A new survey finds that home health agencies are abandoning virtual care due to complexity and a lack of reimbursement. This could hinder efforts by healthcare leaders to extend more hospital services into the home.
Home health agencies embraced telehealth during the COVID pandemic to support patient care, but a growing number are giving up on virtual care, saying it’s too complicated for their patients and unsustainable.
That’s the key takeaway from a study commissioned by the National Institute on Aging and conducted by the University of California, Irvine, and several other universities. Conducted between 2023 and 2024 of roughly 260 home health agencies, it places blame for the drop-off on a lack of Medicare reimbursement, and raises questions about whether home-based care programs can support telehealth at a time when health systems and hospitals are moving more services to the home.
“Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets,” Dana Mukamel, a UC Irvine Distinguished Professor of Medicine and corresponding author for the study, said in a press release.
According to the study, published online in Health Services Research, telehealth adoption among home health agencies stood at roughly 23% in 2019, then surged to 65% in 2021, during the height of the pandemic. By 2024, however, 19% of those organizations had opted to discontinue virtual care, due to a lack of Medicare reimbursement and concerns about sustainability.
On a side note, one-third of all the home health agencies responding to the survey haven’t embraced telehealth at all, saying it’s inappropriate for their hands-on model of care. The study was tilted toward organizations that focus on elderly patients, especially those dealing with dementia-related health concerns.
“These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic,” the press release points out. “The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.”
The study raises two important points.
First, many surveys have shown a decline in telehealth adoption after the pandemic, the inevitable result of patients wanting to get back in front of their doctors after relying almost exclusively on video visits. Telehealth advocates say this pendulum effect should wear off as both providers and patients understand the value of virtual visits and work toward a hybrid strategy that mixes in-person care and telehealth.
The monkey wrench in the works here is reimbursement. Federal and state lawmakers enacted a number of waivers during the pandemic to ease restrictions on telehealth use and boost coverage. While some states have moved to make pandemic-era conditions permanent, the federal waivers are set to end this fall. Many advocates fear that without those waivers, particularly those having to do with Medicare reimbursement, healthcare organizations will scale back their telehealth programs.
Second, there’s the pesky little fact that America’s population is aging, with a large chunk set to hit retirement age soon, and they’re healthier than their predecessors and looking to stay at home and out of the nursing home or assisted living center. The healthcare industry isn’t ready to handle that extra workload – it’s already struggling with workforce shortages and questionable costs. Telehealth offers a channel for providing care to this population while reducing the stress on providers.
While aligning federal policy to improve telehealth reimbursement is a critical piece to telehealth strategy moving forward, the home healthcare industry also needs to rally around virtual care tools and platforms that are effective and intuitive. With health systems and hospitals looking to extend their services into the home, through remote patient monitoring, Hospital at Home and other strategies, they’ll need support from the home health industry to make those services effective and sustainable.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Home health agencies have been dropping their telehealth programs since flocking to virtual care during the COVID-19 pandemic.
A study led by UC Irvine finds that the pandemic interrupted the industry’s gradual adoption of telehealth, and now they say the platform is unsustainable.
With strategies like remote patient monitoring and Hospital at Home becoming more popular, healthcare leaders need support from the home health industry to facilitate more services at home.