With Telehealth’s Uncertain Future, Hospices Must Be ‘Flexible’

Legislators recently proposed to extend the telehealth flexibilities temporarily granted during the pandemic. These efforts come at a time when telehealth utilization is making waves in hospice staff and patient engagement, as well as operational efficiency and care coordination.

Hospices have leveraged telehealth to a greater extent in recent years, with some seeing a range of benefits for employees, patients and their families, according to Patrick Hale, executive vice president and chief information officer at VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHEM).

Reduced access to telehealth could have negative impacts on quality and operational workflows for many providers, Hale stated. Hospices will need to be nimble as the future of telehealth unfolds in health care, he said.


“When we look at the changing landscape of regulations, we’re going to roll with it, whatever it is,” Hale told Hospice News. “But if telehealth was suddenly ‘shut off,’ that would be detrimental. That takes a tool out of our toolbox that we have found is pretty effective at enhancing the care experience and quality of care. If you’re a health care provider today, the watchword is ‘flexibility’ — you have to be ready with wherever the regulations may take you.”

Congress currently is mulling a bill, the Preserving Telehealth, Hospital, and Ambulance Access Act, that proposes to extend the expiration of regulatory flexibilities tied to telehealth through 2026. Currently set to expire Dec. 31, these waivers included the ability for hospices to recertify patients via telehealth services.

If enacted, the legislation could allow hospices more time and opportunities to collect data on the full scope of impacts of telehealth utilization, Hale said. The short period of loosened telehealth regulations has not provided a wide enough view to determine how providers could continue to augment in-person care with virtual services, he stated.


“There’s been a tremendous effect of telehealth, but I think we need to see that borne out in clinical studies to give it a chance to become a more mature offering,” Hale said. “Initial anecdotal evidence shows that it certainly is more effective clinically, but we need more measurable data.”

Hospice telehealth impacts

Telehealth can be used in a variety of ways, but has become a key to addressing patient and family needs during triage hours, according to Hale.

The primary way that VITAS utilizes telehealth is to hold clinical virtual visits with patients and their caregivers during after hours, which can offer insight into emergency situations in need of in-person attention, he said. This telehealth utilization has been the most measurable way to see impacts on cost of care and allocation of staff resources, Hale indicated.

VITAS averages roughly 3,400–3,500 telehealth interactions with patients and families on a monthly basis, Hale said. Overall, telehealth visits account for about 8% of the company’s overall total call volume after hours, he added.

Telehealth utilization thus far has not yet reached a full “tipping point” in end-of-life care, with regulatory uncertainties posing the main barrier to expanded opportunities, Hale indicated. Among the impacts of expanded telehealth have been increased care collaboration among interdisciplinary teams, which has paved the way for improved quality outcomes alongside greater recruitment and retention rates, he stated.

“It augments bedside care, but doesn’t replace it,” Hale said. “We’re using telehealth as an internal recruiting tool and it’s an external patient contact to better utilize our clinical staff in a way that’s most impactful to our patients and families. Our recruitment and retention [have] improved significantly over the last 12 months [and] this is part of a reason why. It’s using very limited talent in after hours clinical staff if we can eliminate a couple bedside visits that may just be quick concerns rather than emergency situations. That’s more beneficial for patients and with job satisfaction.”

Calls are growing louder among providers, stakeholders and legislators alike to make some of telehealth waivers permanent. Among the factors is a drive to improve health disparities and remove barriers to care.

Expanded telehealth services have brought benefits in terms of improved access among underserved patients in rural and hard to reach geographic areas, according to Bivek Pathak, chief information and digital strategy officer at Empath Health. Telehealth utilization has led to improved care coordination, more balanced clinical capacity and more timely hospice access and interactions – particularly during triage hours, Pathek said.

“Clinicians are no longer bound to spending a lot of time traveling to the patient, place or facility,” Pathak said. “And that is basically driving efficiency on the employee side as clinicians have a lot more flexibility to do their job. It’s also more perspective on patient and family engagement.”

Thus far, telehealth utilization has helped Empath to deepen its bedside presence and understanding of both patient and caregiver experiences by providing staff with a virtual window into their environment, Pathak stated. With this greater insight, hospices can help ensure they’re addressing a range of patient and family needs, he said.

Telehealth has also helped lead to  important wins in the battle against staffing shortages that the pandemic exacerbated, he added. Though many providers have seen workforce pressures ease, challenges remain as demand for hospice rises, Pathak indicated.

“[Telehealth] adds one more dimension with that consistency and perspective of scheduling and flexibility [to] drive efficiency and productivity,” Pathak told Hospice News. “Our nurses can be a lot more productive and operate from one place and field an inquiry for a patient. There are a lot of things they can do right from where they are and from the patient and family, it’s based on the benefits of convenience. The flexibility to reach them at home is a big piece of continuity of care.”

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