News Roundup April 3rd, 2020
n this week’s edition we take a detailed look at the changes taking place for Medicare services to address a shortage in the workforce and the ability for clinicians to be flexible in administering services in times of a pandemic.
In an effort to help shepherd actions quickly and decisively the CMS has taken steps to increase flexibility to respond to the COVID-19 pandemic. Health systems right now are going through monumental tests to their structures. Pressures are revealing cracks in the current system that went unnoticed for years. In order to address workforce and capacity issues, sweeping changes are taking place to ensure health systems and hospitals are equipped to handle a potential onslaught of new cases.
Below we take a look at some of the more salient aspects of these changes and how they would also affect home healthcare workers and agencies– in the short term.
“Healthcare workers across the nation are being challenged like never before.” — CMS.gov
As soon as news hit of the first cases of COVID-19 in Washington state, many in the healthcare sector braced for what was unexpected. The speed and path in which the pandemic spread across the US perpetually tested the limits of various healthcare systems throughout the states. Every day new challenges appeared as setbacks to health providers with many feeling overwhelmed by the growing mass of responsibilities the pandemic has incurred.
To ease delivery of care and services, CMS, working in tandem with federal and local governments, lifted various restrictions for Medicare coverage in order to add more opportunities to render care.
“The Center for Medicare and Medicaid Services is taking historic and unprecedented steps to equip American healthcare system with maximum flexibility to respond to the 2019 […] COVID-19 pandemic”
Among the new policies being dispatched out to local providers is a major to change in how care is defined around hospital walls. The “CMS is allowing healthcare systems and hospitals to provide locations beyond their existing walls”. This presents a new definition that CMS is willing to offer for inpatient services as care provided can transcend the physical limits of the institution. Previously, under federal requirements and to be a hospital, hospitals must provide services within their own buildings.
Some examples offered by CMS on their site are as follows: “Hospitals will be able to transfer patients to outside facilities such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels and dormitories while still receiving hospital payments under Medicare.”
Another new policy waiver is that “Medicare will pay laboratory technicians to travel to a beneficiary’s home to collect a specimen for COVID-19 testing.” COVID-19 poses unusual challenges in risk of spread. To minimize infections around clusters of health workers, it is deemed appropriate to render services. With new rule settings, the CMS has [eliminated] the need for a beneficiary to travel to a healthcare facility for testing and avoid exposure to themselves or others.”
The need to rapidly expand the workforce is a continuous call among several levels of the healthcare industry. Therefore, to address the need for more staff, “CMS has temporarily relaxed requirements for local practice clinicians and their staff to be available for temporary employment” in other hospitals and healthcare institutions as well as working in other states “without violating Medicare’s rules.” Additionally, this move is seen as the ability to easily increase workforce capacity by calling on members of the local community and interstate collaboration with other clinicians who may have licenses in other regions.
Finally, a growing question around whether the healthcare system can innovate in times of stress, new policies around virtual care is being addressed as “CMS [expands] access to telehealth services for people with Medicare.”
To clarify, “CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.” And, in home healthcare, “CMS is waiving the requirements for a nurse to conduct an onsite visit every two weeks for home health and hospice.”
Patients can now receive care at any time or place: at home or in a nursing facility and discharge visits and home visits, depending on whether a clinician is allowed to provide telehealth. It is still uncertain what scope and range telehealth covers for many practitioners; this can be seen as steps to modernize an outdated system for healthcare delivery. As “providers can bill for telehealth visits at the same rate as in-person visits” this can be seen as a moment in time where the health industry is forced to innovate in order to survive.
Furthermore, to add to some new context behind the CMS’ policy on telehealth: “Virtual Check-In services, or brief check-ins between a patient and their doctor by audio or video device, could previously only be offered to patients that had an established relationship with their doctor. Now, doctors can provide these services to both new and established patients.” For clinicians who are allowed to provide telehealth, the restrictions on who can access virtual care has been relaxed. However, expanding the definition of who can administer telehealth still remains unseen.
What we have seen from CMS and the Federal government as a response to a growing pandemic is the ability to address instability quickly, without hesitation. In what was once a sprawl of paperwork and approval systems, we see now an easing of restrictions for administrators of health. How this translates to a new scope of regulations and waivers in Medicare, especially as the elderly population continues to grow and the workforce ramps up to decrease service gaps, remains to be seen. As the pandemic continually tests our healthcare systems, the changes taking place in real time may have a lasting effect as the healthcare system continues to modernize and address new realities of health and sickness.
In an article detailing how many agencies are transforming the way they operate and administer care, Healthline describes the efforts of Capital Caring Health in providing Telehealth to patients and families.
“De Jonge [chief of geriatrics for Capital Caring Health] says one of the first decisions they made was to use televisits when possible.”
“We’re setting up Zoom for Healthcare, a HIPAA-compliant app, with our patients and families when we can, using their laptop, smartphone, or tablet,” he said. “It’s better than a phone call. You can see how sick they look and you can make eye contact.”
Under the CARES Act recently approved by the House and Senate we saw the inclusion of the Home Health Care Planning Improvement Act to “permanently authorize physician assistants (PAs) and nurse practitioners (NPs) to order home healthcare services for Medicare patients, consistent with state law.” This inclusion allows home care services to ramp up in order to “ease the burden of hospital systems facing the influx of patients with COVID-19”