- A telemedicine platform that provides real-time virtual care has helped a Long Island skilled nursing facility reduce hospital transfers, improve patient care and staff morale – and earn more than $150,000 in Medicare bonuses for the coming year.
Plainview, N.Y.-based Central Island Healthcare is among just 3 percent of the nation’s 15,000 SNFs to qualify for the maximum bonus in 2019 from the Centers for Medicare & Medicaid Services through the Skilled Nursing Value-Based Purchasing Program. In fact, only 27 percent of those SNFs qualify for any bonus at all in the program, which focuses on avoidable medical complications that result in a return to the hospital within 30 days of discharge.
Michael Ostreicher, the nursing home’s executive director, says CIH was able to reduce its hospital transfers by 44 percent through a connected care platform that enables staff to analyze a patient’s health concerns and immediately connect with a physician for diagnosis and treatment.
“This is 24-hour-a-day urgent care telemedicine,” he says. “This is exactly what we need.”
Like most SNFs, CIH doesn’t have the financial flexibility to hire 24/7 physicians, so it relies on outside physicians to provide care. They’ll drop by the facility a couple times a week, outside their own office hours, to check on residents, and are on call the rest of the time. If a patient has a health concern that requires attention, staff are compelled to phone the on-call physician.
“They’ll usually just say, ‘Send the patient back to the hospital and I’ll see them in the morning,’” Ostreicher says.
Many of those transfers, however, don’t need to happen. In fact, they more often than not stress out the patients – further affecting health outcomes – and their families, put extra pressure on the hospital to provide care, and leave SNF staff feeling like they’re not making a difference.
Added to that pressure, Ostreicher says, is the realization that hospitals are discharging patients sooner, and those patients are ending up in SNFs with more complex health concerns.
“We’re dealing with extremely frail human lives and there’s literally no margin for error for us,” he says, adding that SNFs often get the blame for patients who end up back in the hospital.
Faced with a CMS mandate in 2016 to reduce 30-day readmissions, hospitals and SNFs are slowly coming around to the idea that telemedicine can make a difference. That nudge toward virtual care is expected to become more pronounced now that CMS has published data on individual SNFs and tied those results to Medicare penalties and bonuses.
“This is kinda sending shock waves through the nursing home industry,” Ostreicher says.
CIH is one of the few SNFs to jump on the telehealth bandwagon early. The facility partnered with Brooklyn-based Call9 in 2015 to implement a virtual care platform that gives the SNF round-the-clock access to care.
Through the program, an EMT employed by Call9 is stationed at CIH at all times – Ostreicher says he or she is treated like part of the staff. Whenever a patient has a health concern, that EMT comes in with a telemedicine cart and triages the patient. This process often includes a video consult with an ER doctor retained by Call9. Once a diagnosis and treatment plan has been developed, staff call CIH’s on-call physician, who has the final say on treatment.
Ostreicher says the on-call physician usually accepts the recommendations of the Call9 team. This, in turn, means that patients are only sent back to the hospital if they really need medical attention that can only be given at a hospital.
“Too many of our patients were being cycled back to the hospital, where it costs so much more to treat a patient,” he says. “This saves the system a lot of money and (ensures) that patients are going back if they need that care.”
At the onset, Ostreicher says CIH had to do some hand-holding to get everybody on board with the new technology. Staff were wary, he says, and the facility’s cadre of physicians was worried that the platform would interfere with their workflows or challenge their decisions. That’s why it’s important, he says, to bring everybody into the loop as soon as possible when planning a telemedicine implementation.
The benefits go beyond saving money. Ostreicher says the telemedicine platform reduces stress on CIH staff and gives them more confidence, knowing they can bring in the experts with a simple page or shout down the hallway.
As well, CIH patients and their families are more at ease, knowing that access to emergency care is quick and easy. Likewise, the facility enjoys a more stable patient population, as it isn’t dealing with the chaotic effects of so many hospitals transfers.
This also gives the facility a better reputation. Hospitals are more apt to work with CIH knowing that the facility has a telemedicine platform that reduces transports, Ostreicher says, and that platform also serves as an important benefit in enticing new hires.
“We do market it every chance we get,” he says. “We market it to the local hospitals, and it’s something that they tell to their patients.”
It’s also spurring Ostreicher to take a look at other telemedicine and telehealth services that CIH might someday want to offer, such as telemental health.
“I’m interested to see what else we can do,” he says.
For now, though, he’s looking forward to 2019.