Palliative care providers are faced with uncertainties that abound over the regulatory future of telehealth as they continue to shape their programs.
Some telehealth flexibilities that were temporarily implemented during the COVID public health emergency (PHE) are scheduled to sunset at the end of 2024. During the pandemic, the U.S. Centers for Medicare & Medicaid Services (CMS) allowed palliative care providers to perform patient care visits virtually. Though initially the telehealth waivers weren’t intended to be permanent, they may have lasting impacts on palliative care delivery.
As regulators shape telehealth policies, claims data for telehealth services will paint a picture of their impact, according to Allison Silvers, chief health care transformation officer at Center to Advance Palliative Care (CAPC). The organization recently held a conference in tandem with the Coalition to Transform Advanced Care (C-TAC).
Medicare claims can also be one way regulators gain insight into potential misuse of telehealth services, she said at the C-TAC-CAPC Leadership Summit in Washington, D.C.
“It’s going to be [about] trying to analyze the impact,” Silvers told Palliative Care News. “A part of what the government is concerned about is that it might be easier for fraud, waste and abuse to happen in telehealth. They want to see if there’s any excessive use of medical care because of telehealth. Most are expecting that it isn’t going to have a dramatic increase in volume, and therefore it could signal whether or not there’s a Medicare payment of care for an interaction with a provider.”
Long-term policies in limbo
Recent legislative moves have pushed for more expansive telehealth coverage. In June U.S. Sen. Chuck Grassley (R-Iowa) and 59 bipartisan co-sponsors reintroduced legislation that would extend Medicare coverage of telehealth and make permanent flexibilities implemented during the PHE. A companion bill was also introduced in the U.S. House of Representatives.
If enacted, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act would remove all geographic restrictions on telehealth services and expand originating sites to include the home, among others. It would also permit health centers, rural health clinics and eligible health care professionals to provide telehealth services.
Thus far, neither the House nor the Senate version has made it out of committee.
Expanding the regulatory parameters of telemedicine could benefit underserved rural communities in particular, according to Dr. Samyukta (Sam) Mullangi, medical director of Thyme Care.
A main challenge in rural regions is that seriously ill individuals lack access to palliative care due to a lack of providers in their communities. The ability to offer telepalliative services in rural communities has bridged some of those gaps, and thus improve outcomes and reduce health disparities, Mullangi said.
“There are a lot of shifts that we’re seeing we can benefit from. How telemedicine has scaled to the extent that it has over the last few years is to our advantage,” Mullangi told Palliative Care News. “It’s first providing virtual care team support, but it’s also the fact that because palliative care can be such a rare resource, this is something that can be scaled that much better because of telemedicine’s reach. We certainly capitalize on that in terms of bridging the lack of palliative access in every geographic region where we don’t see enough resources to meet a need.”
Oncology care provider Thyme Care recently completed a $60 million funding round to expand its health services for cancer patients, including palliative care and programs to address social determinants. A portion of the funds will be allocated towards finding solutions to increase access to palliative care in regions with sparse resources, with telehealth a key consideration in that mix, she said.
Boosting access and quality
Thus far, the growth of these services have enabled providers to care for patients and families they otherwise would not be able to reach, according to Dr. Andy Esch, palliative care specialist and senior education advisor at CAPC.
On one hand, telepalliative care has allowed providers to engage with patients at different stages of their illnesses across various health care settings, he said. Telehealth has additionally played a key role in improving caregiving support and connecting patients and families to much-needed resources, he indicated.
“For providers, while the rule is open and we’re able to do it, I think we’re going to embrace it and maximize that – because it impacts quality of life for the patient,” Esch told Palliative Care News at the Leadership Summit. “It’s easier on the caregiver, and patients in general, like telehealth. It also gives us the ability to get to people that normally we might not get to as often as we should or would like to as far as check-ins and other things. There’s equity issues that will keep palliative care providers using it and that improvement of care in terms of quality of life and not being dragged to another doctor’s appointment.”
Telehealth will be a key to meeting the needs of a swelling seriously ill aging population, according to Dr. Jennifer Ritzau, vice president of medical staff services at HopeHealth.
It has already expanded the reach and diversity of palliative care services, she said.
“The silver lining of the pandemic is that it has really catapulted telemedicine. For some people who we really can’t reach in other ways, we either need to get ourselves out to their house, or we need to contact them virtually,” Ritzau said during the Hospice News Palliative Care Executive Webinar series. “These patients are going to be increasingly difficult to reach and to take care of. You cannot take care of the whole person without addressing unmet needs, which really is what palliative care strives to do.”