The COVID-19 pandemic caused havoc and heartache around the world. Nowhere is this more evident than in our US healthcare system. But now that the pandemic is leveling off, it’s time for retrospection about what went wrong and why, and how to prepare for the next one. It’s equally important to identify what went right and how we can leverage those things to improve our healthcare delivery system going forward. “Telehospice” and remote patient monitoring (RPM) are great examples.
Following are four ways providers and patients have benefited by using telehospice and RPM as a patient-centric approach to hospice care during the pandemic.
There has been much research on the clinical and cost benefits of using telehealth in delivering care to hospice patients and their families. Yet just 0.25% of Medicare beneficiaries participate in telehealth services. Barriers to adoption include the reluctance of staff to embrace telehealth and the hesitation to purchase and implementation of the technology, including devices needed to monitor patients remotely. But the pandemic has changed that—quickly.
Hospices have been forced to quickly implement telehealth as the primary tool in delivery care while complying with social distancing guidelines. Many hospices report difficulty getting to their patients in nursing homes and assisted living facilities because they are on lockdown, not allowing anyone other than essential staff inside. Telehospice has enabled caregivers to reach patients where they live, and RPM has allowed providers to continue caring for their patients without compromising quality.
Evidence shows that most patients and their families are willing to accept telehospice and RPM as part of their regular care program. In fact, there is some indication that patients may not want to give it up once the pandemic has waned. In a recent survey of US consumers, 59% said they are “more likely to use telehealth services now than previously,” and 36% said they “would switch their physician in order to have access to virtual care.” The reasons are relatively easy to understand, especially for hospice patients and their families.
Even without a highly infectious pandemic, many families are reluctant to have a stranger, even a nurse, into their loved one’s home without being there with them. But that hesitation is understandably greater during a pandemic when the patient is highly vulnerable to the virus. Every visit is an invitation for infection, and the proof is in the numbers. As of April 20, there have been more than 36,500 cases of COVID-19 and 7,000 deaths, as reported by 4,100 nursing homes across the country.
Expanded Access and Reach
One of the issues the pandemic has highlighted is the absence of care resources in rural and underserved areas. Hospitals in those areas have been closing in record numbers because of increasing financial pressures, leaving patients at increased risk. Prior to regulatory changes brought about by COVID-19 policy, telehealth was approved by the CMS primarily for rural and underserved areas. Due to the pandemic, those requirements were relaxed. Providers are now reimbursed at higher rates for both telehealth and RPM, but it’s too early to know if that will change post-pandemic.
Last October, a bill was introduced to the senate that would ensure patients could get the care they need no matter where they’re located. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 would waive current geographic restrictions around who and where telehealth and virtual care can be delivered. The bill was referred to the Subcommittee on Health on November 1, but no further action has been taken thus far.
To complete the recertification process, providers have to meet face-to-face with the patients 180 days after they enter hospice care. Managing this process is resource-intensive and costly. According to an article in Hospice News, some programs spend up to half a million dollars doing the face-to-face recertifications. The CONNECT for Health Act of 2019 would allow recertifications to be done via telehealth, significantly reducing costs and increasing staff efficiencies. It would allow staff to take on more activities at the office instead of spending the majority of their time traveling.
Here to Stay?
According to the CDC, there are 1.4 million terminally ill patients in the US who receive hospice care. As our nation ages, this number is likely to increase. Caring for these patients is a challenge in regard to costs and resources. What we’ve experienced from the COVID-19 pandemic supports the research: telehealth and RPM can improve the quality of care, increase access, and reduce costs. We would be doing a disservice to our providers and to our patients if we were to overlook this opportunity to make a true, lasting, positive change for terminally ill patients and, instead, return to pre-pandemic policies.
David Ryan, general manager of health and life services at Intel and a board member for the Alliance for Connected Care, is quoted in an article in FierceHealthcare, “At Intel, we have seen how telehealth and remote patient monitoring are facilitating better patient outcomes. This legislation will facilitate the adoption of digital technology that is key to the future of healthcare for our nation’s seniors.”