Telehealth has recently been thrusted to the forefront of health care, specifically as a way to avoid person-to-person contact during the global COVID-19 pandemic.

Despite a lack of direct reimbursement from Medicare, home health company Excelin Home Health recently began providing telehealth services to its clients as a way to prevent the spread of coronavirus.

Moulton, Texas-based Excelin is a Medicare-certified provider that has 12 locations across Texas and California. The company has roughly 500 employees and serves about 2,000 clients.

Even before the pandemic, Excelin was exploring the use of telehealth to supplement its service lines, which include home health care, hospice and private-duty services. COVID-19 kicked those plans into high gear, Alicia Marr, CEO of Excelin, told Home Health Care News.

“We can easily identify its value toward quality outcomes and efficient care models,” Marr said. “However, there are times of crisis, such as this one, that provide unique windows of opportunity to evaluate these platforms.”

Currently, Excelin is using Synzi — an St. Petersburg, Florida based company that provides virtual visit and messaging functionality — as its telehealth platform.

Although telehealth reimbursement under Medicare is still an issue for most home health providers, Excelin has been able to find alternative payer sources, according to Marr.

“Though [the Centers for Medicare & Medicaid Services] isn’t allowing telehealth reimbursement in the home health setting yet, there are some commercial payers who are recognizing the importance of telehealth and have elected to provide some reimbursement for this service,” she said.

Broadly, telehealth’s value goes far beyond preventing person-to-person contact. Like most home health agencies and other health care organizations across the U.S., the coronavirus pandemic has left Excelin scrambling for personal protective equipment (PPE) amid the national shortage of supplies.

“For us, it was really related to resource management and the potential lack of PPE that forced us to evaluate care delivery to keep our staff and patients safe,” Marr said.

Implementing telehealth allowed the company to work around the shortage and preserve PPE with the use of virtual visits, she noted.

Among other things, Excelin has utilized Synzi’s platform for care coordination, medication reconciliation and to complete touchpoints for high-risk patients.

Currently, roughly 15% to 20% of Excelin’s patient population are supplementing their care with telehealth services. The company is offering telehealth services to all of its patients, however.

“Not all visits are appropriate for virtual care, but when used appropriately, telehealth is a very effective tool,” Marr said. “Securing this technology within all of our patient care delivery models would be our goal. At a minimum, providing telehealth to all patients would allow opportunities to triage calls and prevent rehospitalizations.”

Preventing rehospitalizations is especially crucial, as hospitals around the country face over-capacity challenges due to the rising number of coronavirus cases.

“Hospitals are under tremendous pressure right now,” Joanne Cunningham, executive director of Partnership for Quality Home Healthcare (PQHH), previously told HHCN. “They are experiencing and will continue to experience increased strain.”

The home health industry is in a position to help relieve some of the burden hospitals are currently facing, according to Marr.

“Hospitals are being really aggressive about trying to free up beds in anticipation of the peak of COVID-19 patients,” she said. “A lot of our patients are typical chronically ill patients: heart failure, chronic obstructive pulmonary disease (COPD), diabetes. Those are the patients that have the highest risk of contracting COVID-19. These patients need to be at home.”

While telehealth has its benefits, one challenge has been caring for a patient population that isn’t as totally comfortable with navigating technology, according to Marr.

“When you think about an elderly population who may not be as well-versed in using the application on a smart device, there is a little bit of a learning curve,” she said. “Providing education up-front has been one of our best practices. We provide a demonstration of how easy it is to use, making it as user friendly as possible.”

Overall, Marr believes that this time of crisis has forced home health providers to push forward on initiatives and think outside of the box.

“The lesson is that this is ever-changing,” she said. “This is a great opportunity to be creative in how we deliver care, in order to help a lot of patients. It’s our responsibility to take ownership and provide the best care possible.”  

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