Nationally, telehealth appears to have had a positive impact on the CMS Quality Measures regarding Emergency Department (ED) Visits—has your facility shown improvement in this area?
In March 2020, following the declaration of the COVID-19 public health emergency, CMS and CDC guidelines restricted hospital stays and emergency department (ED) transfers. As a result, Telehealth usage in place of ED visits became the ‘new normal’ in many instances.
Benefits of Telehealth in the SNF
Long-Term Care facilities have historically found it necessary to transfer residents to hospital ED’s when there is a health issue the facility cannot adequately address. The use of telehealth in facilities can improve the likelihood of identifying and treating health issues sooner and potentially avoiding sending a resident to the ED and ultimately possibly being admitted/readmitted to the hospital. Elderly resident hospital stays can result in deconditioning due to prolonged bed rest, delirium, and may contribute to other potential medical issues such as pressure ulcers.
| History & Origins of Telehealth |
| In 1925 the inventor Hugo Gemsback wrote an article for Science and Invention magazine which included a prediction of a future where patients could be treated remotely by doctors through a device he called a Teledactyl (Tele, far; Dactyl, finger – from the Greek), allowing the physician to ‘feel at a distance’. His descriptions of the device are similar to what would later become possible with new technology[1]. https://www.smithsonianmag.com/history/telemedicine-predicted-in-1925-124140942/ |
Unnecessary ED visits and hospital readmissions also may negatively impact facility 5-Star QM Measures and can result in Medicare penalties.[i]
Telehealth Usage
The COVID-19 pandemic amplified the usage of Telehealth services in the U.S. The U.S. Centers for Disease Control and Prevention reported a 154% increase in telehealth visits during the last week of March 2020, compared to the same dates in 2019. [ii]
Timeline of changes in Telehealth Restrictions during March 2020 that brought about this change:
- March 6, 2020 – The Coronavirus Preparedness and Response Supplemental Appropriations Act was passed. This allowed the Department of Health and Human Services (HHS) to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.
- March 13, 2020 – President Trump declared the COVID-19 outbreak to be a national emergency resulting in the 1135 waiver, which expanded telehealth services.
- March 28, 2020 – CMS released the Long-Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19. In this memo, CMS waived the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents, allowing for telehealth options.
- March 29, 2020 – The Coronavirus Aid, Relief, and Economic Security CARES) Act was passed, allocating funding for telehealth access and infrastructure.[iii]
Outcome
Since the December 2020 introduction of the COVID-19 vaccines, the number of new cases of COVID has reduced 89.6% (July 14th data).[iv] As the new cases have decreased and number of vaccines administered have risen, CMS and CDC have relaxed some restrictions, including practitioner on-site visits. Even though ED and MD Office visit restrictions have been relaxed, the QM rates continue to drop, as a likely indication that Telehealth and on-site practitioner visits are being proactive in identifying and treating health issues.
| CMS Quality Measures – National Averages | Pre-COVID 1/1/2020 | 1 Year Ago 6/1/2020 | Current Data 6/1/2021 |
| Percentage of short stay residents who had an outpatient emergency department visit (S) | 10.69% | 10.61% | 9.47% |
| Number of outpatient emergency department visits per 1,000 long-stay resident days (L) | 0.95 | 0.95 | 0.77 |
Future of Telehealth
Helping Endure Access to Local Health (HEALTH) Act has been re-introduced as proposed legislation.[v] This bill would remove originating site facility and location requirements for distant site telehealth services furnished by FQHCs (Federally Qualified Health Centers) and RHCs (Rural Health Clinic), and extend coverage to audio-only telehealth services (such as a landline telephone) for patient who can’t access audio-visual telemedicine services. In the meantime, CMS has finalized meaningful expansions of Medicare Telehealth service coverage through 2021 as part of the CY2021 PFS Final Rule.[vi] [vii]
[i] https://www.todaysgeriatricmedicine.com/archive/MJ17p28.shtml
[ii]https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm?s_cid=mm6943a3_e&ACSTrackingID=USCDC_921-DM41453&ACSTrackingLabel=This%20Week%20in%20MMWR%20-%20Vol.%2069%2c%20October%2030%2c%202020&deliveryName=USCDC_921-DM41453
[iii] https://www.aapacn.org/dns/cms-expands-telehealth-services-during-the-covid-19-pandemic-what-the-dns-needs-to-know/
[iv] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
[v] Thompson, Butterfield Introduce The HEALTH Act | Congressman Glenn Thompson (house.gov)
[vi] CMS Finalizes Meaningful Expansions of Medicare Telehealth Service Coverage Through 2021 – Health Management Associates
[vii] Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS
