May 29, 2019, Alex Spanko, Skilled Nursing News - When the Allure Group decided to pursue a new physician telehealth partnership, leadership didn’t want to jump in headfirst — and instead turned to a kind of audition process to pick its eventual partner.
For about a year and a half, the six-building chain tested out two separate telemedicine providers in two facilities, with president and COO Melissa Powell comparing and contrasting the results of each.
“I really just looked at stats and feedback from the line staff, and that was really my metric — how the staff felt interacting with them, and how many hospitalizations I was having and for what reasons,” Powell told SNN.
TeleHealth Solution emerged as the winner of the contest, with the company’s technology now rolled out at Allure’s facilities in Brooklyn and Manhattan. But while Powell praised her partner’s performance, she emphasized that skilled nursing telehealth success isn’t a one-way street.
“I quickly learned that it had to be a partnership,” Powell said. “We had to lift our weight, or it wasn’t going to work.”
The roadmap to risk
In recent years, telehealth in the nursing home space has evolved from a too-expensive curiosity to an integral part of some providers’ overall operational strategies. In particular, operators have looked to cut down on readmissions by contracting with third-party services that offer remote physician interventions during overnights and weekends, when nurses are sometimes forced to send residents directly to the hospital for certain problems that can’t be solved in the SNF in the absence of a doctor.
Companies such as Call9 and Third Eye Health have attracted considerable outside investment for their remote physician services, as SNF providers face increasing pressure to lower resident trips to the hospital. In addition to factoring into an individual building’s overall five-star rating on Nursing Home Compare, readmission rates can also determine whether or not providers earn back a mandatory 2% reimbursement cut under the SNF Value-Based Purchasing (VBP) program.
But the path to lowered readmissions and improved resident care isn’t always smooth. The nursing home space has gained a reputation as one of the least tech-savvy along the care continuum, with anecdotal stories of buildings that continue to use paper records and fax machines to transmit data to hospital and home health partners.
Still, speaking to SNN as part of our anonymous Confessions series, a telehealth executive noted that even if frontline caregivers know how to use the technology, it isn’t worth much if staff and management chooses not to embrace its full potential.
“The technology’s pretty easy to use. The resistance is — I’m going to say — in a sense worse, because if it was just technology, you could fix for that,” the executive said. “The bigger issue is the willingness to up and change those care models, and bring them into what the new care levels are going to demand.”
The key, in the executive’s view, is that telehealth should be a tool to taking on higher-acuity residents, and not just a means to the end of reducing hospital visits. With expanded doctor coverage, the thinking goes, providers can shift from providing custodial care to serving the kinds of medically complex residents that new payment models — including the Patient-Driven Payment Model — are increasingly rewarding.
“I think just overall, [there’s] this mindset change of being able to treat in place and the idea that a nursing home is now a health care facility, not just the Shady Acres Retirement Home,” the executive said.
Allure had something of a leg up when it first explored telehealth tech: The company had already targeted higher-acuity patients before implementing either telemedicine provider, with bedside dialysis and ventilator care among its offerings. This strategy had actually placed the company at something of a disadvantage in the competitive New York City marketplace, Powell said.
“I wanted to do better, and I couldn’t get past a certain threshold of rehospitalization stats,” she said. “I was differentiating myself by the patients I was accepting, but because the patients were tougher, my stats weren’t better than the nursing home up the street, because their patients were easier.”
Telehealth thus became a way to streamline Allure’s existing high-acuity strategy while working to move even farther up the complexity chain. Having access to doctors allows Allure to look at its buildings as a “mini-hospital environment,” with remote physicians able to write orders and provide consultations on weekends and after normal business hours, Powell said.
The rehospitalization angle remains attractive, however. For instance, having a telehealth partner has meant that physicians can arrange for Allure’s residents to take trips to the hospital for services such as blood transfusions without being formally admitted, a key improvement over the past procedure.
“They were getting admitted because the hospital did a full evaluation,” Powell said. “They were finding other things wrong with the patient — they’re here for a reason.”
Ensuring employee buy-in
That said, Allure still faced some roadblocks when rolling out its new telehealth system. Managing the handoff between doctors on site during the day and the third-party physicians at night was a particular area of focus, as the staff doctors needed some time to become comfortable ceding control; during the off hours, TeleHealth Solution’s physicians become the residents’ primary doctors and can make the decision whether or not to recommend admission to a hospital.
“The doctors were a little nervous, which I can understand — it’s their patient,” Powell said.
Allure’s nurses, meanwhile, largely embraced the new system, with some even asking to be transferred to the company’s telehealth-enabled units during the gradual roll-out process across the buildings. Some even indicated that working in a higher-acuity setting was a main reason they elected to go to nursing school in the first place, Powell said.
“I don’t find that resistance — ‘Hh, we should just send them out to the hospital.’ I don’t find that,” she said. “I find that people are excited and up to the challenge, and want to learn and participate.”
Powell also emphasized that the telehealth offering has become a key part of their marketing and outreach strategy to family members of residents: Knowing that their relative will have constant access to a physician helps ease family members’ fears or misconceptions about the nursing home setting.
“Families are anxious when you have a sick patient in a facility like this versus a hospital,” she said. “A lot of people still picture a nursing home … [as] the sleepy old place where you just sit and watch TV.”