By Adam S. Herbst, Esq.
A friend of mine who is a nurse in a Florida nursing home recently told me how, using an iPad, she was able to help one of her clients (an 83-year old resident) link-up with an eye doctor at the height of the COVID-19 pandemic. She told me how this “visit” helped the resident receive the necessary eye drops and had this resident gone just one more day without the drops, she would have completely lost her vision. Telehealth works. And the value that it brings to older adults residing in nursing homes and long-term care facilities in unquestionable. COVID-19 put an unprecedented spotlight on the challenges and opportunities, but the fact remains, we need our policymakers and nursing home administrators to not squander the recent lessons learned and to invest in more robust telehealth policy solutions and permanent legislation expanding telehealth’s platforms and enabling more residents the opportunity to have similar success stories as my friend’s resident did.
For years, amidst our exponential hurtle toward a future in which older adults are projected to outnumber children, U.S. economists and social scientists have been sounding the alarm over America’s quickly aging population—especially in the context of how our population crisis could cripple our healthcare system. With the arrival of COVID-19, those warnings became louder, more urgent as nursing homes became disease hotspots, straining our already overtaxed healthcare system. As the abstract concern about America’s age problem became visible to the public eye—so too, the need for change became glaringly evident. Yet, with the onset of COVID-era innovations, the health crisis that spotlighted our health system’s greatest woes also highlighted its best solution: telehealth infrastructure.
In order to shore up telehealth’s vital role in re-imagining healthcare in nursing homes, we need policy solutions that will support new and innovative approaches and permanently expanding telehealth platform.
Amidst a Pandemic, Telehealth Re-Imagines Nursing Home Care
The good news is that the convergence of health care and technology — and how innovations are changing medical care and consumer choice have been demonstrated during the pandemic. Telehealth has clearly benefited nursing homes residents, healthcare providers and staff in many ways, from offering solutions for residents to “visit” providers in distant locations and avoiding transfers to the hospital. The use of telehealth during the COVID-19 pandemic has allowed residents to be treated in the comfort of their own “home”, as opposed to requiring admission or, in some cases, readmission to a hospital. Because some hospital transfers tend to be unnecessary, sending vulnerable seniors to the hospital, both during and post-pandemic, only increases their exposure to a wide range of adverse effects. Secondly, telehealth helps residents with less acute care and in reducing social isolation, such as treatment for chronic care management and specialist consults like physical therapy, rehabilitation or mental health counselors.
From the nursing home’s perspective, the care management and clinical benefits have translated into cost savings and increased revenues. By enabling specialists to facilitate much-needed care remotely and improving the capacity of nursing staff to provide quality care on-site, the less time a resident will spend outside of the facility. Policy makers must take all of these efficiencies as a wake-up call in a post-COVID world, and properly invest in telehealth to promote better health outcomes for nursing home residents.
Call-to-Action for Policy Makers:
In the early stages of the COVID-19 pandemic, policy makers loosened regulatory requirements, such as privacy protection measures and allowed for Medicare to temporarily pay clinicians to provide telehealth services across the country. Now, additional steps must be taken to permanently expand Medicare’s telehealth benefits by covering virtual services for nursing home residents. These policy makers should support funding and policy efforts by the Department of Health and Human Services, the Federal Communications Commission and Agriculture Department to fortify infrastructure for virtual nursing home care, including broadband access, so rural and urban facilities can equally experience the benefits of high-speed internet service and quality. Separately, Congress should find ways to supply reliable and secure apps that link and share video devices to meet the needs of older adults without risk of penalties for noncompliance under HIPAA.
Policy makers must also incentivize healthcare clinicians and nursing home staff to help leverage telehealth services. Even if a resident has access to a device and a suitable application, that doesn’t mean they, or the staff, have the digital skills to take advantage of the telehealth options. Supporting staff education is key as technology and apps continue to change. Greater reimbursement for staff training and data analysis will only further advance clinical assessment and care management systems.
Furthermore, as with most health care programs, healthcare providers will embrace and adopt telehealth technology if they’re paid to offer those services. For that to happen, the Centers for Medicare and Medicaid Services (CMS) needs to permanently loosen both its restrictions on where telehealth programs can be run and how they’re reimbursed. CMS must expand reimbursement coverage for telehealth platforms that include audio-video links and connected devices that help residents connect with a physician or specialist at a moment’s notice in an emergency, possibly eliminating the need for a transport to the hospital.
It’s now up to the policy makers to help deregulate and invest in the technology.
Disparities still exist and even with today’s expanded possibilities for telehealth, not every nursing home resident has the technology to take advantage of telehealth service. The time is now for policy makers to act towards legitimizing and expanding telehealth coverage. “Telehealth is undoubtedly the future of health care,” U.S. Rep. John Curtis has said. “Ultimately, Congress’ objective should be to make many – if not all – of these regulatory changes permanent…because it will ensure we are keeping patients’ health and reducing the costs of care through value-based medicine as our top priorities as we consider expanding telehealth services throughout the country.”
Telehealth’s immediate benefits have been clear, it also offers longer-term capability by increasing healthcare access and providing high-value quality care. It’s now up to the policy makers to help deregulate and invest in the technology to help sustain the rapid growth witnessed during the COVID-19 pandemic and help the healthcare system meet nursing home resident’s needs in the future.
Adam S. Herbst, Esq., is a senior hospital administrator and has devoted his career to specializing at the intersection of where health care law meets with communications, technology, and employment issues. He has extensive experience structuring agreements while advising on risk mitigation and offering solutions on operations, board governance, and regulatory matters. Mr. Herbst has worked on issues related to housing, education, public health, and economic development, and has trial experience in both federal and state courts, as well as arbitrations throughout the country. He is a frequent speaker on health care access and is an adjunct professor at New York Medical College, Columbia University’s Mailman School of Public Health and New York Law School. He teaches on health policy, bioethics, and healthcare access.
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