Even as telehealth takes the world by storm as “new new thing” for healthcare, there are reasons for those in the senior living and care industry to take a step back and evaluate the advantages against the drawbacks as they adjust to life after the pandemic. It’s not, after all, a risk-free proposition.
Virtual care has a role in addressing some worrisome and converging trends. One is the overwhelming number of baby boomers hitting 65: 10,000 a day through 2030. They are living longer and with multiple chronic health conditions that necessitate their move to senior living communities and skilled nursing facilities. The other side of the equation? The growing shortage of healthcare providers through that period: some 121,300 physicians, not to mention a shortfall in nurses and paid and unpaid caregivers.
Virtual health services are a viable option to help narrow the expanding gap between the number of older adults and the availability of health services they’ll need. But senior living providers need to balance the risks and rewards to make it happen. Here are some considerations to keep in mind.
Quality of care and related issues
Residents of senior living communities generally are fragile. Transporting them to a hospital is hazardous when arthritis or osteoporosis can mean broken bones, no matter how carefully they are lifted. That makes telehealth advantageous in that it helps circumvent travel risks for medical care, especially in rural areas where hospitals are few and far between.
There are downsides to think about, though. For starters, virtual diagnoses of residents with cognitive impairments can be more difficult than in-person ones. And precautions are necessary. Consent agreements for a resident’s medical care need to be double-checked. Those typically extend to care that is provided inside the senior living community. But it’s smart to make sure the agreement doesn’t contain language that might preclude telehealth services.
And providers also need to be on top of public and private reimbursement considerations as they firm up their telehealth strategies.
The three-day qualifying hospital stay, for example, is an advantage to the nursing home in terms of reimbursement, as it triggers a high reimbursement Medicaid or Medicare pay rate for, say, a respiratory failure. It can be argued that with the 1135 waiver for COVID, however, it is not a loss, as the facilities can “skill in place.” Still, especially with the push toward bundle payments, senior care facilities will be focused on reducing re-hospitalizations. Telehealth can be an effective tool for that, plus there are benefits in caring for the resident in the lower-cost setting of a nursing home versus a hospital. With Centers for Medicare & Medicaid Services COVID waivers, facilities that accept Medicare or Medicaid payments don’t lose the higher reimbursement, as using telehealth enables them to “skill in place.”
Another case for cyber security precautions
With or without the provision of virtual health services to their residents, senior living providers need to be very careful with their cyber practices. Many consider the long-term care sector as a whole as being less prepared to manage cyber risks than other healthcare segments; their records are valuable and too easy to hack.
Telehealth’s cyber security implications are greater for healthcare providers, as the platforms provide another opening for criminals. But managers in senior living and care already are well aware of the security risks of their residents’ electronic medical records. But their WiFi gateways become even more vulnerable as they accommodate virtual care.
Potential issues with medical directors and revenue impacts
One concern that could pose a sticky issue to senior living and care providers is the extent to which the use of telemedicine cuts out medical directors (unless they also provide tele-medical services, that is). Medical directors typically conduct several monthly visits to facilities and are paid for diagnosing conditions in residents. Take away their revenue, and there could be a problem. It’s something to think about given the medical director’s role in driving some facilities’ acceptable acuity — especially since the higher the level of need, the greater a facility’s growth in revenues.
The pandemic has pushed virtual health into the spotlight for over a year. It’s been a boon to senior living and care providers for augmenting care options for residents during this time. The extent of their embrace going forward takes careful consideration of all the implications.
