A bipartisan group of congressional legislators have introduced corresponding bills in the House and the Senate that would allow hospice physicians to re-certify patients via telehealth systems, among other provisions.
Current Medicare Conditions of Participation require a hospice physician to meet with a patient face-to-face as part of the recertification process that initiates after the patient has been in hospice for 180 days.
Sens. Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.) and Reps. Cindy Hyde-Smith (R-Miss.), Ben Cardin (D-Md.) and Peter Welch (D-Vermont) have put forth the CONNECT for Health Act to expand the use of telehealth throughout the Medicare system across multiple health care settings.
“The Connect for Health Act of 2020 is a common-sense, bipartisan solution that will modernize the way we ensure access to care for Medicare beneficiaries at the end-of-life,” said Tom Koutsoumpas, president & CEO of the National Partnership for Hospice Innovation (NPHI). “Currently, hospice recertifications are required to be performed in-person by a physician which creates unnecessary travel and time away from providing essential care at the bedside, particularly in rural areas of the country.”
The new bipartisan legislation would amends Title 18 of the Social Security Act. Current restrictions due to geographic and originating site requirements allow beneficiaries to receive telehealth services only if they are in certain rural areas and at certain clinical sites, contributing to low telehealth utilization among Medicare-certified organizations. Only 0.25% of Medicare beneficiaries use telehealth services, according to the U.S. Centers for Medicare & Medicaid Services.
If enacted, allowing recertification via telehealth could have a significant business impact on hospice operations.
“The hospices would have to pay for the telehealth technology themselves, but once that was set up, allowing the actual physicians and nurse practitioners to devote more time to working in the organization in other ways would have a great impact,” Mollie Gurian, director of hospice, palliative and home health policy for LeadingAge. “We have heard from some programs that the amount that they spend on full time employees doing these recertifications is quite large. It could be as much as half a million dollars just for the professionals to do face-to-face recertifications. That would be a huge impact, as well as a way to more fully test telehealth in the hospice benefit.”
Expansion of telehealth would have the most impact on patients in remote and rural areas that hospice personnel could take some time to reach. Hospices can leverage the technology in a variety of ways. They allow patients and families improved access to clinicians and enable staff to consult specialists or physicians while in the patient’s home. Clinicians also use the systems to stay in touch with patients during weather emergencies or when road conditions are slowing or impeding travel.
“We think it will have an immediate positive effect on rural areas and hard to reach urban areas and really be able to free up the time of our physicians and nurse practitioners to really focus on patient care,” John Richardson, chief strategy officer for NPHI, told Hospice News. “In hard to reach areas, rural areas, even some densely populated urban areas where there is a long travel time. The need for a physician or nurse practitioner to go out and do this face-to-face recertification can be very burdensome, and these are folks who have a lot of other responsibilities.”
Hospices will still be required to comply with documentation rules for recertifications. Errors and omissions in these processes are common red flags that could bring regulators to a hospice’s door.
CMS is likely to strengthen its oversight of hospices in the wake of several reports from the U.S. Department of Health & Human Services Office of the Inspector General that detailed compliance deficiencies among hospices nationwide, including one report that discussed examples of serious safety issues that put patients at risk.
According to Richardson, relaxing the rules in regards to telehealth is unlikely to lead to complications when it comes to compliance.
“Considering the fact that Medicare allows [telehealth] to be used for other organizations in other settings, I think they have worked out some of that documentation requirements, and I assume they would follow a similar type of policy here,” he said. “I think if telehealth is used correctly we would have no reason to think that there would be any program integrity issues.”