How Telehealth Aids Skilled Nursing Facilities During, Beyond COVID-19

Skilled nursing facilities play a vital role in helping patients transition from the hospital to the home, and the addition of telehealth capabilities could make their services even more impactful.

According to the Kaiser Family Foundation, there are roughly 15,500 skilled nursing facilities in the US. These facilities provide in-patient rehabilitation for patients discharged from a hospital, offering a critical link between the hospital and home. Telehealth has the potential to improve that care, as well as improve a SNF’s financial stability.

The challenge lies in aligning the technology and processes with organizational goals and workflows so that success and sustainability can be assured. Once accomplished, a SNF using telemedicine platforms and mHealth tools can better manage transitions of care, improve patient care, reduce emergency transports and hospital readmissions and improve the morale of patients, family, and staff.

Furthermore, a comprehensive connected health strategy can also impact the SNF's bottom line, reducing Medicare penalties associated with unnecessary hospitalizations and allowing the facility to qualify for value-based care incentives and ensuring a better business environment.

The onset of the Coronavirus pandemic has, in one sense, helped prove how valuable telehealth can be to SNFs, while also pointing out the challenges they face in caring for their patients. Mortality rates are higher in these facilities because the patients they treat are older and more frail, requiring a higher level of medical care. Telemedicine platforms, meanwhile, have allowed staff to treat their patients more effectively, reduce the need for hospital transports, and access critical specialty consults.

Those benefits, however, might not last. While the US government has loosened Medicare restrictions on telehealth in SNFs and made more funding available, those advances will only continue while the emergency is in place. Once the pandemic is under control, those Medicare restrictions will return, and the extra funding will dry up.

It's, therefore, more important than ever that SNFs put this technology to work now — collect the data and keep track of the benefits — to make a case for the continued support of telehealth beyond the pandemic.

Tackling the Care Paradigm with Telehealth

The potential to change the care paradigm in SNFs is driving companies to take their services in a new direction. Initially focused on providing telehealth services in the hospital setting, telehealth providers are now identifying SNFs as an area of growth.

"There is a tremendous opportunity to leverage the technology provided by telehealth to serve as a lever to expand our core capabilities of delivering improved patient and financial outcomes in

value-based care settings," says Brendan McNamara, CEO of Sound Telemedicine.

"We are leveraging technology to add physician coverage via telemedicine," he notes. "It's adding not only physician coverage but also the ability to interact with a highly engaged and skilled physician where there wasn't previously."

SNFs traditionally have a staff of doctors and nurses providing care during business hours and use on-call services during nights and weekends. If a patient's status changes to such a degree that the staff on hand or on-call can't offer treatment, the patient is transported back to the hospital. These transports are disruptive, stressful, time-consuming, and costly — sometimes resulting in Medicare penalties if the transport is deemed unnecessary or caused by a preventable health condition.

Telehealth can change that protocol.

A connected health platform enables SNF staff to contact skilled providers on-demand, offering the same level of care through an audio-visual platform that they would get in the hospital. The platform allows a facility to care for more of its patients on-site, especially on nights and weekends, and reduces the need for transports.

“We find there’s tremendous variation in physician coverage available to skilled nursing facilities based on their night and weekend staffing,” says McNamara. "The opportunity to have a physician who is on shift and focused exclusively on helping treat patients in place can be an incredibly effective and powerful resource for these facilities on nights and weekends when, unfortunately, they’re pairing variable and limited physician coverage.”

In many cases, SNFs are using "the same provider team: the hospitalist," adds Alexandra Walton, Sound Telemedicine's COO. These specialists work with SNFs to treat patients in place and are often considered part of the care team.

Aside from the acute cases, a telehealth platform gives SNF staff a link to live support at any time, enabling doctors and nurses to get whatever help they need, whenever they need it. That’s a welcome resource at a time when SNF staff are overworked and stressed, and facilities across the country are having a difficult time filling open positions.

SNF staff often "feel like they're on an island," treating complex patients without clinical oversight. "Having our docs offer a timely response with an engaged provider who's working with you to help treat that patient in place dramatically improves nurse satisfaction. Likewise, it helps nursing staff gain the confidence to serve to the top of their licenses at that facility and feel more in control," notes McNamara.

These virtual consults can also help SNF staff shift from reactive care to proactive care.

“We can actually get ahead of a clinical deterioration in their status and work with the primary care physician or the medical director to change that plan of care,” says Walton. “We’d rather them call us to get ahead of what today looks like something might be a bit off, but what tomorrow becomes a rapid decompensation.”

As well, during a pandemic such as the Coronavirus emergency, it’s crucial to be able to treat individuals while limiting the risk of exposure to others — patients, staff, and visitors. A telehealth program offers that level of physical separation while maintaining clinical quality.

As SNFs become more familiar with the technology, they can develop remote patient monitoring (RPM) programs that enable staff to keep tabs on their patients daily, adding chronic care management to the mix. The strategy here is to create a platform that becomes second nature to SNF staff, giving them a resource whenever they need it — whether it’s to treat a patient with an acute condition or simply to check on daily care management.

Aside from improving clinical outcomes and care management as well as reducing hospital readmissions, a telehealth platform can have an impact on morale within the SNF. The ability to offer more comprehensive care at the facility reduces stress on patients and their family members, particularly those who worry that an ambulance ride back to the hospital might be a life-or-death situation. In other words, the promise of better care reduces stress.

For SNF staff, a telehealth platform becomes a reassuring option, giving nurses the ability to practice at the top of their profession while knowing they have help when and where they need it. At a time when provider shortages are a real concern and staff turnover is high, a telehealth platform can be an essential marketing tool, a benefit that aids staff retention and hiring efforts and separates the facility from its competitors.

For SNFs, the ROI of a telehealth program can be measured in many different ways. There's money saved by reducing hospital readmissions, which not only exact administrative costs but give the facility exposure to Medicare penalties and reduce the chance of qualifying for value-based care bonuses.

There are also costs associated with interrupted care, such as medication and other supplies ordered for a patient who is no longer there, and the expenses tied to lost bed days.

Beyond that, a telehealth program can improve clinical outcomes, which not only makes for a healthier patient population but reduces turnover and enables staff to better plan for transitions in care. And as mentioned, such a program can improve morale in both patients and staff.