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How Telehealth Can Help Hospitals Manage Post-Acute Care Costs

HHS estimates that 25 percent of all Americans – and 75 percent of those over age 65 – are dealing with multiple chronic conditions like diabetes and congestive heart failure (CHF).

Hospitals and providers now share the responsibility for the total medical expense (TME) of these patients, yet up to 40% of those costs come in the post-acute phase. One key way to lower costs and improve outcomes is to integrate telehealth into a variety of post-acute care settings.

This year’s InTouch Telehealth Innovation Forum offered several blueprints for how to achieve this, including a presentation by Sue Thompson, administrative director for integrated care management at PinnacleHealth System in Pennsylvania.

In a pilot project at Pinnacle’s Colonial Park Care Center, Thompson’s first move was to narrow the network from 40 skilled nursing facilities (SNFs) to just five preferred providers. Each of them received an InTouch telehealth device to aid in things like wound and ostomy evaluations. Colonial Park’s readmission rate quickly dropped from 20%-plus to 16%.

Thompson feels that telehealth technology fosters a “we’re in this together” mindset across the care continuum. “SNFs are now facing the same quality metrics and value-based purchasing requirements that hospitals do,” she said. “All stakeholders are looking for ways to improve post-acute care.”

Thompson’s enthusiasm for telehealth was shared by presenter Barry Bittman, MD, CEO of the Institute of Innovative Healthcare. He used the hypothetical case of 87-year-old “Jennie” – a woman with diabetes and CHF who does well in the hospital but has difficulties in the post-acute phase, whether it’s a SNF, home health provider or simply at home alone. Bittman notes that telehealth can provide the hospital-caliber oversight that the Jennies of the world so urgently need. In his view, telehealth is the most cost-effective way to improve care coordination and reduce the number of costly 911-driven hospital readmissions.

A Porsche dealer wouldn’t dream of letting you drive off the lot without a plan for ongoing maintenance, education and support. Hospitals must likewise have a plan for post-acute care – one that relies heavily on telehealth technology.

Embracing The Network

There have been dozens of books published on how to “fix” healthcare, but probably one of the best is “Where Does It Hurt?: An Entrepreneur’s Guide To Fixing Healthcare” by Jonathan Bush (who also happens to be CEO and co-founder of healthcare software giant athenahealth).

In a recent article, Bush proclaimed that the “future of the hospital is the network.” He praised Mt. Sinai Hospital in New York for its marketing campaign headlined “If Our Beds Are Filled, It Means We’ve Failed.” Those ads show that Mt. Sinai is serious about moving away from isolated, intermittent care to continuous, coordinated care – a shift that Bush feels all hospitals should make.

Bush believes that successful hospitals are rapidly moving from the EHR-centric model, to the patient-centric world of cross-continuum connectedness, a/k/a the network. Telehealth is an integral part of that brave new world.

Telehealth is the arterial system that can connect acute care specialists, home health providers, Ambulatory Surgery Centers, imaging centers, and all points between. Bush foresees a day (coming soon) when a patient can get an immunization at a retail clinic, an outpatient surgery at an ASC, and a telehealth consultation at home all in a single week.

That’s the “right care, right time” mantra that has long been the guiding principle of telehealth.

Bush sees a bright future for telehealth because relying on a robust network is the only way to “unbreak” our healthcare system.

 

Telehealth Network

Telehealth Network

 

 

“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.

 

Hospital Discharge

Hospital Discharge

 

 

How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  

 

By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
Would you like to be on the cutting edge of telemedicine and other health care issues? Learn more about MHA@GW, the online master of health administration from the Milken Institute School of Public Health at The George Washington University.

 

[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.

 

Telehealth for Seniors

Skilled Nursing Facility using telehealth

Home, But Not Alone

The ATA’s Home Telehealth special interest group was launched 16 years ago – and the progress made in that field has been spectacular.

Telehealth was originally envisioned as a way for rural patients to get access to specialists, but now it’s widely used in many other ways:

 Remote patient monitoring has really come of age. For example, the University of Arizona health system uses telehealth technology to provide at-home monitoring of prospective heart transplant patients who are waiting for a donor match.

Remote medication management helps ensure that patients adhere to the appropriate dosages and schedules. Research shows that medication non-adherence is a factor in more than half of hospital readmissions – and nearly twenty-five percent of all nursing home admissions.

