The past 18 months have been devastating to nursing homes, which have long struggled quietly, all-too-often, without adequate staff or resources to meet their residents’ physical or behavioral health care needs. In a bit of dark irony, these past 18 months may have revealed a way to solve both problems going forward: nursing home telemedicine as well as behavioral telehealth in nursing homes. Each of the two topics will be discussed next.
Defining The Medical Problem
Ten percent of residents entering care after an acute episode will never see a physician during the stay. Of those who never see a physician, 28% will be re-hospitalized and 14% dead within 30 days of entering care. Unfortunately, nursing homes have a small window of time to get their patients the support they need. The average length of stay before a patient dies or requires readmittance to the hospital is 11 days. Waiting for even 3.2 days, the overall average delay in nursing homes already puts the home behind the ball. Focus on rural homes only at that number jumps up to 8.1 days, and you can see how short the timelines become. The numbers for nursing home residents receiving behavioral care are yet more dismal.
Nursing Home Telemedicine Offers Viable Solutions
On the other hand, if a patient can see a physician while in nursing home care, it halves the rates of rehospitalization and death in those first 30 days. With an average of 12 million Americans accessing long-term care a year, this is a tremendous impact. As a nursing home professional, the quickest way to get your patients in front of a physician is an on-site Advanced Practice Registered Nurse (APRN) paired with telemedicine. According to Tapestry Health, with the introduction of these services into a nursing home environment, 83% of all issues can be successfully treated on-site. Hospital readmission drops by 70% as well. It’s so effective that even acute encounter hospitalizations go down by 17%. All from one APRN on-site per shift and the use of telemedicine.
Defining the Behavioral Health Problem
The need for behavioral health care in nursing homes is nearly as significant as the need for physical care. One report, Quality of Mental Health Care for Nursing Home Residents: A Literature Review, reviewed several studies and concluded that anywhere between 65 and 91% of nursing home residents presented with some mental illness or disorder. Compare that to just 20% of American adults overall.
Telehealth in Nursing Homes Offers Yet More Viable Solutions
Regardless of a patient’s age, behavioral care can be helpful for patients as well as their families when a loved one is in a nursing home. In addition to therapy, behavioral health issues will also often call for psychopharmacology to manage symptoms that require a prescription in most states. Additionally, physicians may need to conduct a thorough physical exam of the patient to rule out underlying or co-occurring physical issues that might be complicating the presentation.
As with physicians, behavioral health practitioners and prescribers are a limited resource. And, as with physicians, that shortage only gets worse in rural areas. However, as with Remote Patient Monitoring—see Telehealth.org’s article What is Remote Patient Monitoring?—Nursing Home Telemedicine, a digital solution, can easily address that shortage by virtually bringing in clinicians with more availability to homes where on-site or local clinicians simply do not have as much time. With nursing home telemedicine increasing access to clinicians and prescribers, paired with an APRN on-site to notice any significant unexpected changes, a reduction in behavioral health crises becomes predictable.
Reimbursement for Telehealth In Nursing Homes
Moreover, reimbursement for delivering behavioral telehealth in nursing homes is remarkably strong. As described in 2018 by Telehealth.org, many nursing home patients receiving telemedicine were given mental health-related CPT codes, suggesting that the behavioral health needs of nursing home residents can successfully be reimbursed for telehealth interventions. See CMS Congressional Report: 85.4% of all Telehealth Providers Used Mental Health CPT Codes.
Continued reimbursement for delivering care through telehealth in nursing homes can be seen in a variety of recent reports published by Telehealth.org:
- 2021 Physician Fee Schedule for Behavioral Health & Telebehavioral Health
- Permanent Expansion of Medicare Telehealth Reimbursement Announced by CMS
- Future of Telehealth Reimbursement: Offering Medicare Telehealth Services?
Anyone considering a shift in practice focus to full-time telehealth may want to consider delivering telehealth to Medicare recipients, including the delivery of telehealth in nursing homes.
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Introduction to Telehealth Theory & Practice
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