Reducing hospital readmissions through telemedicine partnerships with skilled nursing facilities

Telemedicine systems, including remote presence technology, have evolved over the years from stationary workstations to mobile carts to the latest "robotic" units that self-propel themselves down our hospital corridors without a driver, according to preprogrammed GPS instructions. This technology has been credited with bringing specialists, including critical care intensivists, to the bedside in hospitals where no such practitioners live or work within hundreds of miles.

Through my experience as a hospital CEO, I have seen our hospitals benefit through coverage in a variety of applications, including intensive care unit and hospitalist coverage and specialty consults in both inpatient and outpatient clinic settings. I have seen ICUs that have reopened after the introduction of telemedicine and remote presence physician coverage of the units. In short, telemedicine has proven itself as a revenue producing service for our hospitals.

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Today, under the Affordable Care Act and with the proliferation of accountable care organizations, hospitals are finding ways to use telemedicine technology to not only increase revenue streams, but to also improve patient care quality and reimbursement by reducing readmission rates. We have found that skilled nursing facilities (SNFs), which may not have had access to the same level of telemedicine technology, are willing to partner with hospitals to bring advanced technology and access to specialists to SNF beds. We are able to provide access to the SNF in the specialties of pulmonology, neurology, psychiatry, dermatology and intensivist care by using telemedicine applications.

The results have been similar to those experienced in hospitals. The introduction of telemedicine will, most likely, result in both improved patient care and improved reimbursement. Reimbursement gains are realized by keeping nursing home residents at home in the skilled facility and not transferring them to hospital facilities. Hospitals, on the other hand, gain by not experiencing readmissions within 30 days of discharge.

There is no doubt that with a shortage of physicians, especially in our rural communities, telemedicine will continue to grow in scope and applications. It's also sure to result in dramatic improvements in the quality of patient care that we deliver, as well as cost savings to the entire healthcare delivery system and reimbursement gains under the ACA. The future is now in telemedicine.

Raymond Hino, MPA, FACHE, is the president and CEO of the Sonoma West Medical Center in California.

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