Transforming Skilled Nursing Facilities with a Telehealth Platform

Telehealth is allowing SNFs to provide timely and effective care during the COVID-19 pandemic, but its impact is likely to extend well into the future.

(originally posted on mHealthIntelligence)

"Skilled nursing facilities across the country are using telehealth to reduce costly and unsettling hospitalizations — an essential goal during the coronavirus pandemic. SNFs are also laying the groundwork for improved care management and coordination well after the emergency is over. Skilled nursing facilities across the country are using telehealth to reduce costly and unsettling hospitalizations — an essential goal during the coronavirus pandemic. SNFs are also laying the groundwork for improved care management and coordination well after the emergency is over.

Falls Village Skilled Nursing & Rehabilitation in Cuyahoga Falls, Ohio, went live with Tacoma, WA-based Sound Telemedicine in October 2019. Their goal was to reduce a rehospitalization rate of 23.7 percent that was “higher than you'd (our organization) like it to be,” according to Administrator Nick Gulich. Currently– Falls Village has a 21.9% readmission rate for that same patient cohort which is now better than the national rate of 22.3% for Short-term Medicare patients.

“The whole idea with telehealth originally was to reduce readmissions to the hospital,” he says. “The ability to connect with a dedicated physician on off-hours that could assess decompensating patients has proven to be overwhelmingly valuable and has definitely kept many patients from ending up back in the hospitals unnecessarily.”

“With the emergence of the COVID-19 epidemic, it has taken on a whole new level of importance,” Gulich adds. “The ability to reduce exposure from the community while still having the ability to assess the patients virtually has been crucial. I believe this has become a mutually beneficial tool for both the staff at the facility as well as the providers as it makes them more accessible than they ever would have been previously.”

Before using telehealth, the 103-bed, 130-staff facility used the same protocols for patient care that most other SNFs used. When a patient began showing signs of decline, nurses would call for a doctor — literally, during off-hours and weekends.

“We were relying solely on the nurse caring for the patient to call the physician and give as detailed of an update as they could on what was going on,” Gulich explains. “But it's hard for those attending physicians, especially in the middle of the night, to get the full picture on patients. And many times, they would have been called in too late. Without the doctor being able to lay eyes on the patient or get the full story, plenty of folks would end up going back to the hospital.”

With telehealth, nurses can access a tele-hospitalist, either immediately or by scheduling an online consult for within the hour. A telemedicine cart, equipped with real-time audio-visual capabilities and an mHealth-enabled stethoscope, is wheeled into the patient’s room.

“It has been quite beneficial, even just the access to a dedicated physician so that they (attendings/medical directors) are not being woken up in the middle of the night and caught off guard by this,” Gulich says. “It has certainly prevented numerous residents from going back out to the hospital.”

The telehealth service also ensures that patients who do return to the hospital are there for a good reason. They've been seen — virtually — by a tele-hospitalist who has approved transport and is in touch with the Emergency Department to coordinate care. The platform eliminates unnecessary transfers (which are often flagged by CMS for penalties) because the tele-hospitalist can diagnose and treat more patients right at the facility.

According to Gulich, the telehealth service also instills confidence in nurses.

“Nurses very much appreciate the fact that they have dedicated access to a physician on those off-hours,” he says. And “it boosts their assessment skills. They know what to look for a bit better. It has boosted their confidence.”

And that confidence translates into better care management and better clinical outcomes. With the experience of collaborating with a tele-hospitalist, nurses learn how to be better care providers, knowing what to look for and anticipating when a patient might be having problems.

While the primary goal of the telehealth platform is to reduce off-hours hospitalizations, nurses are beginning to use the service for daily care management as well.

“When we first rolled it out, I strictly saw it as an emergency management type of thing, so I have been a little bit surprised to see that more and more,” Gulich says. “Ultimately, most of the encounters are routine management kind of things. If you're getting more of those addressed promptly, that adds up. With telehealth, they're able to reach out for more routine types of things that aren't necessarily emergent. It's a resource.”

SNF staff can use the technology to get timely answers to questions and better manage day-to-day care. That daily care will be important as Falls Village gets used to telehealth. In the six months since the facility launched a telehealth service, hospitalization rates have decreased and the skilled patient census has inched upwards. More stability translates to better care and better outcomes.

What’s more, hospitals are likelier to do business with facilities such as Falls Village because of that success with telehealth; as a result, SNF administrators can use that as a marketing tool for filling staff openings and becoming a provider of choice for their local hospitals.

“I think the fact that we utilize telemedicine makes us more marketable and appealing to hospitals,” says Gulich.

Among the positive statistics is the SNF’s rehospitalization rate. In the six months that they’ve been using telehealth, the facility has been able to push that rate down to 21.9 percent.

As staff become more accustomed to telehealth, particularly in daily care management, the facility intends to find more ways to use the platform, including access to specialty care services (e.g., mental health, social services, chronic care management). “Utilizing the platform to the fullest extent increases its longevity,” Gulich stresses.

This extended lifespan will be particularly important when the current coronavirus pandemic ends and SNFs run the risk of losing out on Medicare coverage currently included in emergency orders. By proving the value of telehealth, they might be able to persuade lawmakers to extend those benefits or even make them permanent.

“Personally, this is going to be the wave of the future for nursing homes,” Gulich concludes. “It's going to become the norm that every facility would ultimately have telehealth.”"