Earlier this year, the Centers for Medicare & Medicaid Services published a Rural Health Strategy Guide outlining key initiatives for telehealth and telemedicine to improve care in rural America. These findings included expanding the use of and access to telemedicine, but for facilities with limited access to hospitals, how do we utilize a telemedicine solution to its fullest potential?

Telemedicine’s cornerstone in the post-acute long-term care field has always been avoiding hospitalizations. This often takes the form of reacting to an acute change of condition by performing a telemedicine consult. But what about patients who need ongoing care, pain management, or specialty consults? There are unlimited possibilities and situations in which telemedicine is the vehicle to provide facilities, and in particular rural facilities, the highest quality care in these situations as well.

Implementing specialty consults can be done independently of whether or not a facility currently utilizes telemedicine.  Stand-alone specialty services are in demand to meet the very specific needs of many facilities. That said, expanding any current after hours coverage service can effectively double the capabilities of your telemedicine technology, often at minimal cost. Providing these specialty services will allow a facility to be more inclusive and flexible to meet the needs of its residents. A good example of this is geriatric psychiatry. Geriatric psychiatry providers are in great demand given the ever-increasing number of residents with behavioral diagnoses and the growing regulatory burden of caring for these fragile patients. In our experience, many nursing homes are often not receiving the quality or the quantity of geri-psychiatry services that their residents need—sometimes making difficult trade-offs regarding who receives care.

To help alleviate this important concern, Curavi has begun delivering geriatric psychiatric services via telemedicine. Behavioral health has a long history with telehealth delivery (relatively speaking—we are talking about telehealth here!) and accordingly has considerable peer-reviewed literature attesting to the effectiveness and outcomes.  We have found specialty consults to be a particularly effective form of telemedicine. They are scheduled at a convenient time for the facility on an on-going basis to help ensure continuity of care. In our initial pilot facility, Curavi delivered 47 consults by a Board-certified geriatric psychiatrist in the initial 6 months resulting in better care and consistent, on-going monitoring of the residents’ medication regimes.

“Because we are a rural facility, having access to a Geriatric Psychiatrist is extremely valuable, not only to our staff but also to our patients. The slightest change of environment can be stressful on the resident and being able to meet with a board-certified Geriatric Psychiatrist in a familiar environment benefits the resident and staff– it’s a win-win.” – Social Services Manager, Sugar Creek Station

A multi-disciplinary approach was taken with the social worker, floor nurse, and psychiatrist all participating in the consultation to further improve communication and continuity.  

Providing specialty services through telemedicine is not limited to only rural facilities. Suburban and urban facilities can use telemedicine services to overcome common barriers to access, although it may be more costly due to CMS regulations regarding telemedicine reimbursement. In a survey conducted at AMDA, Society for Post-Acute and Long-Term Care Medicine Annual Conference, respondents said they “strongly agree that specialty telemedicine may fill an existing service gap” and “telemedicine may improve timeliness and access to appropriate resident care.” Additionally, physicians responded they would refer their patients to a variety of telemedicine consults for specialty care such as dermatology, psychiatry, infectious diseases and neurology. If your facility is using telemedicine only for changes of condition, consider the many different ways to utilize your telemedicine service.

Alissa Meade is President & CEO of Curavi Health, a company focused on delivering innovative solutions to enhance the quality of care for residents in skilled nursing facilities and in the broader post-acute care environment.