Skilled nursing facilities that implement a telemedicine service and teach staff to use it could reduce their hospital readmissions, but current payment systems do not encourage this, according to a forthcoming study in Health Affairs.
Researchers with Harvard Medical School and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine analyzed the rollout of a telemedicine initiative at 11 Massachusetts long-term care facilities between 2009 and 2011. The videoconferencing service replaced off-hour phone consultations with physicians, and the facilities were not engaged in any other targeted efforts to reduce hospitalizations during the study period, according to the researchers.
The nursing homes that placed few calls to the service did not see a reduction in their hospitalization rate, but the facilities that were more engaged in using the service achieved an 11% reduction, the researchers found. This would translate to about 15 fewer hospitalizations per year, and a savings of $151,000 annually for the Medicare program, the investigators estimated.
Staff engagement in telemedicine can be achieved through efforts such as designating a staff “champion” of the service and having regular meetings about it, according to the research team. However, most providers don’t have incentives to make this effort or to spend the money on implementing a telemedicine service, they noted. This is because Medicare benefits from the savings, while the facilities themselves may actually see reduced cash flow due to the way services are reimbursed for residents who are hospitalized and then return.
However, changes under the Affordable Care Act that strengthen care coordination and penalize providers for hospital readmissions may alter the telemedicine calculus, according to the authors.
Findings will appear in the February issue of Health Affairs.