Telehealth in Hospice: Providing Care, Comfort, and Counseling From Afar

Already seen as helpful for palliative care in rural and remote communities, telehealth has become not just a beneficial option but a vital resource amid the coronavirus pandemic.

Officials with the Centers for Medicare and Medicaid Services (CMS) have issued temporary regulatory waivers that include the use of telehealth in hospice care. As the guidance specifically notes, “Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the hospice physician/hospice nurse practitioner and the patient).”

CMS recognizes the need for adapting reimbursement requirements to allow physicians and other clinicians more flexibility in providing care so that they can protect patients, families, and healthcare workers from COVID-19. Under the waivers, for example, a nurse supervising a hospice aide does not have to conduct an on-site visit every two weeks to evaluate the aide.

Long before the pandemic, guidance from the National Hospice and Palliative Care Organization (NHPCO) on best practices for telehealth in palliative care noted that the use of this technology can:

• Improve access to care.
• Reduce cost of providing care.
• Shorten or eliminate travel time.
• Improve clinical outcomes.
• Increase patient and family satisfaction.

Easing the Transition to Telehealth

Keep in mind, however, that patients and family members dealing with a terminal illness may find learning how to use a telehealth system an additional burden. Because your clients may already be feeling overwhelmed, you can help by being prepared with a well-thought-out plan for bringing telehealth newcomers on board.

Key aspects of the transition to telehealth are providing clear technical guidance and empathetic personal support. Your team should emphasize the purpose and benefits of the system, as well as ensuring that you have informed consent from the patient.

On its coronavirus resource page, NHPCO provides a helpful flow chart from law firm Husch Blackwell to walk hospice agencies through important considerations for using telehealth. As noted in the chart, designating a leader and multidisciplinary support team for your organization’s telehealth effort would be ideal.

Shifting Preferences Amid the Pandemic

Hospice providers have seen large shifts in the care landscape in response to the COVID-19 pandemic. A survey by the National Association for Home Care & Hospice (NAHC) found that 61% of agencies responding had admitted patients with COVID-19 to their hospice service.

In a letter to CMS Administrator Seema Verma, NAHC President William A. Dombi noted that about 98 percent of hospice care is delivered in a patient’s home. “In such cases,” he said, “there is limited control over the environment and over potential exposure to illness.” In his letter, Dombi requested that CMS consider permanent changes to Medicare policies allowing use of telecommunications technologies in hospice care.

The NAHC survey found that more than 95% of hospices responding said existing patients had refused hospice visits because they feared exposure to COVID-19, and more than half of respondents said admissions decreased in March 2020 compared with the same month in 2019.

On the plus side, the flexibility in use of telecommunications technology to substitute for CMS face-to-face recertification requirements and for other hospice visits has made a difference for 62% of respondents. Two-way audio-visual communications are being used by 82% of respondents.

Being able to continue providing in-person visits to skilled nursing facilities has been a daunting challenge for hospice agencies. Only 12% of hospices were able to provide most of the in-person visits they sought to provide in skilled nursing facilities.

Hospices were not able to substitute virtual visits to the same degree as they were previously employing in-person visits. Technology has addressed some of the needs for facility-based patients, but only 4% of those surveyed said technology had addressed all of the patient access needs in facilities.

Continuing Attention to Documentation

Although some aspects of care have shifted as the pandemic affects in-person interactions, providing proper disclosures and keeping accurate documentation remain top priorities. On its website, NHPCO provides a script that RN case managers can use as they conduct a telesupport call. The document provides detailed guidance for nurses on how to conduct a telesupport call, what disclosures to provide, how to seek information from patients and family caregivers, and how to instruct the patient and use the teach-back approach to confirm understanding.

With proper planning and implementation, telehealth can help your hospice patients and their families get information, comfort, and care while nurses and caregivers work to manage their health situation and minimize COVID-19 risks to all involved.