Northwell Launches Telehealth Service for Skilled Nursing Facilities

September 11, 2020 - New York’s largest health system is launching a telehealth program for skilled nursing facilities, aimed at reducing hospitalizations and enabling SNFs to provide more care on site.

Northwell Health unveiled the connected health service this week, with partnerships with the Methodist Home for Nursing and Rehabilitation in the Riverdale section of the Bronx and Glen Cove Nursing and Rehabilitation on Long Island. The two facilities will be connected to the 23-hospital health system through telemedicine carts that enable SNF staff to connect with critical care nurses, intensivists and hospitalists for emergency care and supervision.

“It’s really just a matter of having eyes on the patient at all times … and reviewing the medical record, which can be done by telehealth,” says Iris Berman, RN, MSN, Northwell’s vice president of telehealth services. “This gives them the appropriate supervision so that patients can be tracked and cared for on-site rather than sent back” to the hospital.

Faced with limited clinical resources, a growing population of patients with complex care needs and a regulatory system that penalizes them for readmissions, SNFs have struggled to stay in the black and provide adequate care. Many are now turning to telehealth to establish an on-demand link with nearby health systems.

The ongoing COVID-19 crisis has added to the urgency, with SNFs looking to care for more of their own patients instead of risking contamination through hospital transfers. Hospitals, too, are looking at virtual care, eyeing the fact that SNFs have been at the front of the epidemic.

Mindful of the challenges in integrating a telehealth program with an SNF, Berman says Northwell first tested and perfected its platform with two skilled nursing facilities within the health system.

“They have to be willing to collaborate,” she says of the SNFs. “They have to communicate with and educate their staff, create a template into their EMR and invest in the infrastructure they need” to establish a virtual care platform.

Northwell, which uses the Amwell platform, establishes a connection to an SNF through a telemedicine cart with high-definition cameras and audio-visual links (carts are better than tablets, Berman says, because tablets tend to have less-than-optimal cameras and needled to be handled and maneuvered more often). Through the cart, SNF staff can connect with Northwell’s care providers for assistance during an emergency, regular follow-up care or even just to ask a question.

Berman says the platform is particularly important in providing care when an SNF’s clinical staff aren’t in the building, such as during evenings and weekends, as well as to give staff access to specialists. It can also be used to connect with a patient’s family, to help in care coordination and management.

“It’s a satisfier for the resident, it’s a satisfier for the family (and) it’s a satisfier for the attending who really needs some rest,” she points out.

The platform also enables an SNF to train staff, particularly nurses, in how to care for more complex patients, so that they’re treating more patients on the scene rather than sending them back to the hospital. This, in turn, builds up their confidence.

While the benefits of telehealth in SNFs are numerable, so are the challenges. An SNF has to have the mindset to embrace connected health, as well as the resources to pay for and integrate the technology and broadband connectivity.

The reimbursement landscape could be better, too. While telehealth coverage has been expanded on state and federal levels to help providers during the pandemic, those emergency measures won’t last, and SNFs still aren’t considered by the Centers for Medicare & Medicare Services to be ideal sites for the delivery of telehealth. That robs many SNFs of the support they need to serve a fast-growing Medicare population.

Berman says federal and state governments would do well to understand that telehealth can benefit a wide range of users, not just those in rural locations. Coverage guidelines that address access for underserved populations rather than rural ones would go a long way toward helping SNFs and other facilities in urban areas that struggle to provide care.

“You can be a mile away (in New York City) and still not be able to access the care you need,” she points out.

Berman sees a promising future for Northwell’s new telehealth service, which is already being used at Methodist – it’s already been credited with avoiding one rehospitalization – and will soon be online at Glen Cove.

Other SNFs will be added to the network, she says. And the platform will likely be enhanced as time goes by to allow those facilities to care for more complex patients, with remote patient monitoring and some connected devices added to the menu.

“There’s a lot of potential to improve care at these sites,” says Berman, who used to work in a nursing home and who has a parent living in one now. “This can make a difference.”