AccentCare has leveraged telehealth services as a means of reducing the length of hospital stays for patients who are receiving fragmented care.
Virtual care became a necessity after the pandemic struck, and most hospice providers were quick to invest in and build out their telehealth programs. What began as a stopgap measure soon became an integral component of health care throughout the continuum.
Now, with more than two years under the waivers’ belt, a large contingent of hospices have come to see telehealth as a pathway to a more efficient, higher-touch care model as well as means of reducing expenses.
As they deployed their telehealth programs, Dallas-headquartered AccentCare — a portfolio company of the private equity firm Advent International — began using those services as an additional layer of support for patients who did not have a primary care physician to follow up after a hospital discharge .
“We’re looking at how we can put together an ecosystem that we could bring into any of our partnerships to help manage this, and I think telehealth is a component of that,” AccentCare Chief Medical Officer Dr. Anna Loengard told Hospice News. “Right now, we have partnered with [the Washington-based medical group] Sound Physicians around following our patients home who don’t have an established primary care provider, through the telemedicine waivers. It’s been very successful in getting patients both access to home health and allowing them to leave the hospital while the hospital tries to find them a [primary care provider].
Federal law allows the US Centers for Medicare & Medicaid Services (CMS) to waive certain regulatory requirements during a declared public health emergency (PHE). Waivers allowing for greater telehealth utilization were among the first that CMS implemented in the agency’s efforts to help slow the spread of the virus.
During the pandemic, hospices have been able to provide interdisciplinary services via telemedicine or audio as long as the patient is receiving routine home care level of care and those telemedicine services which are audio-only services are capable of meeting the patient and caregiver needs.
The $2.2 trillion CARES Act, designed to help the economy and essential industries weather the impact of the pandemic, also contained provisions related to hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters.
Hospices have adapted well to this changing environment and — generally speaking — have used telehealth to their advantage.
A May 2022 literature review found that the majority of research papers on telehealth published in 2020 and 2021 demonstrated a high level of patient satisfaction across every medical specialty. The literature review concluded that telemedicine is “undoubtedly” a convenient tool that has helped ensure continuity of medical care during the pandemic.
These findings dovetail with AccentCare’s internal analyses.
“We actually did a study that showed that there was a dramatic reduction in readmissions among patients who got the traditional in-person visits, but then also got a couple of extra touches with telehealth visits,” Loengard said. “I think we’re still looking to determine the optimal use of telehealth, but we definitely know that our on-call evening and weekend team can often solve a patient’s problem without having to send out the local team.”
Based on these and other data, expanded utilization of telehealth appears to be a win-win scenario for most stakeholders. But it still comes with a catch: These flexibilities are temporary.
Without further action the waivers will expire not long after the COVID PHE concludes. This is currently set to occur in October, although the government has extended the PHE multiple times during the past two years and may again.
The health care community, including many hospices and industry organizations, have rallied CMS and Congress to permanently enshrine these temporary considerations. CMS in 2020 indicated that it would conduct a review of the waivers to see which could remain in place for the long haul, but to date the agency has been mum on the future of the temporary rules.
This has left many providers in limbo, weighing the costs and benefits of further telehealth investment against the risk that virtual care won’t be sustainable in the long term.
Policymakers have not ignored this problem, nor have they solved it. But they have taken steps.
The US House of Representatives late last month passed the Advancing Telehealth Beyond COVID-19 Act, which would extend the waivers until the end of 2024, whether or not the COVID-19 public health emergency is extended. This would include the ability to re-certify patients for hospice through virtual visits.
While this legislative approval is a positive sign for proponents of telehealth, this is not a done deal. The bill must now wind its way through the fractious US Senate, which is often beset with well-publicized partisan rancor.
“It seems like a very logical extension or allowance going forward. There’s a lot of opportunity in telehealth, particularly for a patient or a family that’s struggling or in crisis to get immediate help,” Loengard told Hospice News. “I think it would be short sighted to let them expire. It would be a lost opportunity to enhance and expand our provider services via telehealth, particularly in palliative care.”