May 19, 2020

Are your patients refusing home health visits for fear of Covid-19 exposure? Here's how to overcome their fears.

Daily Briefing

    Across the nation, patients are foregoing home health visits out of concerns they will be exposed to the virus that causes Covid-19. According to a Home Care Association of America survey, nearly 90% of home health agencies reported their clients canceled one or more visits because they feared possibly contracting the virus from home health providers coming into their homes.

    Patients are frightened to seek necessary care amid Covid-19. Here's how to overcome their fears.

    One large home health company recently received 8,000 visit cancellations within a week. While some patients have had family and caregivers step in to provide non-medical support, others are delaying necessary medical care which could lead to clinical deterioration and increase their risk of complications.

    For home health agencies (HHAs), there's also a financial risk: fewer home health visits translate into lower reimbursement. Under the Patient-Driven Groupings Model (PDGM), home health providers are hit with a Low Utilization Payment Adjustment (LUPA) claim if they provide fewer than suggested visits during a care episode. Instead of a bundled payment for the episode, they receive a per-visit payment.

    In order for home health agencies (HHAs) to weather the imminent financial storm and ensure patients get the care they need, they must overcome patient and family fears of infection. HHAs can do so by implementing the necessary precautions to reduce patient risk of exposure and effectively communicating these protocols to patients.

    4 tactics to reduce the risk of Covid-19 exposure for home health patients

    1. Separate your Covid-19-related services from other offerings. Most facility-based care sites are cohorting patients to treat Covid-19-positive patients separately from Covid-19-negative patients. HHAs can adopt a similar approach by cohorting their patients by:
      • Hours: HHAs can structure staff member schedules such that Covid-19-negative patients are seen earlier in the shift and positive patients are seen later in the day to reduce the risk of cross-contamination.
      • Staff: HHAs can also assign staff so that only select staff are treating just Covid-19 positive patients.
    2. Real-world example: Interim Health Care revised caregiver schedules so that if they have a combination of Covid-19 positive and negative patients, they will see all of their Covid-19 positive patients at the end of their shift. In locations where they have a big enough Covid-19 population, leaders assign specific clinicians to only care for Covid-19 patients.

    3. Establish screening and testing protocols. HHAs can set patients' minds at ease by establishing clear screening and testing protocols for their staff. For example, providers can:
      • Screen every clinician who will be doing home visits daily before their shifts.
      • Pre-screen patients using the CDC protocols before visits. Consider screening for fever, shortness of breath, cough, and whether they have had exposure to anyone who has been in a highly impacted region.

    4. Adopt universal masking for patients, staff, and their families. While personal protective equipment (PPE) shortages remain a problem for many organizations, those with adequate supplies should alter policies to ensure that staff, patients, and their family members are masked whenever possible during the visit. Some organizations are now giving PPE to patients and their families if they don't have sufficient protection at home.

    5. Use telehealth in lieu of in-person visits when appropriate. While home health providers cannot receive direct reimbursement for those services, telehealth minimizes the number of in-person visits a patient receives thereby minimizing infection risk.

      Real-world example: Providence Home Health is using telehealth to limit in-person visits and reduce the risk of staff and patient exposure to Covid-19, as 30% of their staff is high risk. While the costs for rolling out telehealth capabilities have been borne by Providence, the agency is tracking metrics like patient satisfaction and willingness to accept telehealth to help them quantify value and track success.

    4 tactics for communicating your facilities' safety protocols.

    If you've already adopted the safety precautions outlined above, the next step is to communicate those changes to current and potential patients and families. While you're developing your Covid-19 messaging strategy, consider these four tips:

    1. Include a compelling statement to patients and their family about the negative impact delays can have on health outcomes, and the actions you are taking to mitigate infection risk. Consider incorporating supporting data regarding the proportion of patients declining home health and indicating that delaying needed care can result in a greater likelihood of hospitalization.

    2. When possible, provide direct access to nurses by phone to answer any questions related to patient fear about potential exposure to Covid-19 during in-home visits.

      Real-world example: Select organizations are offering a nurse call line for patients hesitant to accept home health. Patient refusal to receive in-home care, triggers an immediate call back from the nurse, who speaks with the patient about their concerns and reassures them about the precautions they have in place to ensure safety during the home health visit.

    3. Communicate with upstream referral sources about the safety precautions in place and your HHA's willingness to accept new patients.

    4. Feature images or videos of the safety precautions your organization has put into place. This strategy has been utilized by non-health care organizations such as Walmart. In its video, Walmart CEO John Furner walks through a Walmart in Alabama to show the precautions put in place to keep customers safe and minimize the risk of contracting Covid-19.

    Even after the number of emerging Covid-19 cases slows down, we suspect consumer fears and anxiety will persist. To prevent further volume erosion, home health providers must prioritize implementing recommended safety precautions and educate patients, families, and referral sources about downstream risks of deferring essential post-acute care.  

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