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Telemedicine Gives SNFs a Tool to Improve Care, Cut Medicare Costs

Using an after-hours telemedicine platform, a Brooklyn-based skilled nursing facility treated more patients on-site, reduced costly hospital transports and cut its Medicare expenses by more than $1.5 million in one year.

Source: ThinkStock

By Eric Wicklund

- An after-hours telemedicine platform helped a Brooklyn-based skilled nursing facility eliminate almost 100 hospitalizations and save roughly $1.5 million in Medicare costs in one year.

Those outcomes are included in a case study published in the August edition of the American Journal of Managed Care (AJMC). Using that as a benchmark, the case study’s authors say a connected care platform could save the nation $1.5 million per year.

“As nursing facilities are called upon to care for higher-acuity patients and drive better clinical outcomes at a fraction of the cost of a hospitalization, systems that deliver quality physicians to the bedside at times of change of condition will be required,” they note. “This study found that use of a dedicated, virtual, after-hours physician coverage service in an SNF demonstrated a significant reduction in Medicare costs (acute inpatient hospital, subacute care, and transfer costs).”

“These efforts present an opportunity to improve both clinical outcomes for older adults in need of long-term and post-acute services and financial outcomes for those providing the care,” the authors conclude.

The authors - David Chess, MD, the founder, president and chief medical officer of Connecticut-based Tapestry Telehealth; John J. Whitman, MBA of the TRECS (Targeting Revolutionary Elder Care Solutions) Institute; Diane Croll, DNP, of Long Island-based TripleCare; and Richard Stefanacci, DO, of the Jefferson College of Population Health at Thomas Jefferson University – focused their study on the 365-bed Cobble Hill Health Center in Brooklyn, N.Y., which uses the TripleCare telehealth platform. From March 2015 to March 2016, the SNF used the technology to treat 313 patients.

Of that group, 259 patients (83 percent) were treated via telemedicine at Cobble Hill, while 54 were transported to a hospital. According to Cobble Hill’s medical director, Dr. Himanshu Pandya, 91 of the 259 patients treated at Cobble Hill would have required hospitalization had the facility not had access to telemedicine.

The case study, its authors say, recognizes the value of having primary care providers assess patients in an SNF or other care facility before a decision is made on hospitalization – and the value of a virtual care platform in providing those evaluations. And while the Centers for Medicare & Medicaid Services (CMS) is moving slowly toward reimbursing for those evaluations, new accountable care models are embracing the concept to reduce unnecessary and costly hospital transports.

Putting aside the health-related benefits of not having to send a patient to the hospital, the case study found that Medicare benefitted greatly from the telehealth service.

“Treating patients on site eliminated Medicare’s payment to the hospital, the emergency ambulance, and the facility for the skilled days that some of the patients would have received following a three-day qualifying Medicare acute care stay,” Chess and his colleagues report.

“Of the 91 avoided hospitalizations, 31 were individuals whose SNF stay was covered under a Medicare Advantage plan, 57 were dual-eligible individuals (those enrolled in Medicare and Medicaid) whose SNF stay was covered under Medicaid, and three were privately paid,” the case study points out. “Of the 57 individuals covered by Medicaid who avoided hospitalization, the facility estimated that, based on their clinical status, 14 (25 percent) would have been eligible for Medicare benefits had they experienced a hospitalization and returned to the facility. Because they remained in the SNF, they did not convert to Medicare, resulting in Medicare savings.”

That amounts to a savings of $1.55 million in Medicare costs, Chess and his colleagues conclude.

Cobble Hill, meanwhile, spent $60,000 during that year for the telemedicine platform.

“This fee was offset by preventing hospitalizations; helping the facility maintain census, especially in its short-term rehabilitation unit; capturing lost Medicaid days while a patient was hospitalized; and a decrease in transportation costs,” the case study notes. “It is estimated that the facility netted $20,000 above the cost of the program,” which is still in use.

Extrapolating those findings over 30 percent of the nation’s 1.7 million nursing facility beds, Chess and his team estimated that Medicare could save more than $1.5 billion a year by using telemedicine to treat SNF patients.

“Although the payer was significantly advantaged by preventing hospitalizations, the SNF also showed modest financial gains by helping to keep their rehabilitation beds filled,” the study adds. “As the CMS 2 percent hospitalization penalty to the SNFs engages in 2018, the financial consequences of hospitalization will become even more marked.”

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