Based on Early Readmission Success, Excelsior Plots Skilled Nursing Telemedicine Expansion

Since the latter half of 2019, an East Coast health care group has used a telemedicine partnership to intervene in 100 potential hospitalizations, and within that grouping, definitively stopped 30 hospital admissions — in a collaboration with a medical device company that provides real-time heart monitoring and remote care. 

In an effort to reduce unnecessary hospital trips, the Brooklyn, N.Y.-based Excelsior Care Group LLC has outfitted 284 sub-acute and long-term care patients with a wireless patch to oversee heart health in partnership with medical device company ImagineMIC.

The program is currently active in eight facilities, specifically tracking heart and respiratory rates — and serving as an electrocardiogram (EKG) of individual patients.

Based on the early success, Excelsior Care Group has set up four new similar partnerships on the East Coast in the next few months.

“In general … nursing homes are becoming hospitals and hospitals are coming ICUs. We don’t want to have to send residents to the hospital we can potentially treat … just as effectively,” Excelsior Care Group regional administrator Oded Dashiff told SNN.

Dashiff pointed to 30 clear-cut cases of avoiding hospitalizations due to early detection and intervention, involving a collaboration between the ImagineMIC staff and facility nurses and physicians.

Excelsior Care Group chose the Poughkeepsie, N.Y.-based ImagineMIC after meeting with several vendors of similar products. The health management firm found that ImagineMIC’s device and processes the most effective for residents, enabling a wireless patch to be easily applied to a patient’s chest without needing to be attached to other devices.

How it works

The apparatus, which is the size of a credit card, has a monitor with a wireless battery powered device effective for three days. The patch transmits several data points including an EKG, respiratory rate, and heart rate — which is monitored at a station in the facility as well as a remote monitoring center to be analyzed by doctors, nurse practitioners, and specially trained physician assistants.

The small device won’t hinder regular activities, and residents “can move and function completely normally…[while] they’re being monitored, and we want our we want our families to also have the peace of mind that their loved ones are being monitored 24/7,” Dashiff said.

Spotting decline earlier

With hospitals experiencing increasing pressure to shorten post-acute stays and nursing homes serving higher-acuity patients, the skilled nursing space may greatly benefit from these kinds of early interventions. And Excelsior Care Group and ImagineMIC aren’t the only companies to embark on remote monitoring partnerships.

Real Time Medical Systems, for instance, has grown its telehealth platform by touting its ability to catch problems before they rise to the level of hospitalizations, while other companies such as TapestryCare and Third Eye Health allow nursing home staff to consult with physicians via video link.

But this kind of partnership can also come with a high price tag, depending on the exact terms, although participation could potentially point to longer-term financial gains.

The ImagineMIC monitors allow clinicians to catch an impending decline in health with early interventions, but without offering an exact figure, the program is admittedly “very, very expensive,” and is not reimbursed by insurance, Dashiff said. The facility must absorb the cost.

Excelsior provides consulting services to its member facilities, which in turn pay ImagineMIC for its services. This service is not reimbursable by the resident’s insurance, and is covered in full by the facility. Additionally, each facility has an independent agreement with ImagineMIC.

“We do that because we really want to provide that next level of care,” Dashiff said, “[which is] the reason why the decision was made at the corporate level … because it would really benefit the residents.”

Some of the first health indicators to watch in order to avoid hospitalizations, for example, is a spike in heart rate, which should prompt care staff to spot problems immediately.

Remote monitoring can be particularly fruitful in the first three days upon admission, potentially the most volatile transition time for a resident’s status. The device allows staff to detect subtle changes at this time, and potentially guide the overall care plan.

Rehab patients also benefit from participating during the first three days because watching vital signs while undergoing therapy makes it easier for patients to push through challenges while feeling safe to do so, an Excelsior Care Group spokesperson added.

Case Studies: Hypothetical and concrete

In the case of a resident affiliated with emphysema, the person might begin deteriorating while experiencing difficulty breathing. In the past, that patient would have taken a potentially preventable trip to the hospital to have X-rays, and then be given nebulized medication and intravenous steroids, while being monitored for a certain amount of time, Dashiff said.

In another example, for a patient experiencing a medical event overnight, the system allows for a “face-to-face visit with a provider who can also access the resident’s medical information, medical record,…all the labs, all of the meds, and now they’re actually seeing somebody so they have the extra measure of comfort,” he said. “Nobody will go through the trauma of being sent to the hospital, sitting in the ER, potentially contracting another bug.”

Dashiff also gave a specific example from Lakeview Rehabilitation and Nursing Center in Wayne, N.J., where staff was able to avert a more serious episode for a resident experiencing a brief episode of cardiac arrhythmia.

“The provider in the MIC consulted with the Lakeview team and the resident’s primary physician in real time, and a cardiology consultation was ordered. The resident’s medication regimen was adjusted, and he became stable,” Dashiff said in an e-mail.

In an age with a variety of budding telehealth companies trying to more efficiently tend to the needs of complex patients, Excelsior Care Group is focused on streamlining its infrastructure to augment care, not to replace doctors and other clinicians.

“It’s not just the technology; it’s the infrastructure, and the company behind it. You can have other telehealth platforms, but who’s behind it? Are they going to be receptive? Is it just data that you’re watching without intervening?” Dashiff asked. “So this is the whole package of having the technology that works, having the team behind it that can actually intervene and interact with the facility staff.”