The Changing Scope of Telehealth for Hospice Care

Technology has played a vital role in sustaining hospice care during the ongoing national state of emergency. Federal agencies have increasingly allowed for temporarily expanded telehealth use, and hospice providers are anticipating a new normal for delivering patient care as the pandemic begins to peak in some areas across the country.

With the U.S. Centers for Medicare & Medicare Services (CMS) issuing new regulatory waivers and flexibilities for telehealth during the federally declared emergency, many providers are wondering about the potential long-term impacts.

“Changing practice patterns have been introduced by the COVID-19 public health emergency,” said Sharon Harder, president of Illinois-based C3 Advisors, said in a recent Hospice News webinar. “These will likely be sustained over a much longer term, with hospice utilization changed due to the pandemic.”

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In the period immediately following the pandemic, hospices will continue to face obstacles in providing quality end-of-life care with in-person visits, especially to patients who become infected or have been exposed. Telehealth has posed a solution to care delivery challenges, bridging emerging gaps and closing existing ones across the continuum of care settings related to hospice. Virtual technology can help hospices avoid any compromise in quality or effectiveness of patient care, according to Harder.

“The answer [to challenges] is going to be interspersing in-person visits with virtual care, even though this type of care has not been widely used by hospice teams,” Harder said. “The need for more care, more contact and more virtual services will not just be nice, but really critical to patient care management. The resistance to technology is evaporating in the face of risk. We now have explosive growth in virtual care with much widespread adoption on the part of patients and families that we’re trying to serve and better technology. Technology care will be our new normal in the coming days, months or even years.”

Hospice organizations have been leveraging technology such as remote patient monitoring systems to assess patient needs during the pandemic. Additionally, hospice providers are increasingly utilizing data analytics tracking technology to anticipate and identify potential high-need service areas and collaborate with referral partners to provide timely hospice care.

Providers continue to face one caveat as they embrace the wider use of telehealth. Currently, CMS does not allow them to bill Medicare for these telehealth visits, nor are hospices permitted to include those visits in their cost reports. With the number of virtual visits rising and the number of in-person visits falling, this could skew future hospice payments as CMS uses the cost reports to calculate annual rates.

While CMS waivers enabled hospices to use quick-fix solutions like. FaceTime, Zoom and various other communication platforms, the issues of patient privacy, security and spotty connection challenges have led to a booming need to invest in long-term solutions, according to Melissa Kozak, co-founder and CEO of Citus Health, a digital solutions organization for post-acute care providers.

Several critical requirements for utilizing virtual care technology, including secure, instant care support team messaging and live video sessions, electronic signature capture features, broadcast capabilities to patients and families for educational support on care needs, and electronic medical record (EMR) integration, Kozak indicated.

“Technology will enable hospice teams to do more with less,” Kozak said. “Care can’t begin until all those documents that establish the patient and family’s wishes are executed for a hospice’s record. Electronic signature remote forms capabilities give access to get these processes done and get care started. Virtual patient care allows for increased staff productivity as more patients are able to be seen with the same or less amount of physical resources.”

With increased opportunity to create and share surveys and forms for patient and family feedback, hospices stand to improve measurement of quality of care and patient and family experiences.

“Having the ability to stay connected through technology will go a long way towards building family satisfaction,” Kozak said. “It can also improve outcomes and reduce costs of care with increased hospice referrals and addressing patient conditions before they escalate and they end up in the [emergency department].”

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