We are Dedicated to our Patients, Committed to our Associates and Challenged

by our Customers to deliver Excellence

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Objectives• How decision was made to utilize telehealth in the

skilled nursing facility.• Identify types of telehealth services available to

patients in a SNF.• Identify current utilization of telehealth in the SNF.• Identify Benefit of having telehealth available in the

SNF

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Ethica • Community Health Services of Georgia member,•A skilled nursing facility management company, o SNFs throughout GA o Alternative living centers o Assisted living centers

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Getting Started• Need was identified o A need was identified for access to specialists to meet

residents needs,o Traveling long/short distances is challenging for many

skilled nursing facility patients, o Need for “after hours” access to medical consultation to

reduce the number of unnecessary transfers to the hospital or emergency department,

o Increase ability of skilled nursing centers to effectively manage the care of a wider variety of patients.

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Getting Started • Community Benefit:o Centers are not for profit (community benefit

required for our centers),o TeleHealth allows centers to reach out to local

MD’s, o As TeleHealth grows and expands ways to provide

services to associates, patient families, and/or those in the community will be explored.

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Getting Started• Goals Identified: o Provide for Immediate Psychiatric Needs for our

residents o Provide access to specialists to our residents

without need for travel o Provide timely access for wound consult for our

residents o Reduce unnecessary hospitalizations

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16 Centers Currently with Telemedicine

• Oak View Health & RehabilitationFeb. 2011

• Oconee Health & Rehabilitation Jan. 2009

• Orchard Health & RehabilitationApr. 2011

• Scott Health & RehabilitationOct. 2009

• Providence of SpartaFeb. 2009

• Sparta Health & Rehabilitation Feb. 2009

• Shady Acres Health & RehabilitationFeb. 2009

• Lee County Health & Rehabilitation Dec. 2011

•Warrenton Health & Rehabilitation.March 2012

• Brentwood Health & RehabilitationFeb. 2011

• Chaplinwood Health & RehabilitationFeb. 2011

• Dawson Health & Rehabilitation Apr. 2010

• Eatonton Health & RehabilitationFeb. 2009

• Four County Health & RehabilitationApr. 2011

• Green Point Health & RehabilitationDec. 2009

• Lillian Carter Health & RehabilitationApr. 2010

• Oakview Health and RehabilitationApr. 2010

• Oxley Park Health & Rehabilitation Apr. 2010

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Billing & Reimbursement • Current billing o Site Fee - approximately $24.10 with each use,o CR # 6215,

• “The originating site fee is outside the SNF prospective payment system bundle and, as such is not subject to SNF consolidated billing. The originating site fee is a separately billable Part B payment”. (MLN Matters Number: MM6215)

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Telehealth & Ethica • Psychiatric Care:

o 5 Centers with specialty units in Psychiatric/Behavioral Health Care,

o Telehealth has been essential for providing much needed support to these centers.,

• Wound Consultation: o 3 wound consultants (WONC) each with a Mobi device,

• Specialty Consults • Emergency

o 1 Attending/Medical Director has a Mobi Device,o Some regional ER’s have connectivity with the centers, (example: Coffee

Regional)

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Current Utilization• Remains low but improving, • Nurses must be comfortable with the equipment, • Psychiatric, Specialty Consults, and Wound most

often used, • Wound utilization increasing, • Emergency Telemedicine usage remains low.

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Current Utilization

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Current Utilization

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Rehospitalization Rates for January 2012

With Telemedicine 129

Without Telemedicine 248

Ethica Behavioral Health Units• Five centers with additional skill sets to manage

“behavioral health” or “geriatric psych” issues beyond dementia care,

• Associate Medical Director for Psych Services,• Schizophrenia, bipolar disease, affective disorders,

mixed disorders,• Entire centers or a unit of a center,• Adds option for “ more appropriate” placement of

patients from within and from outside Ethica centers.

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Geriatric Psychiatry Care Issues in Georgia

• State regional hospitals overwhelmed by correctional department issues,

• Beds never available for older patients,• Uncooperative general hospitals – fear of patient

dumping by nursing centers,• Few private psychiatric hospitals with dedicated

geriatric-focused units,• Transfers not accompanied by useful information –

failed care plans not altered by either acute or long-term care center.

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Practical Benefits for Psych TeleHealth in Georgia

• TeleHealth connects geriatric psychiatry specialists to our out-lying centers,

• Becomes a connection for cross-referrals,• Patient maintains consistent relationship with their

“head doctor”,• Better communication and documentation between

specialist and (medical) attending practitioners,• Consistent care continues even if a transfer becomes

necessary.

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Telemedicine Behavioral Health Goals

• Reduce transfers (including multiple re-admissions) to acute mental health facilities

• Provide on-site decision-making by a qualified provider to establish an acute intervention and/or stabilize patient

• Provide confidence to the attending physician and caregiver in an acute situation – clinically and legally

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Telemedicine Behavioral Health Goals

• Maintain more consistent and frequent physician/provider contact directly with the patient,

• Meet regulatory/law requirements when it IS necessary to order an immediate transfer out of the facility,

• Provide support in addition to routine onsite visit by psychiatrist/psychiatric Social Worker.

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Psychiatry/Behavioral Support• Ethica Model – On Siteo Psychiatrist/practitioner makes a physical visit to the

behavioral health center monthly or as routinely as needed,o Completes patient rounds,o Conducts mini case management discussions and care plans

with staff for each patient during or immediately after rounds,o May chair a planned or impromptu staff in-service based on a

current question or dilemma presented by a patient,o Staff and practitioner increase comfortable relationship and

begin to learn and anticipate each other’s thoughts and practices.

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Psychiatry/Behavioral Staff Support

• Ethica Model – Off-Site (TeleHealth)o Routine appointment for TeleHealth encounter monthly or as

required by patient load or care unit organization,o Staff case updates, problems encountered or anticipated,o Individual patient encounters as needed or indicated or

requested by patient,

• Off-Site (TeleHealth) - Acute Needo Telephone call to practitioner (or Ga TeleHealth) to arrange

stat appointment,o Units activated – nursing report,o Decision by practitioner for observation, patient encounter,

transfer, or orders.

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Wounds Consult • Provides excellent and detailed view/ assessment of

the wound.• Reduces delays in consult due to scheduling.• We have 4 wound nurses this allows them to provide

video consult to centers reducing the delay.

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Emergency

•Allows for triage via telemedicine unit to avoid unnecessary hospitalizations

•A great way to partner with your local ER to help meet the hospital’s goals as well as the SNFs goals.

•Currently working in GMCF (Georgia Medical Care Foundation) on a project to reduce hospitalizations. Telemedicine will be integrated into this program to help achieve goal of reducing unnecessary hospital admissions.

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Comments/ Questions

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