Patients and healthcare providers alike are fighting an uphill battle during the COVID-19 Pandemic. There are many reasons why:
1. Hospitals have postponed elective surgeries to keep doctors and beds available to treat COVID-19 patients and prevent the spread of the virus.
2. Patients are fearful of both visiting many clinicians from different disciplines and having clinicians enter their home during social distancing and stay-at-home orders.
3. Outpatient facilities are either closed or operating at limited capacity, only taking high-acuity or “priority” patients, such as those who have had surgeries.
4. Assisted/independent living facilities are limiting external clinicians, such as those from home health agencies and visiting physicians, from entering their communities.
5. Some physicians are reluctant to refer to therapy at times due to the unknown risks associated with COVID-19 and not wanting to expose their patients or put others at risk.
6. Healthcare providers, such as those working at hospitals and home health agencies, have staff members that live with at-risk family members or are at-risk themselves. They are thus reluctant to consider working with patients in-person during this time without extraordinary precautions. Such precautions have been difficult to take due to the limited resources of personal protective equipment (PPE) available, thereby necessitating innovative solutions.
Due to these aforementioned situations, amongst many other risks/concerns surrounding COVID-19 in the community, hospitals, outpatient clinics, home healthcare agencies, and other medical facilities have to find ways to assure that they can keep their current patients safe, provide the appropriate services to their current patients, keep their clinicians safe, all while continuing to accept new patients and keep their businesses thriving.
During these unprecedented times, innovation is paramount to optimize business and clinical operations. The leading trend in innovation currently is in telehealth. Although there are still hurdles to jump with telehealth, due to healthcare regulations, there are avenues that this could help facilities achieve their goals while caring for their patients. Medicare has already begun changing by, for example, allowing physicians to conduct their face-to-face visits via telehealth, and home healthcare agencies can currently use any platform to conduct telehealth until further notice without risk of any HIPAA violation. Telehealth platforms are also offering discounted rates and waived set-up fees to ease the financial burden while getting organizations “up and running” quickly and effectively.
Because the geriatric population is most at-risk with COVID-19, because home healthcare is vastly oriented toward care for the elderly, and because home healthcare is built on social proximity while COVID-19 mitigation demands social distancing, we will focus on the advantages of telehealth in the home healthcare industry. Telehealth can be provided to patients in via home healthcare agencies, but currently, due to medical billing regulations, cannot fiscally substitute a billable, in-person visit that is established on the plan of care, even though care can generally be rendered just the same. For example, a frequency of 2wk4 would require 8 visits to be conducted in the home. One way an agency can continue to provide services while limiting clinician-patient “in-person touches” and still providing the patient the care the patient needs, is to supplement frequencies with embedded telehealth visits. It remains imperative that the amount of in-person visits are appropriate and that the dosage of supplemented telehealth visits will assure that the desired outcomes and patient-centered goals are achieved, without increasing the risk for the patient to return to the hospital. This will allow not only for the goals to be achieved while limiting contact with the patient, but will also allow those clinicians that are considered at high-risk of contracting/spreading the virus to continue to provide care via telehealth, and thereby 1.) not put the clinicians out of work during this time where we need “all hands on deck,” 2.) curtail the spread of COVID-19, and 3.) continue to deliver care to those that are in need of care the most. By harnessing telehealth, a home health agency maximizes the number of available clinicians to assist in the continued delivery of patient care.
To summarize, there are many benefits to telehealth, which include, but not limited to:
1. Limiting exposure by decreasing in-person contact with patients.
2. Decreased driving time while doing telehealth allows for more patient care sessions per clinician.
3. Patients will feel more comfortable with continuing care during this pandemic, which decreases the volume of cases put on hold.
4. Decreases risk for re-hospitalization for those patients who otherwise would prefer to be put on hold, with no care being provided.
5. Optimizes patient outcomes and prevents decline in function during a time where access to a provider is not available or is limited.
6. Enables the providers/facilities to continue to accept more patient cases by maximizing available staff.
Besides assuring that the dosage of telehealth vs. in-person visits is appropriate for the patient, home healthcare agencies must also be mindful of not doing enough in-person visits, thus hitting a Low Utilization Payment Adjustment (LUPA) for that payment period. There are many ways that an agency can avoid this. One of the ways agencies can avoid a LUPA while achieving their desired goals/outcomes is to balance nursing/physical therapy visits in-person vs. telehealth, while allowing therapists to practice at the top of their license by contributing value-added services that are within the scope of the therapist. With another issue on the table being shortages of nursing staff, this could be an optimal solution for agencies. Agencies and therapists alike should always refer to their particular state’s regulations and scope of practice acts before executing this.
There are many practices within a therapist’s scope that quite often are not utilized, which results in increased utilization of all disciplines on a case, increased potential for care fragmentation, and increased exposure of the patient to potential vectors of COVID-19 transmission. With a therapist practicing at the top of their license, a home health agency can utilize their services appropriately, avoid LUPA, achieve desired outcomes and patient-centered goals, minimize exposure risks, and maximize revenue and profitability. The following includes services that are within a therapist’s scope of practice:
1. Medication Management and Reconciliation
2. Wound Care
3. Vital Sign Monitoring
4. Pulmonary Rehab/Postural Drainage
5. Respiratory Therapy / Nebulized Medications / Breathing Treatment(s) and Techniques
6. Orthopedic Rehab and Suture / Staple Removal
7. PT INR and Blood Sugar Check
8. Disease Management and Patient/Caregiver Education
9. Nutritional Management
10. Incontinence Training
11. Home Safety and Environment Assessment
12. ADL / IADL Training
13. Skin/Body Assessments, and Prevention of Skin Breakdown
14. Case Conferencing and Physician / Interdisciplinary Communication
15. Development of Care Plans and Supervision of Home Health Aides
16. Endurance and Strength Training
17. Fall Prevention and Balance Training
Telehealth companies like Virtual Therapy Partners (VTP) can partner with home healthcare agencies and assist the general community by having therapists provide care to patients at the top of their license and at the full scope of their practice. This can enable the optimal development and utilization of a multidisciplinary team to develop and conduct a hybridized in-person/telehealth plan of care. Furthermore, mitigating risk for the staff members is just as critical as caring for patients, and many home healthcare agencies have seasoned nurses and other care providers that themselves are considered to be at-risk populations for COVID-19. By partnering with telehealth-focused therapy companies like VTP, enabling the therapy team to practice at the top of their license, and allowing all the aforementioned interventions within their scope, the home healthcare agency is able to accept new cases and have their nursing staff supplement their in-person visits with VTP’s telehealth therapy visits to maximize patient outcomes and prevent re-hospitalizations. The referring and/or following physicians are educated that therapy will conduct an in-person OASIS Assessment and/or an in-person discipline-specific start of care (depending on how the agency and telehealth team discern what is the best method of care for each particular patient case), will develop the plan of care in conjunction with the skilled nursing team, and will provide the telehealth visits to supplement the in-person visits.
Allowing telehealth into your agency while maximizing the scope of therapy practices, will result in home healthcare agencies being successful during these unprecedented times. Furthermore, by adopting unique partnerships and telehealth practices, an agency will have a new model to provide innovative care during and beyond the COVID-19 Crisis.