemic.
On the other hand, telehealth cannot be reimbursed under the Medicare home health benefit. This is an obstacle that providers, advocates, and lawmakers are keen on overcoming. Home health providers certainly do not want to deliver telehealth services at no cost forever. The question now for providers is how much to invest in telehealth as the absolute need for it wanes along with the threat of the pandemic and the reimbursement issue remains uncertain.
Telehealth Guidelines
Despite no clear mechanism from the Centers for Medicare & Medicaid Services (CMS) for reimbursement, telehealth presents an opportunity for home health agencies to optimize patient care delivery considering the limitations brought by the pandemic and the staffing shortage.
Here are some guidelines to keep in mind to maintain compliant telehealth services:
- Telehealth visits should be ordered by the physician. A lack of in-person visits will still trigger a low utilization payment adjustment (LUPA). But once the LUPA threshold is met, agencies can have the freedom to conduct more remote visits.
- Telehealth services should be part of the plan of care (POC) that has been set up by the physician.
- Providers must use interactive audio and video telecommunications system that permits real-time communication between the remote site and the patient at home.
- As per the 2022 final rule, CMS permits the use of telecommunications technology when performing the 14-day supervisory visit requirement when a patient is receiving skilled services.
Growth Opportunities in Telehealth
Despite the questions and the seemingly halted momentum of telehealth, it is still worth investing in. The demand for home-based care is still prevalent as ever, which would require virtual visits, among others. The virtual visit model was intended to alleviate the dire staffing shortage, which it successfully has.
However, considering the benefits and growth potential of telehealth, it should still be utilized as an add-on service rather than a replacement for in-person visits. There are ways to use telehealth strategically as a supplementary service that incorporates hands-on care. After all, telehealth can include telemedicine, wherein clinicians remotely monitor patients’ vital signs, activity levels, and medication usage; and personal emergency response systems, which signal when something has gone wrong.
For instance, you visit a patient who is recovering from a hip fracture and discover they have chronic diseases. Following this visit, you can examine how to deal with their chronic disease such as chronic obstructive pulmonary disease (COPD) and their cognitive impairment. In this case, a home check would be face-to-face, but a medical reconciliation meeting can be virtual. Clinicians can then send patients reminders or interactive video tutorials to educate them on their condition.
Tips for Successful Telehealth Visits
Here are some recommendations to make the most of virtual check-ins:
- Help your patient with the technical setup. Spend a few minutes during in-person visits to ensure patients can sign on and use the telehealth system. Include this as a standard step when onboarding patients so that the time spent will be on their health and not on technical issues.
- Watch for patient cues. Pay attention to signs of physical and emotional changes and ask about them. Doing this through a computer screen can make this more challenging, so train yourself to probe further as these would be important clues that might be worth investigating. Below are some key things to look out for:
- Is moving or adjusting their position seemingly painful?
- Do they seem distracted and anxious?
- Is it challenging for them to answer questions, which could indicate cognitive issues?
- Are there obvious signs of fatigue that could be due to sleep deprivation?
- Are there indicators that they have been crying and are possibly depressed?
- Is there a new abrasion or bruise that could have been sustained in a fall? Ask them about it.
- Increase participation by inviting family caregivers. This would cultivate a more comfortable environment for the patient and would therefore be helpful in uncovering health or safety concerns. Having loved ones present would also help in reinforcing your care plan.
- Check-in by phone. Although audio alone does not count as a valid telehealth visit, phone calls are still an effective and efficient way to check on patients between visits. Casual conversations through phone calls build patient rapport and signify that a home health provider is reachable which is crucial to effective home healthcare.
Sustaining Business Growth
With the increasing demand for home-based care, home health businesses must strategize to pursue growth opportunities amidst setbacks in staffing. In order to increase capacity to take on more patients, agencies must maximize clinical staffing utilization and optimize patient visit schedules.
Aside from taking advantage of technology such as telehealth, agencies can also partner with an outsourced clinical team that can provide support for back-office functions. In this case, the agency’s in-house clinicians can focus on seeing patients and improving care delivery. By having a reliable outsourcing partner, agencies are equipped with more time and opportunities to explore endeavors that drive growth in all aspects.
