Long-term and post-acute care organizations have not received the same support as other care settings for creating interoperable patient data tools, putting home health and hospice providers at a disadvantage, according to new research by the Department of Health and Human Services.

Electronic health records (EHRs) are used by the vast majority of long-term and post-acute care (LTPAC) providers. Within the home health and hospice industries, roughly 78% of providers have adopted an EHR, according to the study. And while their functionality is largely the same as those used in other care settings, EHRs used by home care and hospice providers fall short when it comes to their interoperability capabilities. 

A key reason for this, HHS found, is that LTPAC organizations have not been incentivized to use interoperable technology in the same way as other healthcare providers.

“Due to thin operating margins, lack of adequate financial incentives has made it difficult to fund and implement interoperable HIT systems,” HHS said in its December report. “Organizations need a system or market reason to exchange data. Without the proper financial and policy incentives, it will be difficult to make organic progress toward interoperability.”

Meanwhile, other care settings have been able to benefit from government programs that encourage use of interoperable health data tools. Hospitals, for example, were selected to participate in Promoting Interoperability Programs, which offered financial incentives for implementing interoperable HIT.

And since hospitals and other acute care settings received this head start, many LTPAC providers have not been able to lay the groundwork to create interoperable HIT systems.

“Providers and vendors do not have a clear understanding of what data reporting and interoperability requirements will be in the future,” the report noted. “LTPAC organizations and vendors are left to do what they think is best, with limited guidance resulting in the lack of standardized and codified data to support interoperability,” the report said. 

LTPAC organizations have long petitioned lawmakers for help with creating interoperable patient data tools. And while hospitals were successful in earning this support, home health and hospice providers have not been able to do the same, HHS said in its report.

Still, the “next big step” in nationwide health data interoperability may be yet to come. The Trusted Exchange Framework and Common Agreement (TEFCA) has been slated for launch in the first quarter of 2024, and will create interoperable functionality among five EHR systems. LTPAC stakeholders have expressed hopes that TEFCA might benefit, rather than overlook, home health and hospice providers.

Home health agencies that do not have electronic health record systems in place are at a disadvantage, but many still lack this technology, according to a recent study published in the journal Home Health Care Management and Practice.

Among a sample of more than 1,500 Medicare home health providers, approximately 10% did not use EHRs. Some instead used paper and pencil for clinical documentation, whereas others explored other means of transmitting patients’ health information, such as by using telephone calls. EHR tools, however, were found to be the most effective, whereas the alternatives led to challenges for the providers and the patients they served.

Those challenges included operational and administrative slowdowns. Paper charting was found to be less efficient and more time-consuming than electronic means, and as a result, providers using those outdated means experienced more challenges coordinating care with patients’ other providers.

Those providers without EHR systems in place tended to be smaller, and were more often for-profit rather than nonprofit entities. Those without EHRs also had lower Star Ratings and weaker Home Health Consumer Assessment of Healthcare Providers and Systems scores, on average.

EHR advantages

Meanwhile, providers that use EHR systems were reportedly better able to monitor their patient population, more effectively coordinate care and collect data for quality improvement. They generally produced better health outcomes at lower costs, the study found. 

But those agencies still noted challenges that came with using EHR tools. For example, electronic health information platforms can be difficult for staff members to learn and use, the researchers noted. Some providers reported “ongoing difficulties and barriers” preventing effective use of EHR technology.

“These challenges may inadvertently lead to higher workloads due to the need to transcribe paper notes into the EHR and resolve HIT issues, which may decrease user satisfaction with the system,” the researchers wrote. “The switch to a new EHR system increased the time clinicians spent on charting, suggesting that there may be an initial learning curve associated with instituting new technology resulting in an initial increase in workload.”

Big investment

The process of adopting an EHR can be a challenge in and of itself, as selecting the appropriate electronic tool requires a large investment of time and money, according to the study. A highly fragmented market of EHR tools impedes healthcare interoperability, reducing efficiency and making care coordination harder, the researchers noted.

In related news, five EHR vendors entered the Trusted Exchange Framework and Common Agreement in a move that could advance efforts of creating interoperable patient data tools. Epic Nexus, Health Gorilla, KONZA and MedAllies and eHealth Exchange make up the first five qualified health information networks under TEFCA. They will be able to share patient data with providers using any other TEFCA-aligned EHR software.

The share of people aged 65 or more years who are employed has almost doubled in the past 35 years, according to a new report by the Pew Research Center.

Pew reached the finding using data from the Census Bureau Current Population Survey and the Federal Reserve 2022 Survey of Household Economics and Decisionmaking. It found that almost 20% of Americans aged 65 or more were in the workforce in 2023, and those employees are working more hours and earning more money than ever before.

More than 60% of those older workers are working full time; in 1987, the percentage was less than half. They also are more likely to be receiving employee benefits such as health insurance or pension plans, and 44% of the older workers have a bachelor’s degree or higher, which is only 1 percentage point lower than the proportion of degree-holding workers aged 25 to 64.

