Virtual Behavioral Health Services Can Cut Skilled Nursing Costs

Telehealth services that focus on behavioral health can reduce the overall costs of care for long-term care (LTC) residents by keeping them out of the hospital and emergency department (ED). The technology allows LTC facilities, particularly rural ones, to deliver needed behavioral health services to their residents, a new study found.

Specifically, the services can reduce the likelihood of emergency department visits and reduce outpatient hospital visits by more than 11 percentage points, according to new findings published by the Healthcare Financial Management Association.

Louis Rossiter of the College of William and Mary, William Austin of Riverside Health System, and Jonathon Gammon of Universal Health Service studied the results of the Bridges to Behavioral Health Project. The initiative deployed telebehavioral health for residents in facilities operated by Riverside Health System, which is based in Newport News, Virginia.


“Elderly patients often require more time and resources than do younger patients, and the care requirements for the elderly become even more complicated when these patients have behavioral health needs,” the authors wrote. “Geriatric and palliative care providers are trained to treat these patients but are in limited supply nationwide. As the population ages, the need for these specialists will only grow in the coming years.”

The authors examined several factors for return on investment (ROI). These included:

-Telebehavioral health visits and the increased Medicare revenue derived from them


-Indirect revenue of avoided hospital services and ED visits

-The original capital outlays for secure telebehavioral health equipment, compliant with the Health Insurance Portability and Accountability Act (HIPAA)

The intervention in Virginia virtually broke even in the first year. Significant payback began in the second year and increased each year afterward, the authors said, with total patient revenues growing 34% in the second and third years.

“Telebehavioral health has a large ROI largely because of the favorable effects on indirect revenue,” the authors wrote.

While the study cautioned that provision and billing of Medicare for telehealth is subject to both Centers for Medicare & Medicaid Services (CMS) rules and state laws, Medicare’s coverage of telehealth is likely to expand. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which aimed to expand Medicare coverage for telehealth services, was included in the recent budget deal.

But there are other considerations than revenue versus expenses, the authors added. Real value also comes from being able to keep each patient in the proper care setting without disrupting workflows, they noted. In addition to avoiding disruption of the patient’s life, family members are more likely to be pleased with the care their loved ones are receiving.

“Satisfied patients and families are qualitative benefits that offer financial rewards to facilities and health systems,” they concluded.

Written by Maggie Flynn

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