Telemedicine in LTC: Help for patients with multiple chronic conditions
Ryan Macy, President and CEO, Satchel Health
Three in four Americans aged 65 and older live with more than one chronic condition. In fact, more than 90% of Medicare fee-for-service spending goes towards care for patients with multiple chronic conditions (or comorbidities). Caregivers in long-term care facilities face unique challenges in caring for patients with comorbidities and preventing costly readmissions to the hospital, but telemedicine technology offers new hope for improving care and quality of life for these most vulnerable patients.
Today there is growing evidence of the benefits telemedicine can deliver in caring for patients with chronic conditions. In a systematic review of studies evaluating the use of telemedicine for congestive heart failure, stroke and chronic obstructive pulmonary disease, researchers found measurable improvements in patient outcomes, including fewer episodes of health worsening, reductions in mortality, reduced readmissions to the hospital and fewer emergency department visits.
These improvements – powered by telemedicine – represent an important opportunity for long-term care providers who face growing pressures to demonstrate quality, manage risk and minimize readmissions to acute facilities.
Patients – especially those living with multiple chronic conditions – are best managed by face-to-face evaluations. In long-term care facilities, face-to-face examinations occur primarily when the physician or other advanced practice provider comes onsite to see and examine the patient. Most facilities do not have a provider onsite 24/7. When a patient needs an intervention, the onsite nurse will contact a provider by phone, requiring the provider to make treatment decisions without seeing or having direct contact with the patient. Telehealth technology allows the onsite nurse to quickly engage a provider who can examine the patient in real time and initiate the appropriate treatment – creating another pathway for essential face-to-face interactions.
To understand the value of these interactions, consider a recent encounter that took place at a client's facility. A 70-year-old female patient – with a history of diabetes, hypertension, multiple sclerosis, renal failure, seizure disorder and dementia – experienced a decreased level of consciousness. The patient was not running any fever, but had a heart rate of 50 beats per minute. Immediately the facility engaged a remote telemedicine provider who joined the encounter to see the patient and perform a clinical exam.
Through lab tests and an electrocardiogram (EKG), the provider determined that the patient was not clinically septic or experiencing a cardiac arrhythmia. The provider ordered the removal of excess pain patches and scheduled a follow-up telehealth visit in four hours. The patient was appropriately diagnosed with a urinary tract infection and polypharmacy. The onsite nurse placed a Foley catheter and adjusted the pain medications based on the provider's order. The patient was managed successfully without being transferred to an acute facility.
If the same encounter were managed through telephone contact, the remote provider would have a long list of questions about the patient's decreased level of consciousness. Is it a stroke? Is it an infection? Is it cardiac? Is it being caused by her pain or seizure medicines? Most of all, the provider would want to know, what does the patient look like? Without the ability to see the patient and directly evaluate her condition, the remote provider would – for both clinical and legal reasons – have little choice but to send the patient to the nearest emergency department. Telehealth encounters allow remote providers to see and examine their patients in real-time – much like a bedside encounter – and create an immediate care plan.
In another recent encounter at the same facility, a 72-year-old patient experienced difficulty breathing. She suffered from hypertension, had difficulty swallowing and was diagnosed with failure to thrive. Initially the facility contacted the primary care physician who ordered lab tests, an EKG and a breathing treatment. After one hour – and seemingly no change in the patient's condition, the nurse contacted the on-call telemedicine provider to evaluate the patient. The provider conducted an exam and found the patient had a respiratory rate of 35, oxygen saturation of 95 percent on five liters of oxygen, a temperature of 99.3 degrees, a heart rate of 95 and blood pressure of 110/57. Based on the examination, the telemedicine provider determined that the patient was in much greater respiratory distress than the facility could handle and ordered an immediate transfer for the patient.
Like the first example, this encounter illustrates the value of a live, real-time telemedicine examination in determining the patient's condition and making critical decisions on their care. In this instance, the telemedicine examination helped expedite the decision to move the patient to the most appropriate care setting – increasing the likelihood of a positive outcome for the patient.
New telemedicine software platforms combine live-streaming two-way video, digitally connected tools and analytics to help identify, treat and manage high-risk patients. For patients with chronic conditions like chronic heart failure and COPD, sudden changes in acuity are common – requiring immediate clinical intervention. Through telemedicine platforms, these changes can be detected more quickly. Specialists can be consulted almost immediately to initiate treatment, often eliminating the need for transfers and reducing the risk of readmissions to the hospital. Patients gain greater access to physicians, and their treatment experience is less stressful, less taxing and far more comfortable – leading to higher patient and family satisfaction.
In addition to improved patient satisfaction, telemedicine solutions can also drive greater financial success through direct revenue from reimbursement, reduced risk of financial penalties associated with readmissions and lower operating costs. Implementing a telemedicine platform can help facilities and health systems expand the capacity of their providers and generate more billable patient encounters.
As facilities continually strive to improve care quality – particularly among their most complex patients – telemedicine offers a unique opportunity to boost both their health outcomes and their financial sustainability for many years to come.