March 04, 2019 – A proposal to give skilled nursing facilities (SNFs) more incentives to use telehealth and telemedicine will be heading back to Congress soon.
Politico reported last week that lawmakers are putting the finishing touches on a reintroduction of the Reducing Unnecessary Senior Hospitalizations (RUSH) Act, which stalled in the House during the last legislative session.
Introduced in 2018 by U.S. Reps. Adrian Smith (R-Neb.), Diane Black (R-Tenn.), Joe Crowley (D-N.Y.), Morgan Griffith (R-Va.) and Ben Ray Lujan (D-N.M.), the bill sought to create an “SNF-based Provision of Preventive Acute Care and Hospitalization Reduction Program,” which would be overseen by the Centers for Medicare & Medicaid Services and qualify SNFs to receive telemedicine and telehealth equipment described as “non-surgical items and services furnished at a hospital emergency department that may be safely furnished by a qualified group practice at a qualified skilled nursing facility.”
The bill would have enabled CMS to reimburse these SNFs for the technology, while also requiring the agency to evaluate each recipient six months after receiving the technology and at least once every two years after that.
“Currently, most nursing homes are not equipped to handle even minor emergencies,” Lujan said in a joint press release last year when the bill was introduced. “This means most patients are sent via ambulance to a hospital emergency room at any sign of emergency. This can be expensive and hard on patients and their families – especially in rural areas. The RUSH Act provides an exciting new opportunity to allow technology to bridge the gaps for patients and providers in nursing homes across the country.”
According to the Centers for Medicare & Medicaid Services, almost 20 percent of all hospital transfers originate from SNFs, and 45 percent of them could have been avoided through access to virtual care. In addition, the Medicare Payment Advisory Commission (MedPAC) has noted that rehospitalizations expose seniors to increased risk of falls, delirium, infections and adverse medication interactions.
In 2012, the Center for Connected Health Policy (CCHP) identified telehealth as an important tool for SNFs to improve quality, health and costs of care.
“SNFs provide services to a population of predominantly older adults who have limitations in their ability to independently care for themselves due to multiple and coexisting cognitive, physical and chronic conditions,” the CCHP noted in its report. “An aging population and a lack of resources for long-term health care are leaving skilled nursing staff increasingly responsible for a growing frail patient population that requires significant medical, therapeutic, and rehabilitation services due to their significant risk for adverse, complicated, and costly health events.”
“However, SNF physicians are often off-site or unavailable when patient assessments and care recommendations are most urgently needed,” the report added. “As a consequence, residents often have to be transported off-site to receive appropriate care such as to an emergency department for immediate assessment and possible hospitalization. Frequently they experience preventable negative health outcomes from the lack of timely care.”
The bill garnered support from several organizations, including the American Telemedicine Association, American Heart Association, West Health and Health IT Now (now known as the Health Innovation Alliance).