Expanding telemedicine definitions
The quickest, and most dangerous, way to dismiss the concept of telemedicine in long-term care is to envision it as a physician or nurse sitting in front of a computer with an elderly resident on the other side.
That can be what telemedicine is for some facilities or systems. Witness Carolinas Healthcare System offering a $49 visit for a Virtual Visit at any date or time to help patients with basic allergies, cough or skin conditions. But telemedicine also encompasses remote monitoring or mobile health applications, which are far more popular among long-term care systems and vendors.
No matter how it's defined, two barriers exist in the minds of healthcare executives, according to a recent report and executive survey from Foley & Lardner LLP. While 84% of respondents said the development of telemedicine is either “very important” or “important,” almost half said their organization is not reimbursed at all for telemedicine. And — as if long-term care needed another reason to dislike managed care — almost one-fourth of respondents said they received lower rates from managed care companies for telemedicine than for in-person care.
So that's the reimbursement problem, and lobbyists are on the case.
The second big challenge is 48% of executives said they are highly concerned about convincing physicians about telemedicine's credibility. To that end, there are a few success stories I want to note.
The first is in wound care. One of the winners of the McKnight's Technology Awards in 2013, Nexion Health Management, used Apple's FaceTime mobile application to let wound care specialists obtain virtual bedside access to examine wounds. This, to me, is a no-brainer. Not all long-term care facilities can have a full-time wound care expert on site at all times, and the benefits of that expert seeing a wound promptly can not only mean better resident care, but lower costs, and the possible avoidance of a hospital readmission.
The second is, as Centrex Rehab's Kristy Brown writes today in a Guest Column, around therapy services. This is similar to wound care specialists, as she writes that “the cost of bringing therapists to rural areas or asking patients to travel long distances to find therapy services can be astronomical.” She notes one study that said patients who had knee surgery “increased compliance with rehabilitation instructions when telehealth was a factor in their recoveries.”
Finally, there is the critical need for different types of mental health services in long-term care. This is the hardest one for many to embrace, as the therapist-patient relationship seems personal, not to mention connected to lying on a couch and discussing our mothers. (Hi, Mom!) But the Front Porch Center for Innovation and Wellbeing recently conducted a successful telehealth counseling program with the University of California Davis for older adults. One of the interesting points made by Davis Park, the Center for Innovation and Wellbeing director at Front Porch, was that he said some seniors actually appreciated the extra distance of talking through an iPad, noting that they'd never accept face-to-face counseling services. This also can mitigate the fear and stigma some seniors have around mental health services, especially if they are from a culture that looks down upon counseling.
Ultimately, the biggest factor in telemedicine's success in long-term care will be pressure put on skilled nursing facilities to find innovative ways to reduce hospital readmissions — and for the cost of not taking part in telemedicine to become astronomical.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.