Market Overview

After-Hours Telemedicine Helps Skilled Nursing Facilities Avoid Unnecessary Hospitalizations, AJMC® Study Finds


As skilled nursing facilities handle more complex care, the need
arises for physician input before sending patients to the hospital.
Study findings reported this month in
The American Journal of
Managed Care® show that using telemedicine for this
purpose can lead to fewer hospitalizations and savings for Medicare.

When doctors could be reached via telemedicine to decide whether a
patient in a skilled nursing facility (SNF) should be hospitalized, 29%
of the patients evaluated avoided a hospital visit, saving $1.55 million
over the course of a year, according to results reported in
the current issue
of The American Journal of Managed Care®.

The study by TripleCare physicians' group and the TRECS (Targeting
Revolutionary Elder Care Solutions) Institute took place at Cobble Hill
Health Center in Brooklyn, N.Y., from March 2015 to March 2016. The
telemedicine services were offered at the 365-bed SNF between 6 p.m. and
7 a.m. on weekdays, as well as throughout the entire weekend. Nurses
called a toll-free number if they needed a physician to evaluate a
change in patient condition, such as fever, chest pain, or shortness of
breath. If the patient needed a physical exam, the telemedicine unit
would be placed bedside, and the physician and nurse collaborated on the
exam. Physicians also accessed patient electronic health records.

In a year's time, 313 patients were cared for by physicians via
telemedicine and 259 (83 percent) were treated at the SNF, including 91
who avoided hospitalization, as verified by a third party. Another 54
were transported to the hospital.

The study authors, led by David Chess, MD, of Tapestry Telehealth,
calculated that the savings to Medicare and other payers were $1.55
million, including approximately $500,000 that went to a Medicare
managed care payer. If implemented more broadly, "Medicare would save
$500,000 in an average 120-bed facility, or $4,167 per bed," the authors

The authors noted that the treating physicians were exclusively
dedicated to caring for patients at the health system's SNFs and were
not also working in an emergency department or hospital. The initiative
helped the SNF as well, since the facility did not lose revenue when
patients were sent to the hospital, and nurses improved their assessment

"As nursing facilities are called upon to care for higher-acuity
patients and drive better clinical outcomes at a fraction of the cost of
a hospitalization, systems that deliver better quality physicians to the
bedside at times of a change of condition will be required," the authors

"Treating people with dignity at the bedside is key," said Chess.
"Telemedicine is part of that solution; by leveraging technology, we can
improve the quality of both primary and acute care in nursing
facilities, transforming care and often preventing the trauma associated
with hospitalization in the elderly."

About The American Journal of Managed Care®:

The American Journal of Managed Care® (AJMC®)
is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the
forefront of health policy by publishing research relevant to industry
decision makers as they work to promote the efficient delivery of
high-quality care. is the essential website for managed care
professionals, distributing industry updates daily to leading
stakeholders. Other titles in the AJMC® family
include The American Journal of Accountable Care®,
and two evidence-based series, Evidence-Based Oncologyand Evidence-Based
Diabetes Management
. These comprehensive offerings bring
together stakeholder views from payers, providers, policymakers and
other industry leaders in managed care. To order reprints of articles
appearing in AJMC® publications, please contact
Jeff Prescott at 609-716-7777, ext. 331.

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