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Preventing Readmissions Virtually: Telemedicine & Your Facility

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Preventing Readmissions Virtually: Telemedicine & Your Facility

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RelyMD co-founder and director of virtual health, Dr. Bobby Park presents during LeadingAge NC's 2017 Annual Conference. View these slides to learn how nursing homes and CCRCs are utilizing telemedicine to decrease hospitalizations and save on costs for their facility.

RelyMD co-founder and director of virtual health, Dr. Bobby Park presents during LeadingAge NC's 2017 Annual Conference. View these slides to learn how nursing homes and CCRCs are utilizing telemedicine to decrease hospitalizations and save on costs for their facility.

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Preventing Readmissions Virtually: Telemedicine & Your Facility

  1. 1. PREVENTING READMISSIONS VIRTUALLY: TELEMEDICINE & YOUR FACILITY
  2. 2. Bobby Park, MD Co-Founder & Director of Virtual Health, RelyMD Emergency Medicine Physician, WakeMed Health & Hospitals bobby.park@weppa.org
  3. 3. THE WORLD OF HEALTHCARE IS CHANGING
  4. 4. Patient records used to be kept on paper. Not on the cloud.
  5. 5. Patients relied on their doctor for answers. Not WebMD.
  6. 6. Patients could wait weeks to see a doctor. Not 10 minutes.
  7. 7. WE HAVE COME A LONG WAY
  8. 8. EHR PATIENT PORTALS WEARABLE TECH SELF-SERVE TELEMEDICINE
  9. 9. TELEMEDICINE  Direct-to-consumer, online urgent care  Tele-ICU  Telestroke  Teledermatology  Telepsychiatry  Telemedicine for nursing homes
  10. 10. About 84% of healthcare executives felt that the development of telemedicine is either very important (53%) or important (32%) to their organizations. *Source: Foley 2014 Telemedicine Executive Summary After telemedicine services were employed by the Veterans Health Administration post-cardiac arrest care program, hospital readmissions decreased by 51% for heart failure and 44% of other illnesses. *Source: The Promise of Telehealth For Hospitals, Health Systems and Their Communities, TrendWatch, January 2015 According to a study on the Geisinger Health Plan, patient readmissions were 44% lower over 30 days and 38% lower over 90 days, compared to patients not enrolled in the telemedicine program. *Source: The Promise of Telehealth For Hospitals, Health Systems and Their Communities, TrendWatch, January 2015
  11. 11. The future business of nursing homes is going to become a lot more complex.
  12. 12. More regulations than NASA?
  13. 13. 2% PAYMENT ADJUSTMENT COMING IN 2018
  14. 14. 2% of your Medicare payment will be held to fund the incentive payment pool.
  15. 15. The highest ranked facilities will receive the highest payments. You want to be this facility!
  16. 16. Nursing homes are experiencing greater rates of hospital admissions along with greater opportunities for penalties.
  17. 17. The highest ranked facilities will receive the highest payments. You want to be this facility!
  18. 18. SNFRM (SNF Readmission Measure) & SNFPPR (SNF Potentially Preventable Readmission Measure) contribute to those rankings.
  19. 19. Nursing homes are having to take in patients with higher acuity levels than previously seen.
  20. 20. Requiring a larger nursing staff & more specialized staff. RN MD ARNP Respiratory Therapist Social Worker
  21. 21. Attracting & retaining staff is becoming more and more difficult.
  22. 22. Private-pay population numbers are declining.
  23. 23. All of the above is being compounded for rural facilities.
  24. 24. HOW CAN TELEMEDICINE HELP?
  25. 25. 80% of hospital admissions among nursing facility residents are caused by… PneumoniaUTI Dehydration CHF Falls/Trauma
  26. 26. Approximately 45% of hospital admissions among individuals receiving Medicare or Medicaid nursing facility services could have been avoided. CMS 2005
  27. 27. This accounted for 314,000 potentially avoidable hospitalizations… CMS 2005
  28. 28. And $2.6 billion in Medicare expenditures in 2005. CMS 2005
  29. 29. One study showed telemedicine helped decrease hospitalizations by up to 11.3%. Commonwealth Fund -9.7 -11.3 -5.2 -12 -10 -8 -6 -4 -2 0 Decrease in Nursing Homes’ Hospitalization Rates in More-Engaged and Less-Engaged Facilities After Telemedicine Total Treatment Group More Engaged Facilities Less Engaged Facilities Control Group -5.3 Percent decrease in hospitalizations per 1,000 resident days
  30. 30. Another showed even greater results. McKnights “We have seen a reduction in our return to hospital rates, retained 75% of the patients who had a sudden acute change in condition (resulting in over 500 retained patient days), and helped contribute to millions in healthcare savings by eliminating avoidable hospital admissions.” -10 months after implementing a telemedicine solution.
  31. 31. What that means for your facility’s cost savings. CMS Innovations Award. RAVEN. Dr. Steven Handler at UPMC Facility Cost Each Potentially Avoidable Hospitalization: • 6.1 Average Hospital Length of Stay • Loss of 6 days of SNF revenue (“head in bed”) • Average RUGs payment of $380 per day Medicare Part A • Lost Resident Revenue $380 x 6.1 days = $2318 • Labs / Nursing Readmission Cost = $ 200 Average SNF Loss Per Hospitalization $2518
  32. 32. RAVEN Telemedicine Results. CMS Innovations Award. RAVEN. Dr. Steven Handler at UPMC 117 of 184 (63.6%) Hospital Transfers were Avoided through Telemedicine Consults
  33. 33. Reduce staffing costs while providing current staff with more support, 24/7.
  34. 34. Rural nursing homes are feeling the heat. Less applicants to choose from Located further from hospitals Inability to attract top medical talent Rely more on Medicaid
  35. 35. HOW IT WORKS
  36. 36. 1 2 43 5 A resident within a nursing facility experiences a medical situation that requires a physician consultation.
  37. 37. 1 2 43 5 The resident’s nurse accesses a telemedicine platform and connects with a physician from a tablet or computer.
  38. 38. 1 2 43 5 The nurse & telemedicine physician review the health concerns & assess symptoms via video.
  39. 39. 1 2 43 5 The physician helps the nurse determine if a hospital transfer is necessary. If not, the physician helps to establish a treatment & monitoring plan.
  40. 40. 1 2 43 5 Medical visit notes are added to the resident’s record to provide clear communication.
  41. 41. 1 2 43 5 If the physician feels that a hospitalization is necessary, they will call ahead to the designated ED to help facilitate the hospital visit. *
  42. 42. WHAT TO EXPECT IMPROVED CLINICAL OUTCOMES INCREASED QUALITY MEASURES GREATER COMPETITIVE ADVANTAGE HEALTHIER RESIDENTS & HAPPIER FAMILIES EXPANDED REVENUE OPPORTUNITIES REDUCED MEDICARE EXPENDITURES
  43. 43. BARRIERS TO ENTRY • Telemedicine parity • Reimbursement models • Facility technical capabilities • Cost of entry, depending on chosen provider • Forward-thoughtfulness of facility & owners
  44. 44. ABOUT RELYMD  Founded in 2015 by a group of over 100 emergency-medicine physicians  Fully staffed by Wake Emergency Physicians, PA  All of our providers are located in North Carolina
  45. 45. VISIT WITH A DOCTOR Web Browser Phone Call Mobile App (Mobile Phone, Tablet)
  46. 46. ANYTIME Doctors are available  24 hours a day  7 days a week  365 days a year
  47. 47. WAIT TIMES TO SEE A DOCTOR ON AVERAGE, LESS THAN
  48. 48. QUESTIONS?

