The onset of the COVID-19 pandemic in 2020 quickly led to rapid adoption of telehealth across all healthcare sectors, including hospice and palliative care.
A year later, hospice and palliative clinicians continue to incorporate telehealth into their daily practices to help establish, implement and inform a plan of care for home-based, seriously ill patients and their caregivers. Virtual visits enhance population health management by connecting patients and caregivers to the services and support they need, which helps to improve the overall experience and outcomes.
Telehealth also extends clinical reach by providing care when and where it’s needed to reduce missed appointments; provide access to specialists regardless of location; limit patient and caregiver travel time, expense and time away from work; improve outcomes through timely care and immediate access to the care team; relieve caregiver burden; and promote greater patient/caregiver and provider satisfaction.
Rather than viewing telehealth as a compromise on palliative and hospice care for the seriously ill, clinicians should see this as an option that is safer as it reduces exposure. Many individuals also find it more comfortable than in-person visits and less time-consuming for patients.
In fact, one study of outpatient palliative care telemedicine visits resulted in 8.9 out of 10 satisfaction level for patients and 8.8 out of 10 for caregivers. Another study examining patient and caregivers use of telehealth in rural and remote areas — with a focus on people with chronic conditions, parents with young children and caregivers of elderly patients — found 67% satisfaction for reducing inconvenience and cost of travel, absenteeism from work and family, and dependence on caregivers for transport or childcare.
Connect with patients anywhere
Telehealth provides an important way for hospice and palliative care professionals to connect with patients and their caregivers, especially for those who live far away or are too ill to attend a clinic or office appointment. Virtual visits increase patient access to providers and can increase the number of patient visits — by almost double — significantly decreasing the lead-time to initial consult.
Telehealth also makes it more efficient to assess symptomatic patients by dramatically reducing the time commitment required for an in-person visit. Virtual visits are useful for conferencing with team members and other health care providers, providing coaching to caregivers, and conducting case management meetings and hospice interdisciplinary meetings.
Case example: Prior to the COVID-19 pandemic, one team of palliative care clinicians performed about 40% of their visits in the home, with the remainder by phone. During the height of the pandemic, home visits were temporarily stopped, and the team switched to phone and video visits. While these team members have currently returned to performing home visits — and strongly advocate for face-to-face visits — they continue to use virtual visits as an essential way to provide ongoing support for patients and caregivers.
Barriers to adoption
Despite the advantages that telehealth provides, it still remains out of reach for many individuals. People who have hearing, vision or cognitive impairments may not be able to participate, depending on the equipment they can access. For instance, a visually impaired person may struggle to use a phone, or a hearing-impaired patient may require home visits.
It’s also important to keep in mind that some people can’t afford or are unable to operate a smart phone or computer — or they may live in an environment with poor wifi connection and may not have access to video visits. This especially impacts low-income patients, which raises concerns about CMS halting reimbursement for telephone-only visits post-pandemic.
Nevertheless, adoption and utilization of telehealth is strong. A J.D. Power’s annual Commercial Member Health Plan Study found 36% of commercial plan members said they had used telehealth services, up from 9% in 2020’s study. That corresponded with a gain in member satisfaction over the last year, according to the report. In addition, 32% of plan members said they connected with their insurance plan through the web, mobile apps or text messaging in the past year.
Telehealth guidelines/best practices
Given that 69% of home and hospice professionals plan to adopt telehealth, it’s important to follow American Telemedicine Association Guidelines and Accreditation Commission for Health Care Telehealth Standards.
Like any new method, it’s essential to practice using telehealth before making the transition to virtual visits and establish effective rapport with patients, especially for new patients. By practicing with colleagues, users can become familiar with the equipment and technology and learn how to troubleshoot common problems.
Five steps to optimize virtual visits:
- Prepare with intention
- Listen intently
- Agree on what matters most
- Connect with the patient’s story
- Explore emotional cues
Telehealth-specific metrics should focus on delivering the right care to the right patient at the right time through the right modality, focusing on utilization, outcomes, cost and access.
The pending Protecting Access to Post-COVID-19 Telehealth Act of 2021 aims to eliminate certain restrictions and permanently expand coverage during and beyond the pandemic to establish that telehealth services can be rendered in the patient’s home to:
- Expand coverage for telehealth at federally qualified clinics and rural health clinics
- Authorize CMS to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency
- Empower Health and Human Services to expand telehealth services through Medicare in future emergencies
- Require a study on the use of telehealth during the pandemic around costs, uptake rates, health outcomes and racial and geographic disparities
Ultimately, virtual visits are likely to remain as a supplement to in-home visits that offer considerable value for hospice and palliative care organizations and improve quality of life and outcomes for patients and caregivers.
Robert Crook, M.D., FACP, FAAHPM, is a hospice and palliative care physician at the Cleveland Clinic.
Terri Maxwell, Ph.D., APRN, is chief clinical officer at Turn-Key Health.