Christy Crider

Long-term care is a highly competitive market with razor-thin margins. LTC providers are constantly on the lookout for how to deliver greater services to residents for less cost. New sources of revenue are essential.  

While telemedicine is not new,  telemedicine for LTC centers is more accessible than ever before. In this two-part article series, we will discuss what telemedicine is, why should you consider it and how to make it work for your LTC center.

What is telemedicine?

The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.” While this definition includes a wide range of communications technology (including the telephone), most references to telemedicine practice refer to live, interactive two-way videoconferencing applications.   

Telemedicine brings value by making generalist and specialist level care accessible and convenient, especially in areas where access to care is limited. Innovative programs have been developed to provide care in a variety of settings including long term care, post-acute care, correctional health, rural and geographically remote areas, and other underserved patient populations.  

Bundled Payments for Care Improvement participants, Accountable Care Organizations and those using other at-risk payment models can especially benefit from increased timely access to needed specialist care for high-complexity patients. Specialties with well-established telemedicine programs include primary care specialties, psychiatry, neurology, radiology, pathology, dermatology, and emergency medicine.  An impressive body of research demonstrates consistently high rates of patient satisfaction and acceptability of services provided using telemedicine technology as well as quality and effectiveness comparable to in-person care.

Telemedicine benefits

The benefits of telemedicine are pretty straightforward. Technology has advanced most other areas of our lives, while technology has been slow to keep pace in healthcare, likely related to the failure of reimbursement to catch up to the times. The most apparent benefits of telemedicine are:  

  • Improved access to care: LTC providers, particularly those in rural areas, often struggle to secure reliable, accessible physician services, especially specialists.  Readily available geri-psychiatry, dermatology, radiology and similar services can make a real difference in the care of LTC residents. Telemedicine can provide timely, cost-effective access to those specialists, improving the care provided to the resident.  
  • Competitive advantage: LTC centers are in the business of taking care of people and want a center full of people to care for. Increased census comes from setting your center apart from your competitors. Telemedicine can do that. In some circumstances, the equipment used to communicate with providers (video feeds and private location) can be used to allow families to spend time with their loved ones using the technology. Prospective families will love that.
  • Better risk management: LTC centers have been hit with big liability for failure to get residents to the doctor quickly enough and failure to get residents the specialty care they need, such as wound care consultation and geri-psychiatry services. Having a dermatologist who specializes in wound care available to see the resident through technology is a big advantage. The availability of psychiatrists to consult via video feed on combative residents can prevent a resident-on-resident abuse case. That is good risk management.  
  • Regulatory compliance: Surveyors are quick to cite facilities for failure to keep residents at their “highest practical” level of well-being. Transporting residents out to see specialists has its own set of downsides. Taking the resident to a secure room in the facility to consult via technology with a specialist has few disadvantages. As this technology becomes more readily available and affordable, at what point will providing this service be considered a standard, required part of providing good care? Specialty consults with residents can keep the surveyors at bay.
  • Increased revenue: As will be discussed in the second article in this series, the reimbursement structure is slowly catching up to technology. There is positive movement on the reimbursement front and smart providers will be poised to take advantage of that.

Making telemedicine work

Acquiring the necessary equipment to participate in a telemedicine program is well within the means of any healthcare facility. In recent years, the acquisition cost of hardware for medical telecommunications has fallen drastically and purpose-built hardware is no longer required. Excellent videoconferencing applications are available for use with off-the-shelf consumer computer equipment.  A number of digital diagnostic instruments can pair with telecommunications equipment using Bluetooth. Reliable broadband Internet access is necessary.  A dedicated line or network avoids sharing bandwidth with an unpredictable number of other users on a guest network.

A dedicated telemedicine space is ideal, though many facilities schedule use of a multipurpose space for patients who see remote clinicians via telemedicine. A private setting allowing for confidentiality and limited noise distraction is needed. A clinical presenter typically attends the patient at clinic site, though this requirement varies by state. Most states require specific consent – written, verbal or both – for treatment by telemedicine.  

All states require licensure in the state where the patient is located, so telemedicine practitioners typically have licenses in multiple states. Liability insurance coverage that includes telemedicine practice and care protocols that include local backup for emergencies that cannot be managed via telecommunications are other important considerations.  

The boundaries of medication prescription as a component of telemedicine practice are also important to understand. Laws and regulations governing prescriptive practice vary by state, and are often confused with laws aimed at so-called “internet prescribing,” which is essentially drug diversion. It is helpful to communicate directly with state Boards of Medicine, Nursing, and Pharmacy to clarify the limits, if any, on prescribing in the context of a legitimate clinician-patient relationship established via telemedicine. The Drug Enforcement Administration also regulates the prescription of controlled substances by telemedicine via the Ryan Haight Act.

Another critical element in making telemedicine work for your LTC center is ensuring you get paid for providing telehealth services. In the second part of this series, we will discuss how to navigate reimbursement for telemedicine.

Christy Tosh Crider and Anthea Daniels are shareholders at Baker Donelson. John L. Shuster, Jr. is CMO at MindCare Solutions.