The potential expiration of temporary telehealth waivers that were implemented during the pandemic is causing significant concern among stakeholders in the hospice care industry. These waivers have dramatically increased the flexibility and reach of hospice care services, particularly benefiting underserved and rural areas. However, as their expiration looms, many stakeholders are worried about the negative consequences that could arise. These concerns have sparked a vigorous push to make these flexibilities permanent to ensure that the care quality and accessibility that improved during the pandemic do not deteriorate.
Regulatory Landscape Changes
The Impact of Telehealth Waivers
The temporary telehealth waivers granted during the pandemic have opened up new possibilities for the delivery of hospice care. By allowing for greater flexibility and reach, these waivers have made it possible for providers to deliver care to populations that were previously hard to reach, particularly in underserved and rural areas. This expanded access has had a significant positive impact on patient care, enabling more timely and effective interventions. As a result, many in the hospice community are deeply concerned about the potential expiration of these waivers and the implications it could have on the future delivery of hospice care.
In essence, the waivers allowed hospice providers to adapt to the rapidly evolving healthcare environment during the pandemic. They facilitated the use of telehealth to conduct virtual visits, consultations, and even necessary recertifications that would otherwise require in-person interactions. This flexibility was particularly crucial for areas with limited medical resources, where travel barriers and workforce shortages already strained the system. The looming expiration of these waivers raises the question of how the industry will continue to meet the high standards of care that were established during this period of increased flexibility.
Challenges of Merging Old and New Legislation
Michael Fratkin, board president at the Institute for Rural Psychedelic Care and a palliative care specialist at Humboldt Center for New Growth, has highlighted the significant challenges involved in reconciling pre-pandemic legislation with current healthcare delivery demands. The pandemic has fundamentally altered the landscape of healthcare delivery, making it clear that the regulatory framework in place before the crisis is no longer adequate. Fratkin emphasizes the need for continuous adaptation to legislative parameters to maintain high-quality care in this new context.
The issue lies in the gap between the antiquated legislative framework and the modern realities of healthcare delivery. The pandemic has demonstrated the efficacy and necessity of telehealth, especially in regions where access to in-person care is challenging. Reconciling these outdated laws with the contemporary needs of healthcare delivery requires careful consideration and action from lawmakers. Fratkin, along with other industry leaders, calls for a legislative overhaul that keeps pace with technological advancements and the evolving needs of patients and providers.
Benefits of Telehealth in Hospice Care
Enhancing Access to Care
Telehealth has played a transformative role in enhancing access to hospice care, enabling providers to reach some of the most vulnerable populations, particularly in underserved and rural areas. The flexibility afforded by telehealth has allowed hospice providers to overcome significant geographical and logistical barriers, ensuring that patients in remote locations receive the timely and compassionate care they need. This has had a profound impact on these patients’ quality of life, as well as on the ability of hospice providers to deliver comprehensive and coordinated care.
By leveraging telehealth, hospice providers have been able to extend their services to patients who might otherwise have been unable to access care due to transportation difficulties or the lack of nearby medical facilities. This has been particularly beneficial in rural areas, where patients may be spread out over large distances and healthcare resources are often scarce. The ability to conduct virtual visits and consultations has also improved continuity of care, as providers can maintain regular contact with patients and caregivers, addressing concerns and adjusting care plans as needed.
Improved Symptom Management and Patient Satisfaction
The use of telehealth in hospice care has also facilitated improved symptom management and patient satisfaction by providing more timely and efficient interventions. Patients and caregivers have reported high levels of satisfaction with telehealth visits, citing the convenience and accessibility it offers. In addition, telehealth has enabled better-coordinated care transitions, which are critical for ensuring that patients receive consistent and comprehensive care throughout their hospice journey.
Telehealth has allowed hospice providers to monitor patients’ symptoms more closely and make real-time adjustments to treatment plans, leading to more effective symptom management. This is particularly important in hospice care, where patients’ conditions can change rapidly, and timely interventions are crucial for maintaining comfort and quality of life. The ability to provide virtual support and education to caregivers has also been a significant benefit, as it helps them feel more confident and capable in their roles, ultimately leading to better patient outcomes.
Push for Permanent Telehealth Flexibilities
Industry Stakeholders’ Advocacy
Industry stakeholders, including leading organizations such as LeadingAge and the American Academy of Hospice and Palliative Medicine, have been actively advocating for the extension or permanent implementation of telehealth waivers granted during the pandemic. Recognizing the critical role that telehealth has played in enhancing hospice care, these groups have taken steps to communicate the importance of maintaining these flexibilities to policymakers. Recently, LeadingAge sent a letter to Congress requesting a two-year extension of temporary telehealth waivers related to hospice recertification and other Medicare telehealth regulations.
This advocacy effort underscores the belief that telehealth has become an indispensable tool in the hospice care continuum, leading to improved patient outcomes and operational efficiencies. Stakeholders argue that making these waivers permanent would not only sustain the benefits realized during the pandemic but also pave the way for more innovative approaches to healthcare delivery. The letter to Congress highlighted how the absence of these flexibilities would be detrimental to hospices and other providers offering Part B services, emphasizing the need for legislative action to prevent the regression of care standards.
Legislative Efforts and Challenges
The Preserving Telehealth, Hospital, and Ambulance Access Act currently under deliberation in Congress seeks to extend the expiration of telehealth regulatory flexibilities through 2026. This proposed legislation would include specific exceptions, such as excluding hospices under enhanced oversight by the Centers for Medicare & Medicaid Services (CMS) or those with clinicians not enrolled in Medicare from telehealth recertifications. Despite significant support for the bill, it has stalled in committee, creating uncertainty about the future of telehealth regulations in hospice care.
