After scoring significant successes in reducing hospital readmissions among its own nursing homes with telehealth, a major hospital network is looking to market its virtual interventions to a wider swath of post-acute and long-term care facilities.
Northwell Health, the largest health care provider in New York State, saw rehospitalizations decline by up to half at its two nursing facilities — the Stern Family Center for Rehabilitation in Manhasset, N.Y. and the Orzac Center for Rehabilitation in Valley Stream, N.Y. — after implementing technology initially designed to provide virtual intensive care services.
“What we found is that we decreased by 30% to 50% — in some cases even more — the unnecessary or avoidable hospitalizations, which translates into dollars,” Iris Berman, Northwell’s vice president of telehealth services, told SNN.
Based on that success, the health system recently expanded its telehealth services to a pair of non-affiliated facilities: Paragon Healthcare SNF’s Glen Cove Nursing and Rehabilitation in Glen Cove, N.Y., and the non-profit Methodist Home for Nursing and Rehabilitation in the Bronx.
“We are so pleased to be able to offer an even higher level of care to our residents in partnership with Northwell Health’s TeleSNF program,” Maria Perez, CEO and administrator at Methodist Home for Nursing and Rehabilitation, said in a statement announcing the partnerships. “Our legacy of compassionate care continues with this integration of future-ready technology allowing our skilled staff to connect with Northwell physicians 24/7.”
Berman is the first person to hold that title at the New Hyde Park, N.Y.-based Northwell, which operates 23 acute-care hospitals and a network of nearly 800 outpatient care sites across the New York City metropolitan area. A registered nurse, Berman helped Northwell develop and refine a tele-ICU model based around a centralized core, where higher-level clinicians — from nurse practitioners to physician assistants to hospitalists — provide around-the-clock interventions outside of the network’s acute-care centers.
Expanding the model to Stern and Orzac was a natural evolution for the program. Hospital readmissions, even before the COVID-19 pandemic, represent a major obstacle to both quality care and financial stability for nursing homes: Transfers present a significant risk of infection and other complications for frail nursing home residents, and a high rate of readmissions has a host of negative effects under payment and compliance models.
The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, for instance, penalizes buildings that do not meet certain readmission benchmarks by withholding a portion of their Medicare reimbursements; provider networks also often use the metric as a reason to include or exclude a given facility from their all-important referral pipelines. In addition, a hospital readmission means an empty bed to fill at the nursing facility, Berman noted, another potential source of financial strain.
But for many years, sending a resident with a complex medical issue to the hospital has been the default solution for facilities, particularly as they struggle with persistently low staffing — especially among higher-level clinicians.
“The only other alternative would be for the doctor to get in the car and drive there,” Berman said. “They weren’t going to do that, so the patient just got sent to the ED regardless.”
For Northwell, the skilled nursing telehealth push started with the in-network facilities asking for more after-hours coverage of specialists, who are typically unavailable after regular business hours. By using mobile carts with video technology, Northwell was able to bring the remote team of specialists into Stern and Orzac: Cameras can allow the core team to read charts and EKG readouts, for instance, potentially enabling the remote team to walk on-site staff through interventions that stop short of a full-blown hospital readmission.
And it isn’t just readmissions.
“They’ve increased the types of medication in their emergency drug box, because you now have the supervision of physicians and a critical care nurse — something they couldn’t do before,” Berman said. “They couldn’t have the surveillance. That’s a small step that made a big difference.”
Northwell isn’t alone in its desire to expand telehealth services to nursing homes, with both quality care and financial savings as a core part of the pitch. Other tech companies — including Third Eye Health and Tapestry Telehealth, among others — have demonstrated positive outcomes with remote interventions and ongoing monitoring by the types of physicians and critical-care nurses that are in such short supply in the elder care sector.
The path forward hasn’t always been easy: Call9, a tech company that pulled in tens of millions in capital, shut down last year after running into problems preaching its value-based model in post-acute landscape still dominated by fee-for-service Medicare, according to its founder.
But COVID-19 has already brought sweeping changes to the way both payers and providers view telehealth, with the federal government erasing most existing restrictions on virtual services for the duration of the coronavirus emergency — and laying the groundwork for making some of those changes permanent.
President Trump last month signed an executive order directing the Department of Health and Human Services (HHS) to review which COVID-19 telehealth changes can and should last past the public health emergency, and Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma urged federal lawmakers to take action in areas where rulemaking and executive orders aren’t enough.
“We cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of providers authorized to provide it,” Verma said in early August. “Any extension of the removal of restrictions on the site of care, eligible providers, and non-rural areas must come from Congress. The legislative branch then has an essential role to play in following through on this historic opportunity.”
Various leaders have since predicted that telehealth in skilled nursing is here to stay; Call9’s founder even launched a new data and tech firm this past spring in the wake of the COVID-19 pandemic and the resultant tech flexibilities.
Back at Northwell, inquiries for the nursing home telehealth coverage were active even before COVID-19. In most cases, the health system will charge partners a flat monthly fee, based on historical case volume, for the service; both sides and review the arrangement every six months based on upper and lower “guardrails.”
Potential partners are responsible for furnishing the actual hardware, and Berman emphasized that information about each facility’s distinct needs and pain points is essential for success.
“It’s really important that they have data — otherwise we’re flying in the dark,” she said.
At a time when nursing homes are struggling mightily with reduced revenue, staffing strains, and general uncertainty about the future of the space, Northwell believes the services can help maximize the finite amount of expertise and manpower available in the post-acute and long-term landscape.
“What technology allows you to do is amplify resources that are out there,” Berman said. “I can be in more than one place, essentially.”