- In the latest effort by Congress to compel Medicare to embrace telehealth, a group a lawmakers have submitted a bill that would enable skilled nursing facilities to adopt connected health technology.
The Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2018 aims to reduce rehospitalizations at qualified SNFs by giving them more incentives to use telemedicine and telehealth to improve patient care.
The bill was introduced by U.S. Reps. Adrian Smith (R-Neb.), Diane Black (R-Tenn.), Joe Crowley (D-N.Y.), Morgan Griffith (R-Va.) and Ben Ray Lujan (D-N.M.).
“Skilled nursing facilities are often faced with few options to treat residents in need of emergency care, leading to excessive and costly hospital transfers,” the lawmakers said in a joint press release. “However, allowing medical professionals already working within these facilities to provide needed emergency care through telehealth, the RUSH Act will offer Medicare recipients with better access to care at a lower cost to taxpayers.”
According to the Centers for Medicare & Medicaid Services, almost 20 percent of all hospital transfers originate from SNFs, and 45 percent of them could have been avoided through access to virtual care. In addition, the Medicare Payment Advisory Commission (MedPAC) has noted that rehospitalizations expose seniors to increased risk of falls, delirium, infections and adverse medication interactions.
In 2012, the Center for Connected Health Policy (CCHP) identified telehealth as an important tool for SNFs to improve quality, health and costs of care.
“SNFs provide services to a population of predominantly older adults who have limitations in their ability to independently care for themselves due to multiple and coexisting cognitive, physical and chronic conditions,” the CCHP noted in its report. “An aging population and a lack of resources for long-term health care are leaving skilled nursing staff increasingly responsible for a growing frail patient population that requires significant medical, therapeutic, and rehabilitation services due to their significant risk for adverse, complicated, and costly health events.”
“However, SNF physicians are often off-site or unavailable when patient assessments and care recommendations are most urgently needed,” the report added. “As a consequence, residents often have to be transported off-site to receive appropriate care such as to an emergency department for immediate assessment and possible hospitalization. Frequently they experience preventable negative health outcomes from the lack of timely care.”
The RUSH Act would, if made into law, create an “SNF-based Provision of Preventive Acute Care and Hospitalization Reduction Program,” which would be overseen by CMS and qualify SNFs to receive telemedicine and telehealth equipment described as “non-surgical items and services furnished at a hospital emergency department that may be safely furnished by a qualified group practice at a qualified skilled nursing facility.”
The bill would enable CMS to reimburse these SNFs for the technology, while also requiring the agency to evaluate each recipient six months after receiving the technology and at least once every two years after that.
“Currently, most nursing homes are not equipped to handle even minor emergencies,” Rep. Lujan said in the press release. “This means most patients are sent via ambulance to a hospital emergency room at any sign of emergency. This can be expensive and hard on patients and their families – especially in rural areas. The RUSH Act provides an exciting new opportunity to allow technology to bridge the gaps for patients and providers in nursing homes across the country.”
CMS has shown interest in this issue in the past. Two years ago, the agency helped to fund a pilot project, coordinated by the non-profit TRECS (Targeting Revolutionary Elder Care Solutions) Institute, in which three Florida-based SNFs were equipped with telemedicine technology developed by TripleCare.
“Changes in patients’ conditions often occur in the off hours when physicians are not physically present at SNFs - this is precisely the time when TripleCare’s virtual physician services kick in,” Mary Jo Gorman, chief executive officer at the New York-based telehealth company, said. “As a result, these virtual visits are reaping considerable financial savings for SNFs and our nation’s healthcare system. We also afford SNF patients and their families a better care experience and peace of mind.”
With the RUSH Act, lawmakers are hoping to expand the possibilities identified in that pilot program to SNFs throughout the country.
“Medical innovation and technology is at the forefront of today’s healthcare system, and it is vital that the Medicare program embrace advances in emergency medicine to ensure that quality, affordable care remains available to our nation’s seniors,” Rep. Black, a registered nurse for more than 45 years, said in the press release.