After-hours telemedicine can lead to fewer hospitalizations and more savings

When doctors could be reached via telemedicine to decide whether a patient in a skilled nursing facility (SNF) should be hospitalized, 29% of the patients evaluated avoided a hospital visit, saving $1.55 million over the course of a year, according to results reported in the current issue of The American Journal of Managed Care®.

The study by TripleCare physicians' group and the TRECS (Targeting Revolutionary Elder Care Solutions) Institute took place at Cobble Hill Health Center in Brooklyn, N.Y., from March 2015 to March 2016. The telemedicine services were offered at the 365-bed SNF between 6 p.m. and 7 a.m. on weekdays, as well as throughout the entire weekend. Nurses called a toll-free number if they needed a physician to evaluate a change in patient condition, such as fever, chest pain, or shortness of breath. If the patient needed a physical exam, the telemedicine unit would be placed bedside, and the physician and nurse collaborated on the exam. Physicians also accessed patient electronic health records.

In a year's time, 313 patients were cared for by physicians via telemedicine and 259 (83 percent) were treated at the SNF, including 91 who avoided hospitalization, as verified by a third party. Another 54 were transported to the hospital.

The study authors, led by David Chess, MD, of Tapestry Telehealth, calculated that the savings to Medicare and other payers were $1.55 million, including approximately $500,000 that went to a Medicare managed care payer. If implemented more broadly, "Medicare would save $500,000 in an average 120-bed facility, or $4,167 per bed," the authors wrote.

The authors noted that the treating physicians were exclusively dedicated to caring for patients at the health system's SNFs and were not also working in an emergency department or hospital. The initiative helped the SNF as well, since the facility did not lose revenue when patients were sent to the hospital, and nurses improved their assessment skills.

"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 better quality physicians to the bedside at times of a change of condition will be required," the authors concluded.

"Treating people with dignity at the bedside is key," said Chess. "Telemedicine is part of that solution; by leveraging technology, we can improve the quality of both primary and acute care in nursing facilities, transforming care and often preventing the trauma associated with hospitalization in the elderly."​

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