It’s the reimbursement. Telemedicine in nursing homes by specialists on call seems like a natural. A nursing home resident is usually older and frail. Nursing homes don’t generally have doctors in the facility; only 10 percent are estimated to have on-site doctors. A telemedicine consult administered by a nurse or even a trained assistant can provide proactive, just-in-time care, and possibly prevent an expensive hospital/ER visit–two-thirds of which may be potentially avoidable. That ER visit also can start a disastrous and expensive decline in the resident. 

So the problem in the stars is…economics.What insurance companies pay for telehealth/telemedicine services. It varies if the patient is covered by Medicare, Medicaid, or dual-eligible–and also by private or LTC insurance. Some providers and payers are engaged with value-based care and payment models–others are not. CMS is concerned that telehealth drives up costs, not reduces them. Finally, administrators and nursing/clinical staff in the facility are not necessarily comfortable with technology in general. (Excel spreadsheets are, believe it or not, foreign to many.)

As Readers know, Call 9 couldn’t figure out the reimbursement problem nor how to keep up with payer demands–and ceased business [TTA 26 June]. Others like Curavi and Third Eye Health provide a video cart and provide on-demand consults. On the Federal level with Medicare, payments have been expanded for end-stage renal disease and stroke treatment, and Medicare Advantage plans can now offer telehealth. Still, there is no direct payment under Medicare for virtual emergency medicine. And telemedicine remains a rarity in SNFs, who prefer to send their residents to ERs ‘just to be sure’. POLITICO