Telemedicine in Senior Living Centers
Telemedicine is the practice of providing patient care
remotely. This is typically done through phone consultation or video
conferencing. Numerous advances in
technology allow telemedicine to be conducted following HIPPA guidelines. Currently, many platforms are
available. These range from simple
video-conferencing platforms to those that combine video-conferencing and
remote monitoring technologies. In
addition to patient and provider uses, telemedicine is also being used to
provide communication among providers at different levels of care, such as a
PCP to a hospital or a specialist.
This technology can bridge gaps in care for those patients
in senior living communities.
Typically, these older adults seek care for illness and related medical
concerns more often than seniors residing in their home settings. Research
indicates that older adults use medical services four times more frequently
than do younger adults. However, there are many barriers in obtaining this
care. One hurdle is the lack of same
day appointments with primary care physicians (PCPs). This may be the result of a shortage of PCPs
and Geriatricians. Another barrier is
transportation. Many of these adults do
not drive and/or are not able to navigate the public transit system. For some, the cost of public transit is
prohibitive, while others may have impairments which prevent them from being
able to use public transportation. These
may be cognitive or physical (Shah, McDermott, Gillespie, Philbrick and Nelson,
2013).
High-intensity telemedicine is a way to provide older adults
with the services they need in a timely manner.
These systems allow providers to perform complete exams remotely and
have been successfully used for pediatric populations. Telemedicine has proven to be a feasible,
acceptable, and effective treatment option.
This approach has also been effective in nursing home situations (Shah,
McDermott, Gillespie, Philbrick and Nelson, 2013).
Veterans Affairs /
Oklahoma conducted an informative pilot study using high-intensity telemedicine
with rural residents suffering complex medical histories and mental illness.
The program allowed the VA to provide care to Veterans who would not have
otherwise qualified for home-based care since they lived outside the service area. Participants in this VA study showed
improvements in physical strength, improvements in occupational therapy
evaluations, improved social function, as well as increased compliance with
their treatment plans. One participant showed marked improvement in his A1C
measurements. In addition, he reported
feeling more accountable for his own care as a result of daily monitoring and
data transmission. Findings also indicated decreased caregiver burnout. Telemedicine not only provides opportunities
for access to care, but it can also allow older adults more control in managing
their own health (Sorocco, Qureshi, Bratkovich, Wingo, and Mason, 2013).
Cost-Benefit
The average cost of a telemedicine visit is estimated to be
$40 - $50 per visit, while the average cost of an office visit is about $136 -
$176. Research indicates that the patient’s issue can be successfully treated
via telehealth 83% of the time. It is
estimated that telemedicine visits save an average of $126 for commercial
insurance carriers. Interestingly,
Medicare programs reimburse telehealth visits at the same rate as in-person
visits, but have been shown to still provide a $45/visit saving for Medicare
overall.
Telemedicine also allows better access to care beyond
traditional office hours. For example,
many practitioners offer this service on weekends and after hours. It has also positively impacted the use of
alternative sites of care. One study
indicated that for every 100 patients using telehealth:
● 5.6% would have gone to an emergency room;
● 45.85% would have
visited urgent care;
● 30.9% would have
gone to their PCP office,
● 5.4% would have
visited other clinics,
● 12.3% would have
done nothing to treat their acute problem.
Using telehealth
services instead of alternate care sites such as the ER and Urgent care has
been shown to provide cost saving.
Estimated saving per visit by site, depending on type of insurance,
include the following:
Site of Care Commercial Medicare
ER $1595 $943
Urgent Care 116 98
PCP 98 83
Other Clinics 57 83
While “doing nothing” did not have an associated cost, it
could lead to the subsequent need of reaching out to one of the alternative
care sites as a result of a worsening condition. Potentially, this could lead to needing a
higher level of care or extended hospitalization. (Yamamoto, 2014).
Concluding Comments
Telemedicine visits remove many barriers to care, such as
lack of transportation. It also
decreases Caregiver stress in trying to get patients to appointments. Telemedicine may also improve overall care,
especially when patients would otherwise seek care in emergency rooms or urgent
care centers. Typically, emergency/urgent care providers do not have access to
patients’ health histories, medications and baseline status (Shah, McDermott,
Gillespie, Philbrick and Nelson, 2013). This could lead to inadvertently
prescribing medications or treatment that may have an adverse effect on the
patient.
The initial cost of equipment and software is of concern and
varies significantly depending upon what vendor is used. However, studies suggest that start-up costs
could be made up in four years of implementation. There are also some administrative costs
involved, such as program managers and schedulers. Another concern, as noted in the VA study was
lack of integration between the technology and the EMR. However, it is becoming more common for
telemedicine to be integrated into EMRs.
References
Shah, M. N., McDermott,
R., Gillespie, S. M., Phillbrick, E. B., & Nelson, D. (2013). Potential of
telemedicine to provide acute medical care for adults in senior living
communities. Society for Academic
Emergency Medicine, 20(2),
162-168. https//doi.org/10.111/acem.12075
Sorocco, K. H., Qureshi,
S. M., Bratkovich, K. L., & Mason, P. J. (2013). Integrating care
coordination home telehealth and home-based primary care in rural Oklahoma: A
pilot study. Psychological Services, 10(3), 350-352.
https://doi.org/10.1037/a0032785
Yamamoto, D. H. (2014,
December). Assessment of the feasibility
and cost of replacing in-person care with acute care telehealth services.
About the Author
Chandra Garcia, RN,
BSN, CEN is an Emergency Room nurse with 25 years’ nursing experience – 20
years of which were served in the ER.
Currently, she is Director of a Level 1 Trauma Center Emergency
Department in Northern Virginia. In addition, she is completing her M.H.A.
degree at Saint Joseph’s College / Maine.
