Telehealth: Pursuing, Planning and Prospering

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Telehealth Pursuing, Planning and Prospering

• Joyce Doughty, BSN, PHN, RN
• MN Telehealth Coordinator
• Good Samaritan Society

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Objectives

• Name two groups of individuals needed to buy-in
  to telehealth for its successful implementation.
• Identify two lessons learned in telehealth start
  up.
• Identify one process improvement method.

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How to Get Started With a Telehealth Program

• We started our telehealth program in 2001 with a
  grant from the Bush Foundation to provide
  Assisted Living like services to people in their
  own homes.
• In 2003 the program expanded to four additional
  home care agencies with assistance from a USDA
  grant.

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How to Get Started

• 2007 the program is expanding to three additional
  home care agencies with assistance from another
  USDA grant.

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How to Get Started

• There are grants available to help with start up
  costs but you need to look for them.
• Many foundations will fund new and innovative
  ways for providing health care services.
• Most equipment companies have lease contracts
  available to help with start up.

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How to Get Started

• Need staff and physician buy-in
• Staff concerns
• -All onsite visit replaced with telehealth
  visits and they will not have a job.
• -Use of equipment. Most of our nurses did not
  learn how to run a computer in college.

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How to Get Started

• -Clients will not agree to telehealth visit
  because they are too impersonal.
• -Clients will not be able to use the equipment.
• -No continuity of care. The primary nurse will
  not know what is happening with their clients.

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How to Get Started

• Taught all staff how to run the equipment and the
  basics for installing it in clients home.
• If left up to everyone no one does it.
• Appointed one nurse to be the telehealth nurse
  (telehealth champion). She is the point of
  contact with all referrals.

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How to Get Started

• We talk about telehealth at our weekly staffing
  meetings.
• Primarily one or two nurses do the telehealth
  visits. Nurses and clients become familiar with
  each other.
• All nurses do telehealth visits on occasion.

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How to Get Started

• Physician concerns
• -Did not know much about telehealth and what a
  visit involved.
• -Confused telehealth with telemedicine.
• -Patients and families will not want telehealth
  visits.

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How to Get Started

• When we think a client can benefit from
  telehealth we call their physician and explain
  what telehealth includes.
• We explain how it can benefit them with decreased
  readmits to the hospital and decreased phone
  calls from families.

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How to Get Started

• We visit physicians to demonstrate our equipment
  and answer questions.
• We offer to provide them with a user name and
  password for accessing the secure website where
  the data on their patients is kept.

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Lessons We Bring to The Table Getting it Right!

• A telehealth program does not happen overnight.
• You need to be committed to telehealth to make it
  work for you.
• You need to know what it is you are trying to
  accomplish and start with that in mind.

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Lessons We Bring

• Families really like the idea of telehealth but
  our clients where initially afraid of it.
• We often heard, I dont know how to run a
  computer.
• We learned what not to say to clients as we
  introduce telehealth to them.

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Lessons We Bring

• We would encourage clients to try it for a few
  weeks.
• Clients adjusted very quickly.
• We had 98 very satisfied response on our clients
  satisfaction survey.
• Can teach almost anyone to use the equipment.

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Lessons We Bring

• One size does not fit all. Need to choose the
  appropriate technology for the client.
• We found that telehealth does help keep clients
  from having frequent ER visits and readmits to
  the hospital.
• Clients take control of their health.

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Lessons We Bring

• We can do 3-4 telehealth visits for each in home
  visit. This allows us to provide services to
  additional clients without additional staff.
• Cut down drive time and mileage costs allowing us
  to have a positive bottom line.

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Lessons We Bring

• Medicare allows us to use telehealth in an
  episode of care but they do not count toward the
  five visits needed to get full episode payment.
  (Legislation introduced by Rep. Ramstad)
• In Minnesota Medical Assistance will pay for
  telehealth skilled nurse visits.

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Lessons We Bring

• We have contracted with counties to pay a rental
  fee for the monitoring units to cover the nurse
  oversight time.
• We have also contracted for nonskilled visits for
  medication reminders.

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Lessons We Bring

• We have begun conversations with the MSHO Health
  Plans in Minnesota for reimbursement of nurse
  oversight time for the monitoring units as well
  as a rental fee for the equipment.

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Lessons We Bring

• If we feel the client can benefit from telehealth
  we contact their insurance company.
• We have developed a private pay model for
  individuals or families who would like telehealth
  services that are not paid for by other payers.

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Lessons We Bring

• The small numbers in our project make it
  difficult to get the results that payers will
  look at.
• The system to pay for telehealth has not been in
  place, but it is coming.

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Where Do We Go

• Telehealth providers need to combine outcomes to
  take to the payers.
• As Medicare begins to look at telehealth in home
  care they will expect it to be part of what we
  provide.
• We need to make telehealth part of our standard
  of care.

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Where Do We Go From Here Process Improvement

• Outcomes need to be addressed at the start of the
  program.
• We are combining the numbers of seven home care
  agencies to get statistically significant results
  to bring to payers.

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Where Do We Go

• As we are faced with pay for performance there
  will be monetary incentives to use telehealth.
• Current event

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Contact Information

• Joyce Doughty
• jdought1_at_good-sam.com