Ethica Health & Retirement Communities


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Ethica Health & Retirement Communities

  1. 1. We are Dedicated to our Patients,Committed to our Associates and Challenged by our Customers to deliver Excellence 1
  2. 2. Objectives• How decision was made to utilize telehealth in the skilled nursing facility.• Identify types of telehealth services available to patients in a SNF.• Identify current utilization of telehealth in the SNF.• Identify Benefit of having telehealth available in the SNF 2
  3. 3. Ethica• Community Health Services of Georgia member,• A skilled nursing facility management company, o SNFs throughout GA o Alternative living centers o Assisted living centers 3
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  5. 5. Getting Started• Need was identified o A need was identified for access to specialists to meet residents needs, o Traveling long/short distances is challenging for many skilled nursing facility patients, o Need for “after hours” access to medical consultation to reduce the number of unnecessary transfers to the hospital or emergency department, o Increase ability of skilled nursing centers to effectively manage the care of a wider variety of patients. 5
  6. 6. Getting Started• Community Benefit: o Centers are not for profit (community benefit required for our centers), o TeleHealth allows centers to reach out to local MD’s, o As TeleHealth grows and expands ways to provide services to associates, patient families, and/or those in the community will be explored. 6
  7. 7. Getting Started• Goals Identified: o Provide for Immediate Psychiatric Needs for our residents o Provide access to specialists to our residents without need for travel o Provide timely access for wound consult for our residents o Reduce unnecessary hospitalizations 7
  8. 8. 16 Centers Currently with Telemedicine• Brentwood Health & Rehabilitation • Oak View Health & Rehabilitation Feb. 2011 Feb. 2011• Chaplinwood Health & Rehabilitation • Oconee Health & Rehabilitation Feb. 2011 Jan. 2009• Dawson Health & Rehabilitation • Orchard Health & Rehabilitation Apr. 2010 Apr. 2011• Eatonton Health & Rehabilitation • Scott Health & Rehabilitation Feb. 2009 Oct. 2009• Four County Health & Rehabilitation • Providence of Sparta Apr. 2011 Feb. 2009• Green Point Health & Rehabilitation • Sparta Health & Rehabilitation Dec. 2009 Feb. 2009• Lillian Carter Health & Rehabilitation • Shady Acres Health & Rehabilitation Apr. 2010 Feb. 2009• Oakview Health and Rehabilitation • Lee County Health & Rehabilitation Apr. 2010 Dec. 2011• Oxley Park Health & Rehabilitation •Warrenton Health & Rehabilitation. Apr. 2010 March 2012 8
  9. 9. Billing & Reimbursement• Current billing o Site Fee - approximately $24.10 with each use, o CR # 6215, • “The originating site fee is outside the SNF prospective payment system bundle and, as such is not subject to SNF consolidated billing. The originating site fee is a separately billable Part B payment”. (MLN Matters Number: MM6215) 9
  10. 10. Telehealth & Ethica• Psychiatric Care: o 5 Centers with specialty units in Psychiatric/Behavioral Health Care, o Telehealth has been essential for providing much needed support to these centers.,• Wound Consultation: o 3 wound consultants (WONC) each with a Mobi device,• Specialty Consults• Emergency o 1 Attending/Medical Director has a Mobi Device, o Some regional ER’s have connectivity with the centers, (example: Coffee Regional) 10
  11. 11. Current Utilization• Remains low but improving,• Nurses must be comfortable with the equipment,• Psychiatric, Specialty Consults, and Wound most often used,• Wound utilization increasing,• Emergency Telemedicine usage remains low. 11
  12. 12. Current Utilization 12
  13. 13. Current Utilization 13
  14. 14. Rehospitalization Rates for January 2012 WithTelemedicine 129 WithoutTelemedicine 248 14
  15. 15. Ethica Behavioral Health Units• Five centers with additional skill sets to manage “behavioral health” or “geriatric psych” issues beyond dementia care,• Associate Medical Director for Psych Services,• Schizophrenia, bipolar disease, affective disorders, mixed disorders,• Entire centers or a unit of a center,• Adds option for “ more appropriate” placement of patients from within and from outside Ethica centers. 15
  16. 16. Geriatric Psychiatry Care Issues in Georgia• State regional hospitals overwhelmed by correctional department issues,• Beds never available for older patients,• Uncooperative general hospitals – fear of patient dumping by nursing centers,• Few private psychiatric hospitals with dedicated geriatric-focused units,• Transfers not accompanied by useful information – failed care plans not altered by either acute or long- term care center. 16
  17. 17. Practical Benefits for Psych TeleHealth in Georgia• TeleHealth connects geriatric psychiatry specialists to our out-lying centers,• Becomes a connection for cross-referrals,• Patient maintains consistent relationship with their “head doctor”,• Better communication and documentation between specialist and (medical) attending practitioners,• Consistent care continues even if a transfer becomes necessary. 17
  18. 18. Telemedicine Behavioral Health Goals• Reduce transfers (including multiple re-admissions) to acute mental health facilities• Provide on-site decision-making by a qualified provider to establish an acute intervention and/or stabilize patient• Provide confidence to the attending physician and caregiver in an acute situation – clinically and legally 18
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  21. 21. Telemedicine Behavioral Health Goals• Maintain more consistent and frequent physician/provider contact directly with the patient,• Meet regulatory/law requirements when it IS necessary to order an immediate transfer out of the facility,• Provide support in addition to routine onsite visit by psychiatrist/psychiatric Social Worker. 21
  22. 22. Psychiatry/Behavioral Support• Ethica Model – On Site o Psychiatrist/practitioner makes a physical visit to the behavioral health center monthly or as routinely as needed, o Completes patient rounds, o Conducts mini case management discussions and care plans with staff for each patient during or immediately after rounds, o May chair a planned or impromptu staff in-service based on a current question or dilemma presented by a patient, o Staff and practitioner increase comfortable relationship and begin to learn and anticipate each other’s thoughts and practices. 22
  23. 23. Psychiatry/Behavioral Staff Support• Ethica Model – Off-Site (TeleHealth) o Routine appointment for TeleHealth encounter monthly or as required by patient load or care unit organization, o Staff case updates, problems encountered or anticipated, o Individual patient encounters as needed or indicated or requested by patient,• Off-Site (TeleHealth) - Acute Need o Telephone call to practitioner (or Ga TeleHealth) to arrange stat appointment, o Units activated – nursing report, o Decision by practitioner for observation, patient encounter, transfer, or orders. 23
  24. 24. Wounds Consult• Provides excellent and detailed view/ assessment of the wound.• Reduces delays in consult due to scheduling.• We have 4 wound nurses this allows them to provide video consult to centers reducing the delay. 24
  25. 25. Emergency• Allows for triage via telemedicine unit to avoid unnecessary hospitalizations• A great way to partner with your local ER to help meet the hospital’s goals as well as the SNFs goals.• Currently working in GMCF (Georgia Medical Care Foundation) on a project to reduce hospitalizations. Telemedicine will be integrated into this program to help achieve goal of reducing unnecessary hospital admissions. 25
  26. 26. Comments/ Questions 26