Adopting Telemedicine Increases Ability to Treat in Place and Lower Hospitalizations

Skilled Nursing Facilities (SNFs) nationwide are experiencing increasing challenges. These include sicker patients, higher turnover in staff, narrowing of referral networks, increased regulatory oversight and pressure to achieve certain clinical outcomes.

Telemedicine is proving to be a vehicle by which SNFs can address these issues and meet the demands of our nation’s ever-increasing aging population. Adopting telemedicine offers ways to deliver care on-demand, cost effectively and efficiently; a solution where all constituents stand to benefit.

Based on its successes in improving care and reducing costs, telemedicine is growing at a rapid pace. It is expected that the number of patients using telehealth services will rise to seven million this year, up from less than 350,000 in 2013. (¹⁾

Broadly defined, telemedicine encompasses the monitoring, diagnosing and treating of patients from a distance using technology. Recent technological advances – especially emergent ones over the past 10 years –have enabled medical providers at many levels to be virtually at the patient’s bedside like never before.

Telemedicine has been proven to deliver results across a variety of settings with definitive positive impact on measurables relating to mortality, length of stay, readmissions, emergency room visits and improved access to caregivers.

Evolution of the Emergence and Acceptance of Telemedicine

In October 2012, Medicare started rewarding hospitals that were providing high-quality care for their patients through the Hospital Value-Based Purchasing (VBP) Program. Under the VBP, hospitals are paid for inpatient acute care services based on quality of care — not the volume of services they provide. To this end, a hospital’s Total Performance Score (TPS) and unplanned readmissions are significantly and inversely related to readmission rates.(²⁾

These new payment models have driven hospitals to evaluate the variables that might impact the readmissions of their patients. One of the most common discharge locations for hospitalized patients are SNFs. This increased scrutiny has required that facilities evaluate how they can provide services that prevent readmissions so that they can remain a preferred referral source.

Beginning Oct. 1, the SNF VBP Program will begin to reward (or penalize) SNFs for 2017 performance by offering incentive payments for the quality of care they deliver to Medicare patients. In this new environment, SNFs across the nation are now — more than ever — seeking creative ways to utilize telemedicine to distinguish themselves with their hospital partners and deliver a higher level of care to their patients by treating them in place, thereby avoiding hospital transfers.

Telemedicine directly supports the Institute for Healthcare Improvement’s (IHI) Triple Aim. The IHI created the Triple Aim framework, with a mission focused on improving the patient experience of care, improving the health of populations and reducing the per capita cost of health care.

Telemedicine complements the Triple Aim in the following ways:

• Improving the patient experience of care
  • Enhancing communication
  • Reducing uncomfortable transportation and wait periods
  • Reassurance from technology investment
• Improving the health of the following populations
  • Those vulnerable due to injury or recent surgery
  • The elderly
• Reducing the per capita cost of health care
  • Reducing costs due to improved standardization and timely intervention, allowing care to be delivered in a lower-cost setting

Telemedicine Benefits all Constituents

There are several approaches to telemedicine. When executed properly, the service can benefit all constituents in the care process.

Below are a few of the ways patients, physicians and facilities are able to benefit from telemedicine:

Patient Benefits

• Improved response to their changes in conditions
• Improved intervention time by a physician
• Avoided ambulance transfers and long Emergency Department wait times

Physician Benefits

• On-call partnering to better respond to patients’ needs
• Improved lifestyle due to better after-hours coverage
• Preserved autonomy
• Preserved professional fee billing

Facility Benefits

• Competitive market advantage leading to referral increases
• Ability to benchmark performance
• Improved financial performance
• Improved staff retention

Telemedicine’s Influence and Positive Impact

When considering the use of telemedicine services, it is critical for the SNF to partner with an experienced provider with proven results. They will witness the best successes by gaining a keen understanding of their baseline data and setting clear objectives for their own programs. Important baseline elements to track before and after the installation of telemedicine services, include:

• The typical length of stay for a patient
• Number of patients who return to the hospital each month
• The percent of those who leave and who never return
• The percent who return after a hospital stay
• The facility Resource Utilization Groups (RUG) Rates

Using this information, a facility can derive the impact on lost revenue. By comparing the results quarterly to baseline data, the return on investment can be clearly demonstrated.

In a recent study (³⁾ featured in the American Journal of Managed Care, the use of a dedicated virtual after-hours physician coverage service in an SNF demonstrated a significant reduction in avoidable hospitalizations. The study, conducted in a 365-bed SNF, addressed the potential clinical and financial impacts of an after-hours physician coverage service to prevent avoidable hospitalizations.

Outcomes were tracked and evaluated for the initial year. Avoided hospitalizations were identified as such by the covering physicians and confirmed by the facility’s medical director. Out of the 313 patients cared for by the telemedicine-enabled covering physicians during the year of service, 259 (83%) were treated on site, including 91 who avoided hospitalizations as verified by a third party, and 54 were transferred to the hospital.

The fee for the service was offset for the facility by preventing hospitalizations. This helped the facility maintain census, especially in its short-term rehabilitation unit; capture lost Medicaid days while a patient was hospitalized; and decrease transportation costs.

In another example, specifically since introducing the physician-based telemedicine services provided by TripleCare, the average treat-in-place (TIP) rates across three leading East Coast-based SNFs was 81% for complex patients with a change in condition. In addition to improving patient outcomes, retaining patients in these three facilities improved facility census and also increased revenue. Revenue retention across each of these three facilities was also quite significant.

TIP and retained revenue details by location were:

• 107 episodes reported, of which 98 were treated in place, yielding total revenue retained of $77,824
• 114 episodes reported, of which 100 were treated in place, yielding total revenue retained of $77,824
• 89 episodes reported, of which 53 were treated in place, yielding a total revenue retained of $46,931

CONCLUSION

Telemedicine is benefitting physicians, providers, patients and their families. By keeping patients where they live and treating them in place, they are more comfortable, experience better outcomes and the cost of care is lower all around.

Implementing a successful telemedicine solution is a smart and affordable way to stay in preferred provider networks, increase facility census, reduce hospital readmissions, allow for happier residents and their families and ensure more confident staff members are part of the facility’s team.

The future holds significant opportunity for bringing telemedicine to more facilities and patients. As technology continues to advance, the adoption of telemedicine will become easier and more prevalent, increasing the extent of benefit to all constituents.

References

1. “Global Telehealth Market Set to Expand,” IHS Markit. February 2014
2. Nursing Economics. 2016 May-Jun;34(3):110-6. Hospital Value-Based Purchasing And 30-Day Readmissions: Are Hospitals Ready? Haley DR, Zhao M, Spaulding A.
3. American Journal of Managed Care. 2018;24(8):600-603