Telehealth Providers Ramp Up Skilled Nursing Rollouts as COVID-19 Rages On

Third Eye Health had a two-year plan to expand the network of skilled nursing facilities that use its telehealth technology from 400 to more than 1,000.

Amid a world-historic pandemic, the Chicago-based tech company reached that multi-year goal in a matter of a few weeks.

“We’ve had truly exponential growth,” Third Eye vice president and chief growth officer Ray George told SNN.

To fight the novel coronavirus, the Centers for Medicare & Medicaid Services (CMS) took a chainsaw to regulations surrounding telehealth coverage in the post-acute and long-term care setting, accomplishing in weeks what advocates and leaders in the space had spent years demanding of the government — unfettered Medicare coverage of remote care in nursing homes, regardless of the region where the residents live.

And as the COVID-19 crisis continues to put a premium on virtual interventions in nursing homes and other care sites, tech firms in the space have raced to adapt their rollout plans in a world where facilities are locked down and frontline caregivers are stretched to the breaking point.

In Third Eye’s case, that meant rapidly changing a growth strategy that for years had been focused on establishing programs in limited numbers of buildings at national nursing home chains — with the goal of gradually proving the tech’s worth and expanding the partnership company-wide.

But in less than a month, Third Eye’s footprint has exploded from sub-sets of buildings operated by major players such as Genesis HealthCare (NYSE: GEN) and Consulate Health Care to encompass their entire portfolios, according to George.

“We’ve been honestly just shipping iPads and training everybody like crazy,” George said.

Tech breaks through lockdowns

Among the many key exemptions that CMS has provided, the federal government waived a rule that required practitioners to establish a face-to-face relationship before they could transition to virtual care.

Given the nationwide ban on non-essential visits to nursing homes that’s been in place since March 14, as well as a general desire to limit outside contact with long-term care residents, the move was vital for facilitating telehealth in a pandemic.

But once a skilled nursing facility signs on with a telehealth partner, staffers must still set up the necessary equipment, typically with in-person training on how to use it — something that the emergency CMS rules would not allow.

“On the one hand, it opens a lot of doors,” TapestryCare chief operating officer Mordy Eisenberg said of the federal waivers. “On the other hand, there’s definitely a lot of challenges.”

TapestryCare, a national telehealth and on-site medical provider that specializes in the skilled nursing space, shot instructional videos for its clients, and encouraged them to take advantage of any existing hardware they had on site when planning their telemedicine rollouts.

The latter point took on increased importance in the early days of the COVID-19 crisis, as TapestryCare’s vendors for cameras and other electronics struggled to keep up with the widespread increases in demand for remote networking technology.

“If you have your own hardware, we have the staff,” Eisenberg said. “It may take a few weeks to get the full set of equipment out to you, but we can really use their own hardware to facilitate the model and get them started quickly.”

Similarly, Third Eye’s team spent February off the road and at the home office, “virtualizing” its onboarding process in anticipation of skyrocketing COVID-19 demand. The company sources iPads to its offices, then loads them with the appropriate software before sending them on to clients, who can typically learn how to work the system within only about 10 minutes, George said.

Removing barriers

As part of the fight against COVID-19, telehealth providers — along with the health care industry as a whole — have increasingly worked to bring down barriers to sharing timely information and tools.

Swift Medical, a tech company with offices in Chicago and Toronto, worked to form a consortium of providers and tech companies focused on providing remote wound care services during the pandemic.

The Telewound Consortium touts operator heavyweights Genesis and ProMedica as members, along with IT and electronic health record (EHR) provider Netsmart, physician group AmeriWound, and medical equipment supplier American Health Technologies.

The goal, according to Swift Medical founder and CEO Carlo Perez, is to both maintain continuity of wound care services despite visitation bans and isolation protocols, and ease the strain on the acute-care system by curbing hospitalizations associated with improperly treated wounds.

“Infection will land you in the ER,” Perez said.

Through the consortium, Swift Medical has begun offering its software — which can detect changes in wounds based on images — for free to skilled nursing facilities. The company’s current footprint includes 3,500 SNFs, but based on the size and scope of the partnership thus far, Perez estimated that his company’s service will be available to about 80% of wound-care patients in the long-term and post-acute setting.

“Living a day with a hole in your body that doesn’t get treated properly is not an interesting proposition, whether you’re a senior or anyone else,” Perez said.

Similarly, both TapestryCare and Third Eye have opened their platforms to any local providers who want to use the service. While the companies maintain teams of doctors that can provide remote care 24/7, they emphasized the importance of allowing residents’ existing specialists and other doctors to check in on their patients remotely.

“That has been accepted nicely — a lot of physicians have taken us up on that,” Eisenberg said.

Where do they go from here?

The COVID-19 crisis is far from over, but one question has increasingly come up in the wake of CMS’s expansive waiver authority: How will things ever go back to the way things were for telehealth?

Of all the temporary suspensions of federal rules, CMS’s decision to stop the enforcement of HIPAA violations for practitioners operating in good faith — opening the door for penalty-free consultations over Skype and FaceTime — was perhaps the most significant.

Perez acknowledged the usefulness of such leeway in an emergency.

“It’s a waterfall effect of challenges, but between having a FaceTime video with your doc to understand your conditions, I’d take FaceTime any day,” he said.

But he also raised concerns about the potential for privacy invasion during the crisis.

“The amount of health care data that I’m worried that folks are collecting and amassing on the dark web right now — I think that’s crazy,” Perez said.

Eisenberg, while praising the emergency efforts, said he hoped that permanent reforms will include a more comprehensive reimbursement structure for telehealth interventions — one that specifically acknowledges that many nursing homes don’t have spare cash to invest in new tech.

Despite the challenges, he predicted that CMS will not be able to un-ring the telemedicine bell.

“It’s really bringing this whole model to the fore,” Eisenberg said. “It used to be a nice-to-have. The longer this goes on, the more people are going to say: This is a must-have.”

Third Eye CEO Dan Herbstman agreed, noting that the company is already working to grow its base of in-house specialists.

“We are actively recruiting more physicians, and probably have to expand that group quite a bit over the next couple of years,” Herbstman said.