The demands, expectations, and even payment for healthcare services has changed in the recent years.  Regulatory changes have been put in place to require healthcare providers to focus on quality of care.  Programs such as the Hospital Readmission Reduction Program (HRRP), the Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), and the IMPACT Act of 2014 (IMPACT) require acute and post-acute healthcare providers to focus on higher quality.  Healthcare providers cannot ignore these requirements because of the potential financial penalties.  Extensive clinical oversight for patients is a must have across all care settings.

Many healthcare providers have taken action to improve quality of care by implementing clinical programs, frequently recurring quality indicator audits, onsite Advanced Nurse Practitioners (APN), Quality Assurance & Performance Improvement (QAPI), and telemedicine for change in condition management. The Triple Aim goal for healthcare is improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.  As quality measure goals increase due to regulation or payer demands, healthcare providers need to be prepared to adjust their quality programs and processes to meet the demands.

Quality is not part time, and therefore quality programs should be put in place during all hours of the day.  Since acute hospitals are discharging patients faster, with higher levels of acuity, the post-acute care population requires greater care than in the past.  Post-acute care nursing staff is required to provide higher levels of care, with improved outcomes and lower length of stays.  Traditionally, Physicians or APNs are not present within the post-acute care setting from 6pm to 8am or on weekends and holidays.  In the event of a change in condition during these “off hours”, an RN relies on their clinical decisions to properly care for the post-acute care patient population.  Traditional clinical process would be to contact via telephone the attending physician or possibly the facility medical director.  While this method has been in place for years, the results vary depending on the physician who is contacted.  The physician who is contacted may be covering for a partner and not familiar with the patient, or she may not answer the telephone.  In either case, the post-acute care RN may be directed to send the patient to the hospital.  Having access to a physician or APN who was prepared to take these change in condition calls creates the opportunity for a different, less disruptive outcome for the patient.

Remote on-call providers with telemedicine capabilities can provide similar services as an on-site provider for a sudden change in condition.  Telemedicine does not replace 911.  However, it is a new tool for the post-acute RN to bring in a physician or APN to the clinical decision making process for conditions that can “avoid” a return to the hospital.  Change in conditions such as rising temperatures, potential need for IV hydration/ABT, change in mental status, increasing or new onset pain, uncontrolled nausea/vomiting, unstable vitals (BP, P, RR, O2 sat), increasing or new SOB, chest pain, or a fall, can be triaged via a remote clinician using telemedicine.  Curatess has found that telemedicine yields similar outcomes as when a Physician or APN is in the building face-to-face.  If your after-hours Return to Hospital (RTH) is impacting your overall RTH, the CARE Telemedicine solution can help.

Our goal is to provide you with the telemedicine tools, workflow, and access to clinicians to eliminate the advanced care gap seen during “off hours”.  If your organization is considering putting in place telemedicine to provide remote physician oversight, Curatess can discuss your goals and determine how we can help your organization.  Please visit our website at to learn more or contact us.