Telehealth-based rural caregiver support feasible, cost-effective

Using telehealth to provide palliative care support to rural family caregivers is a low-cost and feasible strategy for transitioning patients from hospital to home-based care, new research reveals.

Conducted by researchers from the Mayo Clinic, Duke University, and the Minneapolis Veterans Affairs Health Care System, the study examines a telehealth-based palliative care support program for rural family caregivers who face challenges in accessing coordinated care for their loved ones during and after hospitalization. It also evaluated resource use, health system costs, and Medicare reimbursement pathways for this approach. Results were published in the American Journal of Hospice and Palliative Medicine.

For the study, rural caregivers of hospitalized patients were divided into an intervention group and a control group. The intervention group comprised 215 participants, who engaged in video visits conducted by a registered nurse certified in palliative care, supplemented with phone calls and texts, over eight weeks. The nurses provided education, support, and counseling.

The researchers compared the labor costs of a registered nurse conducting the telehealth visits to a nurse practitioner or social worker conducting the visits.

The researchers also identified potential Medicare reimbursement codes for this telehealth-enabled approach and assessed the program's potential costs versus the potential reimbursement.

The study shows that the telehealth-enabled caregiver support approach with a registered nurse was $395 per rural caregiver, compared to $337 if the approach was facilitated by a social worker and $585 for a nurse practitioner.

Additionally, the researchers found that mean Medicare reimbursement using the Transitional Care Management (TCM) CPT code was $322 for high-complexity and $260 for moderate-complexity patients. Using the Chronic Care Management (CCM) CPT code, mean Medicare reimbursement totaled $348 for complex and $274 for non-complex patients.

On analyzing reimbursement using both CPT codes, researchers found that Medicare reimbursement was $496 for high-complexity/complex and $397 for moderate-complexity/non-complex patients.

"What healthcare professionals can take away is that there are strategies and avenues for interacting and connecting with family caregivers that are reimbursable and that the cost attached to this type of research may be less than people at first glance think," said Joan Griffin, PhD, study senior author and a professor of health services research at Mayo Clinic, in a press release. "When we start looking at the next steps for this study, our biggest challenge will be to figure out who is in greatest need of this type of intervention and how we direct these types of services to those people."

As research underscores the clinical and care access benefits of telehealth, healthcare researchers are increasingly examining the cost of the care delivery model.

Studies published so far appear promising. Last year, research revealed that telehealth helped reduce time and travel costs for cancer patients.

For the study, researchers conducted an economic evaluation of cost savings related to completed telehealth visits from April 1, 2020, to June 30, 2021, at a single National Cancer Institute-designated comprehensive cancer center. Researchers included nonelderly patients between 18 and 65 years in the analysis.

The study population included 11,688 patients who participated in 25,486 telehealth visits. Of these visits, 4,525 were new patient visits, and 20,971 were follow-ups. About 15,663 visits included women, and 18,360 included Hispanic non-White patients.

The researchers assessed travel costs and the potential loss of productivity due to the medical visit. They defined travel costs as the roundtrip distance saved from car travel and potential loss of productivity as the income missed from roundtrip travel and the loss of income from in-person clinic visits. They found that the estimated mean total cost savings ranged from $147.4 at $0.56 per mile to $186.1 at $0.82 per mile.