Long Term Care: Telehealth — An Untapped Opportunity for Nursing Facilities
Telehealth has come a long way since its inception, and it continues to show no signs of slowing down. According to a recent Market Data Forecast report, the global telemedicine market is estimated to grow from $25.53 billion in 2015 to $57.92 billion in 2020,1 and the use of telemedicine services is expected to grow from 250,000 patients in 2013 to 3.2 million patients in 2018.2
The field is constantly changing and technological advances are making the practice more affordable and accessible for patients. As the benefits of telehealth have been increasingly proven in recent years, especially in the consumer space, the mode of care is now becoming a popular care delivery option for subacute and long term care facilities. While telehealth in this setting is not popularly discussed, it can be a significant untapped resource for these types of facilities and allow them to provide higher quality care for older adults at lower costs.
Benefits for Long Term Care Facilities
While avoiding unnecessary trips to the hospital can help promote better health outcomes for patients, the skilled nursing facility benefits as well by reducing lost revenue while a patient is in the hospital. Moreover, the Centers for Medicare & Medicaid Services recently announced new penalties for potentially preventable readmissions, which went into effect for long term care facilities in October 2016.3 From the perspective of the hospital, as both hospitalization and readmission penalties have skyrocketed in recent years, hospitals are implementing readmission reduction programs, which are expected to become even more strict moving forward.
A typical way telehealth is implemented in this type of setting is through coordination of patient's care via remote patient monitoring, which can be used, for example, to identify the need for a video visit with an older adult's physician. A patient's personalized remote patient monitoring kit commonly includes not only a patient engagement device such as a tablet but also monitoring technologies that capture physiologic data including blood pressure, peripheral capillary oxygen saturation, weight, glucose, temperature, and heart rate. Via remote monitoring, a physician can keep an eye on a sick patient around the clock to determine whether certain symptoms develop or evolve. Based on how severe the symptoms become, a physician may determine that a patient needs a video consult, for which the nursing facility can use a tablet powered with a camera to launch a conversation with an older adult's physician in a timely manner.
But it's not as simple as just launching the technology. The facility's staff needs to understand how and when to leverage the technology and what steps to take once the conversation has both started and ended. Using a clinical solution that leverages clinical decision support and analysis of data obtained via remote patient monitoring, clinical staff are assisted in identifying patients in need of further assessment and/or treatment. Many telehealth programs offer training and support for staff and clinical program management because adoption and understanding of this technology do not occur overnight. Telehealth requires changing current clinical processes, which can be difficult at first. But in order to make the implementation successful, staff members need to be properly educated on the technology and how it fits into the facility's care management system with an eye toward an established goal.
Benefits for Older Adults
But most importantly, access to immediate care is critical for older adults, as they comprise the population with the most chronic conditions and health emergencies. Eighty percent of the older adult population have at least one chronic health condition, and 68% have two or more.4 Response time is critical, and telehealth provides quick access to a geriatrician who can assess, evaluate, and provide guidance to the nursing or medical team available in residential communities and long term care facilities. Caring for a patient in his or her longtime home allows for aging in place, avoiding instability and negative outcomes related to the interval of time it takes for the patient to receive necessary care.
Telehealth is not only for emergency situations; it's a useful tool for regular check-ins as well as treating common conditions and allows patients to have more frequent interaction with their physicians. For instance, if a patient in a nursing home has a cold, a staff member can quickly launch a video consult with a physician to discuss the symptoms and evaluate the patient. This type of remote consultation allows a physician to see the patient and catch any visual or speaking symptoms that may have been unknown or not apparent through previous monitoring or phone conversations.
Other benefits of telehealth for older adults include increased patient engagement, reduced costs, and time saved. Telehealth enables patients to be more engaged in their own health and well-being. Additionally, this model of care is a cost-effective option for both facilities and residents. The average telehealth visit saves patients about $100 or more compared with the estimated cost for in-person care.5
Telehealth does not replace human interaction and care; it simply enhances the care. Therefore, technology must be tailored to the situation, based on its benefits and proper use. Telehealth would not be possible, let alone successful, without human care teams applying it. Additionally, physician-patient relationships are of the utmost importance, and this technology promotes strengthening these relationships for older adults who, more than any other population, seek familiarity, trust, and consistency in physicians who examine them.
Benefits for Physicians
Adoption Moving Forward
— Tom Edmondson, MD, CMD, AGSF, FACP, is physician director at Philips Hospital to Home in Baltimore.
2. National Conference of State Legislatures. Telehealth policy trends and considerations. http://www.ncsl.org/documents/health/telehealth2015.pdf. Published 2015.
3. Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) final rule policy and payment changes for fiscal year (FY) 2017. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-02.html. Published August 2, 2016.
4. Chronic disease management. National Council on Aging website. https://www.ncoa.org/healthy-aging/chronic-disease/
5. Yamamoto DH. Assessment of the feasibility and cost of replacing in-person care with acute care telehealth services. Alliance for Connected Care website. http://www.connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf. Published December 2014. Accessed February 20, 2017.
6. Public Health Institute Center for Connected Health Policy. State telehealth laws and Medicaid program policies: a comprehensive scan of the 50 states and District of Columbia. http://cchpca.org/sites/default/files/resources/50%20State%20FINAL%20April%202016.pdf. Published March 2016.