Q&A: Deploying telemedicine to cut hospitalizations Special

Posted Feb 23, 2019 by Tim Sandle
All nursing homes are dealing with the challenge of trying to care for higher acuity patients on tight budgets. To assist with cost control and as a means of lowering hospitalization rates, telemedicine can assist as Central Island Healthcare explain.
File photo: A person at a workplace  communicating via a Video Relay Service video.
File photo: A person at a workplace, communicating via a Video Relay Service video.
SignVideo, London, U.K (CC BY-SA 4.0)
That telemedicine can make a difference is shown in the case of Central Island Healthcare (CIH), based in the U.S. CIH was one of the first skilled nursing facilities (a type of nursing home) to jump on board with telemedicine. This was through partnering provider Call9.
With Call9's help, CIH is now able to treat residents in place and avoid sending them to the hospital for common ailments such as hypertension, fever, chest pain and COPD. To understand the benefits of telemedicine further, Digital Journal spoke with Michael Ostreicher, executive director of CIH.
Digital Journal: What are the current challenges facing nursing homes?
Michael Ostreicher: One of the most significant changes in the industry has been the level of acuity in the patients we receive from hospitals. In the past, the clinical cases we typically received in the nursing home were much easier to manage. Patients used to spend more time in the hospital before they came to us. Nowadays, even the clinically complex patients are discharged from the hospital after 2-3 days. Patients come to us more unstable than we could have imagined them to be. But we’re not hospitals. We typically don’t have advanced diagnostic equipment on-site, and while our staff is highly skilled at caring for the chronic needs of our residents, they’re often not trained to treat that level of acuity.
DJ: Are these challenges set to increase?
Ostreicher: These challenges have become the new norm across the industry. And now there’s financial skin in the game to make sure you can handle those patients. There are tremendous financial rewards in the form of Medicare bonuses for improved 30-day readmission rates back to hospitals, and also penalties if patients return to hospital.
You take all of those factors together, and it’s getting much harder to handle these difficult cases, which have become the norm. Something dramatic had to change – and that’s where Call9 comes into play. Call9 gives our staff a level of confidence that we’re able to take care of these complex patients.
DJ: How would you define telemedicine?
Ostreicher: For my purposes, I would define telemedicine as having a physician at the bedside on-demand 24/7.
DJ: How can telemedicine assist with providing medical care to those residing in nursing homes?
Ostreicher: In the traditional model of nursing homes, you have a dozen physicians that are attending at the facility. Their primary job is to have office hours, and beyond that, they might drop by the facility a few times a week to check on patients. But that doesn’t really help you when your patients can go south during the 24-hour cycle of the day. With telemedicine, I’m able to flip a switch, and there’s a doctor at the bedside.
With Call9 specifically, they provide an on-site emergency-trained first responder 24/7 in our facility who works collaboratively with our staff when patients have an acute change in condition. They bring a cart with advanced diagnostics to the patient’s bedside within minutes and can immediately connect with a Call9 clinician, which provides that higher level of trained clinical staff.
DJ: How was the implementation process at Central Island Healthcare undertaken?
Ostreicher: Tim Peck, the founder of Call9, actually approached me back in 2015. I had been trying to figure out how I could provide a higher level of care for these clinically complex patients hospitals were sending us, and then out of the blue, I got an email from Tim asking if I’d be interested in having Call9 in the facility. I later realized that Tim had reached out to more than 2,000 other facilities around the country, and I was one of the few to get back to him. It was simply too much of an unknown, a risk, for others.
My one stipulation was that he agree to live in the facility to ensure the highest level of patient safety and care. And he agreed. So he set up a cot in one of our conference rooms and lived at Central Island, full-time, for three months while the Call9 team was developing the technology.
DJ: Did you run a pilot? If so how did you measure success?
Ostreicher: The pilot was really the first few months that Tim lived at the facility. Once we were confident in the Call9 solution, he was able to treat patients remotely. We measured success based on data. After three months, we started seeing significant changes in that the number of discharges decreased dramatically.
In fact since implementation, we’ve seen a consistent 40-50% drop in transfers to the Emergency Department, which has improved our census and increased patient satisfaction among both our residents and their family members. Hospitals have recognized our ability to treat difficult cases, and now we’re a destination for these types of patients.
DJ: What challenges did you face?
Ostreicher: Success didn’t happen overnight; it took time for the physicians and nurses on our team to buy in. They had concerns about Call9 disrupting their workflows and challenging their decisions. Eventually Call9 started proving itself to our physicians and nurses as a true solution to the problem. Attending physicians realized that Call9 could be there when they weren’t in the building. And our nurses were able to have more confidence that patients who might have previously been sent out could be safely treated at the facility.
DJ: How did users respond to the technology?
Ostreicher: In addition to physicians and nurses really understanding the value Call9 brings, we’ve have an incredible response from patients themselves and their family members. Most patients would rather not go to the Emergency Department. It’s disruptive and chaotic; they’d rather be treated in place. The family have such a greater peace of mind that their loved ones are able to receive treatment in the comfort of their beds when they need it most.