Major changes for the “Good” for Medicare-2019

Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019.

“Although there have been many strides in adopting and using virtual care and telehealth within the past year, there is considerable opportunity for the home health industry to more fully embrace the power and value of this technology,” Horner said. “Barriers include the fear of a new technology being disruptive to current workflows, lack of an IT infrastructure which can support patients’ evolving digital health habits, and reimbursement policies.”

In October, CMS proposed a rule that would give MA plans more flexibility to offer government-funded telehealth benefits to all enrollees, regardless of whether they live in rural or urban areas. In addition to eliminating the market restriction, CMS’ proposal would also allow MA enrollees to receive telehealth services from home, rather than requiring them to go to a clinic, SNF or other health care facility.

If implemented, the proposed changes would go into effect for the 2020 plan year. In part, CMS is proposing the changes, according to the agency, because the Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” as part of government-funded “basic benefits.”

Medicare Advantage is an increasingly prominent payer for home health agencies. These plans — offered by private insurers using government funds — also will be allowed to cover private duty home care services starting in 2019.

“Expanded access and coverage for virtual care will benefit the entire health care ecosystem,” Horner said. “The use of technology to allow visiting nurses and home health providers to deliver care remotely will optimize productivity by turning ‘drive time’ to ‘patient time,’ while also helping agency owners and administrators better hire, train and retain talent.”

‘A step in the right direction’

Spun out of Stratus Video’s telehealth division at the beginning of 2018, Synzi is an example of the impact telehealth can have on home health providers’ operations. Synzi’s tech platform uses a combination of video, email and secure messaging tools to help home health providers stay in touch with patients.

Trilogy Home Healthcare, a Florida-based home health company with roughly 3,000 patients and about 700 employees, began using Synzi in June across a handful of its locations.

“The feedback we have received from referral sources has been very positive,” Trilogy CEO Dale Clift told HHCN. “The accounts that are using the Synzi platform appreciate that we are being proactive in case managing our shared patients.”

Trilogy is not yet able to quantify how telehealth has improved its operations, Clift said, but promising findings have been reported in a number of past pilot programs.

One telehealth home health pilot program in Colorado, for example, reported a 62% reduction in 30-day re-hospitalizations related to congestive heart failure, chronic obstructive pulmonary failure and diabetes. Over a 60-day episode of care, emergency department use also fell sharply, as did nurse home visits and costs of care.

“Anytime CMS approves and reimburses for additional services that will enable the patient to get better comprehensive care and engages them in their own outcomes is a step in the right direction,” Clift said. “Right now, telehealth is an incurred cost and an investment by the agency. I think with the current landscape, one needs to be a ‘big picture’ and forward-thinking type of agency in order to validate the return on investment.”

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