The future of telehealth is confusing for home health care providers. And it has left many scratching their heads, wondering how much they should invest into virtual care models.
On one hand, telehealth usage skyrocketed over the last two years. And no matter how much that usage stabilizes post-pandemic, it will likely never return to where it was in 2019.
At the same time, the home health sector is left out of the telehealth reimbursement picture. It’s not an easy fix, either. The home health benefit itself strictly prohibits agencies’ ability to get reimbursed for telehealth services.
“From a Medicare home health perspective, you’ve got a roadblock,” National Association for Home Care & Hospice President William A. Dombi said earlier this year. “The statute itself prohibits payment for telehealth services within the payment model.”
Dombi and other advocates were much more confident about the prospect of gaining reimbursement for telehealth services earlier on in 2020.
“I think we’re getting closer to making it happen,” he said in May of 2020.
Since then, despite efforts from advocates and lawmakers alike, momentum – for one reason or another – seems to have slowed. Telehealth usage has also slowed, but not so much that providers have gotten any less hungry for reimbursement.
In order to get it, Dombi believes the only way would be through Congress, and then afterward, through a pilot program developed through the Center for Medicare & Medicaid Innovation (CMMI).
But now that home health providers have delivered successful care virtually for so long, for free, some lawmakers are taking that for granted.
“Both in home health and in hospice, [agencies] delivered telehealth services quite robustly during the pandemic for free,” Dombi said. “And so now the next expectation is [they’ll] always do it for free.”
Home health providers feel a different way. They certainly don’t want to deliver telehealth services for free forever. To do it appropriately it takes time, resources and effort.
The question for providers, then, is how much to invest in telehealth as the pandemic somewhat wanes and the the reimbursement issue remains up in the air.
“I still think we have the momentum to get there eventually,” Dombi said. “It’s more about how you price it and how you credit it than anything else. But it’s not going to be the easy slide down into success that we’d hoped it would be to start with.”
The ROI of telehealth
Health Recovery Solutions (HRS) – the telehealth and remote patient monitoring (RPM) solutions company – has been helping home health providers deliver telehealth for years.
The company believes that no matter the reimbursement landscape, telehealth is more than worth investing in.
That’s particularly true in a time when there’s more demand for home-based care services, but dire shortages from a workforce perspective.
“When you look at the virtual visit model and the cadence of visits, we schedule them so that the patient gets a touch at least every third day, be it virtual or in person,” Patty Upham, the VP of clinical services for HRS, told Home Health Care News. “So actually, in most instances, the patient is getting more connection than they normally would if the nurse was visiting the patient.”
HRS aims to find ways for clients to gain a financial return on investment (ROI) without being reimbursed by a payer for telehealth visits.
“Part of what we do for clients is look at that ROI,” Upham said. “They need to be able to grow, they need to be able to support the referral sources. The virtual visit model was created to address the nursing shortage, but also to increase capacity for organizations to continue to grow, while keeping quality measures extremely high. … It really is effective, we do drive down the skilled nursing visits per day, and we do increase capacity to take on more patients.”
It’s a “simple mathematical equation,” Upham said. If you decrease skilled nursing visits by one or two per month, for 100 patients, that’s ends up being a lot of visits saved that can be used elsewhere.
HRS also has an ROI calculator to show exactly how the financials are adding up with supplemental telehealth visits.
“We include the costs of setting up the program, the cost of staffing and the cost of equipment, so that we actually can show what the net is, right?” Upham said. “It’s a really compelling tool, and when [agencies] see it, they’re like, ‘Wow, we need to get there.’”
Companies featured in this article:
Health Recovery Solutions, National Association for Home Care & Hospice
