With concerns around staffing and supply shortages in nursing homes amid the coronavirus, telemedicine has emerged as a key potential weapon, receiving the first-ever major green light for reimbursement on the national level — as part of an $8.3 billion bill allowing the federal government to cover remote care for Medicare recipients passed last Wednesday.
But the bill is only a partial win, and doesn’t cover new patient relationships.
With the death toll at a nursing facility in Kirkland, Wash., operated by Life Care Centers of America, reaching 18 people, concerns about increasingly vulnerable residents and staff are pushing industry experts and politicians to think outside the box and come up with alternative patient care solutions — particularly as the government recommends heavily restricting all non-emergency visits to nursing homes.
Traditionally, telemedicine was an out-of-pocket expense for many operators, unless the facility was located in a rural community. The new emergency bill waives this restriction, but the latest infusion of funds will only be funneled into telemedicine services for pre-existing relationships between providers and patients, according to two telemedicine providers.
“It was very exciting when it came out, like, ‘Wow, Congress recognized that telemedicine is going to be so crucial to this,’” Mordy Eisenberg, chief operating officer of the Stratford, Conn.,-based telehealth provider TapestryCare, said of the coronavirus crisis. “But it feels like our hands are tied … We can’t see new admissions over telemedicine.”
The only way to allow new patient telemedicine access is to place practitioners in a facility, Eisenberg said — not an ideal method for infection prevention.
Pointing to good intentions, Eisenberg noted that the bill will give primary care doctors increased opportunities to see their patients at home.
But for nursing homes, he said, “this legislation falls very short — because it really does not allow us to start care for these patients that are really vulnerable, especially [as] you get these new admissions coming in, especially now. Even if we’re in a facility right now, and we’ve never seen that particular patient and if that patient develops an illness, we can’t see them.”
Merely focusing on funding rural telemedicine “doesn’t make sense anymore,” he stated.
“The benefits of telemedicine into facilities are the same no matter where they are,” Eisenberg said, adding that he hopes the restrictions baked into the new bill are temporary. “There are many urban facilities that don’t have access to care, and then telemedicine makes a big difference.”
As some loved ones with relatives in nursing homes are currently “in the dark,” Eisenberg said, having the ability to use telemedicine services include offering instant communication with families and allows for clinicians to see patients without risking anyone’s health.
At Chicago-based Third Eye Health, which also offers remote care in the nursing home sector, CEO Dan Herbstman admitted the emergency bill “wasn’t as broad as everyone saw it might be, and so they’re still pushing for some of those bigger waivers.”
Third Eye currently has a lobbyist group in Washington pushing for the expansion of telehealth access among patients and providers as part of the COVID-19 appropriations bill — and as a greater part of other legislation, such as the RUSH Act, which would generally expand coverage of telehealth equipment and services in nursing homes.
The company has been seeing an uptick in business since the coronavirus scare, and is working on contingency plans and infection-control policies with several new nursing homes.
Touting the bill’s inclusion of telehealth in the broader discussion of disease prevention, Third Eye is lining up more group physician partnerships where they don’t already have providers, and is in. the process of expanding to the Pacific Northwest for a total of 30 states. The company is also assisting health systems in using their existing telemedicine technology in states where a practice isn’t already set up.
“We haven’t talked to a lot of people who have actual reported cases, but we do have people who are putting policies in place now, where they think that pretty soon it may be difficult for their own staff or physicians, who would normally have come on site,” Herbstman said.
Provider licensing restrictions per state have not been changed in the bill, but the telehealth leaders are hopeful that some of these parameters could be waived in the very near future, he said.
Although some nursing home medical directors and primary care providers may be concerned that telehealth companies will inherently change care plans or clinical protocols, Herbstman and Third Eye chief growth officer Ray George said that their model involves referring back to the primary care provider and the acute care provider when a practitioner isn’t available.
Telemedicine is an investment, but in the long run, it could be a lifesaver for staying afloat in the turbulent waters of the nursing home sector — especially during an infectious-disease scare. When a facility sends a patient to the hospital for an unnecessary transfer, his or her bed is normally held at the nursing home for the approximate time of a four-day stay, with daily Medicare reimbursement at $500 a day.
“So typically a nursing home doesn’t get $2,000 for holding the bed while the resident stays at the hospital,” Herbstman said.
Although TapestryCare is seeing more interest in new partnerships as well, Eisenberg stressed the importance of containment in order to ensure that more people don’t visit nursing homes. The company is taking a proactive approach to help streamline new policies around screening visitors and what to do in the case of an outbreak.
“We have our own infectious diseases specialists and group that have written up some policies that we’ve been helping disseminate to the facilities,” he said.
For now, a patient’s primary care physician will be able in theory to provide telehealth services in an urban setting with the new bill.
“But do they have the equipment to use? Probably not. Do they have the time to deal with it? Probably not. We’re set up for this and we’re doing it very well in the rural markets,” Eisenberg said. “It would be very easy to turn this on for our urban facilities, but I think they missed the mark.”