Transcript PowerPoint 64KB

Telehealth: Pursuing, Planning
and Prospering
Joyce Doughty, BSN, PHN, RN
Director
Good Samaritan Home Health Care
Objectives
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Will be able to name two groups of
individuals needed to buy-in to
telehealth for it’s successful
implementation.
Will be able to identify two lessons
learned in telehealth start up.
Will be able to identify one process
improvement method.
About Good Samaritan Home
Health Care
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Rural area in Southwest Minnesota
Medicare certified home care provider
RN, HHA, OT, PT, ST, homemakers,
companions
Serve 7 counties
Average client load, 80-100
How to Get Started With a
Telehealth Program
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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.
The program has expanding to four
additional home care agencies with
assistance from a USDA grant.
How to Get Started…
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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 rental
contracts available to help with start up.
How to Get Started…
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Need staff and physician buy-in.
Staff concerns:
-All onsite visits replaced with telehealth
visits and they will not have a job.
-Use of the equipment. Most of our
nurses did not learn how to run a
computer in college.
How to Get Started…
-Clients will not agree to telehealth visits
because they are too impersonal.
-Clients will not be able to use the
equipment.
-No continuity of care. The primary
nurse would not know what is
happening with their clients.
How to Get Started…
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Taught all staff how to run equipment
and the basics for installing equipment
in client homes.
If left up to everyone no one does it.
Appointed one nurse to be the
telehealth nurse. This nurse needs to
really embrace telehealth. She is the
point of contact with all referrals.
How to Get Started…
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We talk about telehealth at our weekly
staffing meetings.
Primarily one or two nurses do the
telehealth visit. Nurse and clients
become familiar with each other.
All the nurses do telehealth visits at
least monthly.
How to Get Started…
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Physician concerns:
-Don’t know much about telehealth and
what a visit involves.
-Can confuse telehealth with
telemedicine.
-Patients and their families will not want
telehealth visits.
How to Get Started…
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When we think a client can benefit from
telehealth we call their physician and
explain to them what telehealth
includes.
We explain how it can benefit them with
decreased readmits to the hospital and
decrease phone calls from families.
How to Get Started…
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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 keep.
Lessons We Bring To The
Table: Getting it Right!
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You need to be committed to telehealth
to make it work for you.
A telehealth program does not just
happen overnight.
You need to know what it is you are
trying to accomplish and start with that
in mind.
Lesson We Bring…
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Families really like the idea of telehealth
but our clients where initially afraid of it.
We often heard, “I don’t know how to
run a computer.”
We would encourage them to try it for
few weeks.
Clients adjusted very quickly.
Lessons We Bring...
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Can teach almost anyone to use the
equipment.
One size does not fit all. Need to
choose the appropriate technology for
the client.
We learned what not to say to clients as
we introduce telehealth to them.
Lessons We Bring…
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We found that telehealth really does
help keep clients from having frequent
ER visits and readmits to hospitals.
We allow our clients to call us when
they are not feeling well. We will then
do a connect with them.
Clients do start taking control of their
health.
Lessons We Bring…
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We can do 5-6 telehealth visit for each
in home visits. This allows us to provide
services to additional clients without
additional staff.
We cut down on drive time and mileage
costs allowing us to have a positive
bottom line.
Lessons We Bring
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Medicare allows us to use telehealth in
an episode of care but they do not
count toward our five visits needed to
get a full episode payment. (Legislation
introduced by Rep. Ramstad).
In Minnesota Medical Assistance will
pay for telehealth skilled nurse visit.
Lessons We Bring…
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We have worked with counties to
contract to pay for nonskilled visits for
medication reminders.
Have begun conversations with MN
Department of Human Services to allow
nonskilled visits and monitoring unit
services to be part of their reimbursable
service menu.
Lessons We Bring…
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If we feel the client can benefit from
telehealth we contact their insurance
provider. Some insurance providers will
pay for telehealth visits.
We have developed a private pay
program for individuals or families who
would like telehealth services that are
paid for by other payors.
Lessons We Bring…
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The small numbers in our project made
it difficult to get results that payors will
look at.
The system to pay for telehealth visits
has not been in place, but it is coming.
Where Do We Go From Here:
Process Improvement
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Outcomes need to be addressed at the
start of the program.
From 2001-2003 we looked at five
clients in retrospect. We found that we
kept them out of a higher level of care
for 24 months.
Where Do We Go……
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We our combining the numbers of four
home care agencies to get statistically
significant results to bring to payors.
Telehealth providers need to combine
outcomes to get the numbers that are
needed to take to payors. When we
have the numbers the payors will
respond.
Where Do We Go…
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As more home care providers begin
asking for reimbursement payors will
have to address this.
As people and physicians hear about
our telehealth program we get referrals
for telehealth.
Where Do We Go…
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Telehealth gives us as edge over home
care agencies that do not have
telehealth.
We have to make telehealth part of our
standard of care.
Where Do We Go…
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As Medicare begins to look at telehealth
in home care they will expect it to be
part of what we provide.
In the future there will be monetary
incentives to use telehealth.
As telehealth gains momentum it will
become expected as part of our
standards of care.
Contact Information
Joyce Doughty
[email protected]