On July 1st, 2023 CMS began requiring home health agencies to document their utilization of telehealth services on their Medicare Fee-For-Service (FFS) claims. As finalized in the CY 2023 Home Health Payment System Rate Update, agencies are responsible to identify one of three services they provide using new Healthcare Common Procedure Coding System (HCPCS) codes.
These codes are added as a separate visit line on the claim based on the date each service is provided. CMS notes in the rule that these services are for reporting only, since CMS does not reimburse for these services. The HCPCS codes are:
| HCPCS | Description |
|---|---|
| G0320 | Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system |
| G0321 | Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system |
| G0322 | Collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency i.e., remote patient monitoring (RPM). |
Using data from the SHP national database, we pulled out some of these initial insights for the six months ending December 2023:
Key Findings
- Adoption Rates:
- Agency Participation: 30.5% of agencies provided at least one telehealth service.
- Claims with Telehealth Codes: Only 3.9% of all claims included one of the telehealth HCPCS codes, indicating that while many agencies are utilizing telehealth, it is applied to a smaller subset of patients.
- Telehealth Service Distribution:
- Total Services: 217,114 HCPCS service lines were recorded on the claims.
- Service Types:
- Audio/Video (G0320): 5.7% of telehealth “visits”
- Audio Only (G0321): 94.3% of telehealth “visits”
- Remote Patient Monitoring (RPM) (G0322): 365,599 days on service
- Service Duration:
- Audio/Video: Average duration was 17.4 minutes per visit.
- Audio Only: Average duration was 15.2 minutes per visit.
- RPM: Average duration was 9.64 days per claim.
Use Cases and Risk of Hospitalization
Telehealth services have been cited for their potential benefits, including reducing hospitalizations, supplementing in-person visits to optimize costs and staffing, and improving patient outcomes through better tracking of biometrics. The data further supports these use cases:
- Risk of Hospitalization:
- No Telehealth: 22.3%
- Audio/Visual: 25.9%
- Audio Only: 26.3%
- RPM: 29.5%
The higher rates of hospitalization risk among patients receiving telehealth services, particularly those under RPM, suggest that these services are targeted towards higher-risk patients. RPM, in particular, is used to monitor and manage patients who require closer surveillance of their health biometrics.
Implications for Home Health Agencies
The emphasis on value-based care models, such as the Home Health Value-Based Purchasing (HHVBP) program, means that agencies must focus on improving patient outcomes and reducing hospitalizations to achieve better star ratings and bonuses. Telehealth services offer a valuable tool in this quality improvement effort.
Recommendations
- Expand Telehealth Utilization: Given the higher risk profile of patients utilizing telehealth, agencies should consider integrating these services more broadly across their patient base to enhance monitoring and intervention capabilities.
- Focus on RPM for High-Risk Patients: Agencies should particularly focus on RPM for patients with higher risks of hospitalization, as it provides continuous monitoring that can preemptively address health issues.
- Enhance Staff Training and Resource Allocation: To maximize the benefits of telehealth, agencies should invest in training for their staff and allocate resources effectively to support telehealth initiatives, ensuring that they can be integrated seamlessly with in-person care.
- Analyze Telehealth Impact on Outcomes: Agencies should continuously analyze the impact of telehealth services on patient outcomes to refine their use and demonstrate their value in reducing hospitalizations and improving care quality.
By leveraging telehealth effectively, home health agencies can enhance their care delivery models, ultimately leading to better patient outcomes and positioning themselves favorably in value-based care environments.
