Incorporating Telehealth in Post-Acute Care Settings

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Practices for success in value-based care

There is a troubling lack of standardization and utilization of best practices within many post-acute care settings today. The results can be seen in unsatisfactory patient/family experiences and poorer outcomes, including higher readmission rates. In 2015 alone, hospitals and other providers faced penalties of more than $428 billion for unnecessary readmissions.1

Skilled nursing facilities (SNF) and other post-acute care settings are exploring a range of strategies to address these challenges. A promising trend is the growth of telehealth to provide patients and clinical staff greater and more timely access to physicians.

Comparing the Old with the New

Consider what may happen in a typical SNF readmission.  An elderly patient falls at home and is taken to the local emergency department (ED) where she is found to have fractured her hip. Her pain is controlled and a foley catheter is inserted while she awaits admission to the hospital where her hip will be surgically repaired. Post-operatively, she is discharged to a SNF for recovery. Shortly thereafter she develops a fever.  he nursing staff attempts to have the SNF physician evaluate the patient; however, the physician is not available in a timely fashion. As the patient worsens, the staff has the patient transported back to the ED where the patient now is bordering on septic; the cycle begins yet again.

Now consider this same scenario where the telehealth physician, preferably the same hospitalist, ED physician or the SNF physician that has treated the patient, is immediately contacted by the SNF staff through a HIPAA secure video platform. The physician speaks to the SNF nurses and virtually evaluates the patient. A urinalysis is immediately obtained that quickly confirms a urinary tract infection.  Appropriate antibiotics are rapidly administered, an ED revisit and hospital re-admission is avoided, the outcome is improved and the patient and family experience optimized.

Another way that telehealth may be used is with patients who are discharged from the hospital to their home. There are often many questions and issues that arise the first few days after a hospitalization. Busy primary care physicians may not be able to see patients within the first 48 to 72 hours. However, a telehealth program can ensure patients get post-discharge care and a prompt “virtual” follow-up visit to address needs, ensuring adherence to prescriptions and care orders and even further assisting with scheduling additional appointments.

Ensuring the Right Telehealth Approach

Simply adding telehealth technology is not the answer, however. The key is in a coordinated approach: one that helps to break down the silos in healthcare today and that integrates telehealth along the entire continuum of care.

Achieving those goals may seem easier said than done; but it can and is being done today. Below is a summary of best practice strategies for the use of telehealth in post-acute care settings:

  • Recognize the value of telehealth in post-acute care.  The national readmission rate from SNFs is 25%, and at some facilities over 40%.2 By connecting patients and/or their caregivers with telehealth physicians, concerns can be addressed; providers can ensure adherence to post-discharge care; and unnecessary trips to the ED can be avoided.
  • Build the program around a unified care team so that patients can connect with the same group of physicians that are caring for them in the SNF or that cared for them in the hospital. That level of coordination, and the ability to share the same care plan, helps considerably with patient engagement and satisfaction, as well as with reduction of medical errors and avoidance of ED and hospital readmissions.
  • Integrate the telehealth program with all care points on the continuum. All SNF programs have policies and procedures.  Ensure that access to telehealth becomes one of them and then encourage collaboration and coordination with all the providers along the continuum to break down walls and build a cohesive team.
  • Define the scope of telehealth programs at the organization.  Some organizations offer access to providers 24 hours per day, seven days per week; others focus on ensuring physicians are available during regularly scheduled hours or support after-hours and weekend coverage. SNF programs can also take a step-wise approach to telehealth, beginning with connecting physician and the nursing staff at the SNF, and then expanding to patients over time. The length of time telehealth will be made available to patients must also be considered. It can be as short as 72 hours or up to three months post discharge.
  • Communicate with local community physicians. In some areas, busy primary care providers (PCP) will greatly appreciate the assurance that their patients are getting prompt follow-up care through a telehealth program. In communities with PCPs that have availability to be more engaged, the concern may be over the potential to disrupt the existing physician/patient relationship. Something as simple as a phone call to that provider (and again, especially if it comes from the same physician who cared for the patient in the hospital and who will be providing the telehealth engagement) will be especially appreciated and help to alleviate concerns.
  • Make sure the technology used is accessible to patients. Not all patients today use smart phones or laptops, many have older PCs. Ensure the telehealth program is able to communicate with a range of devices. Recognize that some patients may need technical support to help them understand how to use the program.

Improving SNF Performance

While telehealth is growing as a strategy in primary care settings, its use in other areas is still relatively unexplored; it’s time to change that paradigm. The fact is, most patients are comfortable with telehealth. A survey from the American Hospital Association found that more than 76% of patients prioritize access to care over in-person interaction.3 In short, patients want to have questions and health needs conveniently and promptly addressed.

However, to provide optimal value, telehealth must be positioned as not a simple episodic service, but as part of a comprehensive strategy of care that expands the reach of brick and mortar physicians while remaining an integral part of the continuum of services.

Building telehealth programs that integrate the hospital and SNF care teams will greatly improve outcomes and patient satisfaction, while helping organizations manage costs, reduce penalties and survive in the new value-based healthcare reality.

References

  1. Kaiser Health News:  Aiming for Fewer Hospital U-Turns . . . Jan. 29, 2015. Available at: http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/
  2. Skilled Nursing Facility Readmission Measure (SNFRM) NQF #2510: All-Cause Risk-Standardized Readmission Measure. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/SNFRM-Technical-Report-3252015.pdf
  3. American Hospital Association, 2015. Available at: http://www.aha.org/research/reports/tw/15jan-tw-telehealth.pdf
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About Author

Richard Newell, MD, FACEP
Richard Newell, MD, FACEP

Richard Newell, MD, FACEP, is director of Telehealth Quality and Performance at CEP America, a provider of acute care management and staffing solutions, serving more than 200 practices and 6.3 million patients annually. Newell also practices emergency medicine at Good Samaritan Hospital in San Jose, Calif. He is a member of the American College of Emergency Physicians Quality and Performance Committee. Newell obtained his Masters of Public Health in Healthcare Management from Harvard University and completed his medical education at the State University of New York at Buffalo. He completed his Emergency Medicine residency training at Harbor/UCLA Medical Center.

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