Older adults’ health likely makes it possible for them to work longer, the authors said. Across the past 15 years, older adults today generally are healthier and less likely to have a disability, making it easier to “extend their working lives,” according to Pew. Also, many more jobs are “age-friendly” now compared with decades past, promoting safer, more flexible work environments, the authors noted.

Beyond those reasons, however, government policy and shifting employer expectations have kept many individuals working into what has been traditionally considered retirement age. Defined contribution plans such as 401(k)s, which are increasingly common, do less to encourage early retirement compared with benefit plans such as pensions. And in 1983, the federal government began increasing the age at which workers could collect their full Social Security benefits, so many older adults have remained working longer, according to the report. For instance, whereas everyone formerly could collect full benefits at age 65, now, those born from 1943 to 1954 had to wait until they were 66, those born from 1955 to 1959 must wait until they are 66 and a varying amount of months depending on birth year, and those born in 1960 or later must wait until they are 67.

Within healthcare, the average age of a registered nurse is 43 years, slightly higher than the age in all other occupations, which is 42 years, according to a recent study by the ADP Research Institute. Still, as burnout, stress and other on-the-job factors push many nurses towards retirement, the average tenure within the field has declined in recent years.

Senior care policy institute PHI recently threw its support behind the Home- and Community-Based Services Relief Act. LeadingAge is a supporter, too.

The legislation, recently introduced by Sen. Bob Casey (D-PA) would provide two years of ensured Medicaid funding for HCBS providers to “stabilize their HCBS service delivery networks, recruit and retain HCBS direct care workers, and meet the long-term service and support needs of people eligible for Medicaid home and community-based services,” according to the bill. This funding would come in the form of a 10% increase to the Federal Medical Assistance Percentage, or FMAP, for state Medicaid programs, equating to hundreds of millions of dollars on the table for HCBS programs, according to PHI.

But states lately have had a hard time generating funding for HCBS. In the last year, a majority of states have reported that some HCBS providers have had to close their doors permanently, according to PHI. And adding to this problem, there are hundreds of medical services that fall under the HCBS “umbrella,” according to the Medicaid and CHIP Payment and Access Commission. As a result, it can be hard for Medicaid programs to determine one rate that can provide for all the various HCBS providers.

Casey’s relief act would give states the flexibility to institute more generous rates, thereby providing for more of their HCBS programs. In a recent statement, PHI underscored the importance of securing this funding.

“The HCBS Relief Act comes at a time when the need for robust home and community-based services is more pressing than ever,” said Murray Devine, PHI’s director of communications, in a statement. “By providing dedicated funding to stabilize HCBS programs and support direct care workers, the legislation offers a pragmatic solution to a complex problem. It is an important step forward in addressing America’s caregiving crisis and ensuring that individuals can receive the care they need in the setting of their choice.”

But Devine noted that the bill does not represent the “end of the journey.” The FMAP boost would only last two years; funds from the American Rescue Plan Act, which have also helped support HCBS, are on track to expire by 2025. 

“While the HCBS Relief Act is a significant step in the right direction,” Devine said, “longer-term investment is essential for the sustainability and expansion of HCBS.”

When older adults become more familiar and comfortable with online and digital tools, the odds of their health improving increase.

Older adults have a powerful new tool to help them connect online with care providers, and it cuts 6% off of the cost of care. The Papa digital health companionship platform now is brandishing a new digital health literacy feature.

As part of the new feature, Papa assesses members’ social needs, including facets such as their internet access and online literacy. Then, an in-home visit between the member and a Papa Pal, a kind of nonmedical caregiver, takes place.

After the initial visit, follow-ups allow the caregivers to make sure the member’s needs are being met over time. Finally, Papa provides a report on each step of the process so that health plans can track the program’s effectiveness.

“Having a trusted companion sit side-by-side with members to guide them through new technology is invaluable and often the key to success, particularly when working with older populations,” Andrew Parker, founder and CEO of Papa, said in a statement announcing the upgrade last week. “It’s past time we address the technological barriers that exist in getting people the care they so desperately need.”

The vast majority of Medicare Advantage plans offer telehealth services as a benefit, but many older adults have a difficult time using these services to their fullest potential, according to Papa. Almost 3 in 4 older adults reportedly need help setting up and using new devices, whereas about 15% of Papa members request technological assistance when they enroll in the company’s standard companionship program. Those statistics demonstrate the need for a program to improve members’ digital health literacy, Papa said.

The company predicts $242 can be saved per care episode for members using the new digital literacy feature. Many of those patients are unable to use telehealth services and instead rely on more costly resources such as emergency department services. The $242 represents a 6% savings in the cost of care.

In recent years, Papa has focused on addressing members’ social determinants of health as a means of reducing costs and improving health outcomes. Services such as caregiver-assisted technological support can not only improve outcomes; it can advance health equity, the company noted.

“Leveraging our national network of Papa Pals and expert social care navigators, Papa’s digital health literacy offering ensures members have the proper resources and support to stay connected with their care teams and mental health resources, no matter their race, age or economic standing,” Parker said.

CHICAGO — Despite the challenge of implementing it, artificial intelligence is a “game changer” that potentially could revolutionize almost every aspect of healthcare delivery, according to home care leaders.

