The cost of quality care through telemedicine

As value-based care takes center stage, how medical professionals can incorporate technology to better serve underserved communities

Providing comfort to those in extremis is among the most important things medical professionals can do in the field. Being with people at the moment of their greatest vulnerability and providing companionship, connection and support can be just as important as providing breathing treatments, fluids or antibiotics. This is especially true for patients in nursing homes, one of most vulnerable populations in the nation, but how can we make this type of care a priority to this demographic?

In 2015, I cofounded Call9 after living in a nursing home for three months. I was 34 years old and wanted to understand this patient population and their experience so I could better serve them. Before then, I had been an Emergency Physician at Beth Israel Deaconess in Boston and time and again had cared for patients making seemingly avoidable visits to the Emergency Department (ED). If the facilities had the time, tools and technology to treat them in place, it would make for a more comfortable experience for the patient and would be more cost effective to the payer. There were three key takeaways from my experience.

1. Bring Value-Based Care to an Underserved Population

A consistent challenge that nursing homes work to overcome is the concern that their residents may feel isolated or lonely. Staffing needs for nursing homes are an ever-present challenge; on average, the national nursing-to-patient ratio is 1:36, and patients typically receive 40 minutes of nursing care a day. This population is a prime example of how value-based care can transform the patient experience.

2. Cut Costs by Reducing Unnecessary Emergency Transfers

The staffing challenge – and shortage – is due to the current economics of nursing home care. Most homes operate under very tight margins and per patient reimbursement, via public and private insurers, that does not provide the necessary resources to care for patients in their nursing home beds.

As such, patients are often transferred to the ED at a cost to insurance payers that is many multiples greater than would have been incurred had the patient been treated in their nursing home bed. On average, the cost per patient transfer to the ED from a nursing home is more than $15,000, and this patient population is almost always admitted to the hospital. Patients suffering from lower-risk complications often end up spending days in a hospital, costing the healthcare system tens of thousands of dollars that can all be avoided.

People who can be cared for in lower-cost settings should be — particularly when it means avoiding unnecessary, and often traumatic, transfer experiences. This cycle demonstrates the real need for a structure that allows for the skills, technology and expertise to be brought to the patient rather than bringing the patient to the care.

The way we can do this is through hands-on connections, coupled with technological solutions.

3. High-Tech, High-Touch Solutions are the Future of Healthcare

As technology has become more prominent in the healthcare industry, there have been some learned limitations of a high-tech only approach to a humanized field. Healthcare workers in nursing homes, hospitals and any healthcare setting, work in a fast-paced environment and cannot have technology completely upset their workflows. It often goes unused – understandably, these healthcare professionals have people to care for.

The solution is tech-enabled medical service companies with specialized healthcare workers partnering with traditional brick and mortar nursing homes. This allows for the training and execution that delivers value for the patient and the healthcare system - and it allows medical professionals to be with patients, delivering emergency care, when they need it. Ultimately, models like these will combine the right skills with technology while keeping the human touch in healthcare, and will inform future medical interventions via data and analytics to constantly improve our understanding of emergency care.

The current payer reimbursement model typically limits the options available to nursing home operators, and in order to make this type of care more accessible, additional payment reform and value-based arrangements are greatly needed. Recently, the Centers for Medicare and Medicaid Services (CMS) proposed overhauling its billing standards, which would increase doctors' time spent with patients and pay doctors for telehealth visits. Additionally, innovative bills are being introduced to Congress, including the RUSH Act, which seeks to reduce unnecessary hospitalizations by enabling the use of telehealth services and technology in skilled nursing facilities.

The growing embrace of innovation by the industry is encouraging, and the more payers and providers shift to value based care combined with high-tech, high-touch solutions, the better it will be for patients, their families and the healthcare system.

Author: Timothy C. Peck, MD, Cofounder and CEO, Call9
Timothy Peck, MD, is the Cofounder and CEO of Call9. He previously held a faculty position at Harvard Medical School and was the Chief Resident in the Emergency Department at Beth Israel Deaconess/Harvard.

While at Beth Israel Deaconess, Peck repeatedly encountered the challenge of treating patients who would have had superior outcomes had he and his team been able to treat them earlier. After investigating this problem, Peck learned that 1) Skilled Nursing Facility (SNF) patients make up nearly 20% of ambulance transfers to the ED, and 2) the average time it takes for a SNF patient to see an Emergency Physician is over 60 minutes. Shortly after learning the scope of the problem, Peck conceived of Call9, applied to the startup incubator Y Combinator and set out to solve it via a combination of on-site care coupled with technology.

Prior to his time in Boston—where Peck also studied entrepreneurship, learning and technology at Harvard’s Graduate School of Education—Peck earned his MD from NYU.

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