This article is sponsored by Tapestry Health. In this Voices interview, Skilled Nursing News sits down with Tapestry Health Co-Founder and Chief Operating Officer Mordy Eisenberg to learn about why he believes the term “telemedicine” is often misused, how Tapestry Health has helped reduce re-hospitalizations and mortality rates at skilled nursing facilities (SNF), and why there is new opportunity for telemedicine during the COVID-19 pandemic.
Skilled Nursing News: You were in the nursing home business for some time, and now obviously home health. Tell me about your journey to Tapestry Health.
Mordy Eisenberg: I got my start in the nursing home world in 1996 as a nursing home administrator. Around the same time, I became a volunteer EMT, and the two positions converged. They’re my two passions: taking care of people, and administration.
I later became a volunteer paramedic, which is a much higher level of care than an EMT, and it always frustrated me that as a paramedic coming into a nursing home, I could do more for a resident out of my bag than a nursing home can do with the staff that are on hand. I would be able to identify problems, clinical issues or clinical solutions, but there was always this disconnect between finding a problem and fixing the problem, specifically on a patient level.
When Dr. David Chess and I founded Tapestry, it was the culmination of 25 years of work. With Tapestry, we were now able to make a diagnosis and then treat that person right there at the bedside, which is definitely best for the patient.
What do you say when people describe Tapestry as “a telemedicine company?”
We’re not a telemedicine company. We are a medical practice enabled by technology. I think the word telemedicine is becoming this commoditized term that doesn’t really mean what it is that we do. We see telemedicine as a delivery method. Our aim is to provide 24/7 face-to-face care for residents living in nursing homes, or in other settings that can benefit from our services.
Sometimes that means we have an on-site person. In some of the larger and urban settings, we have somebody actually physically based in the building. In the smaller and rural settings we would do it via telemedicine.
But again, it’s important to understand that telemedicine is just a way of getting to the building. It’s a way of bringing resources from one place to another place that may not have that kind of resource. When people say, “Oh, you’re a telemedicine.” We’re not a telemedicine. We’re a medical practice.
What do you say to someone who claims that Tapestry doesn’t provide any significantly different level of telecare than anyone else?
Our approach is very different, very unique. Most of the telemedicine providers who are in this space specifically provide urgent care after hours or even during the day, but it’s not a dedicated provider. It’s a different person every time. They rely on the EMR [electronic medical record] to get information about the patient.
We dedicate specific providers to each nursing home. For example, Nursing Home A has one nurse practitioner assigned to that building. That person is there virtually every day, whether they’re on site or off site, doing rounds in the building. They really get in deep with those buildings. They know the patients. They know the families and the staff members. It’s a much more focused approach than that doc-in-a-box or one-off encounter. It’s a deep, meaningful relationship with the building.
Additionally, we bring a lot of different pieces into buildings — primary care, after-hours, urgent care, behavioral health, specialists, medical director services, and more. There’s no cookie-cutter approach. If your facility only needs one piece, that’s all we’re providing. If you need all of it, that’s what we’re providing. We have the ability to partner with many groups and many facilities where you can have a different tailor-made program in each building just to fill the needs there.
Tell me about the products you have in development and what they will mean to the way we deliver health care in SNFs.
At our core, we try to be proactive rather than reactive, and I know that it’s almost cliche already, but we really live that.
Many of the initiatives that we’ve been taking are around predicting when somebody gets sick. I think one of the big challenges that I’ve seen over the years is: You take a list of people who were hospitalized, and then there’s a little box that you can check off that says whether this was considered avoidable or unavoidable. Many of the patients are checked off as unavoidable.
But when you peel it back and you go back three, four days beforehand, there are clinical indicators that led to the hospitalization. Most of our initiatives are around trying to predict and pull those out. That means working with predictive analytics software to help predict when somebody may require a visit or an intervention so that we can keep them from becoming that three o’clock in the morning, “I can’t breathe” call.
Doing the right thing clinically definitely pays off for the facility, and we’ve seen tremendous outcomes on many fronts. We’ve seen reduced hospitalizations, and then we’ve seen hospitalizations go from the mid- to upper teens down to the low single digits. We’ve seen antipsychotic usage also go from the mid- to upper teens down to the lower single digits. We’ve seen CMI Medicaid rates go up significantly because of the amount of intervention that we have with those residents. There’s a facility of ours where we did a study and they saw the mortality rate cut in half.
