Journal Article

Understanding Home Health Agencies' Perspectives Toward Telehealth Use Among Home Health Stakeholders in the Post–COVID-19 Era: Qualitative Interview Study

Sterling, Madeline R, Jung, Hye-Young, Thompson, Michael P, Yu, Jiani, Abraham-Aggarwal, Kiran, Spertus, Daniel, Unruh, Mark Aaron, Bowles, Kathryn H, Espinosa, Cisco

2025

Overview

In the United States, the COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC), but its sustainability remains uncertain. Despite telehealth's potential benefits, including improved patient monitoring and expanded access, the lack of reimbursement and regulatory constraints may limit widespread adoption. Understanding how home health agencies (HHAs) perceive these challenges is critical for shaping future telehealth policy. To examine HHA stakeholders' perspectives on the adoption, implementation, and sustainability of telehealth in the postpandemic era, with particular attention to operational benefits, financial and regulatory barriers, and the impact of new Centers for Medicare & Medicaid Services (CMS) billing codes (G-codes) for telehealth documentation. Qualitative study using semistructured interviews conducted between February and December 2024. The study followed the Practical Implementation Sustainability Model (PRISM) framework for data collection and analysis. Participants were recruited from HHAs and home health policy organizations across the United States, representing a range of agency types and geographic regions. A purposive and snowball sampling strategy was used to recruit 14 stakeholders, including HHA leaders, HHC clinicians, and policy experts. Interviews were transcribed and analyzed thematically using both deductive codes from the PRISM framework and inductive codes to capture emergent themes. Participants described their experiences with telehealth in HHC, including its operational feasibility, clinical utility, financial impact, and response to new CMS G-codes introduced in July 2023 for telehealth documentation. Primary topics of focus included stakeholders' perceptions of telehealth's benefits, barriers, and future viability in HHC. Stakeholders identified 4 key themes: (1) telehealth offers operational efficiencies (eg, increased patient touchpoints and workforce support) and clinical benefits (eg, improved patient monitoring and potential reduction in rehospitalizations); (2) the lack of CMS reimbursement makes telehealth adoption financially unsustainable for many HHAs; (3) specific HHAs, particularly those integrated with health systems or serving high-risk patient populations, may derive sufficient benefits to continue telehealth use despite financial constraints; and (4) current regulatory policies, including new CMS G-codes, increase administrative burden without providing financial incentives and discouraging telehealth adoption. While stakeholders recognize the benefits of telehealth in HHC, financial and regulatory challenges pose substantial barriers to its sustainability. Policymakers must weigh the advantages of telehealth reimbursement and regulatory support against concerns about wasteful care.

• Publisher: Journal of Medical Internet Research,JMIR Publications
• Subject: Adoption and Change Management of eHealth Systems / COVID-19 - epidemiology / Digital Health, Telehealth and e-Innovation in Clinical Settings / E-Health / Health Services Research and New Models of Care / E-Health Policy and Health Systems Innovation / Finance / Home Care / Home Care Agencies / Home Care Services / Home care services industry / Humans / Interviews as Topic / Original Paper / Qualitative Research / SARS-CoV-2 / Stakeholder Participation / Surveys / Technology application / Telehealth and Telemonitoring / Telemedicine / United States