By Paul Knight, MBA, Founder, Curatess

Healthcare delivery around the world has forever changed due to the COVID-19 pandemic.  This global pandemic is having the largest impact on our seniors, especially those who reside within a skilled nursing facility (SNF). As COVID-19 spread, stay at home orders and social distancing restrictions became widespread, and access to care was restricted. In a matter of weeks, patients and residents residing in SNFs were unable to be seen by their physicians or loved ones due to visitation restrictions. Furthermore, sending patients to the hospital was challenging given hospitals being overwhelmed with COVID-19 patients. The use of telehealth became one of the only options to deliver healthcare and limit personal contact to prevent further spread of the virus.  

CMS waivers made telehealth widely available for physicians to deliver virtual face-to-face visits to their patients by activating reimbursement at the same rates as in-person visits. The race was on for SNFs to operationalize telehealth into their clinical workflows.

Consequently, telehealth has become one of the most talked-about topics among SNFs due to COVID-19.  Telehealth sessions for seniors living in a SNF are very different from telehealth delivered to home care settings.  Most sessions are composed of communication between a remote physician and a nurse at the side of the patient. Through telehealth, a remote clinician benefits by being able to manage patient change of conditions, regular patient rounding, and other patient-care and compliance requirements without having to drive to and enter the facility (which is now even more burdensome due to COVID-19 restrictions and risks). The SNF patient indirectly benefits from better and more timely care, and key metrics such as hospital readmissions are improved to support the financial health of the facility.

So, how should “telehealth” visits for SNFs ideally be designed? First and foremost, we believe that it must be more than just adding a video connection to existing workflows and tools if telehealth is to truly deliver the improvements in healthcare access and quality we all yearn for.  COVID-19 has further highlighted the importance of getting it right for SNFs.

A number of key questions arise when trying to understand how telehealth for SNF patients is different from other telehealth venues:

  • Beyond simply adding a video connection, what additional tasks must be performed, and information provided, to deliver a great experience for both the clinicians and the patient?  
  • How can a clinician deliver similar or better care remotely as in-person, particularly in the common scenario where the clinician must serve multiple SNFs ?
  • How can telehealth be leveraged to engage the entire care team, meaning primary care providers, specialists, families, and the patients themselves?

We will address these questions in depth In subsequent posts in this series (click here to subscribe). Back to some stories and statements from the field to spur interest for our future discussions:

The benefit of having an existing telehealth program in place allowed operators to quickly ramp up telehealth to enable remote patient care. One owner and operator of a SNF said, “I was able to go to a local store to buy more iPads to quickly expand telehealth for our COVID-19 zippered off wing”.  He added, “I am so glad we already had telehealth in place, we had no other method to deliver healthcare to our patients and residents”.  

Let’s look in more detail at what SNF operators who did not have an existing telehealth program in place had to orchestrate to enable telehealth in their buildings.

  1. Apps and Credentials: The nurse’s required a device with a camera and an array of video chat applications to support the physician’s preference. Each app used for video chats required a separate log-in and user interface to learn. Imagine how operators managed these accounts across multiple shifts of nurses.
  1. Scheduling and Coordination: Speaking with several physician group advisors they had one primary goal to quickly activate virtually rounding on their patients. As noted earlier, most patients and residents do not have the tools to collaborate directly with their physicians. A VP of clinical operations of a multi-location SNF stated, “How can our nurses be expected to round with all of our physicians and meet the needs of our patients”. Scheduling a telehealth encounter in a SNF requires coordination with the physician, patient, and nurse. Nurses were managing all of their patients, routine duties, and family requests while being expected to participate in a telehealth call. In addition, other physicians are trying to coordinate telehealth encounters with those same nurses.
  1. Health Information Access: Without a connected telehealth platform, physicians can’t effectively gain direct access to critical health information. “Access to the patient’s health record is critical to my telehealth sessions,” said a corporate Medical Director. Without remote access to the health record or multiple devices\displays to view the medical record and the patient simultaneously, physicians are limited in their ability to deliver a comprehensive telehealth session. Physicians become dependent on the nurse to communicate or interpret diagnostic medical information verbally, placing even more responsibility on the SNF nursing staff. 

While video chats are helpful, it is clear from our discussions with our clients and SNF operators that video chat capability alone is not sufficient long term to deliver effective telehealth during the COVID-19 crisis and beyond.

John Vrba, the CEO of Burgess Square & Rehab Centre and a client stated, “Telehealth solutions should provide the ability to conduct the change in condition assessment in coordination with the RN to allow for clinical collaboration that helps the facility determine a safe and effective treatment plan”. 

The top 3 things we have learned, and will further explore in this series, to deliver effective telehealth in SNFs are:

  1. Easy to use solutions and processes for the physician, SNF nurse, and patient to expand access to care. 
  2. Improved intelligent collaboration between physicians, the SNF nursing staff, and other care team members to coordinate telehealthcare.
  3. Empower clinical workflows that remove the barriers to access and equality for seniors.  Remote physicians deserve unrestricted access to clinical information while delivering telehealthcare.

Looking forward to feedback in this discussion series regarding how we, as an extended SNF community, should embrace and evolve telehealth healthcare delivery more broadly.  COVID-19 has made so clear that the status quo is no longer an option and telehealth is here to stay.   
Subscribe here to learn more about this series.