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Clinical Leaders Sound Off on Home Health Care’s Biggest Challenges


Clinical Leaders Sound Off on Home Health Care’s Biggest Challenges

By Joyce Famakinwa for Home Health Care News

The home health industry continues to settle into 2021, buoyed by the optimism associated with the country’s vaccination progress.

For the first time in months, clinical leadership teams have a chance to take stock of their operations while evaluating a number of different opportunities, challenges and trends across home-based care. One specific area where clinical leaders are currently seeing challenges is on the administrative side.

Similar to the rest of the health care sector, for example, the home health arena has been bogged down by electronic health record (EHR) burdens. At AccentCare, making sure this doesn’t become a barrier to care has been critical, according to Dr. Anna Loengard, the company’s chief medical officer.

“The EHR has been a major dissatisfier for clinicians,” Loengard said during a recent Home Health Care News webinar. “It has really taken their time, energy and efforts away from focusing on patients and really caring for patients. One of my areas of great focus here at AccentCare is [working on] bringing the joy back to our clinicians’ lives every day. How do we make sure that we’re not getting in the way of taking care of patients?”

Dallas-based AccentCare has over 200 locations across the U.S. As a company, it provides skilled home health and personal care services, along with hospice care, private-duty nursing and care management services.

While providers are working on creative solutions to lessen administrative burdens, employee vaccinations — and the COVID-19 emergency at large — are still top of mind.

For Intrepid USA Healthcare Services, this means keeping track of which employees have begun the vaccination process, according to Dr. Bob Parker, the company’s chief clinical and compliance officer.

“Fortunately, we implemented technology — a patient engagement platform that we were getting ready to roll out just as COVID hit us,” Parker said during the same webinar. “We were quickly able to translate that to screen our staff. We are now working to build out a survey [to track] who’s gotten their COVID vaccine, have they gotten their first one, have they gotten their second one.”

Intrepid USA, also headquartered in Dallas, has 75 local care centers across 17 states.

While Intrepid USA is still working on pinning down the exact number of staff members that have received the vaccine, Parker noted that the company is seeing more success in rural markets versus larger metropolitan ones.

Similarly, AccentCare hasn’t faced an easy road in regard to getting its staff vaccinated.

As of mid-February, roughly 20% of its workforce had received at least a first dose of a COVID-19 vaccine. Since then, this percentage has increased to about 30%, according to Loengard.

“We’re nowhere near the 80% that we would like to get to hopefully before this summer,” she said. “I think that’s, in large part, because we don’t have easy access to vaccines. If it were as simple as having our HR team call up and say, ‘I have these 100 people who need to be vaccinated in Austin, CVS tell me when we can bring them in,’ that would be really nice. But it’s not that organized.”

Further compounding challenges is AccentCare’s position as a large organization. Currently, the company has about 30,000 employees.

Aside from vaccination efforts, home health clinical leaders continue to determine what systems and processes should be virtualized.

The public health emergency has allowed Intrepid USA to accelerate this undertaking.

“It allowed us to really experiment with a lot of different platforms, processes and how we put these things together,” Parker said.

One specific development that has come out of this experimentation is the company’s move to virtualize the OASIS clinical process at its care centers.

“We are in real-time looking at what it is that we’re doing with these patients,” Parker said. “And we can adjust in real-time, so that we get things started correctly, there’s oversight.”

Along these lines, AccentCare has turned to technology and telehealth as a mode of care delivery.

“I think it’s one of those areas of medicine where everyone had a three-year plan of ‘how do we launch telehealth’ that became a three-day plan,” Loengard said. “I think that is an innovation that’s here to stay in some way. It’s helped us to access those patients [in congregate living settings].”

Throughout the public health emergency, providers have struggled to gain access to long-term care facilities and assisted living facilities, as new restrictions were put in place to curb further spread of the virus.

Loengard believes that in order for telehealth to have a permanent role in care delivery, reimbursement efforts must continue to move forward.

“We need to figure out how to get paid for that,” she said. “Right now, for us, only UnitedHealthcare is paying for those types of visits. It needs to be part of how you get paid for that home health episode. I think that we need to work with policymakers to figure out what that looks like and how do you put guardrails on that? We need to be really proactive in designing what that looks like.”

In February, the Office of Inspector General (OIG) announced an audit known as the “HHA Telehealth Project.” The audit will look into home health providers’ telehealth usage in 2020, when the U.S. Centers for Medicare & Medicaid Services (CMS) issued waivers aimed at creating flexibility.

While an announcement of its kind could, understandably, provoke fear in providers, Loengard hopes it doesn’t discourage telehealth use in home health.

Parker stressed that providers need to stand behind the necessary decisions they made throughout the COVID-19 emergency.

“Did we get every single thing right throughout that horrific six to eight months,” he said. “Not at all. If you dig, you’ll find something. I think [OIG] needs to come at this … [with the intention] of ‘let’s learn from it.’ Let’s make sure it becomes part of what we are doing going forward. Not as a ‘gotcha.’”

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