Like providers, patients and families are adapting to rising use of telehealth in hospice care during the COVID-19 pandemic, as apparent plans to make temporary regulatory flexibilities permanent start to move forward. If telehealth remains a growing priority among hospices, gauging patient and family satisfaction with those services will be critical, particularly as they prepare to negotiate with Medicare Advantage plans starting in 2021.
The U.S. Centers for Medicare & Medicaid Services (CMS) extended a number of flexibilities for telehealth on a temporary basis during the COVID-19 national emergency. The White House recently issued an executive order instructing the U.S. Department of Health & Human Services to review those actions to see which could be made permanent. These moves by CMS coupled with the need to maintain social distancing has caused demand for telehealth to skyrocket.
Patient and family satisfaction will be critical to maximize as hospice moves towards value-based payment models in 2021. Emerging evidence suggests that senior citizens comprise the demographic that is most eager to use telehealth for chronic care management, according to a recent consumer survey by health care company American Well (AmWell). Respondents cited chronic disease management and prescription renewals as the leading drives towards telehealth among older populations.
AmWell reported that of the 47.8 million Americans over the age of 65, 24.85 million were willing to use telehealth. Interest in telehealth among seniors was found to be driven most by faster access to care providers.
“The 65+ demographic was most interested in using telehealth to receive faster care,” read the report. “Seniors were also the demographic most interested in receiving better access to their health care professionals, which they valued almost as much as cost savings.”
Another survey from data solutions company Kyruss spanning the COVID-19 pandemic’s initial hit into the nation from February to May also showed positive patient perception of telehealth, reporting high overall satisfaction with virtual care among the responses, including those in hospice settings.
“Seniors are very receptive to [telehealth] when it is recommended by their doctors, yet the technology they use needs to be simple,” said Drew Livingston, who spoke on the evolution and innovation of telehealth at a recent 36|86 virtual health care event. “The rule of thumb for seniors, based on my experience in telehealth, is that if an individual can text, they will be able to engage with their provider through a telemedicine visit.”
Livingston is chief innovation officer of Harrow Health, Inc., and CEO of Visionology, a telemedicine company launching later this year. He previously co-founded telemedicine software solution company Doxy.me.
“Time is of the essence for health care when you are a senior,” Livingston told Hospice News following the event. “Getting quick access to a care provider via telemedicine can make all the difference. Telehealth for hospice gives patients a level of comfort knowing that care is a click away. Many seniors feel isolated and alone when they are in hospice care. Telehealth also allows a caretaker or family member to involve other loved ones through a three-way, HIPAA-compliant video call so that everyone can be part of the hospice care process without having to be in the same room physically.”
Despite positive feedback, hospice providers have faced several challenges as they work to expand their telehealth programming. With barriers such as a lack of internet access for some patients and social isolation among seniors, hospices are zeroing in more closely on social determinants of health.
According to the AmWell survey findings, providers should seek to gain a better understanding of consumer health care personas in order to tailor telehealth programming to age-specific patient needs, including those who serve older populations. Hospice providers have increasingly utilized technology, such as adoption of predictive analytic systems, to help identify patients in need of their services further upstream in their disease trajectories.
The complex needs involved around the end of life have many hospice providers concerned about their ability to adequately assess patient needs virtually. CMS reported that patient assessment topped the list of most common deficiencies found during regulatory surveys in 2019, with 42% of hospices surveyed failing to provide key content in areas such as pain assessment and updated comprehensive care plans.
“The most common objection I hear is the fear that talking about difficult issues via telehealth will be harder somehow, but the opposite is usually true,” Brian Mistler, chief operating officer of California-based palliative service provider Resolution Care, which operates a virtual palliative care program that enables clinicians to support patients and families in real time. “People often find it easier to get to the heart of the matter more quickly and to share what’s really going on within the frame of the telehealth platform when the doctor or other facilitator is an expert. There’s something about the clear boundary of telehealth that actually helps people open up and focus.”
Patient monitoring systems have aided hospices in assessing care needs remotely with the ability to analyze data collected through routine visits such as blood pressure, weight, heart rate and blood sugar and oxygen levels. Technological advances are expected to continue to unfold in the hospice industry as telehealth programming opportunities expand beyond COVID-19.
“The future for telehealth in the hospice space will have more diagnostics that work seamlessly with a telehealth visit,” said Livingston. “For example, smart bed sheets can measure blood pressure, blood oxygen, hydration and more, and they alert the hospice care provider so that a patient’s care can be escalated as needed. At the end of the day, the use of telehealth in hospice care needs to be driven by care providers and family members pushing for their loved ones to take advantage.”
While CMS may permanently enshrine the temporary COVID-19 telehealth rules, the number provisions affecting hospices remains undetermined as the agency conducts its review. Preparing for the post-pandemic landscape will involve hospices embracing the changing winds towards increased virtual care, as well as buy-in from policymakers.
“Hospice and palliative care often work with the most vulnerable populations in many ways, dealing with very difficult issues,” Mistler told Hospice News. “There is perhaps no other field where telehealth offered in a quality way is as critical and transformative as it is for hospice and palliative care patients. Individuals who may not be your traditional first adopters also have had a chance to explore technology because it keeps them safer, and they’ve found it’s also a lot more efficient and convenient. It is critical that local, state and national governments continue to prioritize broadband internet access for all communities so every individual and every health plan both can take advantage of telehealth’s convenience and cost savings across populations.”