In October 2012, Medicare began rewarding hospitals that provide high-quality care for their patients through the Hospital Value-Based Purchasing (VBP) Program. Under VBP, hospitals are paid for inpatient acute care services based on quality of care — not the volume of services they provide. To this end, a hospital’s Total Performance Score (TPS) and unplanned readmissions are significantly and inversely related to readmission rates.
These new payment models have driven hospitals to evaluate the variables that might impact the readmissions of their patients. One of the most common discharge locations for hospitalized patients are Skilled Nursing Facilities (SNFs). In some communities, this increased scrutiny has revealed that facilities that are not providing services adequate to prevent readmissions, which results in those facilities no longer being a preferred referral source.
Beginning on October 1, 2018, the SNF VBP Program will begin to reward (or penalize) SNFs for 2017 performance by offering incentive payments for the quality of care they deliver to Medicare patients. In this new environment, SNFs across the nation are now – more than ever — seeking creative ways to utilize telemedicine to distinguish themselves with their hospital partners and deliver a higher level of care to their patients by treating them in place, thereby avoiding hospital transfers.
Telemedicine is growing at a rapid pace, and the number of patients using telehealth services will rise to seven million in 2018, up from less than 350,000 in 2013. Broadly defined, telemedicine is the monitoring, diagnosing and treating of patients from a distance using technology. Recent technological advances, particularly during the past 10 years, have enabled medical providers at many levels to be virtually at the bedside like never before.
Telemedicine has been proven to deliver results across a variety of settings with definitive measurables such as length of stay, readmissions, emergency room visits and improved access to caregivers. However, to achieve positive results and reap the benefits, consideration should be given to several factors.
As SNFs assess the value of telemedicine at their individual facilities, here are areas they ought to consider before taking the leap:
How does this service fit into our overall strategy of patient care? A good telemedicine program can make patients and families more comfortable and confident in the care at the facility level. It is beneficial to take into consideration if this will be used to attract new patients. The program should retain patients at the facility, avoiding costly and uncomfortable ambulance trips and Emergency Department visits. Also, it’s best to determine if the results achieved will be used to maintain preferred provider status. The support given to the nursing staff can result in less stress and turnover. It’s important that the organization articulate the reason for adopting a new service and can support both its installation and usage.
How will this integrate with current workflow? As with any new program, an important factor to consider with any telemedicine implementation is how it fits within an existing workflow. Ideal telemedicine solutions should enhance and support the care already being delivered, not create one-off processes that required additional staff time.
What is the status of the facility’s wireless internet capability? Facilities will need to ensure that they have enough bandwidth to implement the types of telemedicine services they are considering. This can be as simple as adding some new access points or range extenders as well as if more complex solutions might be required. The wireless capability should be assessed in tandem with the telemedicine service provider. The equipment proposed by the telemedicine provider can have an important impact on the necessary upgrades.
How much additional staff training will the service require? It is important to understand what the training costs are in terms of dollars as well as the time needed for educating staff and attending physicians on how the telemedicine solution will be used. Is the proposed equipment so complex that the nursing team might struggle with engaging the telemedicine physicians?
Is there reporting available to measure the results of the service? How can metrics be accessed and communicated to the facility leadership and in what format? Is there a customer service group that works to enable satisfaction and results after the initial launch of the service? Assuring that the telemedicine provider is prepared to measure and meet the SNF administrative needs are critical success factors.
Measuring the Impact
For SNFs moving forward with telemedicine services, they will find the best successes by understanding their baseline data and setting clear objectives for the program. Important baseline elements to track before and after the service installation are:
- The typical length of stay for a patient
- Number of patients who return to the hospital each month
- The percent of those who leave and who never return
- The percent who return after a hospital stay
- The facility Resource Utilization Groups (RUG) Rates
Using this information, the facility can derive the impact on lost revenue. By comparing the results quarterly to baseline data, the return on investment can be clearly demonstrated.
Implementing a successful telemedicine solution is a smart and affordable way to stay in preferred provider networks, increase facility census, reduce hospital readmissions, make room for happier residents and their families and ensure more confident staff members are part of the team.
Go ahead and take the leap; it may just be what helps you stay afloat amid the changing healthcare waters.
Mary Jo Gorman, M.D, is chief executive officer of TripleCare, a leading high-acuity telemedicine services provider to skilled nursing facilities throughout the U.S. She can be reached at email@example.com.