“There’s nothing that won’t be touched in our industry by AI in some way, shape or form,” Caring Senior Services CEO Jeff Salter said Monday during a panel discussion at the 2023 Home Care Association of America National Conference.

One of the most exciting uses for AI, according to Salter, is that it gives providers an opportunity to make sense of unstructured, difficult-to-interpret data. For example, AI can identify and analyze isolation better than more basic algorithm-based technologies, which require detailed, laborious data entry on the part of caregivers, Salter said. By using AI, caregivers can more efficiently prescribe care for a lonely patient, he said.

Everything from scheduling, patient-caregiver matching, analysis of shift notes and clinical documentation has the potential to be made easier by AI, according to Wyatt Godfrey, vice president of technology at home care provider Right at Home. But these advancements will not come easily, members of the panel agreed. Resistance to new technologies on the part of employees and clients can pose challenges for providers looking to implement cutting-edge tools.

“There’s definitely going to be continued pushback from people that are not knowledgeable, so our job is to really help educate them on what we’re trying to accomplish and how it can benefit them,” Salter said in an interview with McKnight’s Home Care following the session. The beginning stages of implementing new technology can be the hardest, he noted, so change management is key.

To make this transition easier, it’s wise to find AI solutions that not only work well with existing technologies but also seamlessly integrate into the systems that already are in place. AI tools embedded into other software reduce the number of logins an employee needs to perform throughout the workday. Numerous log-ins can reduce operational efficiency and can lead to burnout, according to Godfrey.

“Because of AI, the types of things that will be critical to your employees and staff will be different,” he said. In the next three to five years, everything from hiring practices to office management will be changed by AI, so the people must be able to adapt alongside, Godfrey added.

In Arizona, Cypress HomeCare Solutions has been exploring AI applications that can help offset rising care costs. Company co-founder and Managing Partner Bob Roth expressed his excitement for the technology in the panel discussion.

“This isn’t something you should be scared of, but it’s something that will help us do our jobs better,” Roth said. “And at the end of the day, we’re going to have happier clients and we’re going to keep them at home because that’s where they want to be.”

Since 2021, use of remote patient monitoring has grown by more than 300%, according to a report by digital healthcare firm Vivalink. And many providers are using it for hospital-at-home programs. 

“The paradigm shift in healthcare has occurred. Where RPM adoption was promising just over two years ago, it’s now an integral part of care models, according to providers,” Vivalink CEO Jiang Li said in a statement.

Two years ago, only about 20% of clinicians used RPM tools on patients, according to the report. Today, that number has grown to 81%. Of the total number of respondents, 84% plan to increase their usage of RPM next year. Also, 45% of providers use RPM for acute monitoring, such as hospital-at-home.

Reasons for the shift come down to the accessibility of many RPM tools. They typically are small and often affordable and allow for services such as blood pressure or heart rate monitoring to be done outside of clinics, according to the report. The ability to keep tabs on patients at home frees up hospital space, reducing payer strain and challenges from staffing shortages.

Usage of RPM is expected to continue growing. More than three fourths of survey respondents predict that RPM-based care will outpace traditional hospital care within the next five years. 

Experts also point to RPM’s potential to close care gaps and advance health equity, as monitoring that can be done at home will reduce patients’ need for inpatient visits to hospitals and other clinics.

Other research has found tools such as home blood pressure monitoring to be a cost-effective preventive health measure for people with cardiovascular disease or diabetes. According to an American Journal of Preventive Medicine study, in-home blood pressure checks can reduce patients’ risk of stroke by 3.8% and healthcare costs by more than $7,000, on average, over 20 years. The benefits were found to be greater for people of color and individuals living in areas with limited care access, further advancing health equity.

“Understanding how inequities are created and maintained is important for understanding how we can advance equity in the home health care setting,” lead researcher Shekinah Fashaw-Walters said.

To achieve this understanding, the University of Minnesota team used data from the 2016-2017 Outcome and Assessment Information Set, the Medicare Beneficiary Summary File and census data. Among a sample of more than 3 million people, the greatest proportion of patients experiencing functional improvement was found in white people, at 79%, followed by 76% of Asians and Pacific Islanders, 72% of Black people and Native Americans, and 70% of Hispanic people.

The results also showed that Black, Hispanic and Native American home health patients were more likely to be discharged without experiencing any functional improvement, and that higher-income people in general had better access to better-quality home healthcare than lower-income individuals. Even within the same home health agency, lower-income patients, on average, experienced less functional improvement than higher-income patients at the same provider.

Those findings were attributed in part to the accessibility of high-quality home care. White and higher-income patients typically have better access to higher-quality providers, Fashaw-Walters said, which often is a result of structural or institutional racism such as redlining.

The researchers recommend strategies to minimize inequities among home health patients, such as improving providers that serve a greater proportion of marginalized groups, using incentives to encourage health equity and training staff on socially-conscious care delivery. 

“Inequities are not created equally,” Fashaw-Walters said. “To create change for most racial and ethnically minoritized home health patients we have to focus on improving access to higher quality agencies; but for lower-income home health patients we have to focus on making sure they are receiving equitable treatment within each agency.”