Clinical specialists and telemedicine are key to caring for a higher-acuity population among skilled nursing facilities, with the likelihood of less readmissions.
Ideally, specialists should be on a clinical team within a nursing home, led by a medical director, but sometimes facilities don’t have access to needed specialists because of location and the wider staffing shortage plaguing the industry.
“One of the most common complications with COVID-19 has been pneumonia and respiratory failure,” said Dr. Madhu Murthy, president and CEO of nodMD. Murthy is also a board-certified infectious disease specialist. “What you’ve seen is a trend in the higher acuity of patients, especially managing respiratory failure, requiring let’s say mechanical ventilation, like with a BiPAP or CPAP, and also obviously airway care.”
Chronic kidney management, renal and cardiac complications post-COVID also contributed to the industry’s shifting patient population, in turn leading to a need for more specialists, Murthy said.
That’s where telemedicine can help SNFs care for its increasingly sicker patients, and partnering with companies like nodMD to save SNFs the trouble and expense of finding these specialists on their own.
“We align with the local specialists and give them all the tools — as an example, telemedicine,” explained Murtha. “Having a network of specialists, right, that’s where there is backup coverage. [We] make sure there is consistent communication with the primary team. At the end of the day it’s all about establishing that communication, and then setting up looking for those like-minded partners.”
Murtha, along with nodMD’s vice president of medical affairs Dr. Kevin Stephan, spoke at SNN’s virtual Clinical Executive Summit last week. Phoenix, Az.-based nodMD connects specialist physicians to facilities via a digital health platform; about 250,000 independent specialists use nodMD’s platform.
“If an individual SNF was going to try to gain access to specialty care on their own, that would probably be a challenging proposition because there is such a shortage and a lot of specialists are focused on the acute care setting in the large metropolitan areas,” added Stephan.
Telemedicine allows operators to get the right talent and bring in specialists on an as needed basis, Stephan said. The flexibility and timeliness of care made possible by telemedicine helps operators bring in needed specialists when they’re already facing a workforce shortage on the frontline, Stephan and Murthy said.
NodMD’s telemedicine component has been a “very convenient” way of recruiting specialists, Murthy added. Specialist physicians like the flexibility and quality of life boost that telemedicine provides.
“Those same providers then can be used in multiple scenarios and in multiple settings,” said Stephan. “Each individual facility probably doesn’t need a [full-time equivalent] endocrinologist … It works well for the SNF and it works well from the provider standpoint.”
Proper admission of sepsis and early institution of treatment pathways curbs the “revolving door” of readmissions, Stephan said as an example; the implementation of other technology like remote patient monitoring can help with timeliness of care.
“Just to be able to talk to the specialty support, that’s going to allow [frontline staff] to take good care of [that patient] and not have to worry about readmission,” added Stephan. “There’s that opportunity to have additional expertise, and it’s convenient and it’s at a time that works for the patient and for the facility.”
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