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Alex Kacik

Home health providers will look to significantly expand their telehealth offerings as they curtail their therapy services, according to a new survey.

The number of home health agencies that use telehealth services like remote patient monitoring, virtual consultations and medication management technology will double over the next two years, according to Definitive Healthcare’s home health study that polled 159 providers in October. More than 53% of respondents indicated that they will use telehealth services within the next two years, up from around 21% currently.

Notably, no home health agencies said they would be expanding their occupational, physical and speech therapy, which more than 85% of the organizations currently provide.

“There’s no doubt the healthcare industry is facing a massive shift that will affect all sectors,” said Curtis Gattis, CEO of the health-tech company LeadingReach, citing the aging population and prevalence of chronic conditions. “Our need for physicians in every specialty is only going to increase. Expanding and growing telehealth offerings in home health and across the entire healthcare industry will help meet this need.”

But virtual care will require better care coordination and communication between providers as the industry adapts to the burgeoning technology, Gattis added.

The home health sector has been preparing for the implementation of the new Patient-Driven Groupings Model, which will no longer base pay on therapy hours and will reimburse 30-day periods of care instead of 60-day stints come Jan. 1. The new pay model is meant to shift the focus from the volume of services provided to one that relies on patient characteristics. Home health agencies that have focused on therapy almost exclusively could see significant revenue declines, according to a recent report from Trella Health.

A similar model was implemented for skilled-nursing facilities on Oct. 1, which prompted a massive workforce restructuring. Occupational therapists, physical therapists and speech-language pathologists who work in home health have reached out to Modern Healthcare, saying they have been laid off or experienced significant pay cuts. Many are concerned that patient care will be diminished as a result.

The CMS said that it will “continue to monitor the amount of therapy provided via the different modes and we will consider revising the policy and enforcement efforts as necessary.”

A recent survey by the National Association for Home Care & Hospice found that 48% of 685 home health providers polled indicated that they plan to decrease therapy utilization by at least 10% in 2020.

While therapy services are poised to decline, home health providers are looking to grow their specialized care offerings. Palliative care, veteran-specific care and mental health services are projected to grow the most over the next two years, according to Definitive’s report. Less than 41% of the home health agencies surveyed currently offer those services; the most common specialty services are wound care, cardiac diseases, COPD, diabetes, joint replacement and degenerative diseases.

“Home health agencies are tailoring their care to specific disease states or conditions, which seems to be more common than it had been,” said Matt Valley, a senior healthcare analyst at Definitive.

But finding and hiring quality staff seems to stand in their way, with 61.6% conveying that as being their greatest challenge. The home healthcare industry is projected to grow 36% by 2028, estimated to add over 1 million jobs in the process, according to the Bureau of Labor Statistics.

The next biggest obstacles were profitability, the uncertain regulatory landscape and payer coverage, particularly when it comes to telehealth.

“Finding qualified staff isn’t just an issue for home health agencies,” Valley said. “But it could be magnified in an expanding sector.”

As home health providers look to mitigate staffing shortages through new technology that aims to automate data entry, improve communication and streamline payment, the CMS has been seemingly supportive of home-based care.

Beyond its Medicare demonstration pilots, the agency loosened restrictions this year in Medicare Advantage that facilitated in-home aid with bathing, dressing, cooking and other tasks. It also allowed plans to pay for palliative care in the home.

In 2020, the agency will reimburse Medicare Advantage plans that expand their in-home coverage of patients with chronic conditions. A home infusion therapy benefit, which will cover professional services, patient education and monitoring for in-home medication delivery, will kick in in 2021.

“This could open the door for massive growth in home healthcare,” Valley said.

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