As Wisconsin coronavirus cases spike, study aims to expand telemedicine
Last month, the University of Wisconsin’s School of Public Medicine announced it was launching a study on how best to expand the state’s telehealth infrastructure. A statement released by the school noted that researchers would be zeroing in on Wisconsin’s nursing homes by studying workflows, interviewing nursing home staff, and observing telehealth encounters between providers and residents.
The study is coming at a critical time. COVID-19 has been spiking in Wisconsin for weeks, and many of the state’s skilled nursing facilities are now and have been for months on the front lines of battling this crisis.
According to tallies by the NY Times, approximately 40 percent of all U.S. deaths from COVID-19 are linked to nursing homes. Across the country, COVID-19 has infected nearly 500,000 skilled nursing facility residents and staff, and killed approximately 77,000 of them. In Wisconsin, as of late September 2020, 62 nursing homes had reported a total of 271 COVID-19 deaths among residents and staff.
Daily Care Telemedicine is based in Wisconsin — which is why the study by University of Wisconsin caught our eye. The researchers there, like us, recognize that in the battle against the novel coronavirus, skilled nursing facilities have a not-so-secret weapon, if only they would use it: telemedicine.
Pressure Builds for Skilled Nursing Facilities
Many nursing homes have struggled to embrace telemedicine. Barriers including cost, technical knowhow, lack of support from staff, reimbursement issues, and market dynamics have all combined to obstruct telemedicine adoption at skilled nursing facilities (or SNFs).
And yet, SNFs have some of the most clear-cut financial incentives: reducing transfers and reducing 30 day readmissions. For the past eight years, since the Affordable Care Act became law, SNFs around the country have made a lot of progress on reducing the “revolving door” of Medicare beneficiaries getting transferred to a nearby hospital and brought back to the SNF only to be sent to the hospital again shortly thereafter.
The ACA’s 30-day readmission penalty led many hospitals and healthcare systems to lend support to SNFs in the form of medical directorship or oversight, or even to acquire them outright to gain better control over the patient population.
Now, SNFs must contend with an additional pressure: the Patient Driven Payment Model (PDPM). This new payment model will dramatically shift the incentives for skilled nursing facilities, from prioritizing patients in need of therapy toward pursuing patients with higher acuity.
In other words, patients in skilled nursing facilities are about to need an even higher level of on-site care than in the recent past. And this, while they are also facing the threat of COVID-19.
COVID-19 prompts telemedicine improvements
The CARES Act, passed by Congress in late March, gave $200 million for programs to secure the safety of physicians and nurses caring for high-risk populations. Much of this money was used to expand telehealth and remote patient monitoring in skilled nursing facilities, from rehabilitation and therapy centers in New York and Georgia, to communities in Minnesota and Wisconsin served by the Mayo Clinic.
In May, a Mayo Clinic physician told a Minnesota TV station that their telemedicine program had seen a 100-fold increase since the start of the health crisis. “We’ve sent some devices to skilled nursing facilities so those residents can be evaluated in place and determine whether they need to transfer to the hospital or whether they’re better off staying in the facility,” said Dr. Steve Ommen.
This question of whether to stay in the SNF or transfer to a hospital is crucial, and as COVID-19 stresses the nation’s healthcare system like nothing before, the ability to make the right determination on-site has only become more important.
Add to that the financial case: Daily Care Telemedicine can put a telemedicine cart in a skilled nursing care facility for a monthly cost which easily pays itself back in avoided revenue loss, while allowing our remote physicians to see and care for patients. That telemedicine visit gets billed to insurance directly. If this one cart allows the nursing home to keep 5-6 patients in a facility over the course of a month, the investment has already been worth it.
Improving patient care
Beyond the financial incentives, nursing homes have other important considerations, namely the quality of patient care. Telemedicine can help fix the revolving door of hospital re-admissions, but as anyone who has seen their loved one in and out of the hospital again and again knows, the continual moving from place to place can in itself cause mental and physical decline.
For patients and their families, providing telemedicine access to physicians inside the nursing facility is a much-preferred alternative to transferring them to a hospital just for evaluations. In many cases, a telemedicine physician can give directions to an on-site nurse to avoid a hospital visit all together.
When family members know there is 24/7 coverage to see their loved ones, it means they can sleep just a little easier. And that’s something everyone can get behind, especially now.
