OIG Recommends Home Health Agencies Evaluate Telehealth Activity

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that despite the positive impact of telehealth flexibilities on home health agencies (HHAs), there is a need for further review of the services they provide and the patients it benefits most.

As COVID-19 cases grew, so did restrictions on in-person healthcare. This was mainly due to precautions surrounding exposure to disease. However, this led to the Centers for Medicare and Medicaid Services (CMS) implementing regulatory flexibilities that helped expand telehealth use.

In the last several years, telehealth has proven beneficial, assisting patients and providers in maintaining access to healthcare. Recently, the OIG reviewed HHA activity, providing further insight into telehealth use among these facilities and necessary steps to take in the future.

HHAs primarily serve Medicare patients, providing care to over 3 million beneficiaries in the initial year of the COVID-19 pandemic. In this review, the HHS OIG surveyed a nationally representative sample of 400 HHAs in fall 2021, of which 396 participated in the Medicare program. It also interviewed 12 HHAs on the topic of challenges and care strategies.

The agency found that the most common hurdles to care during the COVID-19 pandemic related to staffing and infection control. It also noted the common steps that many HHAs took to cope with challenges, along with the government actions that assisted these organizations. These mainly included the offering of paid leave and telehealth flexibilities.

But the persistent difficulties experienced by HHAs when using telehealth raise questions regarding its future in home healthcare, according to the report.

The OIG provided recommendations for future actions, including that CMS should review how HHAs use telehealth specifically, the services provided through telehealth, and the types of patients who benefit the most from it.

The agency also noted the need to evaluate the impact telehealth flexibilities have on home healthcare. Lastly, it recommended that CMS work with the Administration for Strategic Preparedness and Response’s Technical Resources, Assistance Center, and Information Exchanges to compose a set of steps for HHAs to take in the event of a future public health emergency.

Various organizations have recently composed sets of recommendations that aim to enhance telehealth use.

For example, in April, the Government Accountability Office (GAO) informed Medicaid of the need to review the effects of telehealth. GAO took this action after a review of telehealth data from five states that showed sharp increases in use between March 2020 and February 2021.

These findings, along with the consideration that Medicaid had not evaluated the quality of care provided to its beneficiaries, led the GAO to make two recommendations: Medicaid should collect information on telehealth quality and take the necessary steps based on this data.

Research from April described the steps that Boston University and Boston Medical Center researchers took to review how telehealth widened the digital divide as well as how to eliminate digital health inequities.

The main inequities related to digital fluency, which is the ability to use tools, and the capacity for health advocacy, which is a patient’s ability to advocate for their medical needs. Based on this, researchers created a three-pronged strategy that involved creating federal and state policies to operationalize telehealth infrastructure, providing more clarity regarding standards for access portals, and supporting families with limited virtual care experience.