Tim Peck MD, founder of Call9, which provided in-facility emergency care staff with telehealth capability for nursing homes, announced a new venture also targeted to nursing home/skilled nursing home (SNF) and rehabilitative health. Curve Health will provide telemedicine and health information exchange technology to SNFs and physician groups. Physicians calling on SNF patients will be able to access patient information before a telemedicine visit. According to Dr. Peck, Curve Health’s telehealth and HIE software are built on that of Call9’s. POLITICO Morning e-Health.
Call9 closed operations last July after four years and $34 million in investment. It achieved some success in New York state, covering 3,700 beds and a total of 11,000 patients treated. While they experienced measurable success–in a 200-bed SNF, they achieved a 50 percent reduction in ER admissions and a savings of $8M per year–made inroads with major payers like Anthem and Healthfirst plus expanded into community telemedicine, it ran into a funding wall all too common with this sector. While the book of business was decent and they had gone through two well-funded rounds, Call9 could not move easily into a Series C. Value-based care is a great buzzword and beloved by CMS, but it is a long payout curve, too long for many investors. More discussion on this is in our article 26 June 2019.
It is a shame as New York has been the epicenter of COVID-19 nursing home fatalities, due to a foolish (and this Editor is understating) state mandate of returning recovering patients right back to their nursing homes, which could not provide the level of care or isolate them. These patients often worsened, but also infected other patients and staff. Perhaps this could have been mitigated by Call9 or similar–but likely not.
Sadly, there’s a spotlight on nursing homes, rehabs, and LTC because of this pandemic. We look forward to more news from Dr. Peck and Curve Health in this specialized and underserved area of telehealth.
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
Back in March, this Editor noted the substantial $34 million raise over the past three years by Call9. The Brooklyn-based company has pioneered an innovative approach filling a non-glamorous but badly needed gap in care–providing in-facility emergency care in SNFs and rehab facilities. Embedded in-facility first responders summoned by SNF nurses provide immediate care at a higher level than nursing home staff, married to telehealth capability that connects to remotely located emergency medicine doctors via a video cart and diagnostics. The goal is to provide care immediately, avoid unnecessary and potentially harmful ER/ED admissions (estimated at 19 percent of ambulance transports), and generally keep SNF patients healthier while on site.
The numbers are there. Call9 reported in their studies a 50 percent reduction in ER admissions and a savings of $8M per year for a 200-bed nursing facility. Even if these numbers are high, a reduction is welcome news to SNFs, payors, Medicare, and one would think nursing home patients and families. Hospital readmissions within 30 days are also a CMS quality measure important to SNFs–the lower the better.
The Hunter College Center for Health Technology in their blog reported that one Call9 feature is special training for staff at their in-house Call9 Academy in the unique emergency care demands present in a SNF. These were initally learned first hand by the founder, Dr. Timothy Peck, who lived three months in a Long Island SNF’s conference room in order to better understand staff and patient needs.
It not only saves money, but fills other gaps in care and social determinants of health. Part of the Academy training covers the gap in palliative care with residents, and can facilitate Medical Orders for Life-Sustaining Treatment (MOLST) preparation with families. Last year, Call9 partnered with Lyft to provide transportation for family members of nursing home residents who have had a change in condition. Other partnerships serve the needs of community paramedicine services to connect with telehealth services as part of CMS’ ET3 model. The company currently covers over 3,700 beds in New York State, recently expanding to Albany, its third city.
A similar company, Third Eye Health, based in Chicago, covers about 15,000 beds but is a ‘lighter’ system that concentrates on remote care without the embedded staff and purely tablet based remote consults initiated by staff nurses. Both indicate through their growth and funding a surge in realization that both improved care and major savings to healthcare can be realized here.
The positive side of telemedicine for two areas–Long Term Care (LTCF). Skilled Nursing (SNF). Two types of care facilities that don’t get a lot of excited cocktail party chatter or much respect in the health tech field. Yet the needs are there, the tech attention has returned, and apparently the money has as well.
A major provider of behavioral health services for LTCF, Deer Oaks, is turning to telemedicine (SnapMD) to expand their reach. Already working with 1,400 LTCFs in 27 states in the central to southern US, Deer Oaks has been active since 1992 in providing both psychiatric and psychological services for geriatric and disabled patients.
The problem is coverage and the lack of providers. Psychiatry is itself aging out with few young doctors in the field–as well as the uneven distribution of practitioners. Mental health is a significant concern in the older adult population, including those dealing with depression and dementia.
Deer Oaks is adding telemedicine to expand to facilities in smaller, in rural areas, to extend hours, and to reach people with limited mobility. Facilities receive equipment and training. Two significant challenges they found were the lack of tech expertise in the staff, and importantly, the reliability of Wi-Fi in those areas, which is needed at 500 kbs of bandwidth to work. This expansion fits with CMS’ extension of covered telemedicine in rural areas and FCC’s continuing Connected Care Pilot Program, San Antonio-based Deer Oaks is estimated to have over $18 million in revenue (CrunchBase) and sees their growth in this area, according to an interview in mHealth Intelligence.
Assessing developing conditions in a SNF or LTC patient and preventing readmissions will always get this Editor’s attention, as she started in the field with behavioral telemonitoring for this area.
- Real Time Medical Systems raised at end of February $9.2 million from SunBridge Capital Management to fund the growth of their analytics software which uses EMR information plus information from clinicians in routine monitoring of resident status to alert for early changes in resident conditions. Appropriate intervention could prevent hospitalization or a more serious development. Real Time currently has 500 SNFs and 30 hospitals, for a total of about 60,000 covered residents.
- Skilled Nursing News also notes that Call9, an emergency medicine provider that embeds first responders at SNFs to provide onsite care and reduce unnecessary transfers to ERs, has raised a stunning $34 million and is concentrating on both SNF and assisted living. It is connected with several major payers and Medicare Advantage plans.
- More conservatively, Third Eye Health, which provides post-acute emergency telemedicine to 220 SNFs, recently raised $7 million. All these companies have claimed readmission reductions of 40 to as high as 70 percent, and savings from services such as these may be billions.
None of which gets buzzy panels at HIMSS, Health 2.0, or CES, or viral videos on the news as the plight of Mr. Quintana did [TTA 13 Mar, below] but provides a badly needed advance in care services–and savings–for LTCs/SNFs and badly needed and better care for their patient residents.
A largely hidden problem in US skilled nursing facilities (SNFs) has been the inappropriate and over-use of multiple psychotropic drugs in dementia patients. A two-year old telemedicine (telepsychiatry) company, Forefront TeleCare, is targeting SNFs and clinics in rural counties across 18 states. Rural areas have sparse behavioral health coverage; medications to mitigate the effects of dementia and other mental illnesses are often prescribed by non-psychiatrists who have a limited knowledge of their effects over time, particularly in older adults. Forefront’s virtual consults weekly can keep track of these patients and reduce, adjust or update their medications. Video (from ATA). MedCityNews.