Telehealth for care transitions reduces errors as patients move to different care settings: hospital, skilled nursing facility, home care, etc.

The bottom line is that thousands of patients are getting expert care without having to physically visit a specialist or PCP. As they grow comfortable with the benefits of at-home monitoring, they’re much more receptive to acute care consultations when the need arises.

The laws governing home health vary widely from state to state, and that’s why there are efforts underway to create standards and protocols for remote home care.

Without telehealth, most communities will fall short of their population health management goals. Patients with multiple chronic conditions need ongoing education and observation where they matter most: in their own homes.

 

 

Health Reform is Working

By fostering greater hospital partnership, the Affordable Care Act is already showing early signs of success. CMS notes that the national percentage of 30-day hospital readmissions – which was stubbornly stuck at

Health reform is providing both carrot and stick to make collaborative healthcare a reality.

Health reform is providing both carrot and stick to make collaborative healthcare a reality.

19% for years – is finally starting to come down.  It’s now at 17.8%, and health reform and telemedicine deserve a lot of the credit.

Some telemedicine-based programs are getting far better results than the national average. For example, Geisinger Health Plan has implemented a telehealth program that has already cut hospital readmissions by a whopping 44%.

Obviously, the more collaboration between healthcare organizations, the better the results. Spurred by health reform, nearly 60% of hospitals are now part of a broader system. The ACA funded one of the most successful so far: 26 “Hospital Engagement Networks” (HENs) that work with more than 3,700 hospitals to coordinate patient care. According to the Advisory Board Company, the largest of the HENs has reduced its average 30-day readmission rate across 450 hospitals from 11.2% in 2010 to 10.2% by late 2012. That’s encouraging news for the folks in the Big Henhouse at 1600 Pennsylvania Avenue.

Last October, CMS began fining more than 2,000 hospitals with high readmission rates, imposing the maximum penalty of 1% in reduced Medicare reimbursements for 300 of them through the remainder of this year.

There are, of course, other factors driving hospitals to join larger systems: increasing margin pressures, plus the need to find economies of scale to improve care quality. But it’s clear that health reform is providing both carrots and sticks to make collaborative healthcare a reality.

If health reform and telemedicine continue to boost quality and rein in costs, it will be a nightmare for legislators who opposed them. Their biggest fear was that these things would actually work – and that people would love them so much that there would be no turning back.

As more success stories like these come rolling in, the president may soon be proud to call his program “Obamacare.”

A Legislative Turning Point?

It’s not often that a new bill introduced in the U.S. House of Representatives has the ATA shouting “Hallelujah!” But that’s the response so far to a recent measure sponsored by Rep. Mike Thompson (D-Calif.). It may be the most sensible and comprehensive telemedicine legislation ever introduced in the halls of that gridlocked chamber.

The Telehealth Promotion Act of 2012 (H.R. 6719) brilliantly addresses the two chief roadblocks in telemedicine: reimbursement and licensure. Plus it goes much further, calling for some long-needed improvements to existing programs. If enacted, Thompson’s bill would extend the benefits of telemedicine to nearly 75 million Americans by increasing access through Medicare, Medicaid, the VA, Children’s Health Insurance Program, and other federal programs.

ATA chief executive Jon Linkous has called the bill “a panacea for federal involvement in telemedicine, eliminating archaic barriers and expanding opportunities for remote healthcare.” Here are some key provisions in the bill:

  • Ensuring that no federally covered benefit can be excluded because it’s furnished via telemedicine
  • Allowing telemedicine providers in all federal health plans to be licensed solely in the state where they’re physically located and would be free to treat eligible patients anywhere in the nation
  • Providing new incentives for hospitals that lower readmissions with telemedicine
  • Exempting ACOs from telehealth fee-for-service restrictions
  • Creating a Medicaid telemedicine option to handle high-risk pregnancies

We need to do more than applaud Rep. Thompson’s boldness and vision. Now is the time to urge your U.S. representative to join in this common-sense effort to remove the biggest obstacles to telemedicine. Let your elected leaders know that telemedicine has the power to dramatically decrease federal health spending. That’s music to the ears of legislators on both sides of the aisle.

Thompson’s bill is smart and far-reaching. His colleagues can help restore some of the tattered credibility on Capitol Hill by swiftly passing it this year.