Hospices Seek Expanded Telehealth Post-Pandemic as Regulatory Uncertainties Linger

Integration of telehealth has become an important component in serious illness and end-of-life care. Providers leveraged telehealth to build efficiency and increase touch points with patients and families, while also reducing travel and leg work for staff.

But as pandemic restrictions start to wind down, regulatory uncertainties and questions abound about the long-term impact of telehealth.

Temporary regulatory flexibilities have allowed more extensive telehealth use during the COVID-19 public health emergency. For many hospices, what began as a temporary measure has evolved as an integral part of clinical operations.

Telehealth is “incredibly and unbelievably important” in hospice and palliative care, according to Nathan Goldstein, M.D., professor of geriatrics and palliative medicine for the Icahn School of Medicine at Mount Sinai. Goldstein also previously served as president of the American Academy of Hospice and Palliative Medicine (AAHPM).

“Telehealth is a game changer in terms of access and being able to allow immediate care for folks with significant and advanced care symptoms,” Goldstein told Hospice News. “It’s particularly great for those in more rural areas where it otherwise would take hours for clinicians to reach them. It allows staff to take care of more patients, which is important when there’s a tremendous shortage of specialty-trained clinicians in both hospice and palliative care.”

Telehealth has allowed providers to deploy strained employees in a much more efficient way, aiding in the ability to reach more patients in less time, according to Goldstein.

Maximizing efficiency has become vital during the pandemic. COVID-19 has further pressurized long-standing workforce shortages. Some hospices have shut down their programs or halted services due to insufficient staffing to meet demand for care.

Projections for the long term are rarely optimistic. Clinician shortages are projected to worsen during the next 25 years, with research indicating that demand will outpace supply for serious illness and end-of-life care.

Hospices have increasingly leveraged technology to create efficiencies and reduce burnout, and have found applications for staff education and training as well, according to Goldstein.

“With the innovations that continue to emerge as a result of telehealth and lead to more people who can care for the seriously ill, it’s really a win-win-win situation,” said Goldstein. “There are tremendous benefits to teaching our learners of clinicians, nurse practitioners, social workers, chaplains, nutritionists — the list goes on and on. The ability to use telehealth as a training tool really expands access and enhances education because of this ability to peer into patients’ lives and their families even better.”

Hospices have used telehealth systems to identify and educate clinicians about patient needs, including social determinants of health and the condition of their homes or care environment, according to Goldstein. Clinicians have also used virtual visits to assess medication or care plans in real time.

In terms of quality, stakeholders have expressed “cautious optimism” that telehealth can be used to improve the overall hospice experience, according to Erin Vernon, associate professor of health economics at Seattle University.

“Both caregivers and patients have had high satisfaction ratings with their telehealth experiences,” said Vernon during the AAHPM and the Hospice and Palliative Nurses Association (HPNA) Annual Assembly. “What we’ve seen is that hospices moving forward post-pandemic aren’t sure how much telehealth care they’re going to adopt. A lot of them are looking to continue these connections with families and saw it as an extreme benefit to this type of service.”

Patients’ perceptions of telehealth during the pandemic have largely been positive. A recent Net Health study found that roughly 80% of family caregivers indicated they would give a hospice higher quality ratings if the provider had real-time communication capabilities via computer, tablet and smartphone, but fewer than half (44%) do not use a digital platform.

With more clarity around telehealth rules, these services could prove as a promising avenue to help supplement some types of end-of-life and serious illness care, especially in light of the continued workforce shortages, said Vernon.

But the uncertain regulation trajectory is a pressing factor. Officially, the current rules allowing for expanded telehealth are still considered temporary.

Calls have grown louder from providers and industry organizations to make these provisions permanent. Last month, a consortium of 336 health care providers and other stakeholders wrote to U.S. congressional leaders to amplify that request. AAHPM was among these groups, as was the National Hospice and Palliative Care Organization.

While the U.S. Centers for Medicare & Medicaid Services (CMS) is mulling over the fate of those rules, providers can likely expect that telehealth will not be going away when the pandemic fades.

“The [telehealth] regulations are complicated, but they have been relaxed,” said Vernon. “They’re not going to go back to exactly what they were pre-pandemic. The regulations are going to change in this area and be more open to telehealth care.”