Every single day, thousands of elderly nursing home patients are subjected to disorienting and costly transfers to the Emergency Department for health challenges that could potentially be treated in place, if the resources were in place to do so.
Nearly one out of every five ambulance transfers to the ED come from nursing homes. These are often chronically ill, medically complex patients with acute medical needs. The chaos of the ambulance trip causes additional mental and physical distress. They arrive at the hospital alone and are forced to bear the burden of interacting with a new set of “clinical strangers” who are unfamiliar with their symptoms. They’re often put in beds in the hallway and left alone. Frail, vulnerable, elderly patients are simply ignored.
It doesn’t happen because clinicians don’t care or anyone wants these patients to be suffering the loneliness and isolation of the hallway ED, it happens because we have a system that’s broken. One area where politicians can and should be able to find common ground is value-based care arrangements, which have proven to be better for patient care and less costly for the healthcare system.
The Centers for Medicare & Medicaid Services is asking Congress to enable them to make value-based arrangements accessible—which just makes sense. As Adminsitrator Seema Verma recently said at the Alliance for Connected Care, “It’s part of our larger vision of moving to a system that is value based—that rewards value over volume by bringing the best to patients. When we start paying for value, we will foster innovation as providers look for ways to compete for patients by providing the highest quality care at the lowest cost.”
Recently, a bipartisan bill was introduced in the House of Representatives that offers a viable solution for the systemic problem that exists with the way our healthcare system is designed to treat the most vulnerable patients. Reducing Unnecessary Senior Hospitalizations (RUSH) Act (H.R. 6502) will actively deliver better care to people in nursing homes while also providing a mechanism for Medicare to support value for patients, their families and the healthcare system at large.
Every year, there are nearly 1.3 million transfers from the nursing home to an Emergency Department. CMS estimates that two-thirds of those ED visits are unnecessary, and 45 % of the subsequent hospital admissions are avoidable, costing the healthcare system as much as $40 billion in unnecessary spend. The RUSH Act aligns all stakeholders by creating a value-based shared savings arrangement that incentivizes physician groups and nursing homes to treat patients in the nursing home, and then share with Medicare—i.e. the taxpayer—the savings generated by avoiding costly and often harmful trips to the ED. In addition to the massive savings opportunity, passage of the RUSH Act would mean that the millions of patients would have access to care that improves their quality of life.
The groundswell of support for the RUSH Act continues to grow. Eleven U.S. representatives, representing districts from rural Nebraska to Silicon Valley, have signed on to co-sponsor the bill. A coalition of healthcare systems, patient advocacy groups and elder care organizations—including UNC Health Alliance/UNC Senior Alliance, American Heart Association, American Telemedicine Association and West Health, among many others—have pledged their support.
Comprehensive telehealth reform like the RUSH Act closes the gaps in care delivery by focusing on value-based care over volume-based care. This shift is a critical evolution in care for the most vulnerable, highest cost patient population in our country.
Timothy Peck, M.D., is the Cofounder and CEO of Call9. He previously held a faculty position at Harvard Medical School and was the Chief Resident in the Emergency Department at Beth Israel Deaconess/Harvard.
