This article is part of the HHCN+ membership
Home healthcare agencies and their patients are scheduled to wake up to a new, inflexible world of important telehealth on Wednesday.
Home health services are now permitted to use telehealth for in-home encounters, a flexibility that has a perpetualized series of short-term expansions. With government shutdowns looming, this ability could expire unless lawmakers issue extensions before the shutdown. Hospital exemptions are also at risk.
If Telehealth Flexibility is not extended and the government shuts down, patients will “lose,” according to Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, executive director of Ata Action, an advocacy organization focusing on Telehealth's advances.
“Millions of Medicare patients woke up on Wednesday for sleep on Tuesday using Telehealth coverage and lost it,” Zebry told Home Healthcare News. “For five and a half years, they would have had the benefits of technology that would have the right benefits when they sleep on Tuesdays.
Especially in home healthcare institutions, this can limit the pool of patients to be accommodated, hindering patient care and add an extra costly back office burden.
“To qualify for CMS CMS reimbursement, you need to have a face-to-face visit with your doctor or nurse practitioner 90 days before starting your home care, or within 30 days within 90 days.” “Now you can do that virtually. It is considered face-to-face. Eliminating it reduces (eligibility) for many patients, especially for home health. They are at-home therapy. Some of these patients have helped them meet that need as they need to call an ambulance to reach the doctor.”
Sentara Home Care Services offers skilled nursing care, hospice, infusion therapy and more. This is the home-based care arm of Sentara Health, a non-profit health care system headquartered in Hampton Road, Virginia.
Without the ability to make virtual appointments as an acceptable form of in-person visits, home health providers cannot bill services, Kessler said. Therefore, home healthcare institutions are unlikely to accept patients who have not received face-to-face visits within the past 90 days.
The most at-risk patients are those in rural and transport-restricted areas, according to Dr. Madeline Sterling, an internist at Weill Cornell Medicine, who has conducted research into telehealth and home health. Additionally, providers may face additional complications and potential costs if current regulations expire.
“In the case of agents, some people rely on telehealth to provide timely, face-to-face encounters to offset the shortage of nursing (or other home clinicians),” Sterling told HHCN in an email. “Without that, patient visits could occur that quickly. They could also lose referrals, but they could have more management and billing challenges.”
Highly Possible Scenarios
Stakeholders expressed an urgency regarding telehealth flexibility, which is rapidly approaching its expiration date. Many of the most likely scenarios involve a temporary lapse of flexibility, at least, not because there is no shortage of lawmakers' support for widely and common regulations.
“There is a real risk of the “telehealth policy cliff” if Congress does not pass further legislation by October 1, 2025 to make the current telehealth flexibility permanent,” Sterling said. “But there was generally bipartisan support for them, so if lawmakers grant a short-term extension (as before) to extend telehealth use, we might see it here and now.”
The political consensus on flexibility is “stellar,” Zebley said. The problem, he said, is the history of short-term extensions he likened to the film's Groundhog Day. The history of short-term expansions has created one of the worst scenarios, the most likely scenario.
“Despite our broad bipartisan support, the administration has said up and down how supportive they are, and despite the fact that there are no opponents, Congress is very dysfunctional, the federal government can't perform and we'll be victims of that dysfunction,” he said. “Our important priorities benefiting millions of patients are expired. They are expired for the first time since the beginning of the decade. They expire when the health care system isn't properly serving people, as they are.”
Such revocations would exacerbate systemic problems within the US healthcare system, he said.
The worse case scenario that Zebley said isn't is that telehealth flexibility has been completely forgotten and is not included in the next funding bill.
Wideer picture
The current risks to critical home health regulations are the result of a greater political issue, experts told HHCN, but they could echo across the healthcare continuum.
Senior helper at Home Care Provider has witnessed the benefits of Telehealth's flexibility, CEO and co-founder Peter Ross told HHCN. Senior helpers are currently promoting clients' telehealth visits, but Ross said he is ready to transport clients to a doctor's appointment if telehealth access is at risk.
“We've done it for over 20 years so that won't change,” Ross said. “My driving force on this particular topic is to advocate for my family and provider.”
Based in Maryland, Senior Helper is a home care company owned by Waud Capital, operating more than 380 franchise locations in the US, Canada and Australia.
According to Zebley, Telehealth's flexibility will not be extended without obsessing with government fundraising bills. The HAH exemption could also be extended as part of a package with government funding bills, but could be passed separately.
Patients will be sent to more expensive care options when conditions worsen, without including them in the government-funded bill on past Tuesdays.
“It's really important to maintain the radar of rising readmission fees if the provider's ability to bill for virtual care is eliminated,” Kessler said. “The ability to virtually see providers within 24 hours is incredible. If your home health is declining, and if they are not seen quickly enough, we send them to the ER. So if that ability is taken away, we're trying to find a way to overcome it.”
Without a clear plan to fund the government beyond Tuesday, the window to protect this continuity of flexibility is rapidly closing.
“The clock is ticking by,” Sterling said.
