Feature January 27, 2021 John Bernot, MD

COVID-19 has introduced a new world of home-based care

Prior to 2020—which seems like a lifetime ago—the United States healthcare system was slowly advancing its telehealth capabilities. The technology for home-based care existed, but was not widely used because people preferred in-person visits where they received better and more personalized care. The popularity of telehealth changed when COVID-19 arrived on America’s shores early last year. Whether out of fear or comfort, people preferred to stay home and avoid the risks that come with close-proximity indoor spaces whenever possible. Any reluctance from patients to utilize remote technologies was quickly transformed into a new willingness to interact in novel ways. Likewise, issues with offering and billing for remote services were quickly erased by providers and health insurance plans. Reimbursement was suddenly possible, and technology that was underutilized was now revved up. Within months, most Americans started using words like “Zoom” and “Microsoft Teams” and “Webex” in their daily conversations.

The culmination of these events has opened the doors to a more modern and innovative way of engaging with patients. Telehealth technologies such as video visits and e-visits that were rarely used in the past are now integrated into the workflow of many clinics and healthcare practices. The providers are now able to schedule patients in the virtual appointment slots, bill for the visit based on the expanded payment rules, and utilize in-home devices. Beyond the reimbursement for these services, the virtual innovations increase the healthcare community’s arsenal of ways to improve the care that patients receive.

Below are some of the home-based care options available to providers and patients today:

Telehealth

Led by the Center for Medicare and Medicaid Services (CMS), telehealth services were expanded under an emergency authorization in response to COVID-19. These changes allow the healthcare system to provide telehealth services to patients in three different ways, including:

  1. telehealth visits;
  2. virtual check-ins;
  3. and e-visits.

The chart below details the criteria for each of these visits:

Remote patient monitoring (RPM)

Similar to telehealth “visits,” RPM initiatives can also be incorporated into home-based patient care. Providers can be reimbursed for monitoring a patient’s health status through FDA approved devices that reside in the patient’s home, such as bluetooth blood pressure cuffs or scales. Specifically, a healthcare provider can monitor physiologic parameters such as weight, blood pressure, and pulse oximetry. The provider can also monitor the proper form of the exercises and the frequency and duration of recovery sessions, amongst other things.

Watching these important changes in a patient helps healthcare workers more quickly identify patients who need an intervention, and continue to monitor those patients who are on-track. This opens up an opportunity to intercept small problems before they become large problems in real-time, and allow those who are doing well to be able to stay at home and not risk COVID-19 exposure.

Patient checking medicine schedule in home-based care.

Watching important changes in a patient helps healthcare workers more quickly identify patients who need an intervention.

Patient activation and monitoring

Advancements in the use of home-based care technologies have been a silver lining of this devastating pandemic. Most patients and healthcare providers agree that this has been a positive movement for patient care. That said, it’s important to choose a tool for your practice that will add little overhead to a patient’s experience and allow them to participate in a meaningful and engaging way. Patients cannot be expected to set up 3 different logins and portals for 3 different devices, and should not be expected to provide manual check-ins twice a day for any period of time.

Patients still need assistance in knowing when to use these technologies and education on why they are helpful. They also need education on how to best take care of themselves before and after an operation, which is a practice known as patient activation. The combination of effective patient activation with real-time assistance and coaching is becoming the holy grail of home-based care and telemedicine.

I propose the use of a virtual assistant to “quarterback” this process. No matter how many modalities we have, it is imperative that the patient has the right direction at the right time. These communications must be shared back to the appropriate clinician in real-time so that meaningful intervention can occur in an efficient and personal manner.

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