Gregory Alexander, Ph.D., R.N.

Relaxed Medicare regulations have coincided with a significant increase in nursing home telehealth use, according to researchers from the Columbia University School of Nursing. Continued expansion is ideal for residents’ well-being and the health of the sector, they say.

Data were gathered from a national survey of nursing home administrators taken between Jan. 1, 2019, and August 4, 2020. Respondents from a random sample of 664 nursing homes were asked the extent of telehealth use for activities such as medical screenings, follow-up visits and consultations, and medication management.

Use began to rise after March 6, when Medicare restrictions were relaxed to help meet care needs during pandemic lockdowns. Administrators reported using telehealth applications for resident evaluation 11.24 times more after the expansion than they did pre-expansion, wrote lead author Gregory Alexander, Ph.D., RN. and colleagues.

The greatest adoption of the technology occurred in large, metro-area facilities, but respondents reported a wide range of use profiles. Fully 16% said their facility did not use the technology at all, 5% reported maximum use, and 79% reported partial use. Larger metropolitan operators reported greater adoption than their smaller peers in rural areas, small towns and small cities. Facility ownership appeared to have little effect on the results.

Notably, nursing homes who reported “partial” use had significant technology implementation in clinical support areas. These included laboratory systems such as exchange of lab results, and pharmacy systems such as remote medication order entry by pharmacists.

The authors called for the relaxed regulations to continue, with the goal of encouraging greater technology applications in the industry. This ultimately will help residents maintain social connection and prevent isolation, preserve limited resources such as personal protective equipment, and help residents and clinicians continue to practice safe distancing measures, they argued. 

“Without a vaccine and electronic connections to the outside world, nursing home residents could spend weeks, months, or even years in a facility without visitors other than regular staff,” they said.

But it remains to be seen if loosening regulations can help nursing home administrators overcome some of the monumental struggles that they have experienced when trying to keep pace with other health sectors such as acute care, Alexander and colleagues added. These sectors traditionally have received greater financial resources for technology implementation, they said.

The Centers for Medicare & Medicaid Services has continued to expand access to telehealth services. In May, therapy providers were permitted to provide virtual services to nursing home residents. In October, more services were added to the Medicare fee-for-service coverage list.

Administrator Seema Verma has said she favors continuing the expansion program beyond the pandemic period.

The study was published Monday in the Journal of the American Medical Informatics Association.