When you take all those things together, and you’re keeping people in the building longer, you’re keeping them well and healthy longer, you end up actually translating into an improved census number, just by virtue of that alone.
I’m not even talking about the marketability of the facility, which is another piece you can market and talk about the great things that the facility is doing. Even just by improving those metrics around hospitalizations and mortality rate, we’ve seen one facility go from 60% occupancy to 69% occupancy over the course of eight months, just because incrementally people were staying a little bit longer and staying healthier longer. It’s really a win-win when you’re taking care of people properly.
What can you tell us about your medical director services and your onsite programs?
The medical director services piece was born out of necessity. We started the company, and a number of our facilities would come to us and say, “We really need a new medical director. We have physicians who won’t allow us to admit patients, or don’t want to take responsibility for certain patients.”
We stepped into that and said, “We’d love to be your medical director. If there’s a patient who you want to accept to your facility, and you feel comfortable clinically taking care of that patient, we have no issue with that. Our agenda is your agenda.”
I’d say about 20% to 25% of our partners right now use us as a medical director. We pride ourselves on not being a staffing agency. We are providing NPs that are part of our practice. They’re supported heavily by our clinical director, by our physicians. They have somebody to lean on and they’re constantly being educated and presented with best practices. You end up again with the same idea: that 24/7 face-to-face coverage, where there’s an onsite person during the day. For the nights, weekends, and holidays, there’s a backup team that’s available over the telemedicine.
We talked about the proactive-reactive idea. Is it sometimes difficult to be proactive in this rapidly changing health landscape?
It can be difficult to be proactive sometimes, such as dealing with a facility that doesn’t chart that often in their EMR, or they’re using a paper EMR. It just becomes difficult in some facilities to be truly proactive if they are not clinically documenting. The same nurse may not be back for a week, so there are cracks for things to fall through. We can be that overlay to watch out for that, but that only works if the information is actually in the chart, or if somebody is feeding that information to you.
That definitely is a challenge about being proactive, although some technology like remote patient monitoring, where you can actually put a device on a patient — a pulse oximetry, or a glucometer, or some other wearable device. But at the end of the day, you really need staff to be reporting, measuring, and documenting so that you can pick up on these things for them.
What is the status of Tapestry’s home care offering and how does that create new capabilities in transitional care management — the benefits of SNFs?
Our expertise is taking care of chronically ill populations, and taking care of them in the home is certainly a huge need. Unfortunately, reimbursement did not catch up with that, and that’s always been a challenge.
With the COVID-19 emergency, a lot of the rules were relaxed, and we were able to finally act on that and start seeing patients in the home. We’ve been contracted with a number of home care agencies and we’ve been seeing their patients in home, both for emergency-type visits and for their well visits and certifications.
At the same time, we’ve also been working on our Transitional Care Management Program, which is basically a Medicare benefit that requires that you have a visit with a patient in their home within 30 days of discharge from the hospital or nursing home. We’ve started rolling the program out with our nursing home partners. What happens is the nurse practitioner in the nursing home who saw the patient while they were there will be scheduling a visit with the patient within a week or two of getting home.
There are other benefits too, but from just a nursing home perspective, it gives them a little bit more continuity for when they get home. The nursing homes are now being penalized for the 30 days after they leave. With this program, we’re actually able to help them control some of that.
Final question: What is the core promise you make to your prospective clients?
Our new tagline is “Life Improved.” That’s really the promise. It’s a promise to our patients, it’s the promise to the staff members we work with, the families we work with. I think it really encompasses everything we’ve been trying to do: Just improve lives. I think that’s what we’ve been doing and that’s our promise.
Editor’s note: This interview has been edited for length and clarity.
Tapestry Health provides primary care as well as emergency care 24/7, with rapid response capabilities and the ability to see patients as often as their condition warrants, no matter where they are located. To learn more about Tapestry Health, visit TapestryTeleHealth.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact firstname.lastname@example.org