Hospices Brace for Year 4 of COVID PHE, Await Word of Telehealth’s Future

A fourth year into the pandemic, its effects have hospices continuing to combat against financial and operational headwinds, as well as uncertainty about the future of telehealth rules.

The COVID-19 public health emergency (PHE) is likely to endure past another extension. Currently set to expire Jan. 11, 2023, the U.S. Department of Health & Human Services (HHS) has not issued a 60-day notice that the agency indicated it would prior to the PHE’s end. This means the PHE will presumably remain in place an additional 90 days, or until April.

If next year brings a halt to the PHE, this could also mean an end to some of the telehealth flexibilities it brought, spelling operational and patient delivery issues for hospices during times of short staffing.

Telehealth impacts for hospice

The pandemic has helped illuminate areas of fragility across the nation’s health care delivery system, as well as ways that virtual care could help fill gaps, according to U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. The agency is giving careful consideration to the future of telehealth and its long-term impacts on health care, she said.

“We’re very focused on lessons learned. Some of the big ones are virtual care, which has been a lifeline for so many people across the country,” Brooks-LaSure said at the HLTH conference in Las Vegas. “CMS has extended virtual care in Medicare in mental health to the extent of our authority, and Congress has extended a lot of the telehealth flexibilities beyond the public health emergency. One of the biggest pieces is just how much we have to engage people. It’s critical as we think about how to eventually move to the other end of the public health emergency of really making sure that we build back our health system in a much stronger way.”

The Consolidated Appropriations Act of 2022 ensured that CMS would extend telehealth waivers set in place during the PHE for an additional 151 days (or roughly five months) after it expires to allow for a transitional adjustment period.

Some of these waivers will remain permanent, such as the ability for Medicare patients to receive mental or behavioral telehealth services if they meet certain criteria.

Other flexibilities will be phased out, such as those that permitted the use of telehealth to fulfill requirements typically done in person, according to a recent CMS report. This includes recertifications by physicians, which will again require in-person visitation following the PHE’s expiration.

Doing away with some of the telehealth flexibilities will add strain to the hospice clinical workforce, creating dangerous headwinds that will be difficult for many providers to manage and weather through in the post-pandemic era, according to Kathleen Benton, president and CEO of Georgia-based Hospice Savannah.

“The health care world has been turned upside down in a new wave of people who are more acutely ill. We were already preparing for a large baby boomer aging population to rear its head, but that happening simultaneously to COVID just formed a perfect storm,” Benton told Hospice News. “For any of us to survive financially and be able to continue to care for people, it’s going to take innovative health care and technology to help make us more efficient in care delivery. We should feel compelled and called to make telehealth part of our expectations, because health care can’t look the same as it did prior to COVID.”

Telehealth has played a vital role in hospices’ ability to sustain care delivery while also easing some of their staffing strains. Hospices have been able to do more with less clinical staffing resources as demand rose in part due to expanded virtual care, Benton said.

Hospices have seen rising turnover in recent years, with clinicians leaving the industry in higher volumes during the pandemic. Hospice and home health providers saw clinical turnover rise by 16% to 20% in 2020 compared to previous years, according to a study from BerryDunn.

Other disciplines have also seen high rates of loss. Case in point, social workers left the health care field at record-high rates that exceeded pre-pandemic levels by 35%, data from the Peterson-Kaiser Family Foundation Health System Tracker reflected.

Other PHE issues eating away at hospice sustainability in year four

The labor issues have had a significant adverse impact on hospices’ finances and operations. Rising expenses are a major concern, such as rising wages, costs for personal protective equipment and supplies, gas prices, as well as slimming census volumes caused by diminished capacity. Hospices have seen disruptions to their referral mixes, and reductions in referrals from hospitals and other facility-based settings during the outbreak.

While some of these COVID disruptions have eased, the trickle down effects could continue well past the pandemic, according to Benton.

Additionally, some of the pandemic’s long-term impacts may be less visible and more pressing on hospices when the public health emergency eventually ceases – particularly when it comes to staff retention, Benton added.

“The biggest constraints are the intangibles that represent a true problem. The pandemic has put this mentality shift upon us that is rampant among health care workers right now and hasn’t gone away,” Benton told Hospice News. “We are investing tons of dollars and efforts into boosting that morale and shaping our culture. It may sound more philosophical, but retention is the toughest thing to work on a daily basis and will be for years to come after the pandemic.”