The country's home healthcare providers are preparing to see a rise in demand for their services as more elderly patients and those with underlying health conditions stay home to lessen their risk of exposure to COVID-19.
But they see challenges in making sure providers remain healthy—both physically and financially—especially as they compete against hospitals for limited resources.
"Acquiring the protective equipment is becoming problematic," said William Dombi, president of the National Association for Home Care & Hospice, a leading trade group representing home care and hospice organizations. "At the moment, home healthcare providers' access to supplies is minimal at best."
Like hospitals, Dombi said many home health companies are turning to state and local health departments for help in accessing the National Strategic Stockpile for personal protective equipment like N95 respirator masks, gowns and glove. Supplies from the federal stockpile go to states and are then allocated to local health departments, which decide how they are distributed.
Federal health officials have already warned there is not enough equipment within the stockpile to address the current outbreak. HHS has estimated the stockpile had about 40 million N95 masks, or about 1%, of the amount medical professionals would need for a full-blown pandemic.
Stephan Rodgers, CEO of Dallas-based supportive healthcare provider AccentCare, said the challenge in procuring protective equipment has been mitigated in the short term through their emergency planning, which he said began six weeks ago and included a systemwide inventory of supplies and a new system to move equipment to where there was demand.
Rodgers projected the company had enough supplies on hand for the next three months, with plans to acquire additional equipment through non-traditional sources such as suppliers for industrial and waste management companies.
AccentCare also requires that all caregivers take their temperature daily and developed a protocol for personnel to check in with patients over the phone prior to a visit to make sure they are not experiencing symptoms related to COVID-19.
Early in its preparation AccentCare launched an education campaign to train all 25,000 of their care professionals to identify symptoms for COVID-19, and properly wash their hands and use personal protective equipment.
Rodgers said the company plans to also expand its telehealth services. Rodgers wants to have 30% of AccentCare's 25,000 home health patients turn to telehealth. Currently only about 1,500 use the service. He said as the number of coronavirus cases rise, the need to keep caregivers safe will require a greater reliance on such digital tools.
"We're probably not going to get reimbursed for all this telehealth we're going to put out there, but it's the right thing to do," Rodgers said.
This week the Trump administration announced it will temporarily expand telehealth services under Medicare to cover such interactions at the same rate as in-person visits and allow doctors to provide services with their personal phones.
But stakeholders say neither the CMS changes, the $50 billion in federal disaster relief funding available through Trump's emergency declaration, nor the proposed Families First Coronavirus Response Act passed by the Senate on Wednesday allows for home healthcare providers to expand their telehealth services.
While Medicare covers the cost of home health agencies providing remote patient monitoring if it is used to, "augment the care planning process", the program does not reimburse home health providers that use telehealth services to substitute for in-person visits.
"If this [COVID-19 outbreak] becomes widespread, we're going to need to do home visits using telemedicine," said Paul Kusserow, president and CEO of home health giant Amedisys. "We're going to need to supplement our home visits with telemedicine visits and those are going to need to be counted."
Kusserow would also like to see the CMS create greater flexibility around what's known as the "homebound requirement." The program only covers home health services if a patient is homebound, which the CMS defines as being unable to leave your home without assistance from another person or a wheelchair. Kusserow said current rules would prohibit home healthcare providers from treating the majority of people who contract COVID-19.
Like AccentCare, Kusserow said Amedisys centralized its inventory to keep better track of its supplies and has conducted additional employee training on caring for COVID-19 patients.
While he felt confident the company has done what it can to prepare itself for an outbreak of coronavirus cases, Kusserow said CMS will ultimately need to make changes to its home healthcare rules to allow providers to be a viable care alternative if hospitals become overwhelmed with cases.
"If hospital beds are full, I think the idea has to be that people are going to be sent home," Kusserow said. "We think ultimately we'll be in a very good spot to respond to this, but we need more arrows in our quiver and more flexibility to be able to appropriately do this if they really want people taking care of in the home."