This document discusses the use of telehealth services in skilled nursing facilities operated by Community Health Services of Georgia. It outlines the objectives of utilizing telehealth, including providing access to specialists without travel and reducing unnecessary hospital transfers. Telehealth services currently offered include psychiatric care, wound consultations, specialty consultations, and emergency telemedicine. Sixteen of the company's nursing centers have implemented telehealth programs. The benefits discussed include improved access to care and lower rehospitalization rates.

1. We are Dedicated to our Patients,
Committed to our Associates and Challenged
by our Customers to deliver Excellence
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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
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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
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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.
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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.
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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
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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
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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)
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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)
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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.
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12. Current Utilization
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13. Current Utilization
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14. Rehospitalization Rates for January
2012
With
Telemedicine 129
Without
Telemedicine 248
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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26. Comments/ Questions
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