Palliative care delivered via telehealth is effective at improving access to caregiver support. Moreover, these services can also be cost-effective, recent research has found.

For the study, caregivers of hospitalized patients who dwell in rural areas participated in a randomized, 8-week intervention consisting of video visits conducted by a palliative care-certified registered nurse. These visits were supplemented with phone calls and texts.

For reimbursement, providers relied on the Transitional Care Management (TCM) and Chronic Care Management (CCM) billing codes. The research was published in the American Journal of Hospice & Palliative Medicine.

“[Technology-enhanced transitional palliative care] is a feasible, low cost and sustainable strategy to enhance [family caregiver] support in rural areas,” researches indicated in the study. “Potential reimbursement mechanisms are available to offset the costs to the health system for providing transitional palliative care to caregivers of patients recently hospitalized.”

The cost of these services facilitated by a registered nurse was $395 per caregiver, compared to $337 and $585 if offered by a social worker or nurse practitioner, respectively.

When TCM is offered on its own, the mean Medicare reimbursement ranged between $260 and $322 and $260 for families with moderate or high complexity patients. Reimbursement in the CCM-only scenario was $348 and $274 for complex and non-complex patients.

However, when those two types of services were combined, payments fell between $397 and $496.

Complicating the matter is the reality that telehealth flexibilities implemented during the pandemic are slated to expire at the end of this year.

In a recent hearing before the U.S. House Ways and Means Committee, U.S. Health and Human Services Secretary Xavier Becerra said that his agency was willing to make them permanent. However, he said this would require closer collaboration with state governments.

“We’re with you. We can’t allow those flexibilities to expire, and we need to work closer with our state partners, because much of the flexibility that comes from telehealth means being able to go over state lines,” Becerra said. “Right now, because states decide who gets licensed to do care, we have to have the cooperation of the states so we can go beyond its own state borders.”

Hospice providers, industry groups and other stakeholders recently penned a letter urging Congress to improve payment for end-of-life and serious illness care among rural populations.

The letter highlighted the unique challenges that rural and frontier hospice and palliative care providers face, and how strengthened financial support could lead to sustainable access and better care transitions for serious and terminally ill rural-based patients.

Among the signatories were 63 hospice and palliative care providers across the country, 14 state hospice and palliative associations, the National Hospice and Palliative Care Organization (NHPCO) and the health care technology company Axxess.

“Rural hospice [and palliative care] providers are struggling to stay financially viable and for many are relying on community goodwill and donations to keep our doors open …,” the letter indicated. “Without sufficient access to hospice services or palliative treatment, patients and their families will have to turn to emergency rooms, resulting in worse patient outcomes and increased costs to Medicare.”