Telehealth in home healthcare faces setbacks amid lack of federal reimbursements

Many home healthcare agencies adopted telehealth services during the COVID-19 pandemic, but the absence of federal reimbursements for these services has led to an increasing number of providers discontinuing these options, a national survey conducted by the University of California, Irvine, and other institutions reveals. Results are published in Health Services Research.

The National Institute on Aging-funded study offers valuable insights into the role of telehealth in home healthcare, a rapidly expanding sector. As the population ages and seeks alternatives to nursing homes, this field is expected to grow by 10 percent annually.

The survey's findings spotlight the urgent need for policy considerations from the Centers for Medicare & Medicaid Services, which has not reimbursed home healthcare agencies for telehealth services, even during the pandemic.

Conducted from October 2023 to November 2024, the study queried 791 home healthcare agencies, with a response rate of 37 percent. It focused on businesses that served a significant portion of dementia patients, averaging 33 percent of their clientele. The results revealed that only 23 percent of home healthcare agencies had adopted telehealth by 2019. However, that number surged to 65 percent by 2021, primarily driven by the implementation of virtual visits to mitigate disease transmission and address staffing and equipment shortages during the COVID-19 pandemic. Nevertheless, 19 percent of adopting agencies had discontinued telehealth by 2024. The reasons cited for this included a lack of Medicare reimbursement and concerns about the suitability of telehealth for the home healthcare of older, less tech-savvy patients.

This study is the first to provide a comprehensive national picture of telehealth's trajectory in home healthcare. Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets."

Dana B. Mukamel, corresponding author, UC Irvine Distinguished Professor of Medicine

The survey revealed that 33 percent of home healthcare agencies never adopted telehealth, even during the pandemic, often believing it inappropriate for the sector's hands-on model. Virtual visits saw the largest adoption spike in 2020 (21.1 percent), but 22 percent of users had discontinued them by about 2022. Among this group, 60 percent echoed concerns about patient suitability, while 55 percent highlighted costs and lack of reimbursement. Remote patient monitoring and client surveys saw smaller adoption increases and similar discontinuation trends.

These patterns suggest that COVID-19 disrupted telehealth's natural diffusion into home healthcare, which was gaining traction pre-pandemic, with 23 percent adoption by 2019. The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth's limitations for older adults pose barriers to sustained use.

As the Centers for Medicare & Medicaid Services considers telehealth reimbursement policies, the study calls for rigorous evaluations of telehealth's cost-effectiveness and patient outcomes. With home healthcare expenditures projected to grow significantly, policies supporting telehealth could enhance care delivery and manage costs. The results also underscore the need for future research to assess whether these trends hold across all home healthcare agencies, given the study's focus on dementia-serving businesses.

The study, co-authored by experts from UC Irvine, UCLA, Brown University, the University of Minnesota and other institutions, is a critical resource for policymakers navigating the future of home healthcare. As the nation grapples with an aging population and rising care demands, understanding telehealth's role could shape effective, sustainable solutions.