Editor's Notes

  • https://www.quora.com/What-are-the-challenges-in-running-a-nursing-home
  • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1621.pdf
  • Remember the ranking system for repayment?
  • Nursing homes must rely more and more on Medicare reimbursement which is being held and reduced based on 5-star ratings while losing higher-rate payers.
    https://www.agingcare.com/questions/nursing-home-discriminate-because-of-pay-152961.htm
  • We need to look at why hospital readmissions are happening…
  • Nursing homes must rely more and more on Medicare reimbursement which is being held and reduced based on 5-star ratings while losing higher-rate payers.
    https://www.agingcare.com/questions/nursing-home-discriminate-because-of-pay-152961.htm
  • Most hospitalizations are avoidable,
  • Telemedicine is already helping forward-thinking nursing homes prevent hospital admissions
  • Nursing homes must rely more and more on Medicare reimbursement which is being held and reduced based on 5-star ratings while losing higher-rate payers.
    https://www.agingcare.com/questions/nursing-home-discriminate-because-of-pay-152961.htm
  • Not meant to replace primary physician, but helps to extend the level of service a physician provides by being available for calls anytime of the day or night. This could be when the primary doctor is not in the location, especially during after-hours. In addition, the nature of telemedicine being techologically advanced and all online allows all patient records and updates to be easily added to a resident’s record so the primary doctor can review when he is on site for follow ups to any medical conditions that occurred.

    Nurses are happy because they’re able to have more support in the strategy of keeping a resident in-home. Often when a doctor is unavailable, the only option is to send a resident to the hospital because they lack the skill and qualification to diagnose. Now they have a doctor who can do those things in their pocket.
  • Telemedicine can help with all of these:
    Bolsters their staff numbers by providing extra care availability
    Gives the home access to top-notch emergency medicine physicians from the Raleigh-area
    Prevents the longer transports to hospitals saving time to access care for residents. Also- helps the community by keeping limited EMS services available for true emergencies.
    Helps keep Medicaid penalties lower with better care
  • Telemedicine can help with all of the above. So how would a telemedicine service work within a nursing home?

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