The legislative challenges surrounding the extension of telehealth flexibilities are multifaceted. On one hand, there is widespread acknowledgment of the positive impact telehealth has had on care delivery, particularly in underserved areas. On the other hand, there are concerns about ensuring proper oversight and quality standards. Balancing these factors requires careful consideration and collaboration between lawmakers, industry stakeholders, and regulatory agencies. The potential stalling of the bill highlights the complex nature of achieving consensus on this issue, even as the need for a permanent solution becomes increasingly urgent.
Telehealth’s Impact on Quality and Access
Research Supporting Telehealth Benefits
Research has consistently demonstrated the benefits of telehealth, reinforcing its potential to improve access and cost-effectiveness in care delivery. Numerous studies suggest that telehealth can be as effective as in-person care, providing equivalent patient outcomes and satisfaction levels. Additionally, telehealth has been shown to reduce caregiver burden, enhance symptom management, and improve overall care coordination, especially in remote and underserved areas.
The evidence supporting telehealth is robust, with multiple studies highlighting its efficacy in various aspects of care delivery. For instance, research has indicated that telehealth can lead to significant cost savings by reducing unnecessary hospital visits and enabling more efficient use of resources. Telehealth also allows for better monitoring of patients’ conditions, leading to timely interventions that can prevent complications and improve overall outcomes. These findings underscore the importance of maintaining and expanding telehealth flexibilities to ensure that the benefits observed during the pandemic continue to be realized in the long term.
Telehealth in Rural Hospice Care
For rural-based hospice providers, telehealth has been an invaluable tool in managing clinical capacity amid rising demand and workforce shortages. The ability to conduct virtual hospice patient recertifications has enabled providers to use their resources more efficiently, directing high-level clinical expertise where it is most needed. This has been particularly important in rural areas, where the scarcity of healthcare professionals and long distances between patients and providers pose significant challenges.
By leveraging telehealth, rural hospice providers have been able to overcome some of the inherent hurdles associated with delivering care in these settings. Virtual recertifications have allowed providers to maintain regular contact with patients and caregivers, ensuring that care plans are consistently updated and any emerging issues are promptly addressed. This has led to better management of clinical capacity, as providers can allocate their time and expertise more effectively. Additionally, telehealth has facilitated collaboration between rural and urban providers, allowing for shared resources and knowledge to enhance patient care.
Future of Telehealth Regulations
Extension of Telehealth Flexibilities
In a significant move to support the ongoing use of telehealth, the U.S. Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services (HHS) announced an extension of telemedicine flexibilities for prescribing controlled medications. Originally set to expire in 2024, these flexibilities will now extend to December 31, 2025. This extension aims to provide regulators with additional time to formulate comprehensive future telemedicine regulations, reflecting the evolving landscape of healthcare delivery.
The decision to extend these telehealth flexibilities acknowledges the critical role that telemedicine has played during the pandemic and recognizes its potential for continued positive impact. By allowing for the remote prescribing of controlled medications, this extension helps ensure that patients, particularly those with mobility issues or residing in remote areas, can access necessary treatments without undue burden. It also provides an opportunity for regulators to develop thoughtful and effective telemedicine policies that balance accessibility, safety, and quality of care.
Uncertainty Over Face-to-Face Recertifications
Despite the extension of telemedicine flexibilities for prescribing controlled medications, the distinct waiver for virtual face-to-face recertifications remains on a separate timeline and is subject to its own set of uncertainties. This waiver has been a critical component of hospice care delivery, allowing providers to conduct essential recertifications remotely. However, its potential expiration poses significant risks to continuity of care, particularly in areas with limited medical resources.
The uncertainty surrounding the future of virtual face-to-face recertifications is a significant concern for the hospice community. Without this flexibility, providers may struggle to meet the regulatory requirements for recertification, leading to potential disruptions in care. This is particularly problematic in underserved and rural areas, where the logistical challenges of in-person recertifications are most pronounced. Stakeholders urge policymakers to consider the critical importance of maintaining these flexibilities to ensure that patients continue to receive the high-quality care they need.
Stakeholders’ Plea for Permanent Solutions
Importance of Permanent Telehealth Flexibilities
Madison Summers of the National Alliance for Care at Home emphasizes the critical importance of making telehealth flexibilities permanent. The provisions under the DEA, as well as the ability to conduct face-to-face recertifications via telehealth, are seen as essential components of modern hospice care. Summers argues that failing to make these flexibilities permanent would be irresponsible and could lead to unnecessary chaos for both patients and providers. The potential loss of these flexibilities poses significant risks to continuity of care, particularly in areas with limited medical resources.
Summers’ advocacy highlights the broader consensus within the hospice care community regarding the value of telehealth. The flexibility to provide remote care has proven crucial in managing clinical capacity, ensuring timely interventions, and maintaining high standards of care. Making these provisions permanent would not only preserve the progress made during the pandemic but also foster further innovations in care delivery. Summers and other stakeholders continue to call on policymakers to recognize the lasting benefits of telehealth and to take decisive action to ensure its permanence.
Unified Call for Action
The possible expiration of temporary telehealth waivers, which were introduced during the pandemic, is causing a great deal of anxiety among stakeholders in the hospice care sector. These waivers have significantly enhanced the flexibility and accessibility of hospice care services, particularly aiding underserved and rural communities. With the prospect of these waivers ending, many stakeholders fear the negative repercussions that could follow. These worries have led to a strong campaign to make these flexibilities permanent. The goal is to ensure that the improvements in care quality and accessibility seen during the pandemic are not lost. If these waivers expire, it could mean a reduction in the reach of hospice care, depriving many patients, especially in remote areas, of the essential services they gained access to during the pandemic. Advocates argue that permanent adoption of these measures is crucial for maintaining the progress made in patient care and ensuring continued support for vulnerable populations.
