NIC Notes

Insights in Seniors Housing & Care

By: Ryan Brooks  |  May 15, 2020

Telehealth Embraced as a Result of COVID-19 Pandemic

COVID-19  |  Senior Housing  |  Skilled Nursing  |  telehealth

The COVID-19 pandemic has ushered in an era of unprecedented change in the world’s healthcare landscape.  Some of these changes may be temporary – lasting only until a vaccine or widespread testing is available – but others will have secured their place with consumers and will become permanently woven into the fabric of the healthcare system. There is an increased sense of uneasiness in visiting medical office buildings, urgent care sites, and hospitals, especially for routine checkups and minor ailments. Despite this apprehension, the level of care needed to support the United States’ population has not subsided.

It is a real concern that people may be deferring or delaying preventive care and physician visits out of a fear of getting infected, potentially allowing problems to remain undetected and untreated. In lieu of face-to-face health visits, telehealth has stepped in to bridge the gap, as individuals can now increasingly use interactive apps with audio and video capabilities to visit with their clinician for a broad array of services.

CMS Regulatory Changes Encourage Telehealth Adoption

CMS (Centers for Medicare and Medicaid Services) is taking aggressive regulatory action to allow for the rapid implementation and expansion of telehealth programs. Among these actions is a series of waivers intended to break down barriers so that patients can access these services and to ensure that providers are reimbursed for them. These actions are currently intended to remain in effect only during the coronavirus public health emergency. One can easily imagine that a tipping point may be reached during the pandemic, where telehealth is proven to be a viable solution to health needs and is ultimately embraced as fully in a post-COVID world as it is being embraced currently.

Prior to these waivers, health care professionals could only bill Medicare fee-for-service for patient care delivered by telehealth if the established-relationship rule was met, meaning the patient had been to an in-person, face-to-face visit with the provider at least once in the prior three years. CMS has clarified that the established-relationship rule will not be enforced during the state of public emergency.  Medicare’s originating site rule has also been waived, meaning that instead of providers needing to be in a medical office, community clinic, hospital, stroke unit, dialysis center, or other more traditional healthcare delivery site, providers can virtually treat patients from anywhere – including their home.

CMS is also temporarily breaking down state boundaries to allow providers to practice across state lines, giving patients in rural areas improved access to telemedicine while simultaneously preserving the nation’s frontline medical staff. Such measures are encouraging the utilization and adoption of telemedicine and preventing the spread of coronavirus.telehealth for elderly resident of senior housing

What’s been made clear with the changes in the telemedicine regulatory environment is that CMS believes this practice is a viable channel for delivering care, if a patient’s condition doesn’t require more intensive hospital care. For routine physicals, prescription refills, and other minor ailments, telemedicine is a preferred conduit for obtaining care. What was intended to be a temporary measure during a public health emergency may have cemented a role in the future of our nation’s healthcare.

Benefits of Telemedicine Implementation

The COVID-19 pandemic has resulted in an extraordinary adoption in telemedicine by providers and patients alike and there’s no doubt that there are general benefits to expanded telehealth programs. Certainly, there is a convenience factor for patients who no longer experience long waits in a physician’s office waiting room. For frail elders and residents of seniors housing properties, however, the benefits are even greater. Those with a high risk of falling no longer need to hesitate when making appointments for fear of navigating parking structures and medical offices. Patients can rest easier knowing they can avoid potential exposure as telemedicine can connect them to specialized medical expertise to determine if they really require that trip to the hospital.

Residents of seniors housing and care properties that have established telemedicine programs are also able to rely on the expertise of on-site staff to use the remote equipment appropriately. For routine physicals and checkups, having an audio/visual connection will often suffice. But for more complex health problems, on-site staff are available to properly use the cameras, otoscopes, and stethoscopes that are making telemedicine technologies so robust. Having the staff onsite to assist with these remote office visits is delivering improved care to residents. Without this assistance, providers would not have access to the real-time vital signs and patient images that allow them to deliver high-quality care.

Establishing Telemedicine Programs in Seniors Housing and Care

Seniors housing and care providers had begun to experiment with telemedicine even before the coronavirus and COVID-19 pandemic became our reality. But in the new world we are living in, the pace at which properties are adopting and accepting this new form of care delivery is rapidly increasing.

Winter Park, Florida’s Holiday Retirement, the largest independent senior living provider in the U.S. announced in March that it has provided telehealth access and services to the residents of its 250+ senior living communities for urgent care situations and other conditions from the safety and comfort of their home. Senior leadership with Holiday indicated that partnering with MeMD’s national network of healthcare providers was in part a way to provide convenient care to residents, but also a larger strategy to reduce the stress on the United States’ healthcare delivery system. In the recently released Q1 2020 earnings report, Sabra Health Care REIT CEO Rick Matros commented that Holiday Retirement had done an effective job keeping infections low in their independent living buildings, in part due to the valuable rollout of their telemedicine program.Hh

Glendale, California-based senior living provider Front Porch Retirement Communities is working to expand the telehealth programs within the variety of senior living options they offer. As Kari Olson, chief innovation and technology officer indicates, “Any expansion of telehealth services is a very good thing, especially during this time when we need folks to stay home, and in particular, to safeguard people over 65 as well as other high-risk individuals.” Front Porch has been a proponent of telehealth for years, believing that telemedicine reduces barriers to accessing care, such as travel time and transportation risks.

Whether seniors housing and care providers are entering the world of telemedicine as a result of our new reality or they are expanding an already established telemedicine program, one thing is clear: telemedicine is proving itself to be a valuable aspect of care delivery in this country.


About Ryan Brooks

Senior Principal Ryan Brooks works with the research team in providing research, analysis, and contributions in the areas of healthcare collaboration and partnerships, telemedicine implementation, EHR optimization, and value-based care transition. Prior to joining NIC, he served as Clinical Administrator for multiple service lines within the Johns Hopkins Health System, where he focused on patient throughput strategies, regulatory compliance, and lean deployment throughout the organization. Brooks received his Bachelor’s in Health Services Administration from James Madison University and his Master’s in Business Administration from the University of Maryland.

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